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Chen Z, Huang J, Kwak-Kim J, Wang W. Immune checkpoint inhibitors and reproductive failures. J Reprod Immunol 2023; 156:103799. [PMID: 36724630 DOI: 10.1016/j.jri.2023.103799] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
The human conceptus is a semi-allograft, which is antigenically foreign to the mother. Hence, the implantation process needs mechanisms to prevent allograft rejection during successful pregnancy. Immune checkpoints are a group of inhibitory pathways expressed on the surface of various immune cells in the form of ligand receptors. Immune cells possess these pathways to regulate the magnitude of immune responses and induce maternal-fetal tolerance. Briefly, 1) CTLA-4 can weaken T cell receptor (TCR) signals and inhibit T cell response; 2) The PD-1/PD-L1 pathway can reduce T cell proliferation, enhance T cell anergy and fatigue, reduce cytokine production, and increase T regulatory cell activity to complete the immunosuppression; 3) TIM3 interacts with T cells by binding Gal-9, weakening Th1 cell-mediated immunity and T cell apoptosis; 4) The LAG-3 binding to MHC II can inhibit T cell activation by interfering with the binding of CD4 to MHC II, and; 5) TIGIT can release inhibitory signals to NK and T cells through the ITIM structure of its cytoplasmic tail. Therefore, dysregulated immune checkpoints or the application of immune checkpoint inhibitors may impair human reproduction. This review intends to deliver a comprehensive overview of immune checkpoints in pregnancy, including CTLA-4, PD-1/PD-L1, TIM-3, LAG-3, TIGIT, and their inhibitors, reviewing their roles in normal and pathological human pregnancies.
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Affiliation(s)
- Zeyang Chen
- School of Medicine, Qingdao University, 38 Dengzhou Road, Qingdao 266000, PR China; Reproduction Medical Center, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, PR China
| | - Jinxia Huang
- Reproduction Medical Center, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, PR China; Department of Gynecology, Weihai Central Hospital Affiliated to Qingdao University, 3 Mishan East Road, Weihai 264400, PR China
| | - Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL 60061, USA; Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
| | - Wenjuan Wang
- Reproduction Medical Center, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, PR China.
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Cheng K, Feng X, Chai Z, Wang Z, Liu Z, Yan Z, Wang Y, Zhang S. 4-1BB-Based CAR T Cells Effectively Reverse Exhaustion and Enhance the Anti-Tumor Immune Response through Autocrine PD-L1 scFv Antibody. Int J Mol Sci 2023; 24:ijms24044197. [PMID: 36835603 PMCID: PMC9961031 DOI: 10.3390/ijms24044197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
Exhaustion of chimeric antigen receptor (CAR) T cells is one of the limitations for CAR T efficacy in solid tumors and for tumor recurrence after initial CAR T treatment. Tumor treatment with a combination of programmed cell death receptor-1 (PD-1)/programmed cell death ligand-1 (PD-L1) blockage and CD28-based CAR T cells has been intensively studied. However, it remains largely unclear whether autocrine single-chain variable fragments (scFv) PD-L1 antibody can improve 4-1BB-based CAR T cell anti-tumor activity and revert CAR T cell exhaustion. Here, we studied T cells engineered with autocrine PD-L1 scFv and 4-1BB-containing CAR. The antitumor activity and exhaustion of CAR T cells were investigated in vitro and in a xenograft cancer model using NCG mice. CAR T cells with autocrine PD-L1 scFv antibody demonstrate enhanced anti-tumor activity in solid tumors and hematologic malignancies by blocking the PD-1/PD-L1 signaling. Importantly, we found that CAR T exhaustion was largely diminished by autocrine PD-L1 scFv antibody in vivo. As such, 4-1BB CAR T with autocrine PD-L1 scFv antibody combined the power of CAR T cells and the immune checkpoint inhibitor, thereby increasing the anti-tumor immune function and CAR T persistence, providing a cell therapy solution for a better clinical outcome.
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Affiliation(s)
- Kang Cheng
- Laboratory of Biotechnology Drugs, School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Xiangming Feng
- Laboratory of Biotechnology Drugs, School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Zhirong Chai
- Laboratory of Epigenetics and Translational Medicine, School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Zhenzhen Wang
- Laboratory of Biotechnology Drugs, School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Zheng Liu
- Laboratory of Epigenetics and Translational Medicine, School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Zhanchao Yan
- Laboratory of Epigenetics and Translational Medicine, School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Yanming Wang
- Laboratory of Epigenetics and Translational Medicine, School of Life Sciences, Henan University, Kaifeng 475004, China
- Correspondence: (Y.W.); (S.Z.)
| | - Shoutao Zhang
- Laboratory of Biotechnology Drugs, School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China
- Longhu Laboratory of Advanced Immunology, Zhengzhou 450001, China
- Correspondence: (Y.W.); (S.Z.)
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103
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Leading Edge: Intratumor Delivery of Monoclonal Antibodies for the Treatment of Solid Tumors. Int J Mol Sci 2023; 24:ijms24032676. [PMID: 36768997 PMCID: PMC9917067 DOI: 10.3390/ijms24032676] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/02/2023] Open
Abstract
Immunotherapies based on immune checkpoint blockade have shown remarkable clinical outcomes and durable responses in patients with many tumor types. Nevertheless, these therapies lack efficacy in most cancer patients, even causing severe adverse events in a small subset of patients, such as inflammatory disorders and hyper-progressive disease. To diminish the risk of developing serious toxicities, intratumor delivery of monoclonal antibodies could be a solution. Encouraging results have been shown in both preclinical and clinical studies. Thus, intratumor immunotherapy as a new strategy may retain efficacy while increasing safety. This approach is still an exploratory frontier in cancer research and opens up new possibilities for next-generation personalized medicine. Local intratumor delivery can be achieved through many means, but an attractive approach is the use of gene therapy vectors expressing mAbs inside the tumor mass. Here, we summarize basic, translational, and clinical results of intratumor mAb delivery, together with descriptions of non-viral and viral strategies for mAb delivery in preclinical and clinical development. Currently, this is an expanding research subject that will surely play a key role in the future of oncology.
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104
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Sa R, Xu Y, Pan X, Wang Y, Lin Z, Zhang X, Zhang B. A bibliometric analysis of research progress on pharmacovigilance and cancer from 2002 to 2021. Front Oncol 2023; 13:1078254. [PMID: 36761953 PMCID: PMC9905820 DOI: 10.3389/fonc.2023.1078254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
The complexity of cancer itself and treatment makes pharmacovigilance critical in oncology. Despite rapid progress on pharmacovigilance and cancer research in the past two decades, there has been no bibliometric analysis in this field. Therefore, based on the Web of Science database, we used CiteSpace, VOS-viewer and R-bibliometrix to analyze and visualize publications, and described the development trend and research hot spots in this field. 502 publications were included. The development of pharmacovigilance and cancer research has continued to grow. The USA has the largest number of publications and citations, followed by France and UK. Vanderbilt University and Sorbonne University are the institutions that contribute the most papers, and 5 of the top 10 high-yield institutions are from France. Salem JE and Lebrun-Vignes B of Sorbonne University have published the most papers, and they have a strong cooperative relationship. Salem JE has the highest H index. Drug Safety has the largest number of publications in the field of pharmacovigilance and cancer, with a high impact factor (IF). In recent years, immune checkpoint inhibitors (ICIs) have been identified as a hot topic and will continue to be maintained. This paper can help researchers get familiar with the current situation and trend of pharmacovigilance and cancer research, and provide valuable reference for the selection of future research directions.
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Affiliation(s)
- Rina Sa
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Xu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xinbo Pan
- Institute of liver diseases, The Second People’s Hospital of Lanzhou, Lanzhou, China
| | - Yu Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhijian Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaomeng Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bing Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China,Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China,*Correspondence: Bing Zhang,
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105
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Zhang X, Gan Y, Zhu H, Liu Z, Yao X, Cheng C, Liu Z, Su C, Zou J. Role of mitochondrial metabolism in immune checkpoint inhibitors-related myocarditis. Front Cardiovasc Med 2023; 10:1112222. [PMID: 36760573 PMCID: PMC9902768 DOI: 10.3389/fcvm.2023.1112222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Background Immune checkpoint inhibitor-related myocarditis is the deadliest complication of immunotherapy. However, the underlying pathophysiological mechanisms of its occurrence and development remain unclear. Due to the long-term lack of effective early diagnosis and treatment options, it is of great significance to understand the pathophysiological mechanism of immune checkpoint inhibitor-related myocarditis. Methods Tissue samples from three patients with immune checkpoint inhibitor-related myocarditis and three control tissue samples were collected for protein analysis. Differentially expressed proteins were screened out using quantitative proteomics technology based on TMT markers. Protein-protein interaction (PPI) and Gene Ontology (GO) functional enrichment analyses of cross-factors were subsequently performed. Combined with the PD-L1 subcellular organelle- level protein interaction network, we searched for hub proteins involved in immune checkpoint inhibitor-related myocarditis and explored potential drug sensitivity and disease correlation. Results A total of 306 differentially expressed proteins were identified in immune checkpoint inhibitor-related myocarditis. Enrichment analysis showed that the differentially expressed proteins were closely related to mitochondrial metabolism. By analyzing mitochondria-related proteins and PD-L1-related proteins, we found four hub proteins, mammalian target of rapamycin (mTOR), Glycogen synthase kinase 3β (GSK3β), Protein tyrosine phosphatase non-receptor type 11 (PTPN11), and Mitofusin 2 (MFN2), indicating that they are closely related to immune checkpoint inhibitor-related myocarditis. Finally, we explored potential drugs for the treatment of immune checkpoint inhibitor-related myocarditis. Conclusion Mitochondrial metabolism is involved in the process of immune checkpoint inhibitor-related myocarditis, and we identified four hub proteins, which may become new biomarkers for the early diagnosis and treatment of immune checkpoint inhibitor-related myocarditis.
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106
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Ni CX, Zhao Y, Qian H, Fu H, Yan YY, Qiu YS, Zhou CC, Huang F, Shen FM, Li DJ, Xu Q. Long survival in a pancreatic carcinoma patient with multi-organ toxicities after sintilimab treatment: A case report. Front Pharmacol 2023; 14:1121122. [PMID: 36744247 PMCID: PMC9894891 DOI: 10.3389/fphar.2023.1121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Pancreatic carcinoma is the leading cause of death among digestive malignancies in China. In particular, there is no breakthrough in prolonging the survival of pancreatic cancer patients with chemical and targeted therapies. Tumor immunotherapy brings opportunities and progress for the treatment of pancreatic cancer. Sintilimab is an innovative PD-1 inhibitor which was reported certain clinical benefits in multi-line treatments of advanced pancreatic cancer with gemcitabine. The combination therapy of PD-1 with gemcitabine plus high-intensity focused ultrasound (HIFU) in pancreatic cancer has not been reported. Here we report a case of a Chinese old patient diagnosed with metastatic pancreatic cancer. Two months after sintilimab treatment, the patient occurred severe immune colitis. The patient was diagnosed with immune ureteritis after 8 months of treatment. The immue-related adverse events (irAEs) refined after timely recognition and correct intervention by the clinician and clinical pharmacist. After first-line treatment of sintilimab plus gemcitabine combined with pancreatic HIFU, the patient achieved a remarkable benefit of 11-month progression-free survival (PFS) and 20-month overall survival (OS). The first-line treatment of sintilimab plus gemcitabine combined with HIFU demonstrates a potential therapeutic effect on metastatic pancreatic carcinoma with tolerable adverse reactions.
