51
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Ugurel S, Spassova I, Wohlfarth J, Drusio C, Cherouny A, Melior A, Sucker A, Zimmer L, Ritter C, Schadendorf D, Becker JC. MHC class-I downregulation in PD-1/PD-L1 inhibitor refractory Merkel cell carcinoma and its potential reversal by histone deacetylase inhibition: a case series. Cancer Immunol Immunother 2019; 68:983-990. [PMID: 30993371 PMCID: PMC11028125 DOI: 10.1007/s00262-019-02341-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive skin cancer in which PD-1/PD-L1 blockade has shown remarkable response rates. However, a significant proportion of patients shows primary or secondary resistance against PD-1/PD-L1 inhibition, with HLA class-I downregulation and insufficient influx of CD8+ T cells into the tumor as possible immune escape mechanisms. Histone deacetylase inhibitors (HDACi) have been demonstrated to reverse low HLA class-I expression caused by epigenetic downregulation of the antigen machinery (APM) in vitro and in pre-clinical models in vivo. CASE PRESENTATIONS We report four cases of patients with metastatic MCC who did not respond to immunotherapy by PD-1/PD-L1 blockade. Two of the patients received, subsequently, the HDACi panobinostat in combination with PD-1/PD-L1 blockade. Tumor biopsies of the patients were analyzed for cellular and molecular markers of antigen processing and presentation as well as the degree of T-cell infiltration. RESULTS AND CONCLUSION Low expression of APM-related genes associated with low HLA class-I surface expression was observed in all MCC patients, progressing on PD-1/PD-L1 blockade. In one evaluable patient, of the two treated with the combination therapy of the HDACi, panobinostat and PD-1/PD-L1 blockade, reintroduction of HLA class-I-related genes, enhanced HLA class-I surface expression, and elevated CD8+ T-cell infiltration into the MCC tumor tissue were observed; however, these changes did not translate into a clinical benefit. Our findings suggest that HDACi may be useful to overcome HLA class-I downregulation as a resistance mechanism against anti-PD-1/PD-L1 antibodies in MCC patients. Prospective clinical trials are needed to evaluate this notion.
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Affiliation(s)
- Selma Ugurel
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Ivelina Spassova
- Translational Skin Cancer Research (TSCR), University Clinic Essen, Universitätsstrasse 1, S05 T05 B, 45141, Essen, Germany
| | | | - Christina Drusio
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Angela Cherouny
- Translational Skin Cancer Research (TSCR), University Clinic Essen, Universitätsstrasse 1, S05 T05 B, 45141, Essen, Germany
| | - Anita Melior
- Translational Skin Cancer Research (TSCR), University Clinic Essen, Universitätsstrasse 1, S05 T05 B, 45141, Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Cathrin Ritter
- Translational Skin Cancer Research (TSCR), University Clinic Essen, Universitätsstrasse 1, S05 T05 B, 45141, Essen, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung, DKTK) Partner Site Essen, Deutsches Krebsforschungsinstitut (DKFZ), Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Clinic Essen, Essen, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung, DKTK) Partner Site Essen, Deutsches Krebsforschungsinstitut (DKFZ), Heidelberg, Germany
| | - Jürgen C Becker
- Department of Dermatology, University Clinic Essen, Essen, Germany.
- Translational Skin Cancer Research (TSCR), University Clinic Essen, Universitätsstrasse 1, S05 T05 B, 45141, Essen, Germany.
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung, DKTK) Partner Site Essen, Deutsches Krebsforschungsinstitut (DKFZ), Heidelberg, Germany.
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Immune Checkpoint Inhibitors and Beyond: An Overview of Immune-Based Therapies in Merkel Cell Carcinoma. Am J Clin Dermatol 2019; 20:391-407. [PMID: 30784027 DOI: 10.1007/s40257-019-00427-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer. Until 2017, patients with advanced disease were typically treated with conventional chemotherapies, with a median response duration of 3 months. Increased evidence of the role of the immune system in controlling this cancer has paved the way for immune-based therapies, with programmed cell death protein 1 (PD-1)/programmed cell death protein ligand 1 (PD-L1) inhibitors at the frontline. Avelumab, an anti-PD-L1 antibody, was the first-ever drug approved in advanced MCC after showing meaningful efficacy in a second-line setting. Objective responses were observed in one-third of patients and, most importantly, were durable with half of patients and one-third of patients still alive at 1 and 2 years, respectively. When used in a first-line setting, PD-1/PD-L1 inhibitors (avelumab, pembrolizumab, nivolumab) are even more promising as objective responses are observed in approximately 50-70% of patients within the first 4-8 weeks of treatment. Safety profiles are acceptable with 10-20% of patients experiencing adverse events grade ≥ 3. PD-1/PD-L1 inhibitors are considered the standard of care in advanced MCC and are currently being investigated in the adjuvant and neoadjuvant settings. However, innovative treatments are still needed in the metastatic setting, as approximately 50% of these patients will not persistently respond to currently available immunotherapies, and no predictors of response are available yet. Therefore, other immunotherapeutic strategies are now being investigated-ideally in combinations-to enhance the various aspects of the immune response against tumoral cells.
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Cohen L, Tsai KY. Molecular and immune targets for Merkel cell carcinoma therapy and prevention. Mol Carcinog 2019; 58:1602-1611. [PMID: 31116890 DOI: 10.1002/mc.23042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/15/2019] [Accepted: 04/28/2019] [Indexed: 12/15/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin, for which the exact mechanisms of carcinogenesis remain unknown. Therapeutic options for this highly aggressive malignancy have historically been limited in both their initial response and response durability. Recent improvements in our understanding of MCC tumor biology have expanded therapeutic options for these patients, namely through the use of immunotherapies such as immune checkpoint inhibitors. Further elucidation of the tumor mutational landscape has identified molecular targets for therapies, which have demonstrated success in other cancer types. In this review, we discuss both current and investigational immune and molecular targets of therapy for MCC.
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Affiliation(s)
- Leah Cohen
- Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.,Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kenneth Y Tsai
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Donald A. Adam Melanoma and Skin Cancer Center of Excellence, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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54
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Harms PW, Harms KL, Moore PS, DeCaprio JA, Nghiem P, Wong MKK, Brownell I. The biology and treatment of Merkel cell carcinoma: current understanding and research priorities. Nat Rev Clin Oncol 2019; 15:763-776. [PMID: 30287935 PMCID: PMC6319370 DOI: 10.1038/s41571-018-0103-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer associated with advanced age and immunosuppression. Over the past decade, an association has been discovered between MCC and either integration of the Merkel cell polyomavirus, which likely drives tumorigenesis, or somatic mutations owing to ultraviolet-induced DNA damage. Both virus-positive and virus-negative MCCs are immunogenic, and inhibition of the programmed cell death protein 1 (PD-1)–programmed cell death 1 ligand 1 (PD-L1) immune checkpoint has proved to be highly effective in treating patients with metastatic MCC; however, not all patients have a durable response to immunotherapy. Despite these rapid advances in the understanding and management of patients with MCC, many basic, translational and clinical research questions remain unanswered. In March 2018, an International Workshop on Merkel Cell Carcinoma Research was held at the US National Cancer Institute, at which academic, government and industry experts met to identify the highest-priority research questions. Here, we review the biology and treatment of MCC and report the consensus-based recommendations agreed upon during the workshop. Merkel cell carcinoma (MCC) is a rare and aggressive form of nonmelanoma skin cancer. The availability of immune checkpoint inhibition has improved the outcomes of a subset of patients with MCC, although many unmet needs continue to exist. In this Consensus Statement, the authors summarize developments in our understanding of MCC while also providing consensus recommendations for future research.
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Affiliation(s)
- Paul W Harms
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kelly L Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patrick S Moore
- Cancer Virology Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Michael K K Wong
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Isaac Brownell
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and National Cancer Institute (NCI), NIH, Bethesda, MD, USA.
