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Aglietta M, Barone C, Sawyer MB, Moore MJ, Miller WH, Bagalà C, Colombi F, Cagnazzo C, Gioeni L, Wang E, Huang B, Fly KD, Leone F. A phase I dose escalation trial of tremelimumab (CP-675,206) in combination with gemcitabine in chemotherapy-naive patients with metastatic pancreatic cancer. Ann Oncol 2014; 25:1750-1755. [PMID: 24907635 DOI: 10.1093/annonc/mdu205] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tremelimumab (CP-675,206) is a fully human monoclonal antibody binding to cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) on T cells that stimulates the immune system by blocking the CTLA4-negative regulatory signal. Combination with standard chemotherapy may strengthen antitumor therapy. This is a phase Ib, multisite, open-label, nonrandomized dose escalation trial evaluating the safety, tolerability, and maximum tolerated dose (MTD) of tremelimumab combined with gemcitabine in patients with metastatic pancreatic cancer. PATIENTS AND METHODS Gemcitabine (1000 mg/m(2) on days 1, 8, and 15 of each 28-day cycles) was administrated with escalating doses of i.v. tremelimumab (6, 10, or 15 mg/kg) on day 1 of each 84-day cycle for a maximum of 4 cycles. The first 18 patients had an initial 4-week gemcitabine-only lead-in period. Dose-limiting toxicities (DLTs) related to tremelimumab were evaluated during the first 6 weeks after the first dose of tremelimumab. RESULTS From June 2008 to August 2011, 34 patients were enrolled and received at least one dose of tremelimumab. No DLTs related to tremelimumab were observed at any dose, even when the maximum dose established for tremelimumab (15 mg/kg) was used. Most frequent grade 3/4 toxicities were asthenia (11.8%) and nausea (8.8%). Only one patient had a serious drug-related event (diarrhea with dehydration). The median overall survival was 7.4 months (95% confidence interval 5.8-9.4 months). At the end of treatment, two patients achieved partial response. Both patients received tremelimumab 15-mg/kg group (n = 2/19, 10.5%). CONCLUSION Tremelimumab plus gemcitabine demonstrated a safety and tolerability profile, warranting further study in patients with metastatic pancreatic cancer. CLINICALTRIALSGOV ID NCT00556023.
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Affiliation(s)
- M Aglietta
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO, IRCCS, Turin.
| | - C Barone
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - M B Sawyer
- Department of Oncology, University of Alberta, Edmonton
| | - M J Moore
- Division of Medical Oncology, Princess Margaret Hospital and University of Toronto, Toronto
| | - W H Miller
- Department of Oncology, McGill University, Montreal, Canada
| | - C Bagalà
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - F Colombi
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO, IRCCS, Turin
| | - C Cagnazzo
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO, IRCCS, Turin
| | - L Gioeni
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO, IRCCS, Turin
| | - E Wang
- Pfizer Oncology Global Research and Development, Groton, USA
| | - B Huang
- Pfizer Oncology Global Research and Development, Groton, USA
| | - K D Fly
- Pfizer Oncology Global Research and Development, Groton, USA
| | - F Leone
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO, IRCCS, Turin
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252
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Mansfield AS, Symanowski JT, Peikert T. Systematic review of response rates of sarcomatoid malignant pleural mesotheliomas in clinical trials. Lung Cancer 2014; 86:133-6. [PMID: 25217189 DOI: 10.1016/j.lungcan.2014.08.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/18/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022]
Abstract
