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Dovedi SJ, Adlard AL, Lipowska-Bhalla G, McKenna C, Jones S, Cheadle EJ, Stratford IJ, Poon E, Morrow M, Stewart R, Jones H, Wilkinson RW, Honeychurch J, Illidge TM. Acquired resistance to fractionated radiotherapy can be overcome by concurrent PD-L1 blockade. Cancer Res 2014; 74:5458-68. [PMID: 25274032 DOI: 10.1158/0008-5472.can-14-1258] [Citation(s) in RCA: 916] [Impact Index Per Article: 91.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radiotherapy is a major part in the treatment of most common cancers, but many patients experience local recurrence with metastatic disease. In evaluating response biomarkers, we found that low doses of fractionated radiotherapy led to PD-L1 upregulation on tumor cells in a variety of syngeneic mouse models of cancer. Notably, fractionated radiotherapy delivered in combination with αPD-1 or αPD-L1 mAbs generated efficacious CD8(+) T-cell responses that improved local tumor control, long-term survival, and protection against tumor rechallenge. These favorable outcomes were associated with induction of a tumor antigen-specific memory immune response. Mechanistic investigations showed that IFNγ produced by CD8(+) T cells was responsible for mediating PD-L1 upregulation on tumor cells after delivery of fractionated radiotherapy. Scheduling of anti-PD-L1 mAb was important for therapeutic outcome, with concomitant but not sequential administration with fractionated radiotherapy required to improve survival. Taken together, our results reveal the mechanistic basis for an adaptive response by tumor cells that mediates resistance to fractionated radiotherapy and its treatment failure. With attention to scheduling, combination immunoradiotherapy with radiotherapy and PD-1/PD-L1 signaling blockade may offer an immediate strategy for clinical evaluation to improve treatment outcomes.
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Affiliation(s)
- Simon J Dovedi
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Amy L Adlard
- Experimental Oncology Group, School of Pharmacy, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Grazyna Lipowska-Bhalla
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Conor McKenna
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Sherrie Jones
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Eleanor J Cheadle
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Ian J Stratford
- Experimental Oncology Group, School of Pharmacy, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Edmund Poon
- MedImmune Ltd, Granta Park, Cambridge, United Kingdom
| | | | - Ross Stewart
- MedImmune Ltd, Granta Park, Cambridge, United Kingdom
| | - Hazel Jones
- MedImmune Ltd, Granta Park, Cambridge, United Kingdom
| | | | - Jamie Honeychurch
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Tim M Illidge
- Targeted Therapy Group, Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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1752
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1753
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Krygier JE, Lewis VO, Cannon CP, Satcher RL, Moon BS, Lin PP. Operative management of metastatic melanoma in bone may require en bloc resection of disease. Clin Orthop Relat Res 2014; 472:3196-203. [PMID: 24989125 PMCID: PMC4160486 DOI: 10.1007/s11999-014-3761-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 06/11/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone metastasis is a poor prognostic indicator in melanoma. Some authors have advocated only palliative treatment for patients with osseous disease. QUESTIONS/PURPOSES We determined (1) overall survival after surgery for bone metastasis in patients with malignant melanoma, (2) the rate of local relapse after surgery for bone metastasis, (3) whether certain patients might benefit from more extensive surgery to reduce the risk of local recurrence, and (4) whether there is an effect of prior radiation on survival and local progression. METHODS We identified 37 patients who underwent 41 orthopaedic procedures for metastatic melanoma to bone in the pelvis or appendicular skeleton, including 20 for pathologic fracture, from our institutional orthopaedic database and performed a retrospective review of their charts and radiographs. The femur (n = 19) and humerus (n = 11) were the most common operative sites. Kaplan-Meier survivorship was used to determine overall survival and local progression-free survival. RESULTS The median survival from surgery was 9 months (range, 1-135 months). Kaplan-Meier analysis showed overall survival of 30% at 12 months and 17% at 24 months. Local recurrence developed in seven of 41 lesions (17%). The local progression-free survival was 87% at 12 months and 67% at 24 months. Patients for whom prior radiation failed and patients who did not have excision of osseous metastases had higher rates of local recurrence. Two patients underwent amputation for uncontrolled local progression of disease. CONCLUSIONS Osseous metastasis from melanoma behaves aggressively. The rate of local progression is substantial, and two of 37 patients in this series required amputation for progressive disease. Despite the poor overall prognosis, local control of bone disease is an important issue, and patients may benefit from resection of osseous metastases, particularly if prior radiation has failed.
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Affiliation(s)
- Jeffrey E. Krygier
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA USA ,Stanford University School of Medicine, Stanford, CA USA
| | - Valerae O. Lewis
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Unit 1448, Houston, TX 77230 USA
| | | | - Robert L. Satcher
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Unit 1448, Houston, TX 77230 USA
| | - Bryan S. Moon
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Unit 1448, Houston, TX 77230 USA
| | - Patrick P. Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Unit 1448, Houston, TX 77230 USA
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1754
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Sherbenou DW, Behrens CR, Su Y, Wolf JL, Martin TG, Liu B. The development of potential antibody-based therapies for myeloma. Blood Rev 2014; 29:81-91. [PMID: 25294123 DOI: 10.1016/j.blre.2014.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 01/27/2023]
Abstract
With optimal target antigen selection antibody-based therapeutics can be very effective agents for hematologic malignancies, but none have yet been approved for myeloma. Rituximab and brentuximab vedotin are examples of success for the naked antibody and antibody-drug conjugate classes, respectively. Plasma cell myeloma is an attractive disease for antibody-based targeting due to target cell accessibility and the complementary mechanism of action with approved therapies. Initial antibodies tested in myeloma were disappointing. However, recent results from targeting well-characterized antigens have been more encouraging. In particular, the CD38 and CD138 targeted therapies are showing single-agent activity in early phase clinical trials. Here we will review the development pipeline for naked antibodies and antibody-drug conjugates for myeloma. There is clear clinical need for new treatments, as myeloma inevitably becomes refractory to standard agents. The full impact is yet to be established, but we are optimistic that the first FDA-approved antibody therapeutic(s) for this disease will emerge in the near future.