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Affiliation(s)
- Chen-Xu Ni
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zhao
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong Qian
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Fu
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Ying Yan
- Department of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Yu-Shuang Qiu
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Can-Can Zhou
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Huang
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fu-Ming Shen
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong-Jie Li
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Dong-Jie Li, ; Qing Xu,
| | - Qing Xu
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Dong-Jie Li, ; Qing Xu,
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107
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Granata V, Fusco R, Setola SV, Simonetti I, Picone C, Simeone E, Festino L, Vanella V, Vitale MG, Montanino A, Morabito A, Izzo F, Ascierto PA, Petrillo A. Immunotherapy Assessment: A New Paradigm for Radiologists. Diagnostics (Basel) 2023; 13:diagnostics13020302. [PMID: 36673112 PMCID: PMC9857844 DOI: 10.3390/diagnostics13020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/31/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023] Open
Abstract
Immunotherapy denotes an exemplar change in an oncological setting. Despite the effective application of these treatments across a broad range of tumors, only a minority of patients have beneficial effects. The efficacy of immunotherapy is affected by several factors, including human immunity, which is strongly correlated to genetic features, such as intra-tumor heterogeneity. Classic imaging assessment, based on computed tomography (CT) or magnetic resonance imaging (MRI), which is useful for conventional treatments, has a limited role in immunotherapy. The reason is due to different patterns of response and/or progression during this kind of treatment which differs from those seen during other treatments, such as the possibility to assess the wide spectrum of immunotherapy-correlated toxic effects (ir-AEs) as soon as possible. In addition, considering the unusual response patterns, the limits of conventional response criteria and the necessity of using related immune-response criteria are clear. Radiomics analysis is a recent field of great interest in a radiological setting and recently it has grown the idea that we could identify patients who will be fit for this treatment or who will develop ir-AEs.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
- Correspondence:
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Carmine Picone
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Paolo Antonio Ascierto
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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Pan L, Meng F, Wang W, Wang XH, Shen H, Bao P, Kang J, Kong D. Nintedanib in an elderly non-small-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis: A case report and literature review. Front Immunol 2023; 13:1072612. [PMID: 36703957 PMCID: PMC9872202 DOI: 10.3389/fimmu.2022.1072612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Immune checkpoint inhibitors tremendously improve cancer prognosis; however, severe-grade immune-related adverse events may cause premature death. Current recommendations for checkpoint inhibitor-related pneumonitis (CIP) treatment are mainly about immunosuppressive therapy, and anti-fibrotic agents are also needed, especially for patients with poor response to corticosteroids and a longer pneumonitis course. This is because fibrotic changes play an important role in the pathological evolution of CIP. Here, we report a case demonstrating that nintedanib is a promising candidate drug for CIP management or prevention, as it has potent anti-fibrotic efficacy and a safety profile. Moreover, nintedanib could partially inhibit tumor growth in patients with non-small-cell lung cancer, and its efficacy can be improved in combination with other anti-tumor therapies.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Fanqi Meng
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xu-hao Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Hui Shen
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Pengchen Bao
- The First Clinical College, China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Delei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Delei Kong,
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Seligman C, Chang YM, Luo J, Garden OA. Exploring the role of immune checkpoint inhibitors in the etiology of myasthenia gravis and Lambert-Eaton myasthenic syndrome: A systematic review. Front Neurol 2023; 13:1004810. [PMID: 36698907 PMCID: PMC9868566 DOI: 10.3389/fneur.2022.1004810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background While immune checkpoint inhibitors (ICIs) have been revolutionary in the treatment of cancer, their administration has been associated with a variety of immune-related adverse events (irAEs), including myasthenia gravis (MG), and Lambert-Eaton myasthenic syndrome (LEMS). Objective To provide a comprehensive synthesis of the evidence supporting an etiological role for ICIs in MG and LEMS in patients with no prior history of autoimmune disease. Hypothesis ICIs may trigger MG and LEMS in patients with no prior susceptibility to autoimmune disease. Methods Relevant primary research on Medline was interrogated using a series of search algorithms. Search terms were constructed based on the PICOS tool endorsed by the Cochrane Collaboration, which describes population, intervention, comparison, outcomes, and study design. Papers were screened according to inclusion and exclusion criteria. Additional papers were retrieved from the reference lists of screened papers. Each paper included in the qualitative synthesis was assigned an integrated metric of evidence (IME) value, ranging from 0 to 7, based on study design, quality of data, likelihood of a causal link between the immune checkpoint inhibitor(s) and MG/LEMS, confidence of MG/LEMS diagnosis, and the number of patients treated with an ICI prior to MG/LEMS diagnosis. Results Ninety-four papers describing at least one patient treated with ICI(s) prior to the onset of MG and/or LEMS were documented. Overall evidence for a causal link between ICI administration and MG/LEMS was low, with a median IME value of 2.88 (range 2.05-6.61). Conclusions There is a paucity of evidence in support of an etiological relationship between ICIs and MG/LEMS, due largely to the lack of mechanistic studies and/or prospective clinical trials with relevant study endpoints. The current literature is dominated by case reports and retrospective cohort studies, which inherently yield only low-level evidence, supporting the need for further work in this area. A role of ICIs in the etiology of MG/LEMS remains plausible, arguing for continued vigilance for irAEs in patients treated with these drugs. We argue that there is a need for future mechanistic, high quality, large-scale studies specifically investigating the possible etiological role of ICIs in MG/LEMS.
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Affiliation(s)
- Carly Seligman
- Garden & Luo Immune Regulation Laboratory, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yu-Mei Chang
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | - Jie Luo
- Garden & Luo Immune Regulation Laboratory, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Oliver A. Garden
- Garden & Luo Immune Regulation Laboratory, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States,Dean's Office, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States,*Correspondence: Oliver A. Garden ✉
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110
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Predictive Biomarkers for Immune-Related Endocrinopathies following Immune Checkpoint Inhibitors Treatment. Cancers (Basel) 2023; 15:cancers15020375. [PMID: 36672324 PMCID: PMC9856539 DOI: 10.3390/cancers15020375] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
In recent years, in the context of the increase in the life expectancy of cancer patients, special attention has been given to immunotherapy and, indeed, to immune checkpoint inhibitors. The use of immune checkpoint inhibitors has increased rapidly, and approximately 40% of cancer patients are eligible for this treatment. Although their impact is valuable on cancer treatment, immune checkpoint inhibitors come with side effects, known as immune-related adverse effects. These can affect many systems, including cutaneous, musculoskeletal, cardiovascular, gastrointestinal, endocrine, neural, and pulmonary systems. In this review, we focus on immune-related endocrinopathies that affect around 10% of all treated patients. Endocrine dysfunctions can manifest as hypophysitis, thyroid dysfunction, hypoparathyroidism, insulin-deficient diabetes mellitus, and primary adrenal insufficiency. Currently, there are multiple ongoing clinical trials that aim to identify possible predictive biomarkers for immune-related adverse effects. The design of those clinical trials relies on collecting a variety of biological specimens (tissue biopsy, blood, plasma, saliva, and stool) at baseline and regular intervals during treatment. In this review, we present the predictive biomarkers (such as antibodies, hormones, cytokines, human leukocyte antigens, and eosinophils) that could potentially be utilized in clinical practice in order to predict adverse effects and manage them appropriately.
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111
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Sun L, Li C, Gao S. Diffuse malignant peritoneal mesothelioma: A review. Front Surg 2023; 9:1015884. [PMID: 36684194 PMCID: PMC9852335 DOI: 10.3389/fsurg.2022.1015884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/09/2022] [Indexed: 01/09/2023] Open
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an unusual and life-threatening locally invasive tumor. The morbidity and mortality of the disease are associated with progressive local effects in the abdominal cavity, such as abdominal distention, painful sensations, and early saturation with reduced oral intake, which eventually lead to intestinal obstruction and cachexia. Computed tomography (CT) has been widely used as a first-line diagnostic tool for DMPM. In addition, the most sensitive immunohistochemical markers of DMPM include WT 1, D2-40, and calmodulin. This paradigm has altered with the advancements in the immunohistochemical analysis of BRCA1-Associated Protein 1 (BAP1) the lack of BAP1 expression shows the diagnosis of malignancy. DMPM is resistant to conventional chemotherapies. Therefore, the gold standard for the treatment of DMPM is the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The overexpression of the phosphatidylinositol 3-kinase (PI3K)/AKT serine/threonine kinase 1 (AKT)/mammalian target of rapamycin (mTOR) signaling pathway drives the malignant phenotype of DMPM, thereby showing promising potential for the treatment of DMPM. The coordinated activities among multiple RTKs are directly involved in the biological processes of DMPM, suggesting that the combined inhibition of the PI3K and mTOR signaling pathways might be an effective measure. This treatment strategy can be easily implemented in clinical practice. However, the combined inhibition of ERBB1(HER1)/ERBB2 (HER2) and ERBB3 (HER3) requires further investigations. Thus, based on these, the discovery of novel targeted therapies might be crucial to improving the prognosis of DMPM patients.
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Affiliation(s)
- Luanbiao Sun
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital, Changchun, China
| | - Chenguang Li
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital, Changchun, China
| | - Shuohui Gao
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital, Changchun, China
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Wong CK, Lam TH, Liao SY, Lau YM, Tse HF, So BYF. Immunopathogenesis of Immune Checkpoint Inhibitor Induced Myocarditis: Insights from Experimental Models and Treatment Implications. Biomedicines 2023; 11:biomedicines11010107. [PMID: 36672615 PMCID: PMC9855410 DOI: 10.3390/biomedicines11010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Despite the extraordinary success of immune checkpoint inhibitors (ICIs) in cancer treatment, their use is associated with a high incidence of immune-related adverse events (IRAEs), resulting from therapy-related autoimmunity against various target organs. ICI-induced myocarditis is one of the most severe forms of IRAE, which is associated with risk of hemodynamic compromise and mortality. Despite increasing recognition and prompt treatment by clinicians, there remain significant gaps in knowledge regarding the pathophysiology, diagnosis and treatment of ICI-induced myocarditis. As the newly emerged disease entity is relatively rare, it is challenging for researchers to perform studies involving patients at scale. Alternatively, mouse models have been developed to facilitate research understanding of the pathogenesis of ICI-induced myocarditis and drug discovery. Transgenic mice with immune checkpoint genes knocked out allow induction of myocarditis in a highly reproducible manner. On the other hand, it has not been possible to induce ICI-induced myocarditis in wild type mice by injecting ICIs monotherapy alone. Additional interventions such as combinational ICI, tumor inoculation, cardiac sarcomere immunization, or cardiac irradiation are necessary to mimic the underlying pathophysiology in human cancer patients and to induce ICI-induced myocarditis successfully. This review focuses on the immunopathogenesis of ICI-induced myocarditis, drawing insights from human studies and animal models, and discusses the potential implications for treatment.