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von der Grün J, Winkelmann R, Meissner M, Wieland U, Silling S, Martin D, Fokas E, Rödel C, Rödel F, Balermpas P. Merkel Cell Polyoma Viral Load and Intratumoral CD8+ Lymphocyte Infiltration Predict Overall Survival in Patients With Merkel Cell Carcinoma. Front Oncol 2019; 9:20. [PMID: 30733932 PMCID: PMC6354572 DOI: 10.3389/fonc.2019.00020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Merkel cell carcinoma (MCC) is linked to the presence of clonally integrated Merkel cell polyomavirus (MCPyV) in up to 80% of the cases. The aim of the study was to determine the prognostic value of baseline MCPyV viral load and lymphocytic infiltration. Methods: MCPyV DNA prevalence, integration status and viral load were determined by specific quantitative real-time PCR in surgical specimens obtained from 49 patients with MCC treated with (n = 22, 45%) or without postoperative radiotherapy (RT). CD8+ tumor infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) status were assessed using immunohistochemistry. MCPyV characteristics and immune marker expression were correlated with clinicopathological factors and overall survival (OS). Results: Median age at diagnosis was 74 (range, 42–100); 51% of the patients were female. One-, three, and five-year OS rates were 83.8, 58.6, and 47.1%, respectively. A positive MCPyV status was associated with female gender (p = 0.042). Tumor localization (head/arms vs. trunk) positively correlated with PD-L1 status (p = 0.011) and combined CD8/PD-L1 expression (p = 0.038). Overall CD8+ infiltration was inversely associated with N-stage (p = 0.048). Stromal TILs correlated significantly with both PD-L1 expression (p = 0.010) and N-stage (p = 0.037). A high viral load (>median) was significantly associated with worse OS (p = 0.029) and high intratumoral CD8+ infiltration with improved OS for the entire cohort (p = 0.045). Conclusion: These data provide important insight on the role of MCPy DNA viral load and TILs in the context of PD-L1 in patients with Merkel cell carcinoma. Future clinical studies should aim to explore the effect of PD-1/PD-L1 immune-checkpoint inhibitors in combination with existing radiotherapy approaches.
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Affiliation(s)
- Jens von der Grün
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Ria Winkelmann
- Dr. Senckenberg Institute of Pathology, University of Frankfurt, Frankfurt, Germany
| | - Markus Meissner
- Department of Dermatology, University of Frankfurt, Frankfurt, Germany
| | - Ulrike Wieland
- Institute of Virology, National Reference Center for Papilloma and Polyomaviruses, University of Cologne, Cologne, Germany
| | - Steffi Silling
- Institute of Virology, National Reference Center for Papilloma and Polyomaviruses, University of Cologne, Cologne, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt, Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt, Frankfurt, Germany.,Department of Radiation Oncology, University Hospital Zürich, Zurich, Switzerland
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56
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Giraldo NA, Nguyen P, Engle EL, Kaunitz GJ, Cottrell TR, Berry S, Green B, Soni A, Cuda JD, Stein JE, Sunshine JC, Succaria F, Xu H, Ogurtsova A, Danilova L, Church CD, Miller NJ, Fling S, Lundgren L, Ramchurren N, Yearley JH, Lipson EJ, Cheever M, Anders RA, Nghiem PT, Topalian SL, Taube JM. Multidimensional, quantitative assessment of PD-1/PD-L1 expression in patients with Merkel cell carcinoma and association with response to pembrolizumab. J Immunother Cancer 2018; 6:99. [PMID: 30285852 PMCID: PMC6167897 DOI: 10.1186/s40425-018-0404-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We recently reported a 56% objective response rate in patients with advanced Merkel cell carcinoma (MCC) receiving pembrolizumab. However, a biomarker predicting clinical response was not identified. METHODS Pretreatment FFPE tumor specimens (n = 26) were stained for CD8, PD-L1, and PD-1 by immunohistochemistry/immunofluorescence (IHC/IF), and the density and distribution of positive cells was quantified to determine the associations with anti-PD-1 response. Multiplex IF was used to test a separate cohort of MCC archival specimens (n = 16), to identify cell types expressing PD-1. RESULTS Tumors from patients who responded to anti-PD-1 showed higher densities of PD-1+ and PD-L1+ cells when compared to non-responders (median cells/mm2, 70.7 vs. 6.7, p = 0.03; and 855.4 vs. 245.0, p = 0.02, respectively). There was no significant association of CD8+ cell density with clinical response. Quantification of PD-1+ cells located within 20 μm of a PD-L1+ cell showed that PD-1/PD-L1 proximity was associated with clinical response (p = 0.03), but CD8/PD-L1 proximity was not. CD4+ and CD8+ cells in the TME expressed similar amounts of PD-1. CONCLUSIONS While the binomial presence or absence of PD-L1 expression in the TME was not sufficient to predict response to anti-PD-1 in patients with MCC, we show that quantitative assessments of PD-1+ and PD-L1+ cell densities as well as the geographic interactions between these two cell populations correlate with clinical response. Cell types expressing PD-1 in the TME include CD8+ T-cells, CD4+ T-cells, Tregs, and CD20+ B-cells, supporting the notion that multiple cell types may potentiate tumor regression following PD-1 blockade.
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Affiliation(s)
- Nicolas A Giraldo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Nguyen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Elizabeth L Engle
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Genevieve J Kaunitz
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tricia R Cottrell
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sneha Berry
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Benjamin Green
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Abha Soni
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan D Cuda
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie E Stein
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel C Sunshine
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farah Succaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haiying Xu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Aleksandra Ogurtsova
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ludmila Danilova
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Candice D Church
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Natalie J Miller
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Steve Fling
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa Lundgren
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nirasha Ramchurren
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | | | - Evan J Lipson
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Mac Cheever
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert A Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul T Nghiem
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Suzanne L Topalian
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Janis M Taube
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA.
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Cellular sheddases are induced by Merkel cell polyomavirus small tumour antigen to mediate cell dissociation and invasiveness. PLoS Pathog 2018; 14:e1007276. [PMID: 30188954 PMCID: PMC6143273 DOI: 10.1371/journal.ppat.1007276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/18/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer with a high propensity for recurrence and metastasis. Merkel cell polyomavirus (MCPyV) is recognised as the causative factor in the majority of MCC cases. The MCPyV small tumour antigen (ST) is considered to be the main viral transforming factor, however potential mechanisms linking ST expression to the highly metastatic nature of MCC are yet to be fully elucidated. Metastasis is a complex process, with several discrete steps required for the formation of secondary tumour sites. One essential trait that underpins the ability of cancer cells to metastasise is how they interact with adjoining tumour cells and the surrounding extracellular matrix. Here we demonstrate that MCPyV ST expression disrupts the integrity of cell-cell junctions, thereby enhancing cell dissociation and implicate the cellular sheddases, A disintegrin and metalloproteinase (ADAM) 10 and 17 proteins in this process. Inhibition of ADAM 10 and 17 activity reduced MCPyV ST-induced cell dissociation and motility, attributing their function as critical to the MCPyV-induced metastatic processes. Consistent with these data, we confirm that ADAM 10 and 17 are upregulated in MCPyV-positive primary MCC tumours. These novel findings implicate cellular sheddases as key host cell factors contributing to virus-mediated cellular transformation and metastasis. Notably, ADAM protein expression may be a novel biomarker of MCC prognosis and given the current interest in cellular sheddase inhibitors for cancer therapeutics, it highlights ADAM 10 and 17 activity as a novel opportunity for targeted interventions for disseminated MCC.