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Affiliation(s)
- Daniel W Sherbenou
- Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA; Department of UCSF Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94110, USA
| | - Christopher R Behrens
- Department of Anesthesia, University of California San Francisco, San Francisco, CA 94110, USA
| | - Yang Su
- Department of Anesthesia, University of California San Francisco, San Francisco, CA 94110, USA
| | - Jeffrey L Wolf
- Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA; Department of UCSF Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94110, USA
| | - Thomas G Martin
- Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA; Department of UCSF Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94110, USA
| | - Bin Liu
- Department of Anesthesia, University of California San Francisco, San Francisco, CA 94110, USA; Department of UCSF Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94110, USA
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1755
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Johnson DB, Hames ML, Sosman JA. The MEK inhibitor trametinib for the treatment of advanced melanoma. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.962513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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1756
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Abstract
In the past decade, we have witnessed unprecedented changes and some remarkable advances that have enabled true personalized medicine. Nevertheless, many challenges in clinical cancer research remain and need to be overcome if we are to witness similar progress in the next decade. Such hurdles include, but are not limited to, clinical development and testing of multiple agents in combination, design of clinical trials to best accommodate the ever increasing knowledge of heterogeneity of the disease, regulatory challenges relating to drug development and trial design, and funding for basic research. With this in mind, we asked four leading cancer researchers from around the world, and who have been associated with the journal since its launch in November 2004 what, in their opinion, we have learnt over the past 10 years and how we should progress in the next 10 years.
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1757
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Robert C, Ribas A, Wolchok JD, Hodi FS, Hamid O, Kefford R, Weber JS, Joshua AM, Hwu WJ, Gangadhar TC, Patnaik A, Dronca R, Zarour H, Joseph RW, Boasberg P, Chmielowski B, Mateus C, Postow MA, Gergich K, Elassaiss-Schaap J, Li XN, Iannone R, Ebbinghaus SW, Kang SP, Daud A. Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial. Lancet 2014; 384:1109-17. [PMID: 25034862 DOI: 10.1016/s0140-6736(14)60958-2] [Citation(s) in RCA: 1363] [Impact Index Per Article: 136.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The anti-programmed-death-receptor-1 (PD-1) antibody pembrolizumab has shown potent antitumour activity at different doses and schedules in patients with melanoma. We compared the efficacy and safety of pembrolizumab at doses of 2 mg/kg and 10 mg/kg every 3 weeks in patients with ipilimumab-refractory advanced melanoma. METHODS In an open-label, international, multicentre expansion cohort of a phase 1 trial, patients (aged ≥18 years) with advanced melanoma whose disease had progressed after at least two ipilimumab doses were randomly assigned with a computer-generated allocation schedule (1:1 final ratio) to intravenous pembrolizumab at 2 mg/kg every 3 weeks or 10 mg/kg every 3 weeks until disease progression, intolerable toxicity, or consent withdrawal. Primary endpoint was overall response rate (ORR) assessed with the Response Evaluation Criteria In Solid Tumors (RECIST, version 1.1) by independent central review. Analysis was done on the full-analysis set (all treated patients with measurable disease at baseline). This study is registered with ClinicalTrials.gov, number NCT01295827. FINDINGS 173 patients received pembrolizumab 2 mg/kg (n=89) or 10 mg/kg (n=84). Median follow-up duration was 8 months. ORR was 26% at both doses--21 of 81 patients in the 2 mg/kg group and 20 of 76 in the 10 mg/kg group (difference 0%, 95% CI -14 to 13; p=0·96). Treatment was well tolerated, with similar safety profiles in the 2 mg/kg and 10 mg/kg groups and no drug-related deaths. The most common drug-related adverse events of any grade in the 2 mg/kg and 10 mg/kg groups were fatigue (29 [33%] vs 31 [37%]), pruritus (23 [26%] vs 16 [19%]), and rash (16 [18%] vs 15 [18%]). Grade 3 fatigue, reported in five (3%) patients in the 2 mg/kg pembrolizumab group, was the only drug-related grade 3 to 4 adverse event reported in more than one patient. INTERPRETATION The results suggest that pembrolizumab at a dose of 2 mg/kg or 10 mg/kg every 3 weeks might be an effective treatment in patients for whom there are few effective treatment options. FUNDING Merck Sharp and Dohme.
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Affiliation(s)
| | - Antoni Ribas
- University of California Los Angeles, Los Angeles, CA, USA
| | - Jedd D Wolchok
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Omid Hamid
- Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | - Richard Kefford
- Crown Princess Mary Cancer Centre, Westmead Hospital and Melanoma Institute Australia, Westmead, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | | | | | - Wen-Jen Hwu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tara C Gangadhar
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, TX, USA
| | | | | | | | - Peter Boasberg
- Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | - Adil Daud
- University of California San Francisco, San Francisco, CA, USA
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1758
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Blocking tumor escape in hematologic malignancies: the anti-PD-1 strategy. Blood Rev 2014; 29:25-32. [PMID: 25260226 DOI: 10.1016/j.blre.2014.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/26/2014] [Accepted: 09/09/2014] [Indexed: 12/31/2022]
Abstract
Immunotherapy remains an important tool for treatment of hematologic malignancies. The Programmed Death-1 (PD-1) immune checkpoint pathway has emerged as a mechanism of tumor evasion from the anti-tumor immune response. The recent development of anti-PD-1 monoclonal antibodies has offered a targeted approach to cancer therapy. Several agents are in various stages of development and have shown clinical responses across a broad spectrum of both solid and hematologic malignancies. The use of anti-PD-1 therapy in hematologic malignancies is limited but has demonstrated clinical responses in relapsed/refractory disease following multiple lines of therapy. PD-1 blockade may reduce relapse rates for patients who fail to obtain a complete remission prior to autologous hematopoietic cell transplant. The role of the PD-1 pathway for tumor escape is reviewed. We explore the use of anti-PD-1 therapy in hematologic malignancies. The proposed mechanism of PD-1 blockade as a modulator of the innate and acquired immune response is considered. Finally, the challenges of anti-PD-1 therapy and the future direction of investigation in this area are reviewed.