RATIONALE Malignant pleural mesothelioma is an almost universally fatal malignancy primarily related to asbestos exposure. Based on the differences in immunologic markers and gene expression between histologic subtypes of mesothelioma, and our clinical impression that response rates vary by histology, we decided to examine the reported response rates of mesothelioma subtypes. OBJECTIVES Our objective was to compare the response rates of sarcomatoid mesotheliomas to the overall response rates in published clinical trials. METHODS We searched PubMed for "mesothelioma" with the clinical trials filter selected. We included articles published between January 1, 2000 and March 20, 2014 in which subjects received first or second line systemic therapy for malignant pleural mesothelioma. Studies investigating multi-modality therapy including surgery were excluded. Response rates [including 95% confidence intervals (95% CI)] were estimated for the entire patient cohort and then separately for subjects with sarcomatoid tumors. MEASUREMENTS AND MAIN RESULTS We reviewed 544 publications of which 41 trials met our inclusion criteria. Eleven of these trials did not include patients with sarcomatoid mesothelioma (27% of eligible studies). The remaining 30 publications included 1475 subjects, 1011 with epithelioid tumors (68.5%), 203 with biphasic tumors (13.8%), 137 with sarcomatoid tumors (9.3%) and 124 with unknown subtypes (8.4%). In total, there were 323 responses (21.9%, complete and partial responses, 95% CI: 16.3, 28.8) to systemic therapy across all histological subtypes. In patients with sarcomatoid tumors (n=137) 19 responses were observed. This accounted for 5.9% of all responses and yields a 13.9% (95% CI: 8.6, 21.6) response rate for patients with sarcomatoid tumors. Multiple biases likely affected this systematic review. CONCLUSION Response rates for different histological subtypes of malignant pleural mesothelioma are infrequently reported. Partial and complete responses to systemic therapies appear to be less common among patients with sarcomatoid tumors.
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Affiliation(s)
- Aaron S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
| | - James T Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute Carolinas HealthCare System, Charlotte, NC, United States
| | - Tobias Peikert
- Department of Internal Medicine, Division of Pulmonary Medicine, Mayo Clinic, Rochester, MN, United States
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Ai J, Stevenson JP. Current issues in malignant pleural mesothelioma evaluation and management. Oncologist 2014; 19:975-84. [PMID: 25061089 PMCID: PMC4153452 DOI: 10.1634/theoncologist.2014-0122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/11/2014] [Indexed: 01/09/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer.
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Affiliation(s)
- Jing Ai
- Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - James P Stevenson
- Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, Ohio, USA
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254
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Ceresoli GL. Second-line treatment in malignant pleural mesothelioma: translating the evidence into clinical practice. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Nearly all patients with malignant pleural mesothelioma (MPM) progress during or after standard first-line treatment with pemetrexed plus a platinum compound. Second-line therapies are being increasingly used in clinical practice, but their role is still unproven, and the optimal regimens remain to be defined. Published studies have frequently severe limitations, due to the small number and to the heterogeneity of patients included. New treatment options are eagerly awaited. In selected cases with a prolonged disease control after first-line chemotherapy, re-treatment with pemetrexed seems to be the best option. In the other cases, patients should be enrolled whenever possible in clinical trials. Single-agent chemotherapy remains a reasonable option for palliation.
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Abstract
Malignant mesothelioma (MM) is a rare disease which can develop in pleura, pericardium or peritoneum and in which the therapies available have limited efficacy and are associated with various side effects. Therefore, there is a need for more targeted and more effective therapies which are able to halt the disease progression. Among them immune therapies actively or passively directed against various structures of the MM cells seem to be particularly promising given their inhibitory potential demonstrated in both experimental and early clinical studies. Mesothelin in particular seem to be not only a biomarker of disease activity but also a therapeutic target. This review discusses the immune therapies currently investigated for MM.