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58
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Kandl TJ, Sagiv O, Curry JL, Ning J, Ma J, Hudgens CW, Van Arnam J, Wargo JA, Esmaeli B, Tetzlaff MT. High expression of PD-1 and PD-L1 in ocular adnexal sebaceous carcinoma. Oncoimmunology 2018; 7:e1475874. [PMID: 30228943 DOI: 10.1080/2162402x.2018.1475874] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 12/24/2022] Open
Abstract
Ocular adnexal sebaceous carcinoma (OASC) is an aggressive malignancy that frequently recurs locally and metastasizes. Surgical extirpation may produce significant aesthetic morbidity, and effective systemic therapies for locally advanced or metastatic disease are largely ineffective. Immune checkpoint inhibitors have shown efficacy in the management of several solid tumors where tumor cell PD-L1 expression correlates with improved response. To determine whether OASC might be amenable to immune checkpoint blockade, we performed comprehensive immune profiling for CD3, CD8, PD-1, FOXP3, and PD-L1 in 24 patients with primary OASC. The composition, distribution and density of the tumor associated immune infiltrate were quantified by automated image analysis and correlated with measures of clinical outcome. Tumor cells in 12 OASCs (50%) expressed PD-L1. Higher densities of CD3+ (p = 0.01), CD8+ (p = 0.006), and PD-1+ (p = 0.024) tumor-associated T cells were associated with higher T category (≥T3a per the 7th edition of the American Joint Committee on Cancer staging manual). Higher tumor cell expression of PD-L1 correlated with higher density of PD-1+ tumor-associated T cells (p = 0.021). Since a CD3+ CD8+ PD-1 + T-cell infiltrate represents a "suppressed T-cell phenotype" apparently permissive toward OASC progression, our findings provide a mechanistic rationale for the effective application of immune checkpoint blockade in OASC to abrogate PD-1/PD-L1 interaction and effectively unleash the immune infiltrate to treat higher-stage tumors.
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Affiliation(s)
- Thomas J Kandl
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Oded Sagiv
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Junsheng Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Van Arnam
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Tetzlaff
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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59
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Uchi H. Merkel Cell Carcinoma: An Update and Immunotherapy. Front Oncol 2018; 8:48. [PMID: 29560342 PMCID: PMC5845720 DOI: 10.3389/fonc.2018.00048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/19/2018] [Indexed: 01/30/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer with frequent metastasis and death. MCC has a mortality rate of 30%, making it more lethal than malignant melanoma, and incidence of MCC has increased almost fourfold over the past 20 years in the USA. MCC has long been considered to be an immunogenic cancer because it occurs more frequently in immunosuppressed patients from organ transplant and HIV infection than in those with immunocompetent. Chronic UV light exposure and clonal integration of Merkel cell polyomavirus (MCPyV) are two major causative factors of MCC. Approximately 80% of MCC are associated with MCPyV, and T cells specific for MCPyV oncoproteins are present in the blood and tumors of patients. Several studies have shown that a subset of MCCs express PD-1 on tumor-infiltrating lymphocytes and express PD-L1 on tumor cells, which suggests an endogenous tumor-reactive immune response that might be unleashed by anti-PD-1 or anti-PD-L1 drugs.
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Affiliation(s)
- Hiroshi Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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61
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Merkel cell carcinomas infiltrated with CD33 + myeloid cells and CD8 + T cells are associated with improved outcome. J Am Acad Dermatol 2017; 78:973-982.e8. [PMID: 29273486 DOI: 10.1016/j.jaad.2017.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare tumor of the skin that has an aggressive behavior. Immunity is the main regulator of MCC development, and many interactions between lymphocytes and tumor cells have been proven. However, the impact of tumor-infiltrating myeloid cells needs better characterization. OBJECTIVE To characterize tumor-infiltrating myeloid cells in MCC and their association with other immune effectors and patient outcome. METHODS MCC cases were reviewed from an ongoing prospective cohort study. In all, 103 triplicate tumor samples were included in a tissue microarray. Macrophages, neutrophils, and myeloid-derived suppressor cells were characterized by the following markers: CD68, CD33, CD163, CD15, CD33, and human leukocyte antigen-DR. Associations of these cell populations with programmed cell death ligand 1 expression, CD8 infiltrates, and vascular density were assessed. Impact on survival was analyzed by log-rank tests and a Cox multivariate model. RESULTS The median density of macrophages was 216 cells/mm2. CD68+ and CD33+ macrophage densities were associated with CD8+ T-cell infiltrates and programmed cell death ligand 1 expression. In addition, MCC harboring CD8+ T cell infiltrates and brisk CD33+ myeloid cell infiltrates were significantly and independently associated with improved outcomes (recurrence-free and overall survival). LIMITATIONS Sampling bias and the retrospective design were potential study limitations. CONCLUSION Infiltration of CD33+ myeloid cells and CD8+ T lymphocytes defines a subset of MCC associated with improved outcome.
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Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol 2017; 78:457-463.e2. [PMID: 29102486 DOI: 10.1016/j.jaad.2017.10.028] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) incidence rates are rising and strongly age-associated, relevant for an aging population. OBJECTIVE Determine MCC incidence in the United States and project incident cases through the year 2025. METHODS Registry data were obtained from the SEER-18 Database, containing 6600 MCC cases. Age- and sex-adjusted projections were generated using US census data. RESULTS During 2000-2013, the number of reported solid cancer cases increased 15%, melanoma cases increased 57%, and MCC cases increased 95%. In 2013, the MCC incidence rate was 0.7 cases/100,000 person-years in the United States, corresponding to 2488 cases/year. MCC incidence increased exponentially with age, from 0.1 to 1.0 to 9.8 (per 100,000 person-years) among age groups 40-44 years, 60-64 years, and ≥85 years, respectively. Due to aging of the Baby Boomer generation, US MCC incident cases are predicted to climb to 2835 cases/year in 2020 and 3284 cases/year in 2025. LIMITATIONS We assumed that the age-adjusted incidence rate would stabilize, and thus, the number of incident cases we projected might be an underestimate. CONCLUSION An aging population is driving brisk increases in the number of new MCC cases in the United States. This growing impact combined with the rapidly evolving therapeutic landscape warrants expanded awareness of MCC diagnosis and management.
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Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority of MCC cases are of viral aetiology; by contrast, in areas with high UV exposure, UV-mediated carcinogenesis is predominant. The two aetiologies share similar clinical, histopathological and prognostic characteristics. MCC presents with a solitary cutaneous or subcutaneous nodule, most frequently in sun-exposed areas. In fact, UV exposure is probably involved in both viral-mediated and non-viral-mediated carcinogenesis, by contributing to immunosuppression or DNA damage, respectively. Confirmation of diagnosis relies on analyses of histological features and immunological marker expression profiles of the lesion. At primary diagnosis, loco-regional metastases are already present in ∼30% of patients. Excision of the tumour is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease. Chemotherapy was the only alternative in advanced-stage or refractory MCC until several clinical trials demonstrated the efficacy of immune-checkpoint inhibitors.
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64
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Barksdale SK. Advances in Merkel cell carcinoma from a pathologist's perspective. Pathology 2017; 49:568-574. [DOI: 10.1016/j.pathol.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
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65
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Schadendorf D, Nghiem P, Bhatia S, Hauschild A, Saiag P, Mahnke L, Hariharan S, Kaufman HL. Immune evasion mechanisms and immune checkpoint inhibition in advanced merkel cell carcinoma. Oncoimmunology 2017; 6:e1338237. [PMID: 29123950 DOI: 10.1080/2162402x.2017.1338237] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/25/2017] [Accepted: 05/27/2017] [Indexed: 12/22/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare skin cancer caused by Merkel cell polyomavirus (MCPyV) infection and/or ultraviolet radiation-induced somatic mutations. The presence of tumor-infiltrating lymphocytes is evidence that an active immune response to MCPyV and tumor-associated neoantigens occurs in some patients. However, inhibitory immune molecules, including programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1), within the MCC tumor microenvironment aid in tumor evasion of T-cell-mediated clearance. Unlike chemotherapy, treatment with anti-PD-L1 (avelumab) or anti-PD-1 (pembrolizumab) antibodies leads to durable responses in MCC, in both virus-positive and virus-negative tumors. As many tumors are established through the evasion of infiltrating immune-cell clearance, the lessons learned in MCC may be broadly relevant to many cancers.