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1759
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Jackson LK, Johnson DB, Sosman JA, Murphy BA, Epstein JB. Oral health in oncology: impact of immunotherapy. Support Care Cancer 2014; 23:1-3. [PMID: 25216852 DOI: 10.1007/s00520-014-2434-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Leanne K Jackson
- Department of Medicine, Vanderbilt University, Nashville, TN, USA,
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1760
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Suresh T, Lee LX, Joshi J, Barta SK. New antibody approaches to lymphoma therapy. J Hematol Oncol 2014; 7:58. [PMID: 25355407 PMCID: PMC4172963 DOI: 10.1186/s13045-014-0058-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/29/2014] [Indexed: 01/01/2023] Open
Abstract
The CD20-directed monoclonal antibody rituximab established a new era in lymphoma therapy. Since then other epitopes on the lymphoma surface have been identified as potential targets for monoclonal antibodies (mAb). While most mAbs eliminate lymphoma cells mainly by antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity or direct cell death, others counter mechanisms utilized by malignant cells to evade immune surveillance. Expression of PD-L1 on malignant or stromal cells in the tumor environment for example leads to T-cell anergy. Targeting either PD-1 or PD-L1 via mAbs can indirectly eliminate cancer cells by unblocking the host intrinsic immune response. Yet another mechanism of targeted therapy with mAbs are bi-specific T-cell engagers (BiTE) such as blinatumomab, which directly engages the host immune cells. These examples highlight the broad spectrum of available therapies targeting the lymphoma surface with mAbs utilizing both passive and active immune pathways. Many of these agents have already demonstrated significant activity in clinical trials. In this review we will focus on novel CD20-directed antibodies as well as mAbs directed against newer targets like CD19, CD22, CD40, CD52 and CCR4. In addition we will review mAbs unblocking immune checkpoints and the BiTE blinatumomab. Given the success of mAbs and the expansion in active and passive immunotherapies, these agents will play an increasing role in the treatment of lymphomas.
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1761
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Sharon E, Streicher H, Goncalves P, Chen HX. Immune checkpoint inhibitors in clinical trials. CHINESE JOURNAL OF CANCER 2014; 33:434-44. [PMID: 25189716 PMCID: PMC4190433 DOI: 10.5732/cjc.014.10122] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/22/2014] [Indexed: 12/14/2022]
Abstract
Immunology-based therapy is rapidly developing into an effective treatment option for a surprising range of cancers. We have learned over the last decade that powerful immunologic effector cells may be blocked by inhibitory regulatory pathways controlled by specific molecules often called "immune checkpoints." These checkpoints serve to control or turn off the immune response when it is no longer needed to prevent tissue injury and autoimmunity. Cancer cells have learned or evolved to use these mechanisms to evade immune control and elimination. The development of a new therapeutic class of drugs that inhibit these inhibitory pathways has recently emerged as a potent strategy in oncology. Three sets of agents have emerged in clinical trials exploiting this strategy. These agents are antibody-based therapies targeting cytotoxic T-lymphocyte antigen 4 (CTLA4), programmed cell death 1 (PD-1), and programmed cell death ligand 1 (PD-L1). These inhibitors of immune inhibition have demonstrated extensive activity as single agents and in combinations. Clinical responses have been seen in melanoma, renal cell carcinoma, non-small cell lung cancer, and several other tumor types. Despite the autoimmune or inflammatory immune-mediated adverse effects which have been seen, the responses and overall survival benefits exhibited thus far warrant further clinical development.
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Affiliation(s)
- Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA.
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1762
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Abstract
BACKGROUND Melanoma is a potentially curable cancer, but around 20% of patients will develop disease which is beyond surgical clearance. Rising incidence alongside breakthroughs in understanding the molecular biology of this disease identifying systemic therapies offering survival gains now demand a more proactive, integrated approach to melanoma management. SOURCES OF DATA PubMed references relating to aspects of melanoma research and treatment. AREAS OF AGREEMENT Rapidly rising incidence throughout the world. Effective surgery as well as new molecular targeted systemic biological agents and immunotherapies necessitating early diagnosis and multidisciplinary therapeutic interventions. AREAS OF CONTROVERSY Role of screening and prevention. Benefit of interventions for locoregional melanoma, including role of sentinel lymph node biopsy. Integration and sequencing of treatments for unresectable melanoma. GROWING POINTS Molecular determinants of melanoma influencing disease outcome and treatment decisions. AREAS TIMELY FOR DEVELOPING RESEARCH Education and training of patient and healthcare professionals. Role of screening, surveillance and follow-up strategies. Biology of melanoma guiding treatment decisions.