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Affiliation(s)
- Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tsun-Ho Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Song-Yan Liao
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
- Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
- Centre for Stem Cell Translational Biology, Hong Kong SAR, China
| | - Benjamin Y. F. So
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-2255-3111
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113
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Dercle L, Sun S, Seban RD, Mekki A, Sun R, Tselikas L, Hans S, Bernard-Tessier A, Mihoubi Bouvier F, Aide N, Vercellino L, Rivas A, Girard A, Mokrane FZ, Manson G, Houot R, Lopci E, Yeh R, Ammari S, Schwartz LH. Emerging and Evolving Concepts in Cancer Immunotherapy Imaging. Radiology 2023; 306:32-46. [PMID: 36472538 DOI: 10.1148/radiol.210518] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Criteria based on measurements of lesion diameter at CT have guided treatment with historical therapies due to the strong association between tumor size and survival. Clinical experience with immune checkpoint modulators shows that editing immune system function can be effective in various solid tumors. Equally, novel immune-related phenomena accompany this novel therapeutic paradigm. These effects of immunotherapy challenge the association of tumor size with response or progression and include risks and adverse events that present new demands for imaging to guide treatment decisions. Emerging and evolving approaches to immunotherapy highlight further key issues for imaging evaluation, such as dissociated response following local administration of immune checkpoint modulators, pseudoprogression due to immune infiltration in the tumor environment, and premature death due to hyperprogression. Research that may offer tools for radiologists to meet these challenges is reviewed. Different modalities are discussed, including immuno-PET, as well as new applications of CT, MRI, and fluorodeoxyglucose PET, such as radiomics and imaging of hematopoietic tissues or anthropometric characteristics. Multilevel integration of imaging and other biomarkers may improve clinical guidance for immunotherapies and provide theranostic opportunities.
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Affiliation(s)
- Laurent Dercle
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Shawn Sun
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Romain-David Seban
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Ahmed Mekki
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Roger Sun
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Lambros Tselikas
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Sophie Hans
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Alice Bernard-Tessier
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Fadila Mihoubi Bouvier
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Nicolas Aide
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Laetitia Vercellino
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Alexia Rivas
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Antoine Girard
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Fatima-Zohra Mokrane
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Guillaume Manson
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Roch Houot
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Egesta Lopci
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Randy Yeh
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Samy Ammari
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Lawrence H Schwartz
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
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Li H, Zheng Y, Xu P, Li Z, Kuang Y, Feng X, He J, Li J, Chen X, Bai L, Tang KJ. Comparison of pneumonitis risk between immunotherapy alone and in combination with chemotherapy: an observational, retrospective pharmacovigilance study. Front Pharmacol 2023; 14:1142016. [PMID: 37124234 PMCID: PMC10133569 DOI: 10.3389/fphar.2023.1142016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
Importance: Checkpoint inhibitor pneumonitis (CIP) is a rare but serious adverse event that may impact treatment decisions. However, there is limited information comparing CIP risks between immune checkpoint inhibitor (ICI) monotherapy and combination with chemotherapy due to a lack of direct cross-comparison in clinical trials. Objective: To determine whether ICI combination with chemotherapy is superior to ICI in other drug regimens (including monotherapy) in terms of CIP risk. Study Design and Methods: This observational, cross-sectional and worldwide pharmacovigilance cohort study included patients who developed CIP from the World Health Organization database (WHO) VigiBase and the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Individual case safety reports (ICSR) were extracted from 2015 to 2020 in FAERS and from 1967 to 2020 in VigiBase. Timing and reporting odds ratio (ROR) of CIP in different treatment strategies were used to detect time-to-onset and the risk of pneumonitis after different immunotherapy regimens. Results: A total of 93,623 and 114,704 ICI-associated ICSRs were included in this study from VigiBase and FAERS databases respectively. 3450 (3.69%) and 3278 (2.86%) CIPs occurred after therapy initiation with a median of 62 days (VigiBase) and 40 days (FAERS). Among all the CIPs, 274 (7.9%) and 537 (16.4%) CIPs were associated with combination therapies. ICIs plus chemotherapy combination was associated with pneumonitis in both VigiBase [ROR 1.35, 95% CI 1.18-1.52] and FAERS [ROR 1.39, 95% CI 1.27-1.53]. The combination of anti-PD-1 antibodies and anti-CTLA-4 antibodies with chemotherapy demonstrated an association with pneumonitis in both VigiBase [PD-1+chemotherapy: 1.76, 95% CI 1.52-2.05; CTLA-4+chemotherapy: 2.36, 95% CI 1.67-3.35] and FAERS [PD-1+chemotherapy: 1.70, 95% CI 1.52-1.91; CTLA-4+chemotherapy: 1.70, 95% CI 1.31-2.20]. Anti-PD-L1 antibodies plus chemotherapy combinations did not show the association. Conclusion: Compared to ICI in other drug regimens (including monotherapy), the combination of ICI plus chemotherapy is significantly associated with higher pneumonitis toxicity. Anti-PD-1/CTLA4 medications in combination with chemotherapy should be obviated in patients with potential risk factors for CIP. Trial Registration: clinicaltrials.gov, ChiCTR2200059067.
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Affiliation(s)
- Huixia Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yifan Zheng
- Department of Clinical Pharmacy Translational Science, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Peihang Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zimu Li
- Department of Pulmonary and Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yukun Kuang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Feng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Junhao He
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lihong Bai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Lihong Bai, ; Ke-Jing Tang,
| | - Ke-Jing Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Lihong Bai, ; Ke-Jing Tang,
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He X, Liu F, Jin Y, Fu H, Mao J. Glomerular diseases after immune checkpoint inhibitors use: What do We know so far? Ren Fail 2022; 44:2046-2055. [DOI: 10.1080/0886022x.2022.2147439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Xue He
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Fei Liu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Yanyan Jin
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Haidong Fu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
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Immunotherapy for Melanoma: The Significance of Immune Checkpoint Inhibitors for the Treatment of Advanced Melanoma. Int J Mol Sci 2022; 23:ijms232415720. [PMID: 36555362 PMCID: PMC9779655 DOI: 10.3390/ijms232415720] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Therapeutic options for treating advanced melanoma have progressed rapidly in recent decades. Until 6 years ago, the regimen for treating advanced melanoma consisted mainly of cytotoxic agents such as dacarbazine and type I interferons. Since 2014, anti-programmed cell death 1 (PD1) antibodies have been recognized as anchor drugs for treating advanced melanoma, with or without additional combination drugs such as ipilimumab, but the efficacies of these immunotherapies are not fully satisfactory. In this review, we describe the development of the currently available anti-PD1 Abs-based immunotherapies for advanced melanoma, focusing on their efficacy and immune-related adverse events (AEs), as well as clinical trials still ongoing for the future treatment of advanced melanoma.
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Wang S, Peng D, Zhu H, Min W, Xue M, Wu R, Shao Y, Pan L, Zhu M. Acetylcholine receptor binding antibody-associated myasthenia gravis, myocarditis, and rhabdomyolysis induced by tislelizumab in a patient with colon cancer: A case report and literature review. Front Oncol 2022; 12:1053370. [PMID: 36568231 PMCID: PMC9773380 DOI: 10.3389/fonc.2022.1053370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Despite the intriguing therapeutic prospects offered by immune checkpoint inhibitors (ICIs), immune-related adverse events (irAEs) become an increasingly important safety issue. Herein, we report a patient with locally advanced colorectal cancer (LACRC) who received anti-programmed cell death protein 1 (PD-1) (tislelizumab) therapy, then developed weakness of the limbs and drooping eyelids. He experienced sequential irAEs including severe myasthenia gravis, myocarditis, and rhabdomyolysis. Although many irAEs caused by tislelizumab have been reported, the cooccurrence of severe myasthenia gravis, myocarditis, and rhabdomyolysis caused by tislelizumab has not been described. The patient responded well to methylprednisolone and intravenous immunoglobulin therapy. This case illustrates the severe toxicity caused by ICIs, highlighting the importance of early prevention, early diagnosis, and appropriate management of irAEs. Multidisciplinary discussions should be held to improve the prognosis of patients.
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Affiliation(s)
- Shengnan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Danping Peng
- Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Hao Zhu
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Wanwan Min
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Mengru Xue
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Wu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanqing Shao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Lin Pan
- Clinical College, Jilin University, Changchun, China
| | - Mingqin Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Vicier C, Isambert N, Cropet C, Hamimed M, Osanno L, Legrand F, de La Motte Rouge T, Ciccolini J, Gonçalves A. MOVIE: a phase I, open-label, multicenter study to evaluate the safety and tolerability of metronomic vinorelbine combined with durvalumab plus tremelimumab in patients with advanced solid tumors. ESMO Open 2022; 7:100646. [PMID: 36521418 PMCID: PMC9808477 DOI: 10.1016/j.esmoop.2022.100646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anti-programmed cell death protein 1 (PD1)/programmed death-ligand 1 (PD-L1) agents have only moderate antitumor activity in some advanced solid tumors (AST), including breast cancer (BC), prostate cancer (PC), cervical cancer (CC), and head and neck cancer (HNC). Combining anti-PD-L1 with anti-cytotoxic T-lymphocyte-associated protein (CTLA) and chemotherapy may significantly improve efficacy. PATIENTS AND METHODS MOVIE is a multicohort phase I/II study examining the combination of anti-PD-L1 durvalumab (Durv; 1500 mg IV Q4W) plus anti-CTLA tremelimumab (Trem; 75 mg IV Q4W) with metronomic vinorelbine (MVino; 20-40 mg orally daily) in various AST resistant to conventional therapies. The primary objective of the phase I part was to determine the maximum tolerated dose (MTD) and recommended dose for phase II (RP2D). RESULTS Among the 14 patients enrolled during phase I, including 13 women and 1 man, 9 had BC, 1 PC, 2 CC, and 2 miscellaneous cancers with high mutational loads. Median age was 53 years. A total of 12 patients were assessable for the dose-escalation part in which only one dose-limiting toxicity (DLT) was observed [one neutropenia without fever, grade (G) 4]. Two (14.3%), four (28.6%), and four (28.6%) patients had G ≥3 adverse events (AEs) related to MVino, Durv, and Trem, respectively. Treatment-related events included mostly clinical AEs with asthenia (eight G2; three G3), colitis (one G2, one G3), diarrhea (one G3), nausea (two G2), dry skin (two G2), maculopapular rash (one G3), and hyperthyroidism (three G2). No toxic death was reported. Preliminary data showed one patient (CC) who presented a complete response and four patients with stable disease (SD). CONCLUSIONS MTD was not reached and dose level 2 (MVino 40 mg, Durv 1500 mg, Trem 75 mg) was selected as RP2D. The safety profile of the combination was manageable and consistent with previous reports of Trem + Durv or MVino. Phase II is currently ongoing in BC, PC, CC, HNC, and miscellaneous cohorts.
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Affiliation(s)
- C Vicier
- Department of Medical Oncology, Inserm U1068, CNRS UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - N Isambert
- Service d'Oncologie médicale, CLCC Georges-François Leclerc, Dijon Cedex, France
| | - C Cropet
- Department of Biostatistics, Direction of Research and Innovation, Centre Léon Bérard, Lyon, France
| | - M Hamimed
- SMARTc unit, Centre de Recherche en Cancérologie de Marseille (CRCM) UMR INSERM U1068, Aix-Marseille University (AMU), Marseille, France
| | - L Osanno
- SMARTc unit, Centre de Recherche en Cancérologie de Marseille (CRCM) UMR INSERM U1068, Aix-Marseille University (AMU), Marseille, France
| | - F Legrand
- UNICANCER, Department of Research & Development, Paris, France
| | - T de La Motte Rouge
- Eugène-Marquis Centre, Avenue de la Bataille Flandres-Dunkerque, Rennes Cedex, France
| | - J Ciccolini
- SMARTc unit, Centre de Recherche en Cancérologie de Marseille (CRCM) UMR INSERM U1068, Aix-Marseille University (AMU), Marseille, France
| | - A Gonçalves
- Department of Medical Oncology, Inserm U1068, CNRS UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France.
