151
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Nivolumab in Relapsed/Refractory Classical Hodgkin Lymphoma - Extended Follow-up of 30 Patients Treated Within the CheckMate 205 Trial in a Single-Center. Hemasphere 2019; 3:e293. [PMID: 31942546 PMCID: PMC6919467 DOI: 10.1097/hs9.0000000000000293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/14/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022] Open
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152
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Roy SF, Louie AV, Liberman M, Wong P, Bahig H. Pathologic response after modern radiotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:S124-S134. [PMID: 31673516 PMCID: PMC6795577 DOI: 10.21037/tlcr.2019.09.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
Abstract
In non-small cell lung cancer (NSCLC), pathologic complete response (pCR) following radiotherapy treatment has been shown to be an independent prognostic factor for long-term survival, progression-free survival and locoregional control. PCR is considered a surrogate to therapeutic efficacy, years before survival data are available, and therefore can be used to guide treatment plans and additional therapeutic interventions post-surgical resection. Given the extensive fibrotic changes induced by radiotherapy in the lung, radiological assessment of response can potentially misrepresent pathologic response. The optimal timing for assessment of pathologic response after conventionally fractionated radiotherapy and stereotactic ablative radiotherapy (SABR) remains poorly understood. In this review, we summarize recent literature on pathologic response after radiotherapy for early stage and locally advanced NSCLC, we discuss current controversies around radiobiological considerations, and we present upcoming trials that will provide insight into current knowledge gaps.
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Affiliation(s)
- Simon F. Roy
- Department of Pathology, University of Montreal, Montreal, QC, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Philip Wong
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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153
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Failing JJ, Dudek OA, Marin Acevedo JA, Chirila RM, Dong H, Markovic SN, Dronca RS. Biomarkers of hyperprogression and pseudoprogression with immune checkpoint inhibitor therapy. Future Oncol 2019; 15:2645-2656. [PMID: 31298573 DOI: 10.2217/fon-2019-0183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hyperprogression and pseudoprogression are two atypical responses to immune checkpoint inhibitor therapy that affect therapeutic decisions and prognosis. Identification of predictive biomarkers for atypical responses either before or during treatment remains a huge unmet need in cancer immunotherapy. Many studies have looked at potential biomarkers, including clinical factors and laboratory findings (e.g., peripheral blood counts, circulating tumor DNA, cytokine levels). The results of these studies have been inconsistent, possibly due to small sample sizes, different tumor types and heterogeneity of the definition of these atypical responses.
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Affiliation(s)
| | - Olivia A Dudek
- Jagiellonian University Medical College, Świętej Anny 12, Krakow 31-008, Poland
| | | | - Razvan M Chirila
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Haidong Dong
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Roxana S Dronca
- Division of Hematology & Medical Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
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154
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Trabjerg ND, Rask C, Jensen LH, Hansen TF. Pseudoprogression during treatment with pembrolizumab followed by rechallenge with chemotherapy in metastatic colorectal cancer: A case report. Clin Case Rep 2019; 7:1445-1449. [PMID: 31360509 PMCID: PMC6637362 DOI: 10.1002/ccr3.2262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/07/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023] Open
Abstract
Disease progression during immunotherapy in colorectal cancer does not always indicate treatment failure. A case argues that carcinoembryonic antigen (CEA) may serve as an early marker to distinguish between pseudoprogression and real progression. Presentation of results from reintroduction of chemotherapy after progression on immunotherapy that suggest increased efficiency.
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Affiliation(s)
| | - Christina Rask
- Danish Colorectal Cancer Center SouthDepartment of OncologyVejle HospitalVejleDenmark
| | - Lars Henrik Jensen
- Danish Colorectal Cancer Center SouthDepartment of OncologyVejle HospitalVejleDenmark
- Institute of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Torben Frøstrup Hansen
- Danish Colorectal Cancer Center SouthDepartment of OncologyVejle HospitalVejleDenmark
- Institute of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
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155
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Kather JN, Hörner C, Weis CA, Aung T, Vokuhl C, Weiss C, Scheer M, Marx A, Simon-Keller K. CD163+ immune cell infiltrates and presence of CD54+ microvessels are prognostic markers for patients with embryonal rhabdomyosarcoma. Sci Rep 2019; 9:9211. [PMID: 31239476 PMCID: PMC6592899 DOI: 10.1038/s41598-019-45551-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 01/06/2023] Open
Abstract
Rhabdomyosarcomas (RMS) are rare and often lethal diseases. It is assumed that the tumor microenvironment (TME) of RMS exerts an immunosuppressive function, but there is currently no systematic analysis of the immune cells infiltrating sarcoma tissue. Focusing on two common types of RMS (alveolar [RMA] and embryonal [RME]), we performed a comprehensive immunohistochemical analysis of tumor-infiltrating immune cells in the TME. We performed a qualitative estimation of infiltrating immune cells in the tumor microenvironment by an experienced pathologist as well as a quantitative digital pathology analysis. We found that (1) manual and automatic quantification of tumor-infiltrating immune cells were consistent; (2) RME tumors showed a higher degree of immune cell infiltration than RMA tumors but (3) the number of tumor infiltrating lymphocytes was low compared to other solid tumor types; (4) microvascular density correlated with immune cell infiltration and (5) CD163 positive macrophages as well as CD54 positive microvessels were more often detected in RME than in RMA and correlated with patient overall and event free survival. Our systematic analysis provides a comprehensive view of the immune landscape of RMS which needs to be taken into account for developing immunotherapies for this rare type of cancer.