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Affiliation(s)
- Pippa Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge CB2 0QQ, UK
| | - Mirela Hategan
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge CB2 0QQ, UK
| | - Kate Fife
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge CB2 0QQ, UK
| | - Christine Parkinson
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge CB2 0QQ, UK
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1763
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Trefzer U, Gutzmer R, Wilhelm T, Schenck F, Kähler KC, Jacobi V, Witthohn K, Lentzen H, Mohr P. Treatment of unresectable stage IV metastatic melanoma with aviscumine after anti-neoplastic treatment failure: a phase II, multi-centre study. J Immunother Cancer 2014; 2:27. [PMID: 25324973 PMCID: PMC4198912 DOI: 10.1186/s40425-014-0027-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background Aviscumine, a recombinant plant protein, is an immune modulator that induces ribotoxic stress at the 28S ribosomal RNA subunit. In this way cytokine release and T-cell responses are enhanced. This phase II trial was conducted to test the efficacy and safety of aviscumine in patients with systemically pre-treated metastatic melanoma stage IV. Methods A total of 32 patients with progressive stage IV melanoma after failure of standard therapy were enrolled onto a single-arm, multi-centre, open-label, phase II trial. All patients had an ECOG performance status of 0 or 1. Patients received 350 ng aviscumine twice weekly by subcutaneous injection until progression. The primary end points were progression-free survival (PFS) and overall survival (OS). Safety was assessed as adverse events (AEs). Tumor response was assessed every eight weeks and survival of patients was followed up to one year after the end of therapy. Thirty one patients (intent-to-treat population (ITT)) were assessed for efficacy; safety was assessed in the whole population. Results One patient achieved a partial response (PR) and 10 patients showed stable disease/no change (SD). The median progression-free survival (mPFS) was 63 days (95% CI 57–85) and median overall survival (mOS) was 335 days (95% CI 210–604). In total 210 treatment-emergent adverse events were recorded. Grade 1 or 2 AEs occurred in 72% of patients and were mostly application-site effects such as pruritus Grade 3–4 treatment-emergent drug-related adverse events occurred in 9% of patients. Conclusion These results suggest that aviscumine may have a clinical impact in patients with previously treated metastatic melanoma and provide rationale for further clinical evaluation of this agent. In the light of effective new immune checkpoint blockers it might be a candidate for combinations with these agents. Trial registration ClinicalTrials.gov: NCT00658437
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Affiliation(s)
| | - Ralf Gutzmer
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Hannover, Germany
| | - Tabea Wilhelm
- Charité- Universitätsmedizin Berlin, Hauttumorcentrum Charité (HTCC), Klinik für Dermatologie, Venerologie und Allergologie, Berlin, Germany
| | | | - Katharina C Kähler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein -Campus Kiel-, Kiel, Germany
| | - Volkmar Jacobi
- Institut für Diagnostische Radiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main, Germany
| | | | | | - Peter Mohr
- Elbe-Klinikum Buxtehude, Dermatologisches Zentrum, Buxtehude, Germany
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1764
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Vaccheli E, Michels J, Hadoux J, Lotz JP. American association for cancer research — AACR congress 2014. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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1765
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Improved mouse models to assess tumour immunity and irAEs after combination cancer immunotherapies. Clin Transl Immunology 2014; 3:e22. [PMID: 25505970 PMCID: PMC4232074 DOI: 10.1038/cti.2014.18] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 02/08/2023] Open
Abstract
The current excitement surrounding cancer immunotherapy stems particularly from clinical data involving agents mediating immune checkpoint receptor blockade, which have induced unprecedented efficacy against a range of tumours compared with previous immunotherapeutic approaches. However, an important consideration in targeting checkpoint receptors has been the emergence of associated toxicities termed immune-related adverse events (irAEs). In light of the clinical benefits observed after co-blockade of checkpoint receptors and data from preclinical mouse models, there is now a strong rationale to combine different checkpoint receptors together, with other immunotherapies or more conventional therapies to assess if clinical benefits to cancer patients can be further improved. However, one may predict the frequency and severity of irAEs will increase with combinations, which may result in premature therapy cessation, thus limiting the realization of such an approach. In addition, there is a limit to how many different combination therapies that can be tested in a timely manner given the legal, regulatory and budgetary issues associated with conducting clinical trials. Thus, there is a need to develop preclinical mouse models that more accurately inform us as to which immunotherapies might combine best to provide the optimal therapeutic index (maximal anti-tumour efficacy and low level irAEs) in different cancer settings. In this review we will discuss the irAEs observed in patients after checkpoint blockade and discuss which mouse models of cancer can be appropriate to assess the development of tumour immunity and irAEs following combination cancer immunotherapies.
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1766
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Ribas A, Tumeh PC. The future of cancer therapy: selecting patients likely to respond to PD1/L1 blockade. Clin Cancer Res 2014; 20:4982-4. [PMID: 24970841 DOI: 10.1158/1078-0432.ccr-14-0933] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is conceivable that, in the near future, an assay that defines the likelihood of a patient with advanced cancer to respond to immunotherapy based on PD1/L1 blockade will be the initial decision point to select the treatment of patients with any cancer type.
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Affiliation(s)
- Antoni Ribas
- Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California. Department of Surgery, University of California Los Angeles, Los Angeles, California. Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California. Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California.
| | - Paul C Tumeh
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
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1767
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Robert L, Harview C, Emerson R, Wang X, Mok S, Homet B, Comin-Anduix B, Koya RC, Robins H, Tumeh PC, Ribas A. Distinct immunological mechanisms of CTLA-4 and PD-1 blockade revealed by analyzing TCR usage in blood lymphocytes. Oncoimmunology 2014; 3:e29244. [PMID: 25083336 PMCID: PMC4108466 DOI: 10.4161/onci.29244] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 01/14/2023] Open
Abstract
Targeting immune inhibitory receptors has brought excitement, innovation and hope to cancer patients. Our recent work revealed the immunological effects of blocking the CTLA4 and PD-1 immune checkpoints on T cell receptor usage among peripheral blood cells, and further uncovers how the expansion of the T cell repertoire matches the immunotoxicity profile of the therapy.