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Sun M, Shi W, Wu Y, He Z, Sun J, Cai S, Luo Q. Immunogenic Nanovesicle-Tandem-Augmented Chemoimmunotherapy via Efficient Cancer-Homing Delivery and Optimized Ordinal-Interval Regime. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 10:e2205247. [PMID: 36453573 PMCID: PMC9811449 DOI: 10.1002/advs.202205247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The strategy of combining immune checkpoint inhibitors (ICIs) with anthracycline is recommended by clinical guidelines for the standard-of-care treatment of triple-negative breast cancer (TNBC). Nevertheless, several fundamental clinical principles are yet to be elucidated to achieve a great therapeutic effect, including cancer-homing delivery efficiency and ordinal-interval regime. Tumor-derived extracellular vesicles (TDEVs), as vectors for intratumoral intercellular communication, can encapsulate therapeutic agents and home tumors. However, PD-L1 overexpression in TDEVs leads to systemic immunosuppression during in vivo circulation, ultimately inhibiting intratumoral T activity. In this study, CRISPR/Cas9-edited Pd-l1KO TDEV-fusogenic anthracycline doxorubicin (DOX) liposomes with high drug encapsulation (97%) are fabricated, which homologously deliver DOX to breast cancer cells to intensify the immunogenic response and induce PD-L1 overexpression in the tumor. By setting the stage for sensitizing tumors to ICIs, sequential treatment with disulfide-linked PD1-cross-anchored TDEVs nanogels at one-day interval could sustainably release PD1 in the tumor, triggering a high proportion of effector T cell-mediated destruction of orthotopic and metastatic tumors without off-target side effects in the 4T1-bearing TNBC mouse model. Such a TDEV-tandem-augmented chemoimmunotherapeutic strategy with efficient cancer-homing delivery capacity and optimized ordinal-interval regime provides a solid foundation for developing chemoimmunotherapeutic formulations for TNBC therapy at the clinical level.
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Affiliation(s)
- Mengchi Sun
- School of PharmacyShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Wen Shi
- Department of PharmacyThe First Hospital of China Medical UniversityShenyangLiaoning110001P. R. China
| | - Yuxia Wu
- Department of PharmacyThe First Hospital of China Medical UniversityShenyangLiaoning110001P. R. China
| | - Zhonggui He
- Wuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Jin Sun
- Wuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Shuang Cai
- Department of PharmacyThe First Hospital of China Medical UniversityShenyangLiaoning110001P. R. China
| | - Qiuhua Luo
- Department of PharmacyThe First Hospital of China Medical UniversityShenyangLiaoning110001P. R. China
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Immune checkpoint blockade in melanoma: Advantages, shortcomings and emerging roles of the nanoparticles. Int Immunopharmacol 2022; 113:109300. [DOI: 10.1016/j.intimp.2022.109300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
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Xie R, Wu J, Shang B, Bi X, Cao C, Guan Y, Shi H, Shou J. Deaths and adverse events from adjuvant therapy with immune checkpoint inhibitors in solid malignant tumors: A systematic review and network meta-analysis. CANCER INNOVATION 2022; 1:293-304. [PMID: 38089086 PMCID: PMC10686117 DOI: 10.1002/cai2.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 10/15/2024]
Abstract
Background By prolonging overall survival and reducing disease recurrence rates, immune checkpoint inhibitors (ICIs) are an emerging adjuvant therapy option for patients with resectable malignant tumors. However, the safety profile (deaths and adverse events [AEs]) of adjuvant ICIs has not been fully described. Methods We searched the literature for phase III randomized clinical trials that compared PD-1, PD-L1, and CTLA-4 inhibitors in solid malignant tumors. Incidences of death, discontinuation, AEs of any cause, treatment-related adverse events (TRAEs), and immune-related adverse events (IRAEs) were extracted for the network meta-analysis. Network meta-analyses with low incidence and poor convergence are reported as incidences with 95% confidence intervals (95% CIs). Results Ten randomized clinical trials that included 9243 patients who received ICI adjuvant therapy were eligible. In total, 21 deaths due to TRAEs were recorded, with an overall incidence of 0.40% (95% CI: 0.26-0.61). The treatment-related mortality rates for ipilimumab (0.76%, 95% CI: 0.31-1.55) and atezolizumab (0.56%, 95% CI: 0.18-1.31) were higher than for pembrolizumab (0.24%, 95% CI: 0.10-0.56) and nivolumab (0.30%, 95% CI: 0.08-0.77). The most frequent causes of death were associated with the gastrointestinal (0.10%, 95% CI: 0.04-0.24) and pulmonary (0.08%, 95% CI: 0.03-0.21) systems. Compared with the control arm, we found that nivolumab (odds ratio [OR]: 2.73, 95% CI: 0.49-15.85) and atezolizumab (OR: 12.43, 95% CI: 2.42-78.48) caused the fewest grade ≥3 TRAEs and IRAEs. Commonly reported IRAEs of special interest were analyzed, and two agents were found to have IRAEs with incidences >10%, i.e., hepatitis for atezolizumab (14.80%, 95% CI: 12.53-17.32) and hypophysitis for ipilimumab (13.53%, 95% CI: 11.38-15.90). Conclusions Ipilimumab and atezolizumab were correlated with higher treatment-related death rates than pembrolizumab and nivolumab, in which the gastrointestinal and pulmonary systems were mostly involved. Regarding severe TRAEs and IRAEs, nivolumab and atezolizumab are likely to be the safest agent, respectively. This study will guide clinical practice for ICI adjuvant therapies.
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Affiliation(s)
- Ruiyang Xie
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Bingqing Shang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Youyan Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Nonsurgical Treatment Strategies for Elderly Head and Neck Cancer Patients: An Emerging Subject Worldwide. Cancers (Basel) 2022; 14:cancers14225689. [PMID: 36428780 PMCID: PMC9688456 DOI: 10.3390/cancers14225689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Consistent with the increasing rate of head and neck cancers among elderly adults, there has been an increase in the rate of those receiving nonsurgical treatments to maintain their function and quality of life. However, various problems, such as poor tolerance to chemoradiotherapy-related toxicity, are of greater concern in elderly adults than in younger individuals. In this review, we describe adverse events that should be particularly noted in elderly patients and provide an overview of countermeasures in nonsurgical treatments. We mainly focus on cisplatin-based chemoradiotherapy-the primary treatment for head and neck squamous cell carcinoma (HNSCC). Furthermore, we review the molecular targeted drugs and immune checkpoint inhibitors for elderly patients with HNSCC. Although the number of older patients is increasing worldwide, clinical trials aimed at determining the standard of care typically enroll younger or well-conditioned elderly patients. There is still very little evidence for treating elderly HNSCC older patients, and the question of optimal treatment needs to be explored.
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Samonis G, Bousmpoukea A, Molfeta A, Kalkinis AD, Petraki K, Koutserimpas C, Bafaloukos D. Severe Gastritis Due to Nivolumab Treatment of a Metastatic Melanoma Patient. Diagnostics (Basel) 2022; 12:diagnostics12112864. [PMID: 36428923 PMCID: PMC9689097 DOI: 10.3390/diagnostics12112864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Nivolumab, an anti-PD-1 check point inhibitor, is an immunotherapeutic agent, representing a major step in the treatment of melanoma. However, its use is associated with severe toxicities. Among them, gastrointestinal (GI) disorders from the lower GI tract have been widely reported. On the contrary, disorders from the upper GI tract are rare. Such a case of delayed nivolumab induced severe gastritis in a 53-year-old Caucasian female patient suffering metastatic melanoma is described. The patient's symptoms from the upper GI tract began 4 months after nivolumab treatment initiation. The diagnosis was based on imaging, including PET/CT, endoscopical and pathological findings. The side effect was successfully treated with prolonged administration of proton pump inhibitors and corticosteroids. There are only a few cases of immune check point inhibitors (ICPis) induced upper GI tract disorders, while it seems that the symptoms from nivolumab induced upper GI tract damages appear later than those reported in the lower part. Nivolumab, among other side effects, may cause severe gastritis. Hence, this pathological entity should be included in the list of this drug's side effects.
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Affiliation(s)
- George Samonis
- First Oncology Department, Metropolitan Hospital, Neon Faliron, 18547 Athens, Greece
- Correspondence: ; Tel.: +30-6944437255
| | | | - Aristea Molfeta
- First Oncology Department, Metropolitan Hospital, Neon Faliron, 18547 Athens, Greece
| | - Antonios D. Kalkinis
- Department of Nuclear Medicine, Metropolitan Hospital, Neon Faliron, 18547 Athens, Greece
| | - Kalliopi Petraki
- Department of Pathology, Metropolitan Hospital, Neon Faliron, 18547 Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece
| | - Dimitrios Bafaloukos
- First Oncology Department, Metropolitan Hospital, Neon Faliron, 18547 Athens, Greece
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van Laar SA, Kapiteijn E, Gombert-Handoko KB, Guchelaar HJ, Zwaveling J. Application of Electronic Health Record Text Mining: Real-World Tolerability, Safety, and Efficacy of Adjuvant Melanoma Treatments. Cancers (Basel) 2022; 14:5426. [PMID: 36358844 PMCID: PMC9657798 DOI: 10.3390/cancers14215426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 08/13/2023] Open
Abstract
Introduction: Nivolumab (N), pembrolizumab (P), and dabrafenib plus trametinib (D + T) have been registered as adjuvant treatments for resected stage III and IV melanoma since 2018. Electronic health records (EHRs) are a real-world data source that can be used to review treatments in clinical practice. In this study, we applied EHR text-mining software to evaluate the real-world tolerability, safety, and efficacy of adjuvant melanoma treatments. Methods: Adult melanoma patients receiving adjuvant treatment between January 2019 and October 2021 at the Leiden University Medical Center, the Netherlands, were included. CTcue text-mining software (v3.1.0, CTcue B.V., Amsterdam, The Netherlands) was used to construct rule-based queries and perform context analysis for patient inclusion and data collection from structured and unstructured EHR data. Results: In total, 122 patients were included: 54 patients treated with nivolumab, 48 with pembrolizumab, and 20 with D + T. Significantly more patients discontinued treatment due to toxicity on D + T (N: 16%, P: 6%, D + T: 40%), and X2 (6, n = 122) = 14.6 and p = 0.024. Immune checkpoint inhibitors (ICIs) mainly showed immune-related treatment-limiting adverse events (AEs), and chronic thyroid-related AE occurred frequently (hyperthyroidism: N: 15%, P: 13%, hypothyroidism: N: 20%, P: 19%). Treatment-limiting toxicity from D + T was primarily a combination of reversible AEs, including pyrexia and fatigue. The 1-year recurrence-free survival was 70.3% after nivolumab, 72.4% after pembrolizumab, and 83.0% after D + T. Conclusions: Text-mining EHR is a valuable method to collect real-world data to evaluate adjuvant melanoma treatments. ICIs were better tolerated than D + T, in line with RCT results. For BRAF+ patients, physicians must weigh the higher risk of reversible treatment-limiting AEs of D + T against the risk of long-term immune-related AEs.