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Affiliation(s)
- Dirk Schadendorf
- Department of Dermatology, Essen University Hospital, Germany and German Cancer Consortium Partner Site Essen/Düsseldorf, Essen, Germany
| | - Paul Nghiem
- Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Shailender Bhatia
- Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Philippe Saiag
- Head of Service de Dermatologie Générale et Oncologique, University of Versailles-SQY, CHU A Paré, Boulogne Cedex, France
| | - Lisa Mahnke
- EMD Serono, Inc., Billerica, Boston, MA, USA
| | | | - Howard L Kaufman
- Department of Surgery and Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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66
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Cassler NM, Merrill D, Bichakjian CK, Brownell I. Merkel Cell Carcinoma Therapeutic Update. Curr Treat Options Oncol 2017; 17:36. [PMID: 27262710 DOI: 10.1007/s11864-016-0409-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OPINION STATEMENT Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Early-stage disease can be cured with surgical resection and radiotherapy (RT). Sentinel lymph node biopsy (SLNB) is an important staging tool, as a microscopic MCC is frequently identified. Adjuvant RT to the primary excision site and regional lymph node bed may improve locoregional control. However, newer studies confirm that patients with biopsy-negative sentinel lymph nodes may not benefit from regional RT. Advanced MCC currently lacks a highly effective treatment as responses to chemotherapy are not durable. Recent work suggests that immunotherapy targeting the programmed cell death receptor 1/programmed cell death ligand 1 (PD-1/PD-L1) checkpoint holds great promise in treating advanced MCC and may provide durable responses in a portion of patients. At the same time, high-throughput sequencing studies have demonstrated significant differences in the mutational profiles of tumors with and without the Merkel cell polyomavirus (MCV). An important secondary endpoint in the ongoing immunotherapy trials for MCC will be determining if there is a response difference between the virus-positive MCC tumors that typically lack a large mutational burden and the virus-negative tumors that have a large number of somatic mutations and predicted tumor neoantigens. Interestingly, sequencing studies have failed to identify a highly recurrent activated driver pathway in the majority of MCC tumors. This may explain why targeted therapies can demonstrate exceptional responses in case reports but fail when treating all comers with MCC. Ultimately, a precision medicine approach may be more appropriate for treating MCC, where identified driver mutations are used to direct targeted therapies. At a minimum, stratifying patients in future clinical trials based on tumor viral status should be considered as virus-negative tumors are more likely to harbor activating driver mutations.
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Affiliation(s)
- Nicole M Cassler
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Dean Merrill
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Isaac Brownell
- Dermatology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1908, USA.
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Cowey CL, Mahnke L, Espirito J, Helwig C, Oksen D, Bharmal M. Real-world treatment outcomes in patients with metastatic Merkel cell carcinoma treated with chemotherapy in the USA. Future Oncol 2017; 13:1699-1710. [DOI: 10.2217/fon-2017-0187] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- C Lance Cowey
- Baylor Charles A. Sammons Cancer Center at Dallas, Texas Oncology, Dallas, TX 75246, USA
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68
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Müller-Richter UDA, Gesierich A, Kübler AC, Hartmann S, Brands RC. Merkel Cell Carcinoma of the Head and Neck: Recommendations for Diagnostics and Treatment. Ann Surg Oncol 2017; 24:3430-3437. [PMID: 28762116 PMCID: PMC5596053 DOI: 10.1245/s10434-017-5993-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 12/14/2022]
Abstract
Background Merkel cell carcinoma (MCC) is a rare, aggressive tumor that often occurs in the head and neck region. Because of these features, the classifications and diagnostic and treatment regimens are frequently modified. Especially in the anatomically complex head and neck region, it is crucial to be aware of the current recommendations for diagnostics and treatment of MCC to ensure appropriate treatment. This overview aims to summarize the currently available literature. Methods The authors reviewed the relevant literature and international guidelines for MCC from 2012 to 2017 with respect to epidemiology and prognosis, diagnostic procedures and imaging, surgery, radiation, systemic treatment, and aftercare. These results were compared with existing guidelines, some of them current, and recommendations were derived. Results Marked developments in imaging have resulted in an increased use of functional imaging. The surgical concepts have changed regarding safety margins and the use of sentinel node biopsies. In systemic treatment, a move from conventional agents toward immuno-oncology can be observed. Conclusions For staging, it is important to be as exact as possible using functional imaging (e.g., positron emission tomography/computed tomography scan), especially in the head and neck area with its complex lymph drainage. This often plays an especially important role in early stages of the tumor, when the resection margin can be reduced to preserve the organ. Aftercare also should include functional imaging. In an advanced, metastatic stage, immuno-oncology (PD-1, PD-L1, CTLA-4) is superior to the previous methods of systemic treatment.
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Affiliation(s)
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, Würzburg University Hospital, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, Würzburg University Hospital, Würzburg, Germany
| | - Roman Camillus Brands
- Department of Oral and Maxillofacial Plastic Surgery, Würzburg University Hospital, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg University Hospital, Würzburg, Germany
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69
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Harms KL, Chubb H, Zhao L, Fullen DR, Bichakjian CK, Johnson TM, Carskadon S, Palanisamy N, Harms PW. Increased expression of EZH2 in Merkel cell carcinoma is associated with disease progression and poorer prognosis. Hum Pathol 2017; 67:78-84. [PMID: 28739498 DOI: 10.1016/j.humpath.2017.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/24/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022]
Abstract
Enhancer of zeste homolog 2 (EZH2) is a histone methyltransferase that affects tumorigenesis by epigenetic gene silencing. Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine carcinoma that has a high risk of disease progression with nodal and distant metastases. Here, we evaluated EZH2 expression by immunohistochemistry in a cohort of 85 MCC tumors (29 primary tumors, 41 lymph node metastases, 13 in-transit metastases, and 2 distant metastases) with clinical follow-up. We show strong/moderate EZH2 expression in 54% of tumors. Importantly, weak expression of EZH2 in the primary tumor, but not nodal metastases, correlated with improved prognosis compared to moderate/strong EZH2 expression (5-year MCC-specific survival of 68% versus 22%, respectively, P=.024). In addition, EZH2 was expressed at higher levels in nodal metastases compared to primary tumors (P=.005). Our data demonstrate that EZH2 has prognostic value and may play an oncogenic role in MCC.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Heather Chubb
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Shannon Carskadon
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Nallasivam Palanisamy
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Paul W Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
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70
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Becker JC, Lorenz E, Ugurel S, Eigentler TK, Kiecker F, Pföhler C, Kellner I, Meier F, Kähler K, Mohr P, Berking C, Haas G, Helwig C, Oksen D, Schadendorf D, Mahnke L, Bharmal M. Evaluation of real-world treatment outcomes in patients with distant metastatic Merkel cell carcinoma following second-line chemotherapy in Europe. Oncotarget 2017; 8:79731-79741. [PMID: 29108353 PMCID: PMC5668086 DOI: 10.18632/oncotarget.19218] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022] Open
Abstract
Background and aims Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer; few treatments exist for patients with advanced disease. Once tumors metastasize to distant sites, patients generally receive chemotherapy, but response duration and progression-free survival (PFS) are typically short. Few studies have assessed the efficacy of second-line chemotherapy for metastatic MCC. Here, we studied outcomes in patients who received ≥ 2 lines of chemotherapy for metastatic MCC. Materials and methods Patients in an MCC-specific registry diagnosed with stage IV MCC between November 1, 2004, and September 15, 2015, and treated with second-line or later chemotherapy were analyzed retrospectively. Patient records, including baseline characteristics, immunocompetent status, and responses to prior chemotherapy, were evaluated. Patients meeting eligibility criteria were followed through December 31, 2015. Results Of 29 patients with metastatic MCC and immunocompetent status who had received ≥ 2 lines of chemotherapy, 3 achieved a partial response, for an objective response rate (ORR) of 10.3% (95% CI, 2.2–27.4). In the overall population including patients with immunocompetent and immunocompromised status (n = 34), the ORR was 8.8% (95% CI, 1.9–23.7). The median duration of response was 1.9 months (range, 1.3–2.1 months; 95% CI, 1.3–2.1). In the immunocompetent population, median PFS and overall survival were 3.0 months (95% CI, 2.5–6.0) and 5.3 months (95% CI, 4.3–6.0), respectively. Conclusions The low response rates and limited durability confirm previous reports of the ineffectiveness of second-line or later chemotherapy in patients with metastatic MCC and provide a benchmark for assessing clinical benefit of new treatments.