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Affiliation(s)
- Lidia Robert
- Department of Medicine (Division of Hematology-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Christina Harview
- Department of Medicine (Division of Dermatology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Ryan Emerson
- Fred Hutchinson Cancer Research Center; Seattle, WA USA ; Adaptive Biotechnologies; Seattle, WA USA
| | - Xiaoyan Wang
- Department of Medicine (Division of Hematology-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA ; Department of Medicine (Statistics core); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Stephen Mok
- Department of Surgery (Division of Surgical-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Blanca Homet
- Department of Medicine (Division of Hematology-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Begonya Comin-Anduix
- Department of Surgery (Division of Surgical-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA ; Jonsson Comprehensive Cancer Center (JCCC); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Richard C Koya
- Department of Surgery (Division of Surgical-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Harlan Robins
- Fred Hutchinson Cancer Research Center; Seattle, WA USA ; Adaptive Biotechnologies; Seattle, WA USA
| | - Paul C Tumeh
- Department of Medicine (Division of Dermatology); University of California Los Angeles (UCLA); Los Angeles, CA USA
| | - Antoni Ribas
- Department of Medicine (Division of Hematology-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA ; Department of Surgery (Division of Surgical-Oncology); University of California Los Angeles (UCLA); Los Angeles, CA USA ; Jonsson Comprehensive Cancer Center (JCCC); University of California Los Angeles (UCLA); Los Angeles, CA USA
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1768
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Luke JJ, Ott PA. New developments in the treatment of metastatic melanoma - role of dabrafenib-trametinib combination therapy. DRUG HEALTHCARE AND PATIENT SAFETY 2014; 6:77-88. [PMID: 25018652 PMCID: PMC4075957 DOI: 10.2147/dhps.s39568] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Development of selective inhibitors of BRAF has improved the survival of patients with BRAF-mutant melanoma. The progression-free survival after treatment with a BRAF inhibitor is modest, however, and BRAF inhibitors induce cutaneous toxicity, likely due to paradoxical activation of the mitogen-activated protein kinase pathway. Combining selective BRAF and MEK inhibition, such as the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib, has been shown to improve the response rate and progression-free survival in patients with advanced melanoma while significantly alleviating the paradoxical activation of mitogen-activated protein kinase. This combination treatment results in a reduction in skin toxicity relative to that seen with a BRAF inhibitor alone; however, addition of the MEK inhibitor adds other toxicities, such as pyrexia and gastrointestinal or ocular toxicity. While combined BRAF–MEK inhibition appears primed to become a standard molecular approach for BRAF-mutant melanoma, the utility of the combination has to be considered in the rapidly changing landscape of immunotherapeutics, such as immune checkpoint blockade using anti-cytotoxic T lymphocyte antigen-4 and anti-programmed death-1/programmed death-L1 antibodies. Here we review the development of the dabrafenib plus trametinib combination, the characteristics of each drug and the combination, and the role of this combination in the management of patients with BRAF-mutant melanoma.
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Affiliation(s)
- Jason J Luke
- Melanoma Disease Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Patrick A Ott
- Melanoma Disease Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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1769
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Malas S, Harrasser M, Lacy KE, Karagiannis SN. Antibody therapies for melanoma: new and emerging opportunities to activate immunity (Review). Oncol Rep 2014; 32:875-86. [PMID: 24969320 PMCID: PMC4121424 DOI: 10.3892/or.2014.3275] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/06/2014] [Indexed: 12/21/2022] Open
Abstract
The interface between malignant melanoma and patient immunity has long been recognised and efforts to treat this most lethal form of skin cancer by activating immune responses with cytokine, vaccine and also antibody immunotherapies have demonstrated promise in limited subsets of patients. In the present study, we discuss different antibody immunotherapy approaches evaluated in the context of melanoma, each designed to act on distinct targets and to employ different mechanisms to restrict tumour growth and spread. Monoclonal antibodies recognising melanoma-associated antigens such as CSPG4/MCSP and targeting elements of tumour-associated vasculature (VEGF) have constituted long-standing translational approaches aimed at reducing melanoma growth and metastasis. Recent insights into mechanisms of immune regulation and tumour-immune cell interactions have helped to identify checkpoint molecules on immune (CTLA4, PD-1) and tumour (PD-L1) cells as promising therapeutic targets. Checkpoint blockade with antibodies to activate immune responses and perhaps to counteract melanoma-associated immunomodulatory mechanisms led to the first clinical breakthrough in the form of an anti-CTLA4 monoclonal antibody. Novel modalities to target key mechanisms of immune suppression and to redirect potent effector cell subsets against tumours are expected to improve clinical outcomes and to provide previously unexplored avenues for therapeutic interventions.