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Affiliation(s)
- Sylvia A. van Laar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Kim B. Gombert-Handoko
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Juliette Zwaveling
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Schwab A, Assaad M, Hamadi R, Zurndorfer J, Abi Melhem R, Holtzbach J, Loeffler J, Ibrahim M. Pembrolizumab-Induced Myasthenia Gravis and Myositis: Literature Review on Neurological Toxicities of Programmed Death Protein 1 Inhibitors. J Med Cases 2022; 13:530-535. [PMID: 36506763 PMCID: PMC9728146 DOI: 10.14740/jmc4008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/28/2022] Open
Abstract
We present herein the case of an elderly male patient, who was receiving immunotherapy for his urothelial cancer and who presented to our facility with lower extremity weakness. The patient was diagnosed with myasthenia gravis, thyroiditis, myositis and myocarditis, which were considered as immune adverse events of pembrolizumab therapy. The patient received pyridostigmine, intravenous immunoglobulin, plasmapheresis, corticosteroids, and rituximab with mild improvement of his symptoms. The patient had some neurological recovery, was discharged to a nursing facility, however he was ventilator dependent. Of importance, our case is followed by review and discussion of the literature related to immunotherapy and its side effects.
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Affiliation(s)
- Alfred Schwab
- Division of Neurocritical Care, Department of Neurology, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Marc Assaad
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA,Corresponding Author: Marc Assaad, Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA.
| | - Rachelle Hamadi
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Juda Zurndorfer
- Division of Neurocritical Care, Department of Neurology, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Racha Abi Melhem
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Jennifer Holtzbach
- Division of Neurocritical Care, Department of Neurology, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Jeffrey Loeffler
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Muhammad Ibrahim
- Division of Neurocritical Care, Department of Neurology, Staten Island University Hospital, Staten Island, NY 10305, USA
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Organizing Pneumonia Due to Nivolumab. Am J Ther 2022; 29:e738-e740. [PMID: 32897903 DOI: 10.1097/mjt.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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127
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Focus on the Dynamics of Neutrophil-to-Lymphocyte Ratio in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Meta-Analysis and Systematic Review. Cancers (Basel) 2022; 14:cancers14215297. [PMID: 36358716 PMCID: PMC9658132 DOI: 10.3390/cancers14215297] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A number of studies have reported an association between the dynamics of neutrophil-to-lymphocyte ratio (NLR) and clinical efficacy in patients treated with immune checkpoint inhibitors (ICIs), but there is still a lack of a meta-analysis or systematic review. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched until September 2022 for studies reporting on the association between the change in NLR after ICI treatment and clinical outcomes. Outcome measures of interest included: change in NLR before and after treatment, overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Results: A total of 4154 patients in 38 studies were included. The pooled percentage of patients with increased NLR was 49.7% (95CI%: 43.7−55.8%). Six studies discussing the change in NLR in patients with different tumor responses all showed that the NLR level in patients without response to immunotherapy may increase after ICI treatment. The upward trend in NLR was associated with shorter OS (pooled HR: 2.05, 95%CI: 1.79−2.35, p < 0.001) and PFS (pooled HR: 1.89, 95%CI: 1.66−2.14, p < 0.001) and higher ORR (pooled OR: 0.27, 95%CI: 0.19−0.39, p < 0.001), and downward trend in NLR was associated with longer OS (pooled HR: 0.49, 95%CI: 0.42−0.58, p < 0.001) and PFS (pooled HR: 0.55, 95%CI: 0.48−0.63, p < 0.001) and lower ORR (pooled OR: 3.26, 95%CI: 1.92−5.53, p < 0.001). In addition, post-treatment high NLR was associated with more impaired survival than baseline high NLR (pooled HR of baseline high NLR: 1.82, 95%CI: 1.52−2.18; pooled HR of post-treatment high NLR: 2.93, 95%CI: 2.26−3.81), but the NLR at different time points may have a similar predictive effect on PFS (pooled HR of baseline high NLR: 1.68, 95%CI: 1.44−1.97; pooled HR of post-treatment high NLR: 2.00, 95%CI: 1.54−2.59). Conclusions: The NLR level of tumor patients after ICI treatment is stable overall, but the NLR level in patients without response to immunotherapy may increase after ICI treatment. Patients with an upward trend in NLR after ICI treatment were associated with worse clinical outcomes; meanwhile, the downward trend in NLR was associated with better clinical outcomes. Post-treatment high NLR was associated with more impaired survival than baseline high NLR.
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128
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Gao Y, Wu C, Chen X, Ma L, Zhang X, Chen J, Liao X, Liu M. PET/CT molecular imaging in the era of immune-checkpoint inhibitors therapy. Front Immunol 2022; 13:1049043. [PMID: 36341331 PMCID: PMC9630646 DOI: 10.3389/fimmu.2022.1049043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 04/24/2024] Open
Abstract
Cancer immunotherapy, especially immune-checkpoint inhibitors (ICIs), has paved a new way for the treatment of many types of malignancies, particularly advanced-stage cancers. Accumulating evidence suggests that as a molecular imaging modality, positron emission tomography/computed tomography (PET/CT) can play a vital role in the management of ICIs therapy by using different molecular probes and metabolic parameters. In this review, we will provide a comprehensive overview of the clinical data to support the importance of 18F-fluorodeoxyglucose PET/CT (18F-FDG PET/CT) imaging in the treatment of ICIs, including the evaluation of the tumor microenvironment, discovery of immune-related adverse events, evaluation of therapeutic efficacy, and prediction of therapeutic prognosis. We also discuss perspectives on the development direction of 18F-FDG PET/CT imaging, with a particular emphasis on possible challenges in the future. In addition, we summarize the researches on novel PET molecular probes that are expected to potentially promote the precise application of ICIs.
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Han X, Chang WW, Xia X. Immune checkpoint inhibitors in advanced and recurrent/metastatic cervical cancer. Front Oncol 2022; 12:996495. [PMID: 36276090 PMCID: PMC9582347 DOI: 10.3389/fonc.2022.996495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer (CC) poses a serious threat to women’s health. Although many early-stage patients have a good prognosis, there are still a lack of effective therapies for advanced and recurrent/metastatic CC. In this context, immunotherapy and immune checkpoint inhibitors (ICIs) are particularly likely to play a role in the treatment of cervical tumors in a variety of disease settings. Some promising immune checkpoints include programmed cell death 1 (PD-1), programmed death ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen 4 (CTLA-4), which exert immunomodulatory effects as negative regulators of T-cell activation and suppress immune responses in cervical cancer through cancer cell immune evasion. Initial trials of ICIs for CC have shown encouraging results in terms of objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), both monotherapy and combination strategies. Meanwhile, human papillomavirus, vaginal microecology and intestinal microenvironment play an important role in CC, which provides new treatment directions. This review analyzed a number of completed or ongoing clinical trials of ICIs in the treatment of advanced and recurrent/metastatic CC. And we also analyzed the important relationship between vaginal microecology and intestinal microecology with CC and their related immunotherapy prospects.
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Affiliation(s)
- Xiling Han
- Department of Obstetrics and Gynecology, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, China
| | - Wei-wei Chang
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Xiaoping Xia
- Department of Obstetrics and Gynecology, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Xiaoping Xia,
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Zhou Y, Song S, Yuan B, Wu Y, Gao Y, Wan G, Li G. A Novel CTLA-4 affinity peptide for cancer immunotherapy by increasing the integrin αvβ3 targeting. Discov Oncol 2022; 13:99. [PMID: 36195696 PMCID: PMC9532478 DOI: 10.1007/s12672-022-00562-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are changing all aspects of malignant tumour therapy as an immunotherapy subverter in oncology. However, the current ICIs might induce systemic immune activation in other tissues and organs since they are not tumour-specific, causing the immune system to attack some normal tissues and organs of the human body. The toxicity can also amplify greatly although combined immunotherapy for cancer has increased the curative efficacy. The LC4 peptide was modified to improve its tumour-targeting ability and reduce peripheral immune system activation, which was obtained through phage display peptide library screening and could block the CTLA-4/CD80 interaction. The LC4 peptide as a result, like other ICIs, exerts anti-tumour effects by refreshing T cell function, and also activates the peripheral immune system. We used the PLGLAG peptide as a linker at the C-terminal of LC4 to connect with a tumour-targeting peptide RGD to increase the tumour tissue targeting ability, and obtain LC4-PLG-RGD. Further experiments demonstrated that the anti-tumour LC4-PLG-RGD activity was better than LC4 in vivo, and the ability to activate the peripheral immune system was weakened. In conclusion, LC4-PLG-RGD can increase the ICIs tumour-targeting and reduce excessive peripheral tissue immune activation, thereby reducing the side effects of ICIs, while increasing their anti-tumour efficacy. This study confirmed that enhanced ICI tumour targeting can effectively reduce immune-related adverse reaction occurrence.
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Affiliation(s)
- Ying Zhou
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China
- Henan Key Laboratory of Bioactive Macromolecules, Zhengzhou University, Zhengzhou, 450001, China
- International Joint Laboratory for Protein and Peptide Drugs of Henan Province, Zheng Zhou University, Zhengzhou, 450001, China
| | - Shuyi Song
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China
- Henan Key Laboratory of Bioactive Macromolecules, Zhengzhou University, Zhengzhou, 450001, China
- International Joint Laboratory for Protein and Peptide Drugs of Henan Province, Zheng Zhou University, Zhengzhou, 450001, China
| | - Baomei Yuan
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Yahong Wu
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China
- Henan Key Laboratory of Bioactive Macromolecules, Zhengzhou University, Zhengzhou, 450001, China
- International Joint Laboratory for Protein and Peptide Drugs of Henan Province, Zheng Zhou University, Zhengzhou, 450001, China
| | - Yanfeng Gao
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, Guangzhou, 510006, China
| | - Guangming Wan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Guodong Li
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001, China.
- Henan Key Laboratory of Bioactive Macromolecules, Zhengzhou University, Zhengzhou, 450001, China.
- International Joint Laboratory for Protein and Peptide Drugs of Henan Province, Zheng Zhou University, Zhengzhou, 450001, China.
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131
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Azuma T, Kano M, Iwata S, Honda S, Miyoshi Y, Nishiguchi J. Utility of periodic medical questionnaires and examinations for immune-related adverse event screening: A prospective observational study. PLoS One 2022; 17:e0274451. [PMID: 36173947 PMCID: PMC9521803 DOI: 10.1371/journal.pone.0274451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/27/2022] [Indexed: 12/18/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs) specific to the immunity-boosting activity of the drugs and may necessitate discontinuation of treatment depending on their severity. IrAEs may be difficult to diagnose in their early stages as they can occur in any organ. The present, prospective, observational study is the first to attempt to assess the utility of periodic medical questionnaires and laboratory, radiological, and physiological examinations in diagnosing irAEs. Methods We analyzed 51 patients who received immunotherapy for metastatic renal or urothelial carcinoma at Tokyo Metropolitan Tama Medical Center between 2016 and 2020. A medical questionnaire consisting of 41 questions and laboratory tests were administered to the patients on the day of each ICI administration and 1 week afterwards. A significant complaint was defined as a complaint not addressed in the questionnaire immediately prior to the first ICI administration. Results Fifty-one patients with metastatic renal or urothelial carcinoma were enrolled. The mean age was 72.1 years (range: 54–88 years). The male: female ratio was 32: 19. Of the total cohort, 26 (51%) patients had renal carcinoma, and 25 (49%) had urothelial carcinoma. The median follow-up time was 2.6 (range: 0.4–40.7) months. Thirty-three patients (65%) experienced irAEs. Conclusions In our cohort, periodic medical questionnaires and examinations were effective for early diagnosis and prompt treatment of irAEs. Although periodic examinations led to a high irAE diagnosis rate, the attendant medical cost was high. Further study is needed to find ways of addressing this issue.