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Affiliation(s)
- Sabina Antonela Antoniu
- Palliative Care-Interdisciplinary Department, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T Popa", 16 Universitaţii Str, 700115, Iaşi, Romania
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Wong RM, Ianculescu I, Sharma S, Gage DL, Olevsky OM, Kotova S, Kostic MN, Grundfest WS, Hou D, Cameron RB. Immunotherapy for Malignant Pleural Mesothelioma. Current Status and Future Prospects. Am J Respir Cell Mol Biol 2014; 50:870-875. [DOI: 10.1165/rcmb.2013-0472tr] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Raymond M. Wong
- Pacific Meso Center at the Pacific Heart, Lung & Blood Institute, Los Angeles, California
| | - Irina Ianculescu
- Pacific Meso Center at the Pacific Heart, Lung & Blood Institute, Los Angeles, California
| | | | | | | | - Svetlana Kotova
- Division of Thoracic Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; and
| | | | | | - Dongmei Hou
- Division of Thoracic Surgery and Comprehensive Mesothelioma Program, University of California, Los Angeles, CA
| | - Robert B. Cameron
- Division of Thoracic Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; and
- Division of Thoracic Surgery and Comprehensive Mesothelioma Program, University of California, Los Angeles, CA
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Tomei S, Wang E, Delogu LG, Marincola FM, Bedognetti D. Non-BRAF-targeted therapy, immunotherapy, and combination therapy for melanoma. Expert Opin Biol Ther 2014; 14:663-86. [DOI: 10.1517/14712598.2014.890586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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258
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Bauzon M, Hermiston T. Armed therapeutic viruses - a disruptive therapy on the horizon of cancer immunotherapy. Front Immunol 2014; 5:74. [PMID: 24605114 PMCID: PMC3932422 DOI: 10.3389/fimmu.2014.00074] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/11/2014] [Indexed: 12/17/2022] Open
Abstract
For the past 150 years cancer immunotherapy has been largely a theoretical hope that recently has begun to show potential as a highly impactful treatment for various cancers. In particular, the identification and targeting of immune checkpoints have given rise to exciting data suggesting that this strategy has the potential to activate sustained antitumor immunity. It is likely that this approach, like other anti-cancer strategies before it, will benefit from co-administration with an additional therapeutic and that it is this combination therapy that may generate the greatest clinical outcome for the patient. In this regard, oncolytic viruses are a therapeutic moiety that is well suited to deliver and augment these immune-modulating therapies in a highly targeted and economically advantageous way over current treatment. In this review, we discuss the blockade of immune checkpoints, how oncolytic viruses complement and extend these therapies, and speculate on how this combination will uniquely impact the future of cancer immunotherapy.
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Affiliation(s)
- Maxine Bauzon
- Bayer HealthCare, US Innovation Center, Biologics Research , San Francisco, CA , USA
| | - Terry Hermiston
- Bayer HealthCare, US Innovation Center, Biologics Research , San Francisco, CA , USA
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259
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Calabrò L, Maio M. Immune checkpoint blockade in malignant mesothelioma: A novel therapeutic strategy against a deadly disease? Oncoimmunology 2014; 3:e27482. [PMID: 24734215 PMCID: PMC3984267 DOI: 10.4161/onci.27482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/09/2013] [Indexed: 12/29/2022] Open
Abstract
Monoclonal antibodies that target immune checkpoints are undoubtedly changing the therapeutic landscape of different human malignancies. Here we comment on the effects of blocking cytotoxic T lymphocyte-associated protein 4 (CTLA4) by means of the monoclonal antibody tremelimumab in patients with refractory malignant mesothelioma, a deadly disease with no effective therapeutic options.
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Affiliation(s)
- Luana Calabrò
- Medical Oncology and Immunotherapy; University Hospital of Siena; Istituto Toscano Tumori; Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy; University Hospital of Siena; Istituto Toscano Tumori; Siena, Italy
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Affiliation(s)
- Benjamin C. Creelan
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Krug L, di Pietro A, Narwal R, Robbins P, Fu D, Shalabi A, Ibrahim R, Calabro L, Kindler H. A phase 2 randomized, double-blind, placebo-controlled study of tremelimumab for second and third line treatment in patients with unresectable pleural or peritoneal mesothelioma. J Immunother Cancer 2013. [PMCID: PMC3990330 DOI: 10.1186/2051-1426-1-s1-p132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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