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Affiliation(s)
- Jürgen C Becker
- Translational Skin Cancer Research (TSCR), German Cancer Research Center (DFKZ) Partner Site Essen/Düsseldorf, Essen University Hospital, 45147, Essen, Germany.,Department of Dermatology, University Hospital of Essen, 45122 Essen, Germany.,Department of Dermatology, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Eva Lorenz
- IMS HEALTH GmbH and Co OHG, 60598, Frankfurt am Main, Germany.,Present address: Institute for Medical Statistics, Epidemiology and Informatics, University Medical Center Mainz, 55131 Mainz, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital of Essen, 45122 Essen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, University Hospital of Tübingen, 72076 Tübingen, Germany
| | - Felix Kiecker
- Charité Universitätsmedizin Berlin, Department of Dermatology, 10117 Berlin, Germany
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, 66421 Homburg/Saar, Germany
| | - Ivonne Kellner
- Helios-Klinik, Department of Dermatology, 99089 Erfurt, Germany
| | - Friedegund Meier
- Skin Cancer Center, University Cancer Centre, and National Center for Tumor Diseases Dresden, 01307 Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus at the TU Dresden, 01307 Dresden, Germany
| | - Katharina Kähler
- Universitätsklinikum, Department of Dermatology, 24105 Kiel, Germany
| | - Peter Mohr
- Elbe-Kliniken, Skin Cancer Center, 21614 Buxtehude, Germany
| | - Carola Berking
- University Hospital Munich (LMU), Department of Dermatology and Allergy, 80337 Munich, Germany
| | - Gabriele Haas
- Department of Dermatology, University Hospital of Essen, 45122 Essen, Germany
| | | | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital of Essen, 45122 Essen, Germany
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71
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Vandeven N, Nghiem P. Rationale for immune-based therapies in Merkel polyomavirus-positive and -negative Merkel cell carcinomas. Immunotherapy 2017; 8:907-21. [PMID: 27381685 DOI: 10.2217/imt-2016-0009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but often deadly skin cancer that is typically caused by the Merkel cell polyomavirus (MCPyV). Polyomavirus T-antigen oncoproteins are persistently expressed in virus-positive MCCs (˜80% of cases), while remarkably high numbers of tumor-associated neoantigens are detected in virus-negative MCCs, suggesting that both MCC subsets may be immunogenic. Here we review mechanisms by which these immunogenic tumors evade multiple levels of host immunity. Additionally, we summarize the exciting potential of diverse immune-based approaches to treat MCC. In particular, agents blocking the PD-1 axis have yielded strikingly high response rates in MCC as compared with other solid tumors, highlighting the potential for immune-mediated treatment of this disease.
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Affiliation(s)
- Natalie Vandeven
- Department of Medicine (Pathology & Dermatology), University of Washington, USA
| | - Paul Nghiem
- Department of Medicine (Pathology & Dermatology), University of Washington, USA
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72
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Ritter C, Fan K, Paschen A, Reker Hardrup S, Ferrone S, Nghiem P, Ugurel S, Schrama D, Becker JC. Epigenetic priming restores the HLA class-I antigen processing machinery expression in Merkel cell carcinoma. Sci Rep 2017; 7:2290. [PMID: 28536458 PMCID: PMC5442125 DOI: 10.1038/s41598-017-02608-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 12/22/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive, yet highly immunogenic skin cancer. The latter is due to its viral or UV-associated carcinogenesis. For tumor progression MCC has to escape the host’s immuno-surveillance, e.g. by loss of HLA class-I expression. Indeed, a reduced HLA class-I expression was observed in MCC tumor tissues and MCC cell lines. This reduced HLA class-I surface expression is caused by an impaired expression of key components of the antigen processing machinery (APM), including LMP2 and LMP7 as well as TAP1 and TAP2. Notably, experimental provisions of HLA class-I binding peptides restored HLA class-I surface expression on MCC cells. Silencing of the HLA class-I APM is due to histone deacetylation as inhibition of histone deacetylases (HDACs) not only induced acetylation of histones in the respective promoter regions but also re-expression of APM components. Thus, HDAC inhibition restored HLA class-I surface expression in vitro and in a mouse xenotransplantation model. In contrast to re-induction of HLA class-I by interferons, HDAC inhibitors did not interfere with the expression of immuno-dominant viral proteins. In summary, restoration of HLA class-I expression on MCC cells by epigenetic priming is an attractive approach to enhance therapies boosting adaptive immune responses.
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Affiliation(s)
- Cathrin Ritter
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kaiji Fan
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Sine Reker Hardrup
- Department of Immunology and Vaccinology, Technical University of Denmark, Frederiksberg, Denmark
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - David Schrama
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Jürgen C Becker
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany. .,German Cancer Consortium (DKTK), Essen, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Dermatology, University Hospital Essen, Essen, Germany.
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Nghiem P, Kaufman HL, Bharmal M, Mahnke L, Phatak H, Becker JC. Systematic literature review of efficacy, safety and tolerability outcomes of chemotherapy regimens in patients with metastatic Merkel cell carcinoma. Future Oncol 2017; 13:1263-1279. [PMID: 28350180 PMCID: PMC6040046 DOI: 10.2217/fon-2017-0072] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIM Merkel cell carcinoma (MCC) is a rare neuroendocrine, cutaneous malignancy with poor prognosis once metastasized. The aim of this study was to conduct a systematic literature review to assess clinical outcomes associated with chemotherapy regimens in metastatic MCC. MATERIALS & METHODS Embase®, MEDLINE®, MEDLINE®-In-Process and CENTRAL were searched for studies published in January 2016. RESULTS & CONCLUSION Overall, the literature on chemotherapy in patients with metastatic MCC is sparse, with most studies being case series/reports. Across all studies, response rates ranged from 20 to 61%, with higher response rates in first-line setting (53-61%) versus second-line setting (23-45%). Among responders, duration of response was short (≤8 months) in both first- and second-line settings. There is a need for novel agents that can induce durable responses in metastatic MCC.
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Affiliation(s)
- Paul Nghiem
- Division of Dermatology, University of Washington Medical School, Fred Hutchinson Cancer Research Center, Seattle, WA 98195-8050, USA
| | - Howard L Kaufman
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | | | - Lisa Mahnke
- Global Research and Early Development, EMD Serono, Billerica, Boston, MA 01821, USA
| | - Hemant Phatak
- Health Economics and Outcomes Research, EMD Serono, Rockland, MA 02370, USA
| | - Jürgen C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner site Essen Düsseldorf, University Hospital Essen, Essen, Germany
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Miller NJ, Church CD, Dong L, Crispin D, Fitzgibbon MP, Lachance K, Jing L, Shinohara M, Gavvovidis I, Willimsky G, McIntosh M, Blankenstein T, Koelle DM, Nghiem P. Tumor-Infiltrating Merkel Cell Polyomavirus-Specific T Cells Are Diverse and Associated with Improved Patient Survival. Cancer Immunol Res 2017; 5:137-147. [PMID: 28093446 PMCID: PMC5421625 DOI: 10.1158/2326-6066.cir-16-0210] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 01/02/2023]
Abstract
Tumor-infiltrating CD8+ T cells are associated with improved survival of patients with Merkel cell carcinoma (MCC), an aggressive skin cancer causally linked to Merkel cell polyomavirus (MCPyV). However, CD8+ T-cell infiltration is robust in only 4% to 18% of MCC tumors. We characterized the T-cell receptor (TCR) repertoire restricted to one prominent epitope of MCPyV (KLLEIAPNC, "KLL") and assessed whether TCR diversity, tumor infiltration, or T-cell avidity correlated with clinical outcome. HLA-A*02:01/KLL tetramer+ CD8+ T cells from MCC patient peripheral blood mononuclear cells (PBMC) and tumor-infiltrating lymphocytes (TIL) were isolated via flow cytometry. TCRβ (TRB) sequencing was performed on tetramer+ cells from PBMCs or TILs (n = 14) and matched tumors (n = 12). Functional avidity of T-cell clones was determined by IFNγ production. We identified KLL tetramer+ T cells in 14% of PBMC and 21% of TIL from MCC patients. TRB repertoires were strikingly diverse (397 unique TRBs were identified from 12 patients) and mostly private (only one TCRb clonotype shared between two patients). An increased fraction of KLL-specific TIL (>1.9%) was associated with significantly increased MCC-specific survival P = 0.0009). T-cell cloning from four patients identified 42 distinct KLL-specific TCRa/b pairs. T-cell clones from patients with improved MCC-specific outcomes were more avid (P < 0.05) and recognized an HLA-appropriate MCC cell line. T cells specific for a single MCPyV epitope display marked TCR diversity within and between patients. Intratumoral infiltration by MCPyV-specific T cells was associated with significantly improved MCC-specific survival, suggesting that augmenting the number or avidity of virus-specific T cells may have therapeutic benefit. Cancer Immunol Res; 5(2); 137-47. ©2017 AACR.
