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Gomez-Roca C, Cassier P, Zamarin D, Machiels JP, Luis Perez Gracia J, Stephen Hodi F, Taus A, Martinez Garcia M, Boni V, Eder JP, Hafez N, Sullivan R, Mcdermott D, Champiat S, Aspeslagh S, Terret C, Jegg AM, Jacob W, Cannarile MA, Ries C, Korski K, Michielin F, Christen R, Babitzki G, Watson C, Meneses-Lorente G, Weisser M, Rüttinger D, Delord JP, Marabelle A. Anti-CSF-1R emactuzumab in combination with anti-PD-L1 atezolizumab in advanced solid tumor patients naïve or experienced for immune checkpoint blockade. J Immunother Cancer 2022; 10:jitc-2021-004076. [PMID: 35577503 PMCID: PMC9114963 DOI: 10.1136/jitc-2021-004076] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This phase 1b study (NCT02323191) evaluated the safety, antitumor activity, pharmacokinetics, and pharmacodynamics of colony-stimulating factor-1 receptor-blocking monoclonal antibody (mAb) emactuzumab in combination with the programmed cell death-1 ligand (PD-L1)-blocking mAb atezolizumab in patients with advanced solid tumors naïve or experienced for immune checkpoint blockers (ICBs). METHODS Emactuzumab (500-1350 mg flat) and atezolizumab (1200 mg flat) were administered intravenously every 3 weeks. Dose escalation of emactuzumab was conducted using the 3+3 design up to the maximum tolerated dose (MTD) or optimal biological dose (OBD). Extension cohorts to evaluate pharmacodynamics and clinical activity were conducted in metastatic ICB-naive urothelial bladder cancer (UBC) and ICB-pretreated melanoma (MEL), non-small cell lung cancer (NSCLC) and UBC patients. RESULTS Overall, 221 patients were treated. No MTD was reached and the OBD was determined at 1000 mg of emactuzumab in combination with 1200 mg of atezolizumab. Grade ≥3 treatment-related adverse events occurred in 25 (11.3%) patients of which fatigue and rash were the most common (14 patients (6.3%) each). The confirmed objective response rate (ORR) was 9.8% for ICB-naïve UBC, 12.5% for ICB-experienced NSCLC, 8.3% for ICB-experienced UBC and 5.6% for ICB-experienced MEL patients, respectively. Tumor biopsy analyses demonstrated increased activated CD8 +tumor infiltrating T lymphocytes (TILs) associated with clinical benefit in ICB-naïve UBC patients and less tumor-associated macrophage (TAM) reduction in ICB-experienced compared with ICB-naïve patients. CONCLUSION Emactuzumab in combination with atezolizumab demonstrated a manageable safety profile with increased fatigue and skin rash over usual atezolizumab monotherapy. A considerable ORR was particularly seen in ICB-experienced NSCLC patients. Increase ofCD8 +TILs under therapy appeared to be associated with persistence of a TAM subpopulation.