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Affiliation(s)
- Sadek Malas
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals, King's College London, London SE1 9RT, UK
| | - Micaela Harrasser
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals, King's College London, London SE1 9RT, UK
| | - Katie E Lacy
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals, King's College London, London SE1 9RT, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals, King's College London, London SE1 9RT, UK
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1770
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Zimmer L, Barlesi F, Martinez-Garcia M, Dieras V, Schellens JHM, Spano JP, Middleton MR, Calvo E, Paz-Ares L, Larkin J, Pacey S, Venturi M, Kraeber-Bodéré F, Tessier JJL, Eberhardt WEE, Paques M, Guarin E, Meresse V, Soria JC. Phase I expansion and pharmacodynamic study of the oral MEK inhibitor RO4987655 (CH4987655) in selected patients with advanced cancer with RAS-RAF mutations. Clin Cancer Res 2014; 20:4251-61. [PMID: 24947927 DOI: 10.1158/1078-0432.ccr-14-0341] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase I expansion study assessed safety, pharmacodynamic effects, and antitumor activity of RO4987655, a pure MEK inhibitor, in selected patients with advanced solid tumor. EXPERIMENTAL DESIGN We undertook a multicenter phase I two-part study (dose escalation and cohort expansion). Here, we present the part 2 expansion that included melanoma, non-small cell lung cancer (NSCLC), and colorectal cancer with oral RO4987655 administered continuously at recommended doses of 8.5 mg twice daily until progressive disease (PD). Sequential tumor sampling investigated multiple markers of pathway activation/tumor effects, including ERK phosphorylation and Ki-67 expression. BRAF and KRAS testing were implemented as selection criteria and broader tumor mutational analysis added. RESULTS Ninety-five patients received RO4987655, including 18 BRAF-mutant melanoma, 23 BRAF wild-type melanoma, 24 KRAS-mutant NSCLC, and 30 KRAS-mutant colorectal cancer. Most frequent adverse events were rash, acneiform dermatitis, and gastrointestinal disorders, mostly grade 1/2. Four (24%) of 17 BRAF-mutated melanoma had partial response as did four (20%) of 20 BRAF wild-type melanoma and two (11%) of 18 KRAS-mutant NSCLC. All KRAS-mutant colorectal cancer developed PD. Paired tumor biopsies demonstrated reduced ERK phosphorylation among all cohorts but significant differences among cohorts in Ki-67 modulation. Sixty-nine percent showed a decrease in fluorodeoxyglucose uptake between baseline and day 15. Detailed mutational profiling confirmed RAS/RAF screening and identified additional aberrations (NRAS/non-BRAF melanomas; PIK3CA/KRAS colorectal cancer) without therapeutic implications. CONCLUSIONS Safety profile of RO4987655 was comparable with other MEK inhibitors. Single-agent activity was observed in all entities except colorectal cancer. Evidence of target modulation and early biologic activity was shown among all indications independent of mutational status. Clin Cancer Res; 20(16); 4251-61. ©2014 AACR.
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Affiliation(s)
- Lisa Zimmer
- Department of Dermatology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Phase I unit, CIC- CPCET, Marseille, France
| | - Maria Martinez-Garcia
- Department of Medical Oncology, Hospital del Mar and Cancer Research Program, IMIM, Barcelona, Spain
| | | | | | | | - Mark R Middleton
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Emiliano Calvo
- START Madrid, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - James Larkin
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Simon Pacey
- University of Cambridge, Department of Oncology, Cambridge, United Kingdom
| | - Miro Venturi
- Pharma Research and Early Development, Oncology, Roche Penzberg, Germany
| | | | - Jean J L Tessier
- Pharma Research and Early Development, Oncology, Roche, Switzerland
| | - Wilfried Ernst Erich Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany.
| | - Michel Paques
- Clinical Investigation Center 1423, Quinze-Vingts Hospital, Paris 6 University, Paris, France
| | - Ernesto Guarin
- Pharma Research and Early Development, Oncology, Roche, Switzerland
| | - Valerie Meresse
- Pharma Research and Early Development, Oncology, Roche, Switzerland
| | - Jean-Charles Soria
- SITEP, Gustave Roussy Cancer Center, University Paris-Sud, Villejuif, Paris, France
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1771
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Kyi C, Hellmann MD, Wolchok JD, Chapman PB, Postow MA. Opportunistic infections in patients treated with immunotherapy for cancer. J Immunother Cancer 2014; 2:19. [PMID: 24991413 PMCID: PMC4079190 DOI: 10.1186/2051-1426-2-19] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/14/2014] [Indexed: 11/10/2022] Open
Abstract
Immunomodulatory antibodies that enhance the immune system to fight cancer are revolutionizing the treatment of patients with an expanding variety of malignancies. There is a unique spectrum of side effects associated with immunomodulatory antibodies, termed immune-related adverse events (irAEs), which include colitis and hepatitis among others. The treatment of refractory or severe irAEs can occasionally require significant immunosuppression, involving steroids or tumor necrosis factor-alpha antagonists, placing these patients at risk for infections. We present the first reported case to our knowledge of an opportunistic infection in a patient treated with an immunomodulatory antibody. As the use of immunomodulatory antibodies expands and more patients develop irAEs that require treatment with immunosuppression, recognition of the potential for opportunistic infections in this emerging patient population will be critical. Prospective trials are needed to define the optimal immunosuppressive management of irAEs and determine whether prophylactic antiviral, antibacterial, or antifungal therapies are beneficial in this unique population.