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Affiliation(s)
- Jakob Nikolas Kather
- Applied Tumor Immunity, German Cancer Research Center, Heidelberg, Germany.,Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Hörner
- Institute of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Thiha Aung
- Center of Plastic-, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - Christian Vokuhl
- Institute of Pathology, Paidopathology, University Medical Center Kiel, Kiel, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Mannheim, Germany
| | - Monika Scheer
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Katja Simon-Keller
- Institute of Pathology, University Medical Center Mannheim, Mannheim, Germany.
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156
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Jagadeeshan S, Prasad M, Ortiz-Cuaran S, Gregoire V, Saintigny P, Elkabets M. Adaptive Responses to Monotherapy in Head and Neck Cancer: Interventions for Rationale-Based Therapeutic Combinations. Trends Cancer 2019; 5:365-390. [PMID: 31208698 DOI: 10.1016/j.trecan.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]
Abstract
Most Phase II and III clinical trials in head and neck cancer (HNC) combine two or more treatment modalities, which are based, in part, on knowledge of the molecular mechanisms of innate and acquired resistance to monotherapy. In this review, we describe the range of tumor-cell autonomously derived (intrinsic) and tumor-microenvironment-derived (extrinsic) acquired-resistance mechanisms to various FDA-approved monotherapies for HNC. Specifically, we describe how tumor cells and the tumor microenvironment (TME) respond to radiation, chemotherapy, targeted therapy (cetuximab), and immunotherapies [programmed cell death 1 (PD-1) inhibitors] and adapt to the selective pressure of these monotherapies. Due to the diversity of adaptive responses to monotherapy, monitoring the response to treatment in patients is critical to understand the path that leads to resistance and to guide the optimal therapeutic drug combinations in the clinical setting. We envisage that applying such a rationale-based therapeutic strategy will improve treatment efficacy in HNC patients.
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Affiliation(s)
- Sankar Jagadeeshan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Manu Prasad
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Sandra Ortiz-Cuaran
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon 69008, France
| | - Vincent Gregoire
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon 69008, France; Department of Radiation Therapy, Centre Léon Bérard, Lyon 69008, France
| | - Pierre Saintigny
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon 69008, France; Department of Medical Oncology, Centre Léon Bérard, Lyon 69008, France
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
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157
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Gibson HM, Viola NT. The importance of examining an active immune system during immunotherapy. Oncotarget 2019; 10:559-560. [PMID: 30728906 PMCID: PMC6355172 DOI: 10.18632/oncotarget.26580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/05/2019] [Indexed: 12/04/2022] Open
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158
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Lauber K, Dunn L. Immunotherapy Mythbusters in Head and Neck Cancer: The Abscopal Effect and Pseudoprogression. Am Soc Clin Oncol Educ Book 2019; 39:352-363. [PMID: 31099687 DOI: 10.1200/edbk_238339] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Atypical patterns of response to immunotherapy have been observed, including the abscopal effect and pseudoprogression. Although both are infrequent in head and neck squamous cell carcinoma, the synergism between radiation and checkpoint blockade therapy has generated excitement for exploitation of the abscopal effect. However, robust abscopal tumor regression observed in preclinical models has not translated to clinical experience. The optimal sequencing of radiotherapy with immunotherapy and dosage of radiation to target lesions to elicit this effect is being explored in clinical trials. Predictive markers of efficacy must be studied further to identify patients who may benefit from an abscopal effect and continued checkpoint inhibitor blockade beyond initial signs of radiologic progression. Given the rarity of pseudoprogression in head and neck squamous cell carcinoma, patients should be carefully selected to continue on immunotherapy, despite early radiologic signs of progression, given the risk of aggressive true progression and clinical deterioration that may result in missed opportunities for alternate treatments.
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Affiliation(s)
- Kirsten Lauber
- 1 Department of Radiation Oncology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
- 2 Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer," Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- 3 German Cancer Consortium, partner site Munich, Germany
| | - Lara Dunn
- 4 Department of Medicine, Head and Neck Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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159
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Onesti CE, Frères P, Jerusalem G. Atypical patterns of response to immune checkpoint inhibitors: interpreting pseudoprogression and hyperprogression in decision making for patients' treatment. J Thorac Dis 2019; 11:35-38. [PMID: 30863564 DOI: 10.21037/jtd.2018.12.47] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Concetta Elisa Onesti
- Laboratory of Human Genetics, GIGA Research Institute, University of Liège, Liège, Belgium.,Department of Medical Oncology, University Hospital (CHU Liège), Liège, Belgium.,Laboratory of Medical Oncology, GIGA Research Institute, University of Liège, Liège, Belgium
| | - Pierre Frères
- Department of Medical Oncology, University Hospital (CHU Liège), Liège, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, University Hospital (CHU Liège), Liège, Belgium.,Laboratory of Medical Oncology, GIGA Research Institute, University of Liège, Liège, Belgium
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160
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Ahmed Y, Calvert P, Dennehy C, Lee J. Immune checkpoint inhibitors in the driver’s seat: Evaluating the evolving evidence in the treatment of extensive-stage small-cell lung cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/jco.jco_12_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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