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MESH Headings
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Carcinoma, Merkel Cell/etiology
- Carcinoma, Merkel Cell/mortality
- Carcinoma, Merkel Cell/pathology
- Clonal Evolution/genetics
- Clonal Evolution/immunology
- Epitopes, T-Lymphocyte/chemistry
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Genetic Variation
- Humans
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Lymphocytes, Tumor-Infiltrating/pathology
- Merkel cell polyomavirus/immunology
- Prognosis
- Receptors, Antigen, T-Cell, alpha-beta/chemistry
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Sequence Analysis, DNA
- Skin Neoplasms/etiology
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- T-Cell Antigen Receptor Specificity/immunology
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
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Affiliation(s)
- Natalie J Miller
- Dermatology/Medicine/Pathology, University of Washington, Seattle, Washington
| | - Candice D Church
- Dermatology/Medicine/Pathology, University of Washington, Seattle, Washington
| | - Lichun Dong
- Department of Medicine/Laboratory Medicine/Global Health, University of Washington, Seattle, Washington
| | - David Crispin
- Fred Hutchinson, Public Health Sciences Division, Seattle, Washington
| | | | - Kristina Lachance
- Dermatology/Medicine/Pathology, University of Washington, Seattle, Washington
| | - Lichen Jing
- Department of Medicine/Laboratory Medicine/Global Health, University of Washington, Seattle, Washington
| | - Michi Shinohara
- Dermatology/Medicine/Pathology, University of Washington, Seattle, Washington
| | - Ioannis Gavvovidis
- Molecular Immunology and Gene Therapy, Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Institute of Immunology, Charité, Berlin, Germany
| | - Gerald Willimsky
- Institute of Immunology, Charité, Berlin, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin McIntosh
- Fred Hutchinson, Public Health Sciences Division, Seattle, Washington
| | - Thomas Blankenstein
- Molecular Immunology and Gene Therapy, Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Institute of Immunology, Charité, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - David M Koelle
- Department of Medicine/Laboratory Medicine/Global Health, University of Washington, Seattle, Washington.
- Fred Hutchinson, Vaccine and Infectious Disease Division, Seattle, Washington
- Benaroya Research Institute, Seattle, Washington
| | - Paul Nghiem
- Dermatology/Medicine/Pathology, University of Washington, Seattle, Washington.
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75
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Schadendorf D, Lebbé C, Zur Hausen A, Avril MF, Hariharan S, Bharmal M, Becker JC. Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer 2016; 71:53-69. [PMID: 27984768 DOI: 10.1016/j.ejca.2016.10.022] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 01/19/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare skin cancer that is associated with Merkel cell polyomavirus infection in most cases. Incidence rates of MCC have increased in past decades. Risk factors for MCC include ultraviolet light exposure, immunosuppression and advanced age. MCC is an aggressive malignancy with frequent recurrences and a high mortality rate, although patient outcomes are generally more favourable if the patient is referred for treatment at an early stage. Although advances have been made recently in the MCC field, large gaps remain with regard to definitive biomarkers and prognostic indicators. Although MCC is chemosensitive, responses in advanced stages are mostly of short duration, and the associated clinical benefit on overall survival is unclear. Recent nonrandomised phase 2 clinical trials with anti-PD-L1/PD-1 antibodies have demonstrated safety and efficacy; however, there are still no approved treatments for patients with metastatic MCC. Patients with advanced disease are encouraged to participate in clinical trials for treatment, indicating the largely unmet need for durable, safe treatment within this population.
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Affiliation(s)
- Dirk Schadendorf
- Dermatology, Essen University Hospital, Essen, Germany; German Cancer Consortium Partner Site Essen/Düsseldorf, Essen University Hospital, Essen, Germany.
| | - Céleste Lebbé
- APHP, Dermatology and CIC, Hôpital Saint-Louis, INSERM U976, University Paris 7 Diderot, Paris, France.
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands.
| | | | | | - Murtuza Bharmal
- Merck KGaA, Global Evidence & Value Development, Darmstadt, Germany.
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), German Cancer Consortium Partner Site Essen/Düsseldorf, Dermatology, Essen University Hospital, Essen, Germany.
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76
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Goh G, Walradt T, Markarov V, Blom A, Riaz N, Doumani R, Stafstrom K, Moshiri A, Yelistratova L, Levinsohn J, Chan TA, Nghiem P, Lifton RP, Choi J. Mutational landscape of MCPyV-positive and MCPyV-negative Merkel cell carcinomas with implications for immunotherapy. Oncotarget 2016; 7:3403-15. [PMID: 26655088 PMCID: PMC4823115 DOI: 10.18632/oncotarget.6494] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/20/2015] [Indexed: 12/17/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive cutaneous neuroendocrine carcinoma, associated with the Merkel cell polyomavirus (MCPyV) in 80% of cases. To define the genetic basis of MCCs, we performed exome sequencing of 49 MCCs. We show that MCPyV-negative MCCs have a high mutation burden (median of 1121 somatic single nucleotide variants (SSNVs) per-exome with frequent mutations in RB1 and TP53 and additional damaging mutations in genes in the chromatin modification (ASXL1, MLL2, and MLL3), JNK (MAP3K1 and TRAF7), and DNA-damage pathways (ATM, MSH2, and BRCA1). In contrast, MCPyV-positive MCCs harbor few SSNVs (median of 12.5 SSNVs/tumor) with none in the genes listed above. In both subgroups, there are rare cancer-promoting mutations predicted to activate the PI3K pathway (HRAS, KRAS, PIK3CA, PTEN, and TSC1) and to inactivate the Notch pathway (Notch1 and Notch2). TP53 mutations appear to be clinically relevant in virus-negative MCCs as 37% of these tumors harbor potentially targetable gain-of-function mutations in TP53 at p.R248 and p.P278. Moreover, TP53 mutational status predicts death in early stage MCC (5-year survival in TP53 mutant vs wild-type stage I and II MCCs is 20% vs. 92%, respectively; P = 0.0036). Lastly, we identified the tumor neoantigens in MCPyV-negative and MCPyV-positive MCCs. We found that virus-negative MCCs harbor more tumor neoantigens than melanomas or non-small cell lung cancers (median of 173, 65, and 111 neoantigens/sample, respectively), two cancers for which immune checkpoint blockade can produce durable clinical responses. Collectively, these data support the use of immunotherapies for virus-negative MCCs.