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Affiliation(s)
- Chrisann Kyi
- New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Matthew D Hellmann
- Memorial Sloan-Kettering Cancer Center, Melanoma and Immunotherapeutics Oncology Service, 300 East 66th Street, New York, NY 10065, USA
| | - Jedd D Wolchok
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Paul B Chapman
- Memorial Sloan-Kettering Cancer Center, Melanoma and Immunotherapeutics Oncology Service, 300 East 66th Street, New York, NY 10065, USA
| | - Michael A Postow
- Memorial Sloan-Kettering Cancer Center, Melanoma and Immunotherapeutics Oncology Service, 300 East 66th Street, New York, NY 10065, USA
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1772
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Wang C, Thudium KB, Han M, Wang XT, Huang H, Feingersh D, Garcia C, Wu Y, Kuhne M, Srinivasan M, Singh S, Wong S, Garner N, Leblanc H, Bunch RT, Blanset D, Selby MJ, Korman AJ. In vitro characterization of the anti-PD-1 antibody nivolumab, BMS-936558, and in vivo toxicology in non-human primates. Cancer Immunol Res 2014; 2:846-56. [PMID: 24872026 DOI: 10.1158/2326-6066.cir-14-0040] [Citation(s) in RCA: 454] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The programmed death-1 (PD-1) receptor serves as an immunologic checkpoint, limiting bystander tissue damage and preventing the development of autoimmunity during inflammatory responses. PD-1 is expressed by activated T cells and downmodulates T-cell effector functions upon binding to its ligands, PD-L1 and PD-L2, on antigen-presenting cells. In patients with cancer, the expression of PD-1 on tumor-infiltrating lymphocytes and its interaction with the ligands on tumor and immune cells in the tumor microenvironment undermine antitumor immunity and support its rationale for PD-1 blockade in cancer immunotherapy. This report details the development and characterization of nivolumab, a fully human IgG4 (S228P) anti-PD-1 receptor-blocking monoclonal antibody. Nivolumab binds to PD-1 with high affinity and specificity, and effectively inhibits the interaction between PD-1 and its ligands. In vitro assays demonstrated the ability of nivolumab to potently enhance T-cell responses and cytokine production in the mixed lymphocyte reaction and superantigen or cytomegalovirus stimulation assays. No in vitro antibody-dependent cell-mediated or complement-dependent cytotoxicity was observed with the use of nivolumab and activated T cells as targets. Nivolumab treatment did not induce adverse immune-related events when given to cynomolgus macaques at high concentrations, independent of circulating anti-nivolumab antibodies where observed. These data provide a comprehensive preclinical characterization of nivolumab, for which antitumor activity and safety have been demonstrated in human clinical trials in various solid tumors.
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Affiliation(s)
- Changyu Wang
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Kent B Thudium
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Minhua Han
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Xi-Tao Wang
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Haichun Huang
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Diane Feingersh
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Candy Garcia
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Yi Wu
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Michelle Kuhne
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Mohan Srinivasan
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Sujata Singh
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Susan Wong
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Neysa Garner
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Heidi Leblanc
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - R Todd Bunch
- Bristol-Myers Squibb Company, Mount Vernon, Indiana; and
| | | | - Mark J Selby
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California
| | - Alan J Korman
- Biologics Discovery California, Bristol-Myers Squibb Company, Redwood City, California;
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1773
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Ascierto PA, Marincola FM. What have we learned from cancer immunotherapy in the last 3 years? J Transl Med 2014; 12:141. [PMID: 24886164 PMCID: PMC4038596 DOI: 10.1186/1479-5876-12-141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/13/2014] [Indexed: 02/03/2023] Open
Abstract
Until recently, most immunotherapeutic approaches used to fight cancer were ineffective, counteracted by the tumour's ability to evade immune attack. However, extensive research has improved our understanding of tumour immunology and enabled the development of novel treatments that can harness the patient's immune system and prevent immune escape. Over the last few years, through numerous clinical trials and real-world experience, we have accumulated a large amount of evidence regarding the potential for long-term survival with immunotherapy agents in various types of malignancy. The results of these studies have also highlighted a number of recurring observations with immuno-oncology agents, including their potential for clinical application across a broad patient population and for both conventional and unconventional response patterns. Furthermore, given the numerous immune checkpoints that exist and the multiple mechanisms used by tumours to escape the immune system, targeting distinct checkpoint pathways using combination approaches is an attractive therapeutic strategy with the potential to further enhance the antitumour immune response.
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Affiliation(s)
- Paolo A Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione “G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
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1774
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Kong YCM, Flynn JC. Opportunistic Autoimmune Disorders Potentiated by Immune-Checkpoint Inhibitors Anti-CTLA-4 and Anti-PD-1. Front Immunol 2014; 5:206. [PMID: 24904570 PMCID: PMC4032988 DOI: 10.3389/fimmu.2014.00206] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/25/2014] [Indexed: 12/16/2022] Open
Abstract
To improve the efficacy of immunotherapy for cancer and autoimmune diseases, recent ongoing and completed clinical trials have focused on specific targets to redirect the immune network toward eradicating a variety of tumors and ameliorating the self-destructive process. In a previous review, both systemic immunomodulators and monoclonal antibodies (mAbs), anti-CTLA-4, and anti-CD52, were discussed regarding therapeutics and autoimmune sequelae, as well as predisposing factors known to exacerbate immune-related adverse events (irAEs). This review will focus on immune-checkpoint inhibitors, and the data from most clinical trials involve blockade with anti-CTLA-4 such as ipilimumab. However, despite the mild to severe irAEs observed with ipilimumab in ~60% of patients, overall survival (OS) averaged ~22-25% at 3-5 years. To boost OS, other mAbs targeting programed death-1 and its ligand are undergoing clinical trials as monotherapy or dual therapy with anti-CTLA-4. Therapeutic combinations may generate different spectrum of opportunistic autoimmune disorders. To simulate clinical scenarios, we have applied regulatory T cell perturbation to murine models combined to examine the balance between thyroid autoimmunity and tumor-specific immunity.
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Affiliation(s)
- Yi-Chi M Kong
- Department of Immunology and Microbiology, Wayne State University School of Medicine , Detroit, MI , USA
| | - Jeffrey C Flynn
- Department of Orthopaedic Surgery, Providence Hospital and Medical Centers , Southfield, MI , USA
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1775
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Shtivelman E, Davies MA, Hwu P, Yang J, Lotem M, Oren M, Flaherty KT, Fisher DE. Pathways and therapeutic targets in melanoma. Oncotarget 2014; 5:1701-52. [PMID: 24743024 PMCID: PMC4039128 DOI: 10.18632/oncotarget.1892] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/07/2014] [Indexed: 02/07/2023] Open
Abstract
This review aims to summarize the current knowledge of molecular pathways and their clinical relevance in melanoma. Metastatic melanoma was a grim diagnosis, but in recent years tremendous advances have been made in treatments. Chemotherapy provided little benefit in these patients, but development of targeted and new immune approaches made radical changes in prognosis. This would not have happened without remarkable advances in understanding the biology of disease and tremendous progress in the genomic (and other "omics") scale analyses of tumors. The big problems facing the field are no longer focused exclusively on the development of new treatment modalities, though this is a very busy area of clinical research. The focus shifted now to understanding and overcoming resistance to targeted therapies, and understanding the underlying causes of the heterogeneous responses to immune therapy.