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Affiliation(s)
- Takeshi Azuma
- Division of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
- * E-mail:
| | - Masato Kano
- Division of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Shohei Iwata
- Division of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Sachi Honda
- Division of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yuji Miyoshi
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Junko Nishiguchi
- Division of Nursing, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Fukunaga H, Sumii K, Kawamura S, Okuno M, Taguchi I, Kawabata G. A case of steroid‐resistant cystitis as an immune‐related adverse event during treatment with nivolumab for lung cancer, which was successfully treated with infliximab. IJU Case Rep 2022; 5:521-523. [PMID: 36341187 PMCID: PMC9626353 DOI: 10.1002/iju5.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Immune checkpoint inhibitors are widely used in various cancers as a standard treatment. However, while various immune‐related adverse events related to immune checkpoint inhibitors have been reported, there are few reports of lower urinary tract symptoms. Case presentation The patient was a 60‐year‐old man with primary lung cancer who was receiving long‐term nivolumab therapy. He was referred to our department due to the sudden onset of glans penile pain and micturition pain. We suspected non‐bacterial cystitis as an immune‐related adverse event caused by nivolumab and were able to treat it by administering prednisolone. While his symptoms and findings on cystoscopy recurred during prednisolone therapy, we were able to treat him again by administering an additional dose of infliximab. Conclusion A few reports have described cases of immune checkpoint inhibitor‐induced cystitis for which prednisolone was effective. This report is the first to describe cystitis as a steroid‐resistant immune‐related adverse event.
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Affiliation(s)
| | - Kenta Sumii
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Shun Kawamura
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Masato Okuno
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Isao Taguchi
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
| | - Gaku Kawabata
- Department of Urology Kansai Rosai Hospital Amagasaki‐shi Japan
- Department of Urology Hakuhokai Central Hospital Amagasaki‐shi Japan
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133
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Jiménez-Alejandre R, Ruiz-Fernández I, Martín P. Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis. Cancers (Basel) 2022; 14:4494. [PMID: 36139654 PMCID: PMC9497311 DOI: 10.3390/cancers14184494] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have recently emerged as strong therapies for a broad spectrum of cancers being the first-line treatment for many of them, even improving the prognosis of malignancies that were considered untreatable. This therapy is based on the administration of monoclonal antibodies targeting inhibitory T-cell receptors, which boost the immune system and prevent immune evasion. However, non-specific T-cell de-repression can result in a wide variety of immune-related adverse events (irAEs), including gastrointestinal, endocrine, and dermatologic, with a smaller proportion of these having the potential for fatal outcomes such as neurotoxicity, pulmonary toxicity, and cardiotoxicity. In recent years, alarm has been raised about cardiotoxicity as it has the highest mortality rate when myocarditis develops. However, due to the difficulty in diagnosing this cardiac condition and the lack of clinical guidelines for the management of cardiovascular disease in patients on therapy with ICIs, early detection of myocarditis has become a challenge in these patients. In this review we outline the mechanisms of tolerance by which this fatal cardiomyopathy may develop in selected cancer patients treated with ICIs, summarize preclinical models of the disease that will allow the development of more accurate strategies for its detection and treatment, and discuss the challenges in the future to decrease the risks of its development with better decision making in susceptible patients.
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Affiliation(s)
| | | | - Pilar Martín
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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134
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Minkove SJ, Sun J, Li Y, Cui X, Cooper D, Eichacker PQ, Torabi‐Parizi P. Comprehensive adjusted outcome data are needed to assess the impact of immune checkpoint inhibitors in cancer patients with COVID-19: Results of a systematic review and meta-analysis. Rev Med Virol 2022; 32:e2352. [PMID: 35416370 PMCID: PMC9111045 DOI: 10.1002/rmv.2352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Determining how prior immune checkpoint inhibitor (ICI) therapy influences outcomes in cancer patients presenting with COVID-19 is essential for patient management but must account for confounding variables. METHODS We performed a systematic review and meta-analysis of studies reporting adjusted effects of ICIs on survival, severe events, or hospitalisation in cancer patients with COVID-19 based on variables including age, gender, diabetes mellitus, hypertension (HTN), chronic obstructive pulmonary disease, and other comorbidities. When adjusted effects were unavailable, unadjusted data were analysed. RESULTS Of 42 observational studies (38 retrospective), 7 reported adjusted outcomes for ICIs and 2 provided sufficient individual patient data to calculate adjusted outcomes. In eight studies, adjusted outcomes were based on ≤7 variables. Over all studies, only one included >100 ICI patients while 26 included <10. ICIs did not alter the odds ratio (95%CI) (OR) of death significantly (random effects model), across adjusted (n = 8) [1.31 (0.58-2.95) p = 0.46; I2 = 42%, p = 0.10], unadjusted (n = 30) [1.06 (0.85-1.32) p = 0.58; I2 = 0%, p = 0.76] or combined [1.09 (0.88;1.36) p = 0.41; I2 = 0%, p = 0.5)] studies. Similarly, ICIs did not alter severe events significantly across adjusted (n = 5) [1.20 (0.30-4.74) p = 0.73; I2 = 52%, p = 0.08], unadjusted (n = 19) [(1.23 (0.87-1.75) p = 0.23; I2 = 16%, p = 0.26] or combined [1.26 (0.90-1.77) p = 0.16; I2 = 25%, p = 0.14] studies. Two studies provided adjusted hospitalisation data and when combined with 13 unadjusted studies, ICIs did not alter hospitalisation significantly [1.19 (0.85-1.68) p = 029; I2 = 5%, p = 0.40]. Results of sensitivity analyses examining ICI effects based on 5 variables were inconclusive. Certainty of evidence was very low. CONCLUSIONS Across studies with adjusted and unadjusted results, ICIs did not alter outcomes significantly. But studies with comprehensive adjusted outcome data controlling for confounding variables are necessary to determine whether ICIs impact COVID-19 outcomes in cancer patients.
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Affiliation(s)
- Samuel J. Minkove
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Junfeng Sun
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Yan Li
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Xizhong Cui
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Diane Cooper
- NIH Library, Clinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Peter Q. Eichacker
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Parizad Torabi‐Parizi
- Critical Care Medicine DepartmentClinical Center, National Institutes of HealthBethesdaMarylandUSA
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135
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Badheeb A, Alkhanbashi O, Rakrouki S, Mahmood T, Alqannas M, Badheeb M, Ahmed F. Bladder rupture after pembrolizumab immunotherapy for bladder cancer: a case report. Pan Afr Med J 2022; 42:98. [PMID: 36034031 PMCID: PMC9379440 DOI: 10.11604/pamj.2022.42.98.33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/01/2022] [Indexed: 12/28/2022] Open
Abstract
Pembrolizumab is a promising checkpoint inhibitor for advanced urothelial carcinoma. Like other immunotherapies, it can cause rare immune-related adverse events. The spontaneous rupture of the urinary bladder after the intravenous injection of pembrolizumab is rare and has not been reported. Here, we present a 74-year-old man patient case of locally advanced transitional cell carcinoma of the urinary bladder who presented severe abdominal pain the same day of the second dose of pembrolizumab administration. The exploratory laparotomy revealed intraperitoneal rupture of the urinary bladder associated with peritonitis. After surgical repair, the patient's condition improved. The purpose of this report is to discuss the possible association of bladder perforation in bladder cancer with pembrolizumab immunotherapy, its management, and the importance of early recognition to prevent more fatal complications.
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Affiliation(s)
- Ahmed Badheeb
- Oncology Center, King Khalid Hospital, Najran, Saudi Arabia
| | - Omar Alkhanbashi
- Department of Urology, King Khalid Hospital, Najran, Saudi Arabia
| | - Slah Rakrouki
- Department of Urology, King Khalid Hospital, Najran, Saudi Arabia
| | - Tahir Mahmood
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mashhoor Alqannas
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohamed Badheeb
- Department of Internal Medicine, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
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136
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Borówka M, Łącki-Zynzeling S, Nicze M, Kozak S, Chudek J. Adverse Renal Effects of Anticancer Immunotherapy: A Review. Cancers (Basel) 2022; 14:4086. [PMID: 36077623 PMCID: PMC9454552 DOI: 10.3390/cancers14174086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Modern oncological therapy utilizes various types of immunotherapy. Immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cells (CAR-T) therapy, cancer vaccines, tumor-targeting monoclonal antibodies (TT-mAbs), bispecific antibodies and cytokine therapy improve patients' outcomes. However, stimulation of the immune system, beneficial in terms of fighting against cancer, generates the risk of harm to other cells in a patient's body. Kidney damage belongs to the relatively rare adverse events (AEs). Best described, but still, superficially, are renal AEs in patients treated with ICIs. International guidelines issued by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) cover the management of immune-related adverse events (irAEs) during ICI therapy. There are fewer data concerning real occurrence and possible presentations of renal adverse drug reactions of other immunotherapeutic methods. This implies the need for the collection of safety data during ongoing clinical trials and in the real-life world to characterize the hazard related to the use of new immunotherapies and management of irAEs.
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Affiliation(s)
| | - Stanisław Łącki-Zynzeling
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Reymonta 8, 40-027 Katowice, Poland
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Xin X, Ni X, Shi K, Shao J, Zhang Y, Peng X, Yang W, Tian C, Zhou W, Zhang B. Iodine-Rich Nanoadjuvants for CT Imaging-Guided Photodynamic Immunotherapy of Breast Cancer. Front Bioeng Biotechnol 2022; 10:915067. [PMID: 36072292 PMCID: PMC9442603 DOI: 10.3389/fbioe.2022.915067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Immunotherapy, which stimulates the body's own immune system to kill cancer cells, has shown great promise in the field of cancer therapy. However, the uncontrolled biodistribution of immunotherapeutic drugs may cause severe side effects. Herein, we report an iodine-rich nanoadjuvant (INA) for photo-immunotherapy. INA is prepared by encapsulating a toll-like receptor 7 agonist (R837) and a photosensitizer (phthalocyanine) into an iodine-rich amphiphilic copolymer PEG-PHEMA-I. By virtue of the enhanced permeation and retention (EPR) effect, INA can effectively accumulate into the tumor site. Under light irradiation, photodynamic therapy (PDT) triggered by INA will induce immunogenic cell death (ICD) in the tumor region to trigger the release of immune-associated cytokines. Such a process may further induce the maturation of dendritic cells which will be accelerated by R837, leading to the proliferation of effector T cells for immunotherapy. The photo-immunotherapy mediated by INA shows good anticancer efficacy both in vitro and in vivo. Meanwhile, INA is also a CT contrast agent owing to its high density of iodine, which can successfully illuminate tumors by CT imaging. Thus, our study develops a light-triggered nanoadjuvant for CT imaging-guided enhanced photo-immunotherapy.
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Affiliation(s)
- Xiaoyan Xin
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyue Ni
- Key Laboratory for Organic Electronics and Information Displays, Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergetic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Kang Shi
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Shao
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Yanqiu Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Peng
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wen Yang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chuanshuai Tian
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wen Zhou
- Key Laboratory for Organic Electronics and Information Displays, Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergetic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Clinical Characteristics and Outcomes of Gastritis Associated With Immune Checkpoint Inhibitors: Scoping Review. J Immunother 2022; 45:363-369. [PMID: 35972801 DOI: 10.1097/cji.0000000000000435] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
Among immune-related adverse events associated with immune checkpoint inhibitors, immune-mediated gastritis (IMG) has been rarely described in the literature and has not yet been well characterized. This scoping review aimed to characterize IMG in terms of precipitating agents, clinical presentations, and prognosis. After the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "immune checkpoint inhibitor," and "immune-related adverse event" from their inception to December 28, 2021. Twenty-two articles, including 5 observational studies and 17 case reports and case series, were included. Nivolumab, pembrolizumab, and combination therapy with those and cytotoxic T-lymphocyte-associated antigen-4 inhibitor (ipilimumab) were commonly used in those with IMG. 59.8% had epigastric pain, and 50% had erosive gastritis. 87.5% had Common Terminology Criteria for Adverse Events (CTCAE) grade 3 gastritis, and 91.2% received corticosteroids. Recurrence was noted in 16.7%, and only 1 expiration was noted. 4.3% had positive helicobacter pylori and cytomegalovirus from the gastric specimen. Similar to immune-related colitis, patients with IMG may have a favorable prognosis with a better response to immune checkpoint inhibitors if treated appropriately. The diagnosis of IMG is made by exclusion, and a thorough workup is necessary to rule out concurrent helicobacter pylori and cytomegalovirus involvement. Further studies are critical for a better understanding of this complication.