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Affiliation(s)
- Gerald Goh
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Howard Hughes Medical Institute, Yale School of Medicine, New Haven, CT, USA
| | - Trent Walradt
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Vladimir Markarov
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Astrid Blom
- Department of Dermatology, University of Washington, Seattle, WA, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, University of Washington, Seattle, WA, USA
| | - Ryan Doumani
- Department of Dermatology, University of Washington, Seattle, WA, USA
| | - Krista Stafstrom
- Department of Dermatology, University of Washington, Seattle, WA, USA
| | - Ata Moshiri
- Department of Dermatology, University of Washington, Seattle, WA, USA
| | - Lola Yelistratova
- Department of Dermatology, University of Washington, Seattle, WA, USA
| | | | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Nghiem
- Department of Dermatology, University of Washington, Seattle, WA, USA.,Department of Pathology, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Howard Hughes Medical Institute, Yale School of Medicine, New Haven, CT, USA
| | - Jaehyuk Choi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Dermatology, Veterans Affairs Healthcare, West Haven, CT, USA.,Current address: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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77
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Walsh NM. Complete spontaneous regression of Merkel cell carcinoma (1986-2016): a 30 year perspective. J Cutan Pathol 2016; 43:1150-1154. [PMID: 27596690 DOI: 10.1111/cup.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Noreen M Walsh
- Departments of Pathology and Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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78
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Zaragoza J, Kervarrec T, Touzé A, Avenel-Audran M, Beneton N, Esteve E, Wierzbicka Hainaut E, Aubin F, Machet L, Samimi M. A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study. J Am Acad Dermatol 2016; 75:712-721.e1. [PMID: 27544490 DOI: 10.1016/j.jaad.2016.05.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/11/2016] [Accepted: 05/29/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date. OBJECTIVE We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC. METHODS We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC. RESULTS Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence. LIMITATIONS Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available. CONCLUSION A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline.
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Affiliation(s)
- Julia Zaragoza
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Antoine Touzé
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France
| | - Martine Avenel-Audran
- Dermatology Department, Centre Hospitalier Universitaire Angers, L'Université Nantes Angers Le Mans (LUNAM), Angers, France
| | - Nathalie Beneton
- Dermatology Department, Centre Hospitalier Régional Le Mans, Le Mans, France
| | - Eric Esteve
- Dermatology Department, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - François Aubin
- Dermatology Department, Centre Hospitalier Universitaire Besançon, Université de Franche Comté, Equipe d'Accueil 3181, Institut Fédératif de Recherche 133, Besançon, France
| | - Laurent Machet
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Mahtab Samimi
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France; Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France.
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79
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Iyer JG, Blom A, Doumani R, Lewis C, Tarabadkar ES, Anderson A, Ma C, Bestick A, Parvathaneni U, Bhatia S, Nghiem P. Response rates and durability of chemotherapy among 62 patients with metastatic Merkel cell carcinoma. Cancer Med 2016; 5:2294-301. [PMID: 27431483 PMCID: PMC5055152 DOI: 10.1002/cam4.815] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023] Open
Abstract
Cytotoxic chemotherapy is commonly used to treat advanced Merkel cell carcinoma (MCC). However, its efficacy in distant metastatic MCC patients is unclear, in part because most prior reports aggregated these patients with those receiving adjuvant chemotherapy and combined chemoradiation for whom prognosis and outcomes may differ. In this retrospective study, we analyzed detailed records from 62 patients with distant metastatic MCC treated with cytotoxic chemotherapy. Efficacy outcomes including response rate (RR), durability of response (DOR), progression‐free survival (PFS), and overall survival (OS) were evaluated. In this cohort, platinum plus etoposide was the most commonly used first‐line regimen (69%). RR to first‐line chemotherapy was 55% (34/62) with complete responses (CR) in 13% (8/62) and partial responses (PR) in 42% (26/62) while 6% (4/62) had stable disease and 39% (24/62) had progressive disease. Median PFS was 94 days and median OS was 9.5 months from start of chemotherapy. Among responding patients (n = 34), median PFS was 168 days and median DOR was 85 days. Among 30 of the 62 patients who received second‐line chemotherapy, RR was 23% (7/30; 1 CR, 6 PR), median PFS was 61 days, and median DOR was 101 days. In summary, first‐line chemotherapy is associated with a high RR in metastatic MCC, but responses are typically not durable, and the median PFS is only 3 months. These results suggest rapid emergence of chemoresistance in MCC tumors, and may serve as a useful comparator for immunotherapies currently being explored for metastatic MCC.
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Affiliation(s)
- Jayasri G Iyer
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Astrid Blom
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Ryan Doumani
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Christopher Lewis
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Erica S Tarabadkar
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Austin Anderson
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Christine Ma
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Amy Bestick
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | | | - Shailender Bhatia
- Department of Medicine/Medical Oncology, University of Washington, Seattle, Washington
| | - Paul Nghiem
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington.
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80
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Bhatia S, Storer BE, Iyer JG, Moshiri A, Parvathaneni U, Byrd D, Sober AJ, Sondak VK, Gershenwald JE, Nghiem P. Adjuvant Radiation Therapy and Chemotherapy in Merkel Cell Carcinoma: Survival Analyses of 6908 Cases From the National Cancer Data Base. J Natl Cancer Inst 2016; 108:djw042. [PMID: 27245173 DOI: 10.1093/jnci/djw042] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/11/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) has a high risk of recurrence after initial surgical therapy. Adjuvant radiation therapy (RT) and chemotherapy may be used to reduce the risk of locoregional and systemic recurrence, respectively, but there are conflicting data regarding their impact on survival. We performed a retrospective analysis of MCC cases from the National Cancer Data Base (NCDB) to assess whether adjuvant therapy was associated with differences in survival. METHODS Six thousand nine hundred and eight MCC patients with staging, treatment, and survival data were included. Multivariable analyses were conducted for overall survival (OS) with various treatment modalities while adjusting for prognostic variables including age, sex, comorbidities (Charlson/Deyo score), margin status, primary tumor site and size, and lymph node status. All statistical tests were two-sided. RESULTS For localized MCC (stage I: n = 3369, stage II: n = 1474 ), surgery plus adjuvant RT was associated with statistically significantly better OS than with surgery alone in multivariable analyses (stage I: hazard ratio [HR] = 0.71, 95% confidence interval [CI] = 0.64 to 0.80, P < .001; stage II: HR = 0.77, 95% CI = 0.66 to 0.89, P < .001). In patients with regional nodal metastases (stage III: n = 2065 ), neither adjuvant RT nor chemotherapy was associated with statistically significantly improved or worsened OS. CONCLUSIONS In this study of the largest MCC cohort reported to date, adjuvant RT was associated with improved OS in stages I-II MCC. Neither adjuvant RT nor chemotherapy was associated with improved OS in stage III MCC. These results, with the limitations of retrospective analyses, are consistent with earlier studies suggesting benefit with adjuvant RT but do not support the routine use of adjuvant chemotherapy in MCC.