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Affiliation(s)
- Carlos Gomez-Roca
- Department of Medical Oncology and Clinical Research Unit, Institut Claudius Regaud, Toulouse, France
| | | | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | | | - F Stephen Hodi
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alvaro Taus
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | | | - Valentina Boni
- Medical Oncology, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Joseph P Eder
- Department of Medical Oncology, Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Navid Hafez
- Department of Medical Oncology, Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Ryan Sullivan
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - David Mcdermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Stephane Champiat
- Drug Development Department, Gustave Roussy Institute, Villejuif, France
| | - Sandrine Aspeslagh
- Drug Development Department, Gustave Roussy Institute, Villejuif, France
| | | | | | | | | | - Carola Ries
- Roche Innovation Center Munich, Penzberg, Germany
| | | | | | | | | | | | | | | | | | - Jean-Pierre Delord
- Department of Medical Oncology and Clinical Research Unit, Institut Claudius Regaud, Toulouse, France
| | - Aurelien Marabelle
- Drug Development Department, Gustave Roussy Institute, Villejuif, France
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Spierenburg G, van der Heijden L, van Langevelde K, Szuhai K, Bovée JVGM, van de Sande MAJ, Gelderblom H. Tenosynovial giant cell tumors (TGCT): molecular biology, drug targets and non-surgical pharmacological approaches. Expert Opin Ther Targets 2022; 26:333-345. [PMID: 35443852 DOI: 10.1080/14728222.2022.2067040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a mono-articular, benign or locally aggressive and often debilitating neoplasm. Systemic therapies are becoming part of the multimodal armamentarium when surgery alone will not confer improvements. Since TGCT is characterized by colony-stimulating factor-1 (CSF1) rearrangements, the most studied molecular pathway is the CSF1 and CSF1 receptor (CSF1R) axis. Inhibiting CSF1-CSF1R interaction often yields considerable radiological and clinical responses; however, adverse events may cause treatment discontinuation because of an unfavorable risk-benefit ratio in benign disease. Only Pexidartinib is approved by the US FDA; however, the European Medicines Agency has not approved it due to uncertainties on the risk-benefit ratio. Thus, there is a need for safer and effective therapies. AREAS COVERED Light is shed on disease mechanisms and potential drug targets. The safety and efficacy of different systemic therapies are evaluated. EXPERT OPINION The CSF1-CSF1R axis is the principal drug target; however, the effect of CSF1R inhibition on angiogenesis and the role of macrophages, which are essential in the postoperative course, needs further elucidation. Systemic therapies have a promising role in treating mainly diffuse-type, TGCT patients who are not expected to clinically improve from surgery. Future drug development should focus on targeting neoplastic TGCT cells.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V G M Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Robert M, Farese H, Miossec P. Update on Tenosynovial Giant Cell Tumor, an Inflammatory Arthritis With Neoplastic Features. Front Immunol 2022; 13:820046. [PMID: 35265077 PMCID: PMC8899011 DOI: 10.3389/fimmu.2022.820046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/03/2022] [Indexed: 12/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to joint destruction and bone erosion. Even if many treatments were developed with success in the last decades, some patients fail to respond, and disease chronicity is still a burden. Mechanisms involved in such resistance may include molecular changes in stromal cells. Other explanations can come from observations of tenosynovial giant cell tumor (TGCT), first considered as an inflammatory arthritis, but with unusual neoplastic features. TGCT leads to synovium hypertrophy and hyperplasia with hemosiderin deposition. It affects young adults, resulting in secondary osteoarthritis and increased morbidity. TGCT shows clinical, histological and genetic similarities with RA but affecting a single joint. However, the monoclonality of some synoviocytes, the presence of translocations and rare metastases also suggest a neoplastic disease, with some features common with sarcoma. TGCT is more probably in an intermediate situation between an inflammatory and a neoplastic process, with a main involvement of the proinflammatory cytokine CSF-1/CSF1R signaling axis. The key treatment option is surgery. New treatments, derived from the RA and sarcoma fields, are emerging. The tyrosine kinase inhibitor pexidartinib was recently FDA-approved as the first drug for severe TGCT where surgery is not an option. Options directly targeting the excessive proliferation of synoviocytes are at a preclinical stage.
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Lin CC. Clinical Development of Colony-Stimulating Factor 1 Receptor (CSF1R) Inhibitors. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:105-114. [PMID: 35663534 PMCID: PMC9153255 DOI: 10.36401/jipo-20-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 04/28/2023]
Abstract
Macrophage infiltration has been identified as an independent poor prognostic factor for several cancers. Macrophages also orchestrate various tumor-promoting processes. This observation sparked an interest to therapeutically target these plastic innate immune cells. To date, blockade of colony-stimulating factor 1 (CSF1) or its receptor represents one of the selective approaches to manipulate tumor-associated macrophages. In this review, I discuss the efficacy and safety of various CSF1 receptor tyrosine kinase inhibitors, anti-CSF1 receptor monoclonal antibodies, and anti-CSF1 monoclonal antibodies in clinical development for patients with cancer and highlight potential combination partners, mainly anti-program cell death protein 1 (PD-1) and program cell death protein ligand 1 (PD-L1) antibodies.