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139
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Immunotherapy-induced Colitis: A Comprehensive Review of Epidemiology, Clinical Presentation, Diagnostic Workup, and Management Plan. J Clin Gastroenterol 2022; 56:555-564. [PMID: 35470301 DOI: 10.1097/mcg.0000000000001705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of a variety of malignancies including advanced melanoma, non-small cell lung cancer, renal cell carcinoma, head and neck cancers among others. Since their introduction, there has been significant improvement in survival and prognosis in patients with advanced malignancies. Unfortunately, improved outcomes have come at a price of significant immune-related adverse events, with those of the gastrointestinal tract being the most common. Gastrointestinal immune-related adverse events frequently present as diarrhea and colitis, the severity of which can range from mild diarrhea to fulminant colitis with intestinal perforation. Currently, management of ICI-induced colitis is primarily guided by retrospective studies and expert opinion. A significant number of ICI-induced colitis responds to high-dose corticosteroids; however, some patients require further therapy with biologics. There is limited information on the factors which may predispose patients to ICI-induced colitis. Future research elucidating these risk factors along with development of a scoring system could allow for risk-stratification of patients before initiation of ICI therapy. Such a system may help clinicians and patients keep a high index of suspicion regarding ICI-induced colitis and could hopefully reduce the incidence of severe cases. Similarly, future studies should investigate protective factors against ICI-induced colitis, which could potentially allow more patients to safely benefit from ICI therapy.
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Granata V, Simonetti I, Fusco R, Setola SV, Izzo F, Scarpato L, Vanella V, Festino L, Simeone E, Ascierto PA, Petrillo A. Management of cutaneous melanoma: radiologists challenging and risk assessment. LA RADIOLOGIA MEDICA 2022; 127:899-911. [PMID: 35834109 DOI: 10.1007/s11547-022-01522-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy.
| | - Igino Simonetti
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia",, Via Mariano Semmola, Naples, Italy
| | - Luigi Scarpato
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Vito Vanella
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Festino
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Ester Simeone
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
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141
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Chen G, Zhang C, Lan J, Lou Z, Zhang H, Zhao Y. Atezolizumab‑associated encephalitis in metastatic breast cancer: A case report. Oncol Lett 2022; 24:324. [PMID: 35949609 PMCID: PMC9353807 DOI: 10.3892/ol.2022.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/22/2022] [Indexed: 11/06/2022] Open
Abstract
Immune checkpoint inhibitors have been critical in the treatment of advanced malignancies in recent years. Encephalitis caused by atezolizumab is an uncommon immune-related adverse event. The case of a 65-year-old female diagnosed with encephalitis closely associated with atezolizumab medication for metastatic advanced breast cancer is presented in the current study. Following a fourth atezolizumab dose 10 days previously, the patient fell into a deep coma. Initial brain magnetic resonance imaging revealed multiple patchy T2 hyperintensities in the bilateral cerebellar hemisphere, vermis of the cerebellum, bilateral frontal lobe, temporal lobe, parietal lobe and occipital cortex. Meanwhile, there were aberrant signs on diffusion-weighted imaging. The diagnosis of atezolizumab-induced encephalitis seemed probable after ruling out other possible causes of encephalitis. Subsequently, the condition of the patient worsened and there were indications of cardiac and respiratory arrest. Chest compressions were provided immediately, as well as a balloon mask for assisted ventilation, a medication boost, stimulated breathing and other symptomatic therapy. The patient's vital signs temporarily stabilised after this series of rescue measures. The patient refused further therapy and insisted on being discharged, and died a few days after being discharged from the hospital. In this case, the patient's encephalitis symptoms associated with atezolizumab were not as typical as previously documented. The patient's condition swiftly deteriorated to heartbeat apnea, and steroid pulse therapy was not received in a timely manner, resulting in an unfavourable outcome.
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Affiliation(s)
- Guixian Chen
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Changlin Zhang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Jiaying Lan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Zhenzhen Lou
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Haibo Zhang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yuanqi Zhao
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
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142
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Zheng D, Hou X, Yu J, He X. Combinatorial Strategies With PD-1/PD-L1 Immune Checkpoint Blockade for Breast Cancer Therapy: Mechanisms and Clinical Outcomes. Front Pharmacol 2022; 13:928369. [PMID: 35935874 PMCID: PMC9355550 DOI: 10.3389/fphar.2022.928369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
As an emerging antitumor strategy, immune checkpoint therapy is one of the most promising anticancer therapies due to its long response duration. Antibodies against the programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) axis have been extensively applied to various cancers and have demonstrated unprecedented efficacy. Nevertheless, a poor response to monotherapy with anti-PD-1/PD-L1 has been observed in metastatic breast cancer. Combination therapy with other standard treatments is expected to overcome this limitation of PD-1/PD-L1 blockade in the treatment of breast cancer. In the present review, we first illustrate the biological functions of PD-1/PD-L1 and their role in maintaining immune homeostasis as well as protecting against immune-mediated tissue damage in a variety of microenvironments. Several combination therapy strategies for the combination of PD-1/PD-L1 blockade with standard treatment modalities have been proposed to solve the limitations of anti-PD-1/PD-L1 treatment, including chemotherapy, radiotherapy, targeted therapy, antiangiogenic therapy, and other immunotherapies. The corresponding clinical trials provide valuable estimates of treatment effects. Notably, several combination options significantly improve the response and efficacy of PD-1/PD-L1 blockade. This review provides a PD-1/PD-L1 clinical trial landscape survey in breast cancer to guide the development of more effective and less toxic combination therapies.
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Affiliation(s)
- Dan Zheng
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
| | - Xiaolin Hou
- Department of Neurosurgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Yu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
| | - Xiujing He
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
- *Correspondence: Xiujing He,
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143
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The predictive potential of autoimmune-inflammatory syndrome induced by adjuvants (ASIA) criteria to assess the risk of adverse events and efficacy of immune checkpoint inhibitor therapy. Immunol Res 2022; 70:765-774. [DOI: 10.1007/s12026-022-09304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
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144
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Liu X, Wu W, Fang L, Liu Y, Chen W. TNF-α Inhibitors and Other Biologic Agents for the Treatment of Immune Checkpoint Inhibitor-Induced Myocarditis. Front Immunol 2022; 13:922782. [PMID: 35844550 PMCID: PMC9283712 DOI: 10.3389/fimmu.2022.922782] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/08/2022] [Indexed: 01/11/2023] Open
Abstract
With anti-PD-1 antibodies serving as a representative drug, immune checkpoint inhibitors (ICIs) have become the main drugs used to treat many advanced malignant tumors. However, immune-related adverse events (irAEs), which might involve multiple organ disorders, should not be ignored. ICI-induced myocarditis is an uncommon but life-threatening irAE. Glucocorticoids are the first choice of treatment for patients with ICI-induced myocarditis, but high proportions of steroid-refractory and steroid-resistant cases persist. According to present guidelines, tumor necrosis factor alpha (TNF-α) inhibitors are recommended for patients who fail to respond to steroid therapy and suffer from severe cardiac toxicity, although evidence-based studies are lacking. On the other hand, TNF-α inhibitors are contraindicated in patients with moderate-to-severe heart failure. This review summarizes real-world data from TNF-α inhibitors and other biologic agents for ICI-induced myocarditis to provide more evidence of the efficacy and safety of TNF-α inhibitors and other biologic agents.
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Affiliation(s)
| | | | | | | | - Wei Chen
- *Correspondence: Yingxian Liu, ; Wei Chen,
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145
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Yu Y, Wang S, Su N, Pan S, Tu B, Zhao J, Shen Y, Qiu Q, Liu X, Luan J, Wang FS, Meng F, Shi M. Increased Circulating Levels of CRP and IL-6 and Decreased Frequencies of T and B Lymphocyte Subsets Are Associated With Immune-Related Adverse Events During Combination Therapy With PD-1 Inhibitors for Liver Cancer. Front Oncol 2022; 12:906824. [PMID: 35756643 PMCID: PMC9232255 DOI: 10.3389/fonc.2022.906824] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 12/11/2022] Open
Abstract
Background Programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) immune-related adverse events (irAEs) are inevitable in patients with liver cancer. Although the incidence of severe irAEs is low, but can result in fatal consequences. To date, only a few commonly used clinical biomarkers have been reported. Aim To assess commonly used clinical biomarkers associated with the occurrence of irAEs to enable better management of irAEs by clinicians. Methods We retrospectively reviewed patients with liver cancer treated with at least one cycle of PD-1 immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs). IrAEs were documented according to the common terminology criteria for adverse events version 5. Clinical and laboratory parameters were also evaluated. Results A total of 67 patients were included, 36 with irAEs and 31 without irAEs. A total of 104 adverse events occurred; 83 of these events were grade 1/2 (G1/G2), 21 were grade 3/4 (G3/G4), and one died of G4 hepatitis. Patients with irAEs had higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6) and lower levels of lymphocyte subsets, except natural killer (NK) cell counts, than those without irAEs (P <0.05). Patients who experienced G3/G4 irAEs had higher levels of CRP and IL-6 and lower levels of CD4+ T lymphocytes and B lymphocytes than those who experienced G1/G2 irAEs (P <0.05). Of note, impairments in liver function and routine blood tests were also observed (P <0.05). The results of univariate and multivariate analyses for any grade of irAEs revealed that the combination of sintilimab and lenvatinib (P= 0.004, odds ratio [OR]: 7.414, 95% confidence interval [95% CI]: 1.925–28.560) and CRP ≥8.2 mg/L (P= 0.024, OR: 3.727, CI: 1.185–11.726) were independent risk factors. Univariate and multivariate analyses of the risk factors of G3/G4 irAEs suggested that the combination of sintilimab and lenvatinib was a potential risk factor (P = 0.049, OR: 8.242, CI: 1.006–67.532). Conclusion Changes in patient CRP, IL-6, and lymphocyte subsets were associated with irAE onset and may act as potential biomarkers of irAEs. Impairments in liver function and routine blood tests owing to the occurrence of irAEs may become new concerns for clinicians.
