Neoadjuvant immune checkpoint inhibitor plus chemotherapy in rare tracheal tumors

[Tracheal Tumours]

Malignant primary tracheal tumours are rare. The most common histological subtypes are squamous cell carcinoma and adenoid cystic carcinoma. These two entities have different prognoses and growth patterns. Tracheobronchoscopy and thoracic sectional imaging are standard diagnostic tools for tumour staging and local evaluation. Complete surgical resection of the affected tracheal segment is the treatment of choice for limited disease without distant metastases. Incomplete gross tumour resection with additional irradiation is an acceptable therapeutic option for adenoid cystic carcinoma. Interventional endoscopy with tumour debulking or tracheal stenting and/or definitive mediastinal radiotherapy are treatment alternatives in either a locally advanced or palliative setting.

Prognostic factors and constructing a nomogram in tracheal cancer patients treated with surgical intervention: A study based on SEER database

Although surgery is considered the first choice of treatment for patients diagnosed with tracheal cancer, the prediction of overall survival (OS) in patients undergoing surgical intervention is poor. To address this issue, we developed a nomogram that combined a risk classification system to estimate the OS of patients with tracheal cancer who underwent surgical intervention. A total of 525 qualified patients were selected from the surveillance, epidemiology, and end results database between 1975 and 2018 and were randomly divided into training and validation cohorts (7:3). The parameters of independent prognostic ability were determined using Cox regression analysis, and a nomogram was formed. The predictive ability of the nomogram was tested using the area under the curve of receiver operating characteristic curves and calibration curves. Survival curves were assessed between the different risk classification groups using the Kaplan-Meier method. The results indicated that Age, stage, histology, and tumor size were independent prognostic factors and were included in the predictive model. The calibration plots demonstrated good agreement between the nomogram prediction and actual observation for 24- and 36-month OS. The receiver operating characteristic curves suggested that the predictive model had good discrimination ability, with the area under the curves (training group 0.817, 0.785, and 0.801, respectively) and validation group (0.744, 0.794, and 0.822, respectively). Furthermore, the low-risk group had a better prognosis than the high-risk group in the total, training, and validation cohorts (all P < .001). This study established a novel nomogram system to predict OS and identify independent prognostic factors in patients with tracheal cancer who underwent surgical intervention. This model has the potential to assist doctors in making decisions regarding treatment options.

LAG3-PD1 or CTLA4-PD1 Inhibition in Advanced Melanoma: Indirect Cross Comparisons of the CheckMate-067 and RELATIVITY-047 Trials

Simple Summary

In the past few decades, targeted therapy and immunotherapy have transformed tremendously the chances of survival. Checkpoint inhibitors that block programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) pathways hold the most promise. However, more than half of the patients treated with CTLA-4-PD1 inhibition suffered from grade 3 or 4 treatment-related adverse events (TRAEs). Recently, Tawbi et al. reported the initial results of the phase 2–3 RELATIVITY-047 trial which evaluated LAG3-PD1 inhibition of relatlimab plus nivolumab in patients with previously untreated advanced melanoma. Here, we performed an indirect cross-comparison of LAG3-PD1 and CTLA4-PD1 inhibition in patients with previously untreated advanced melanoma by deriving individual patient survival data and safety profiles. We found that the PFS of LAG3-PD1 and CTLA4-PD1 inhibition were similar. Compared with CTLA4-PD1-inhibition, LAG3-PD1 inhibition tended to exhibit earlier survival benefit and lesser TRAEs.

Abstract

Objective: To compare the inhibition of LAG3-PD1 versus the inhibition of CTLA-4-PD1 in patients with previously untreated advanced melanoma. Methods: The individual participant data (IPD) were extracted from the KM plots using a graphical reconstructive algorithm. Log-rank, Cox proportional hazard model, Bayesian hierarchical model with time-varying hazard ratio (HR) effect, and restricted mean survival time (RMST) were performed to estimate survival benefits. Results: The CheckMate-067 (n = 630) and RELATIVITY-047 (n = 714) trials were included for analysis. The graphical reconstructive algorithm showed that IPD had similar HRs and log-rank values as the original plots. The HR of nivolumab plus relatlimab (LAG3 inhibitor) versus nivolumab plus ipilimumab (CTLA4 inhibitor) was 1.19 (95% confidence interval [CI] 0.96 to1.48). The 24-months RMST of nivolumab plus relatlimab versus nivolumab was 2.35 (95% CI 0.77–3.94) months, compared with 1.87 (95% CI, 0.25–3.49) months for nivolumab plus ipilimumab versus nivolumab. The Bayesian hierarchical model showed that patients treated with nivolumab plus relatlimab had earlier PFS benefits than those with nivolumab plus ipilimumab. Grade 3 or 4 treatment-related adverse events occurred in 18.9% of patients using nivolumab plus relatlimab and 55.0% of patients using nivolumab plus ipilimumab. Conclusions: These findings suggest that the PFS of LAG3-PD1 and CTLA4-PD1 inhibition were similar and LAG3-PD1 inhibition exhibited earlier survival benefit and lesser TRAEs.