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Affiliation(s)
| | | | - Patrick Hwu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Yang
- National Cancer Institute, NIH, Washington DC, USA
| | - Michal Lotem
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Moshe Oren
- The Weizmann Institute of Science, Rehovot, Israel
| | | | - David E. Fisher
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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1776
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Mardis ER. The translation of cancer genomics: time for a revolution in clinical cancer care. Genome Med 2014; 6:22. [PMID: 25031616 PMCID: PMC4062062 DOI: 10.1186/gm539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The introduction of next-generation sequencing technologies has dramatically impacted the life sciences, perhaps most profoundly in the area of cancer genomics. Clinical applications of next-generation sequencing and associated methods are emerging from ongoing large-scale discovery projects that have catalogued hundreds of genes as having a role in cancer susceptibility, onset and progression. For example, discovery cancer genomics has confirmed that many of the same genes are altered by mutation, copy number gain or loss, or structural variation across multiple tumor types, resulting in a gain or loss of function that likely contributes to cancer development in these tissues. Beyond these frequently mutated genes, we now know there is a 'long tail' of less frequently mutated, but probably important, genes that play roles in cancer onset or progression. Here, I discuss some of the remaining barriers to clinical translation, and look forward to new applications of these technologies in cancer care.
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Affiliation(s)
- Elaine R Mardis
- The Genome Institute, Washington University School of Medicine, 4444 Forest Park Blvd, St Louis, MO 63108, USA
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1777
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O'Sullivan Coyne G, Madan RA, Gulley JL. Nivolumab: promising survival signal coupled with limited toxicity raises expectations. J Clin Oncol 2014; 32:986-8. [PMID: 24590655 DOI: 10.1200/jco.2013.54.5996] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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1778
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Rouhani SJ, Eccles JD, Tewalt EF, Engelhard VH. Regulation of T-cell Tolerance by Lymphatic Endothelial Cells. ACTA ACUST UNITED AC 2014; 5. [PMID: 25580369 PMCID: PMC4286360 DOI: 10.4172/2155-9899.1000242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lymphatic endothelial cells are most often thought of as structural cells that form the lymphatic vasculature, which transports fluid out of peripheral tissues and transports antigens and antigen presenting cells to lymph nodes. Recently, it has been shown that lymphatic endothelial cells also dynamically respond to and influence the immune response in several ways. Here, we describe how lymphatic endothelial cells induce peripheral T-cell tolerance and how this relates to tolerance induced by other types of antigen presenting cells. Furthermore, the ability of lymphatic endothelial cells to alter immune responses under steady-state or inflammatory conditions is explored, and the therapeutic potential of bypassing lymphatic endothelial cell-induced tolerance to enhance cancer immunotherapy is discussed.
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Affiliation(s)
- Sherin J Rouhani
- Carter Immunology Center and Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Jacob D Eccles
- Carter Immunology Center and Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Eric F Tewalt
- Carter Immunology Center and Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Victor H Engelhard
- Carter Immunology Center and Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
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1779
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Tsai KK, Zarzoso I, Daud AI. PD-1 and PD-L1 antibodies for melanoma. Hum Vaccin Immunother 2014; 10:3111-6. [PMID: 25625924 PMCID: PMC4514131 DOI: 10.4161/21645515.2014.983409] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 01/22/2023] Open
Abstract
Melanoma is the most serious form of skin cancer. Metastatic melanoma historically carries a poor prognosis and until recently there have been few effective agents available to treat widely disseminated disease. Recognition of the immunogenic nature of melanoma has resulted in the development of various immunotherapeutic approaches, especially with regards to the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1). Antibodies targeting the PD-1 axis have shown enormous potential in the treatment of metastatic melanoma. Here, we will review the immune basis for the disease and discuss approved immunotherapeutic options for advanced melanoma, as well as the current state of development of PD-1 and PD-L1 antibodies and their importance in shaping the future of melanoma treatment.
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Key Words
- AE, adverse event
- APC, antigen presenting cell
- ASCO, American Society of Clinical Oncology
- BMS-936559
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- FDA, Food and Drug Administration
- ITIM , immunoreceptor tyrosine-based inhibitory motif
- ITSM, immunoreceptor tyrosine-based switch motif
- Ig, immunoglobulin
- MAPK, mitogen-activated protein kinase
- MHC, major histocompatibility complex
- MPDL3280A
- NK, natural killer
- ORR, objective response rate
- OS, overall survival
- PD, progressive disease
- PD-1
- PD-1, programmed cell death 1
- PD-L1
- PD-L1, programmed cell death ligand 1
- PD-L2
- PFS, progression free survival
- TCR, T cell receptor
- TIL, tumor infiltrating lymphocyte
- gp100, glycoprotein 100 vaccine
- immunotherapy
- melanoma
- nivolumab
- pembrolizumab
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Affiliation(s)
- Katy K Tsai
- University of California San Francisco; San Francisco, CA USA
| | - Inés Zarzoso
- University of California San Francisco; San Francisco, CA USA
| | - Adil I Daud
- University of California San Francisco; San Francisco, CA USA
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