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Affiliation(s)
- Yingying Yu
- 302 Clinical Medical School, Peking University, Beijing, China.,Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Siyu Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Nan Su
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shida Pan
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Bo Tu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jinfang Zhao
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yingjuan Shen
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qin Qiu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaomeng Liu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Junqing Luan
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fu-Sheng Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fanping Meng
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Ming Shi
- 302 Clinical Medical School, Peking University, Beijing, China.,Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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146
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Kuo AM, Kraehenbuehl L, King S, Leung DYM, Goleva E, Moy AP, Lacouture ME, Shah NJ, Faleck DM. Contribution of the Skin-Gut Axis to Immune-Related Adverse Events with Multi-System Involvement. Cancers (Basel) 2022; 14:cancers14122995. [PMID: 35740660 PMCID: PMC9221505 DOI: 10.3390/cancers14122995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Increasing numbers of cancer patients are treated with immunotherapy that activates their immune systems to control or even eliminate tumors. However, a substantial proportion of patients experience adverse events mediated by the unleashed immune system. The skin is one of the most frequently affected organs, with toxicities typically manifesting as distinct types of rashes. The gastrointestinal (GI) tract is also commonly affected, with a wide spectrum of symptom manifestations that can range from self-limited diarrhea to life-threatening colitis. Here we present the relationship between skin and GI adverse events among cancer patients receiving treatment with immune checkpoint blockade, which has not been well-studied. Abstract Immune-related adverse events (irAEs) frequently complicate treatment with immune checkpoint blockade (ICB) targeting CTLA-4, PD-1, and PD-L1, which are commonly used to treat solid and hematologic malignancies. The skin and gastrointestinal (GI) tract are most frequently affected by irAEs. While extensive efforts to further characterize organ-specific adverse events have contributed to the understanding and management of individual toxicities, investigations into the relationship between multi-organ toxicities have been limited. Therefore, we aimed to conduct a characterization of irAEs occurring in both the skin and gut. A retrospective analysis of two cohorts of patients treated with ICB at Memorial Sloan Kettering Cancer Center was conducted, including a cohort of patients with cutaneous irAEs (ircAEs) confirmed by dermatologists (n = 152) and a cohort of patients with biopsy-proven immune-related colitis (n = 246). Among both cohorts, 15% (61/398) of patients developed both skin and GI irAEs, of which 72% (44/61) patients had ircAEs preceding GI irAEs (p = 0.00013). Our study suggests that in the subset of patients who develop both ircAEs and GI irAEs, ircAEs are likely to occur first. Further prospective studies with larger sample sizes are needed to validate our findings, to assess the overall incidence of co-incident irAEs, and to determine whether ircAEs are predictors of other irAEs. This analysis highlights the development of multi-system dermatologic and gastrointestinal irAEs and underscores the importance of oncologists, gastroenterologists, and dermatologists confronted with an ircAE to remain alert for additional irAEs.
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Affiliation(s)
- Alyce M. Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Lukas Kraehenbuehl
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence: or
| | - Stephanie King
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
| | - Donald Y. M. Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Elena Goleva
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Andrea P. Moy
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Neil J. Shah
- Genitourinary Solid Tumor Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - David M. Faleck
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
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147
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Manenti S, Orrico M, Masciocchi S, Mandelli A, Finardi A, Furlan R. PD-1/PD-L Axis in Neuroinflammation: New Insights. Front Neurol 2022; 13:877936. [PMID: 35756927 PMCID: PMC9222696 DOI: 10.3389/fneur.2022.877936] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/29/2022] [Indexed: 12/27/2022] Open
Abstract
The approval of immune checkpoint inhibitors (ICIs) by the Food and Drug Administration (FDA) led to an improvement in the treatment of several types of cancer. The main targets of these drugs are cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein-1/programmed death-ligand 1 pathway (PD-1/PD-L1), which are important inhibitory molecules for the immune system. Besides being generally safer than common chemotherapy, the use of ICIs has been associated with several immune-related adverse effects (irAEs). Although rare, neurological adverse effects are reported within the irAEs in clinical trials, particularly in patients treated with anti-PD-1 antibodies or a combination of both anti-CTLA-4 and PD-1 drugs. The observations obtained from clinical trials suggest that the PD-1 axis may play a remarkable role in the regulation of neuroinflammation. Moreover, numerous studies in preclinical models have demonstrated the involvement of PD-1 in several neurological disorders. However, a comprehensive understanding of these cellular mechanisms remains elusive. Our review aims to summarize the most recent evidence concerning the regulation of neuroinflammation through PD-1/PD-L signaling, focusing on cell populations that are involved in this pathway.
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Affiliation(s)
- Susanna Manenti
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Orrico
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Masciocchi
- Neuroimmunology Laboratory and Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Mandelli
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
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148
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Lopci E, Hicks RJ, Dimitrakopoulou-Strauss A, Dercle L, Iravani A, Seban RD, Sachpekidis C, Humbert O, Gheysens O, Glaudemans AWJM, Weber W, Wahl RL, Scott AM, Pandit-Taskar N, Aide N. Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [ 18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:2323-2341. [PMID: 35376991 PMCID: PMC9165250 DOI: 10.1007/s00259-022-05780-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The goal of this guideline/procedure standard is to assist nuclear medicine physicians, other nuclear medicine professionals, oncologists or other medical specialists for recommended use of [18F]FDG PET/CT in oncological patients undergoing immunotherapy, with special focus on response assessment in solid tumors. METHODS In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard. CONCLUSIONS The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [18F]FDG PET/CT during immunotherapy. Local variations to this guideline should be taken into consideration. PREAMBLE The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association founded in 1985 to facilitate worldwide communication among individuals pursuing clinical and academic excellence in nuclear medicine. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote science, technology and practical application of nuclear medicine. The Australian and New Zealand Society of Nuclear Medicine (ANZSNM), founded in 1969, represents the major professional society fostering the technical and professional development of nuclear medicine practice across Australia and New Zealand. It promotes excellence in the nuclear medicine profession through education, research and a commitment to the highest professional standards. EANM, SNMMI and ANZSNM members are physicians, technologists, physicists and scientists specialized in the research and clinical practice of nuclear medicine. All three societies will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the EANM/SNMMI/ANZSNM, has undergone a thorough consensus process, entailing extensive review. These societies recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents based on current knowledge. They are not intended to be inflexible rules or requirements of practice, nor should they be used to establish a legal standard of care. For these reasons and those set forth below, the EANM, SNMMI and ANZSNM caution against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals considering the unique circumstances of each case. Thus, there is no implication that an action differing from what is laid out in the guidelines/procedure standards, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines/procedure standards. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/ guidelines will not ensure a successful outcome. All that should be expected is that practitioners follow a reasonable course of action, based on their level of training, current knowledge, clinical practice guidelines, available resources and the needs/context of the patient being treated. The sole purpose of these guidelines is to assist practitioners in achieving this objective. The present guideline/procedure standard was developed collaboratively by the EANM, the SNMMI and the ANZSNM, with the support of international experts in the field. They summarize also the views of the Oncology and Theranostics and the Inflammation and Infection Committees of the EANM, as well as the procedure standards committee of the SNMMI, and reflect recommendations for which the EANM and SNMMI cannot be held responsible. The recommendations should be taken into the context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions.
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Affiliation(s)
- E Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - R J Hicks
- The Department of Medicine, St Vincent's Medical School, the University of Melbourne, Melbourne, Australia
| | - A Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - L Dercle
- Department of Radiology, New York Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - A Iravani
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - R D Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France
| | - C Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - O Humbert
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
- TIRO-UMR E 4320, Université Côte d'Azur, Nice, France
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A W J M Glaudemans
- Nuclear Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Weber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - R L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Studley Rd, Heidelberg, Victoria, 3084, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - N Pandit-Taskar
- Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10021, USA
| | - N Aide
- Nuclear Medicine Department, University Hospital, Caen, France
- INSERM ANTICIPE, Normandie University, Caen, France
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149
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Mori R, Uemura M, Sekido Y, Hata T, Ogino T, Takahashi H, Miyoshi N, Mizushima T, Doki Y, Eguchi H. Locally advanced rectal cancer receiving total neoadjuvant therapy combined with nivolumab: a case report and literature review. World J Surg Oncol 2022; 20:166. [PMID: 35619103 PMCID: PMC9134598 DOI: 10.1186/s12957-022-02624-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The standard treatment for locally advanced rectal cancer (LARC) is preoperative chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. However, it has been suggested that intensification of neoadjuvant treatment with polychemotherapy in addition to CRT instead of as an adjuvant chemotherapy is better tolerated and associated with a higher pathological complete response (pCR) rate. This concept is known as total neoadjuvant therapy (TNT). Recently, the addition of immunotherapy to preoperative CRT has been reported to be useful in LARC patients with mismatch-repair-deficiency and high levels of microsatellite instability (MSI-H), but there are no reports showing the therapeutic effect of nivolumab in combination with TNT. CASE PRESENTATION A 23-year-old man had frequent diarrhea. Preoperative examination revealed two adenocarcinomas in the rectum. His maternal grandmother had a rectal cancer patient who developed the disease at age 70s. The larger tumor was located at the peritoneal reflection, and its anterior border close to the prostate (<1 mm); there were eight enlarged pararectal lymph nodes. Considering the size and depth of the tumor, it was judged that radical resection with sufficient margins would be difficult. Therefore, it was decided that TNT would be performed. At first, CAPOX (capecitabine and L-OHP) was administered, followed by preoperative CRT (RT:50.4 Gy and capecitabine). During this period, genetic testing diagnosed this patient as MSI-H, so additional nivolumab was administered after CRT. Colonoscopy revealed that the larger tumor was no longer detectable, so robot-assisted intersphincteric resection and bilateral lateral lymph node dissection was performed. The diagnosis of pCR was made for the larger tumor and partial response was achieved for the smaller tumor, and no lymph node metastasis was found. Major complications were not observed and the patient was discharged on the 14th day after surgery. He was followed up without adjuvant chemotherapy and is alive and recurrence-free after 9 months. CONCLUSION A case of LARC with MSI-H was treated with TNT with nivolumab, resulting in pCR and complete radical resection. This result suggests that nivolumab in addition to TNT can be an option as a preoperative strategy for LARC with MSI-H.
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Affiliation(s)
- Ryota Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan.
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 565-0871, 2-2, Yamadaoka, Suita, Osaka, Japan
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Oki T, Inoue A, Nagatani Y, Oki M, Watanabe Y. Computed tomography imaging findings of nivolumab-induced thyroid dysfunction. J Clin Imaging Sci 2022; 12:22. [PMID: 35673588 PMCID: PMC9168394 DOI: 10.25259/jcis_194_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022] Open
Abstract
The thyroid gland is most frequently involved in immune-related adverse events (irAEs) by nivolumab. We reviewed the thyroid function and thyroid gland volume and volume change ratio between baseline and follow-up CT (volume follow-up/volume baseline) in 24 patients treated with nivolumab for lung cancer and renal cell carcinoma. Among them, four (16.7%) demonstrated nivolumab-induced thyroid dysfunction that shows either hypothyroidism or hyperthyroidism. Three and one cases were treated with nivolumab for lung cancer and renal cell carcinoma, respectively. Two patients with hypothyroidism (cases 1 and 2) showed reduced thyroid volume (volume change ratio: 0.80 and 0.84) on computed tomography (CT) images. Besides, remarkably diminished CT attenuation of the thyroid gland was observed in a patient with hypothyroidism (case 2). One of the two patients with hyperthyroidism showed increased thyroid volume (volume change ratio: 1.32) (case 3), whereas no difference in the thyroid gland volume was observed between the previous and follow-up CT in another patient with hyperthyroidism (case 4). Thyroid volume change ratio >0.1 was observed even in 6 of 20 (30%) patients without thyroid dysfunction. Considering the wide use of nivolumab in cancer treatment, radiologists should be aware that changes in the thyroid volume and attenuation on CT are associated with thyroid dysfunction caused by nivolumab, as well as thyroid volume may change even in patients with normal thyroid function during nivolumab therapy.
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Affiliation(s)
- Tatsuya Oki
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan,
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan,
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan,
| | - Maya Oki
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan,
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan,
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