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Affiliation(s)
- Shailender Bhatia
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Barry E Storer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Jayasri G Iyer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Ata Moshiri
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Upendra Parvathaneni
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - David Byrd
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Arthur J Sober
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Vernon K Sondak
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Jeffrey E Gershenwald
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
| | - Paul Nghiem
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA (SB, BES, JGI, AM, UP, DB, PN); Massachusetts General Hospital, Boston, MA (AJS); H. Lee Moffitt Cancer Center, Tampa, FL (VKS); The University of Texas MD Anderson Cancer Center, Houston, TX (JEG)
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81
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Feldmeyer L, Hudgens CW, Ray-Lyons G, Nagarajan P, Aung PP, Curry JL, Torres-Cabala CA, Mino B, Rodriguez-Canales J, Reuben A, Chen PL, Ko JS, Billings SD, Bassett RL, Wistuba II, Cooper ZA, Prieto VG, Wargo JA, Tetzlaff MT. Density, Distribution, and Composition of Immune Infiltrates Correlate with Survival in Merkel Cell Carcinoma. Clin Cancer Res 2016; 22:5553-5563. [PMID: 27166398 DOI: 10.1158/1078-0432.ccr-16-0392] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is an aggressive cancer with frequent metastasis and death with few effective therapies. Because programmed death ligand-1 (PD-L1) is frequently expressed in MCC, immune checkpoint blockade has been leveraged as treatment for metastatic disease. There is therefore a critical need to understand the relationships between MCPyV status, immune profiles, and patient outcomes. EXPERIMENTAL DESIGN IHC for CD3, CD8, PD-1, PD-L1, and MCPyV T-antigen (to determine MCPyV status) was performed on 62 primary MCCs with annotated clinical outcomes. Automated image analysis quantified immune cell density (positive cells/mm2) at discrete geographic locations (tumor periphery, center, and hotspot). T-cell receptor sequencing (TCRseq) was performed in a subset of MCCs. RESULTS No histopathologic variable associated with overall survival (OS) or disease-specific survival (DSS), whereas higher CD3+ (P = 0.004) and CD8+ (P = 0.037) T-cell density at the tumor periphery associated with improved OS. Higher CD8+ T-cell density at the tumor periphery associated with improved DSS (P = 0.049). Stratifying MCCs according to MCPyV status, higher CD3+ (P = 0.026) and CD8+ (P = 0.015) T-cell density at the tumor periphery associated with improved OS for MCPyV+ but not MCPyV- MCC. TCRseq revealed clonal overlap among MCPyV+ samples, suggesting an antigen-specific response against a unifying antigen. CONCLUSIONS These findings establish the tumor-associated immune infiltrate at the tumor periphery as a robust prognostic indicator in MCC and provide a mechanistic rationale to further examine whether the immune infiltrate at the tumor periphery is relevant as a biomarker for response in ongoing and future checkpoint inhibitor trials in MCC. Clin Cancer Res; 22(22); 5553-63. ©2016 AACR.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Genevieve Ray-Lyons
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara Mino
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaime Rodriguez-Canales
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexandre Reuben
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pei-Ling Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zachary A Cooper
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Wargo
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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82
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Walsh NM, Fleming KE, Hanly JG, Dakin Hache K, Doucette S, Ferrara G, Cerroni L. A morphological and immunophenotypic map of the immune response in Merkel cell carcinoma. Hum Pathol 2016; 52:190-6. [PMID: 26980039 DOI: 10.1016/j.humpath.2016.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
Abstract
The susceptibility of Merkel cell carcinoma to the host immune response has prompted a search for effective immunotherapy. CD8-positive T lymphocytes are considered key effectors of this response, but the cellular infiltrates also harbor tumor-protective agents. By developing a comprehensive morphological and immunophenotypic map of tumor-infiltrating lymphocytes (TILS) in Merkel cell carcinoma, we aimed to establish a useful template for future studies. Twenty-two cases (mean age, 79years [range, 52-95]; male-female ratio, 10:12) were studied. TILS were categorized as brisk (7), nonbrisk (9), and absent(6). Merkel cell polyomavirus (MCPyV)-positive (16) and -negative (6) cases were included, as were those with pure (18) and combined (4) morphologies. One MCPyV+ case had undergone spontaneous regression. Immunohistochemical markers included CD3, CD4, CD8, CD20, CD68, FoxP3, PD-1, and CD123. Statistical analysis used Fisher exact tests and Spearman correlations. There was a significant correlation between brisk TILs and MCPyV+ status (P=.025). CD8+ T lymphocytes predominated, were present in significantly higher proportions in brisk infiltrates (P=.003), and showed a significant predilection for the intratumoral environment (P=.003). Immune inhibitors including T regulatory cells (FOXP3+) and PD-1+ "exhausted" immunocytes were present in lower proportions. Our findings support (1) the link between a brisk immune response and MCPyV positivity, (2) the supremacy of CD8+ cells in effecting immunity, and (3) the incorporation of immune inhibitors within the global infiltrate. Efforts to therapeutically arm the "effectors" and disarm the "detractors" are well focused. These will likely have the greatest impact on MCPyV-positive cases.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Kirsten E Fleming
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - John G Hanly
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada
| | - Kelly Dakin Hache
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Steve Doucette
- Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Gerardo Ferrara
- Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy; Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Lorenzo Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
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Tothill R, Estall V, Rischin D. Merkel cell carcinoma: emerging biology, current approaches, and future directions. Am Soc Clin Oncol Educ Book 2016:e519-26. [PMID: 25993218 DOI: 10.14694/edbook_am.2015.35.e519] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine cutaneous cancer that predominantly occurs in patients who are older, and is associated with a high rate of distant failure and mortality. Current management strategies that incorporate surgery and radiotherapy achieve high rates of locoregional control, but distant failure rates remain problematic, highlighting the need for new effective systemic therapies. Chemotherapy can achieve high response rates of limited duration in the metastatic setting, but its role in definitive management remains unproven. Recent developments in our knowledge about the biology of MCC have led to the identification of new potential therapeutic targets and treatments. A key finding has been the discovery that a human polyomavirus may be a causative agent. However, emerging data suggests that MCC may actually be two distinct entities, viral-associated and viral-negative MCC, which is likely to have implications for the management of MCC in the future and for the development of new treatments. In this review, we discuss recent discoveries about the biology of MCC, current approaches to management, and new therapeutic strategies that are being investigated.
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Affiliation(s)
- Richard Tothill
- From the Division of Research, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology and Skin and Melanoma Tumour Stream, Peter MacCallum Cancer Centre, and the Department of Pathology, University of Melbourne, Melbourne, Australia; Division of Cancer Medicine, and Head and Neck Tumour Stream, Peter MacCallum Cancer Centre, the Sir Peter MacCallum Department of Oncology and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Vanessa Estall
- From the Division of Research, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology and Skin and Melanoma Tumour Stream, Peter MacCallum Cancer Centre, and the Department of Pathology, University of Melbourne, Melbourne, Australia; Division of Cancer Medicine, and Head and Neck Tumour Stream, Peter MacCallum Cancer Centre, the Sir Peter MacCallum Department of Oncology and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Danny Rischin
- From the Division of Research, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology and Skin and Melanoma Tumour Stream, Peter MacCallum Cancer Centre, and the Department of Pathology, University of Melbourne, Melbourne, Australia; Division of Cancer Medicine, and Head and Neck Tumour Stream, Peter MacCallum Cancer Centre, the Sir Peter MacCallum Department of Oncology and Department of Medicine, University of Melbourne, Melbourne, Australia
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Becht E, Giraldo NA, Germain C, de Reyniès A, Laurent-Puig P, Zucman-Rossi J, Dieu-Nosjean MC, Sautès-Fridman C, Fridman WH. Immune Contexture, Immunoscore, and Malignant Cell Molecular Subgroups for Prognostic and Theranostic Classifications of Cancers. Adv Immunol 2016; 130:95-190. [DOI: 10.1016/bs.ai.2015.12.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chen S, Tang J, Huang L, Lin J. Expression and prognostic value of Mycl1 in gastric cancer. Biochem Biophys Res Commun 2014; 456:879-83. [PMID: 25528583 DOI: 10.1016/j.bbrc.2014.12.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 01/01/2023]
Abstract
As a member of the Myc proto-oncogene family, MYCL1 has been found to be amplified and overexpressed in some malignancies. However, the clinical significance of Mycl1 expression in gastric cancer is still unknown. Mycl1 expression was detected on tissue microarrays of gastric cancer samples in 176 cases using immunohistochemical staining, and its association with clinicopathological factors and overall survival was also analyzed. Mycl1 showed greater expression in gastric cancer tissue than in adjacent normal tissue (62.5% vs 46.0%, respectively, P=0.002), and its expression was correlated with patient age, tumor differentiation, and TNM stage (P=0.007, 0.003, and 0.002, respectively). The Mycl1 positive group had an unfavorable outcome compared with the negative group (P<0.001). Multivariate analysis showed that Mycl1 expression was an independent prognostic factor of gastric cancer (P=0.009). These results suggest that Mycl1 expression might be useful as a biomarker to predict prognosis and is a promising therapeutic target for patients with gastric cancer.
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Affiliation(s)
- Shuqin Chen
- Department of Pathology, Pre-Clinical College, Fujian Medical University, Fuzhou 350004, China.
| | - Jianqing Tang
- Department of Pathology, The Affiliated First Hospital, Fujian Medical University, Fuzhou 350004, China.
| | - Liyun Huang
- Department of Pathology, Pre-Clinical College, Fujian Medical University, Fuzhou 350004, China.
| | - Jianyin Lin
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Research Center of Molecular Medicine, Fujian Medical University, 88 Jiaotong Road, Fuzhou 350004, China.
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