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Affiliation(s)
- Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Venkatakrishnan K, van der Graaf PH, Holstein SA. The Changing Face of Oncology Research, Drug Development, and Clinical Practice: Toward Patient-Focused Precision Therapeutics. Clin Pharmacol Ther 2021; 108:399-404. [PMID: 33439492 DOI: 10.1002/cpt.1979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Karthik Venkatakrishnan
- EMD Serono Research & Development Institute, Inc., Billerica, Massachusetts, USA.,A Business of, Merck KGaA, Darmstadt, Germany
| | | | - Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Machiels JP, Gomez-Roca C, Michot JM, Zamarin D, Mitchell T, Catala G, Eberst L, Jacob W, Jegg AM, Cannarile MA, Watson C, Babitzki G, Korski K, Klaman I, Teixeira P, Hoves S, Ries C, Meneses-Lorente G, Michielin F, Christen R, Rüttinger D, Weisser M, Delord JP, Cassier P. Phase Ib study of anti-CSF-1R antibody emactuzumab in combination with CD40 agonist selicrelumab in advanced solid tumor patients. J Immunother Cancer 2020; 8:jitc-2020-001153. [PMID: 33097612 PMCID: PMC7590375 DOI: 10.1136/jitc-2020-001153] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background This phase Ib study evaluated the safety, clinical activity, pharmacokinetics, and pharmacodynamics (PD) of emactuzumab (anti-colony stimulating factor 1 receptor monoclonal antibody (mAb)) in combination with selicrelumab (agonistic cluster of differentiation 40 mAb) in patients with advanced solid tumors. Methods Both emactuzumab and selicrelumab were administered intravenously every 3 weeks and doses were concomitantly escalated (emactuzumab: 500 to 1000 mg flat; selicrelumab: 2 to 16 mg flat). Dose escalation was conducted using the product of independent beta probabilities dose-escalation design. PD analyzes were performed on peripheral blood samples and tumor/skin biopsies at baseline and on treatment. Clinical activity was evaluated using investigator-based and Response Evaluation Criteria In Solid Tumors V.1.1-based tumor assessments. Results Three dose-limiting toxicities (all infusion-related reactions (IRRs)) were observed at 8, 12 and 16 mg of selicrelumab together with 1000 mg of emactuzumab. The maximum tolerated dose was not reached at the predefined top doses of emactuzumab (1000 mg) and selicrelumab (16 mg). The most common adverse events were IRRs (75.7%), fatigue (54.1%), facial edema (37.8%), and increase in aspartate aminotransferase and creatinine phosphokinase (35.1% both). PD analyzes demonstrated an increase of Ki67+-activated CD8+ T cells accompanied by a decrease of B cells and the reduction of CD14Dim CD16bright monocytes in peripheral blood. The best objective clinical response was stable disease in 40.5% of patients. Conclusion Emactuzumab in combination with selicrelumab demonstrated a manageable safety profile and evidence of PD activity but did not translate into objective clinical responses. Trialregistration number NCT02760797.
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Affiliation(s)
- Jean-Pascal Machiels
- Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium .,UCLouvain, Brussels, Belgium
| | - Carlos Gomez-Roca
- Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jean-Marie Michot
- Department of Innovative Therapies and Early Phase trials (DITEP), Gustave Roussy, Villejuif, France
| | - Dmitriy Zamarin
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Tara Mitchell
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaetan Catala
- Medial Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Wolfgang Jacob
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Anna-Maria Jegg
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Michael A Cannarile
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | | | - Galina Babitzki
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Konstanty Korski
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Irina Klaman
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Priscila Teixeira
- Pharma Research and Early Development, Roche Innovation Center Welwyn, Welwyn Garden City, UK
| | - Sabine Hoves
- Roche Innovat Ctr Munich Oncol Discovery Pharma, Penzberg, Germany
| | - Carola Ries
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | | | - Francesca Michielin
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Randolph Christen
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Dominik Rüttinger
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Martin Weisser
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
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