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Dai Z, Li N, Wang J, Tan C, Zhang Y, Liu L. Anti-PD-1/PD-L1 for nasopharyngeal carcinoma: a comprehensive analysis of registered trials on ClinicalTrials.gov. Front Pharmacol 2023; 14:1212813. [PMID: 38026930 PMCID: PMC10679443 DOI: 10.3389/fphar.2023.1212813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objective: Clinical trials play an important role in the development of healthcare. However, the current status of clinical trials on anti-PD-1/PD-L1 for nasopharyngeal carcinoma remains unclear. Therefore, this study aims to provide a comprehensive analysis of the registered trials related to anti-PD-1/PD-L1 for nasopharyngeal carcinoma on ClinicalTrials.gov. Methods: A search was conducted on the ClinicalTrials.gov database to identify all registered trials related to anti-PD-1/PD-L1 for nasopharyngeal carcinoma up to 26 February 2023. The characteristics of the trials were examined, and the studied drugs, disease conditions, as well as details of trials with available results were analyzed. Publication status was assessed by a PubMed search using the ClinicalTrials.gov NCT number. Results: A total of 112 interventional clinical trials registered between 2015 and 2023 were included. Of the trials, 90 were carried out in Asia, 72 were in phase 2, and 31 trials had either companies or universities as sponsors/collaborators. The sample sizes across the trials varied greatly, with a median of 71.5 participants per trial. The majority of trials were recruiting participants, with only 6 had posted results. PD-1 inhibitors were preferred over PD-L1, and Toripalimab emerged as the most extensively studied drug. About one-third (33.9%) of the studies looked into recurrent/metastatic nasopharyngeal cancer. Conclusion: This study provides an overview of all registered trials of anti-PD-1/PD-L1 for NPC. It is needed to improve the completeness, outcome selection, randomization and masking of trials and to be transparent and timely in reporting of results.
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Affiliation(s)
- Zelei Dai
- Division of Head and Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Nian Li
- Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Wang
- Division of Head and Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chenfeng Tan
- Division of Head and Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Department of Evidence Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Division of Head and Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Xiao Q, Yu X, Shuai Z, Yao T, Yang X, Zhang Y. The influence of baseline characteristics on the efficacy of immune checkpoint inhibitors for advanced lung cancer: A systematic review and meta-analysis. Front Pharmacol 2022; 13:956788. [PMID: 36176428 PMCID: PMC9513719 DOI: 10.3389/fphar.2022.956788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the impact of different baseline characteristics on the efficacy of immune checkpoint inhibitors (ICIs) for advanced lung cancer.Methods: In order to identify eligible randomized controlled trials (RCTs), a systematic search was conducted in PubMed, Embase, Web of Science, and Scopus Cochrane Library databases. The primary outcomes were hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS). To explore the potential interaction during the administration of ICI, patients were stratified by baseline characteristics.Results: The meta-analysis included 24 RCTs. ① Compared with non-ICI therapy, patients with lung cancer benefitted more from immunotherapy (HR, 0.78; p < 0.0001). ② Patients without liver metastases could get more survival benefits than those with liver metastases (HR, 1.20; p = 0.0139). Similar outcomes were also observed in the following subgroups: small-cell lung cancer (HR, 1.20; p = 0.0433), subsequent line (HR, 1.40; p = 0.0147), and ICI monotherapy (HR, 1.40; p = 0.0147). ③ Subgroup analysis showed that tumor type affected the efficacy of immunotherapy in patients with brain metastases (HR, 0.72 vs. 1.41; interaction, p < 0.01). Among patients with smoking history (HR, 0.87 vs. 1.23; interaction, p = 0.05) and brain metastases (HR, 0.69 vs. 1.21; interaction, p = 0.05), the type of therapy (i.e., monotherapy or combination therapy) had potential influences on the efficacy of immunotherapy.Conclusion: Some critical baseline characteristics could indicate the efficacy of ICI therapy. Liver metastasis status could predict the efficacy of ICI therapy for lung cancer. Compared with small-cell lung cancer, patients with brain metastases might have durable OS in non-small-cell lung cancer. The smoking history or brain metastasis status of patients could indicate the potential clinical benefits of monotherapy or combination therapy.
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Affiliation(s)
- Qionghua Xiao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaolin Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Zhihao Shuai
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ting Yao
- The 2nd Department of Pulmonary Disease in Traditional Chinese Medicine (TCM), China-Japan Friendship Hospital, Beijing, China
| | - Xiaohua Yang
- Department of Respiratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanxia Zhang
- Department of Respiratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yanxia Zhang,
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Iftikhar MS, Talha GM, Aleem M, Shamim A. Bioinformatics–computer programming. NANOTECHNOLOGY IN CANCER MANAGEMENT 2021:125-148. [DOI: 10.1016/b978-0-12-818154-6.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Duan J, Cui L, Zhao X, Bai H, Cai S, Wang G, Zhao Z, Zhao J, Chen S, Song J, Qi C, Wang Q, Huang M, Zhang Y, Huang D, Bai Y, Sun F, Lee JJ, Wang Z, Wang J. Use of Immunotherapy With Programmed Cell Death 1 vs Programmed Cell Death Ligand 1 Inhibitors in Patients With Cancer: A Systematic Review and Meta-analysis. JAMA Oncol 2020; 6:375-384. [PMID: 31876895 DOI: 10.1001/jamaoncol.2019.5367] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Immune checkpoint inhibitors of programmed cell death 1 (PD-1) and its ligand (PD-L1) have led to a paradigm shift in cancer treatment. Understanding the clinical efficacy and safety profile of these drugs is necessary for treatment strategy in clinical practice. Objective To assess the differences between anti-PD-1 and anti-PD-L1 regarding efficacy and safety shown in randomized clinical trials across various tumor types. Data Sources Systematic searches of PubMed, Cochrane CENTRAL, and Embase were conducted from January 1, 2000, to March 1, 2019. In addition, abstracts and presentations from all major conference proceedings were reviewed. Study Selection All randomized clinical trials that compared anti-PD-1 and anti-PD-L1 with standard treatment in patients with cancer were selected as candidates. Retrospective studies, single-arm phase 1/2 studies, and trials comparing anti-PD-1 and anti-PD-L1 with other immunotherapies were excluded. Studies of anti-PD-1 and anti-PD-L1 therapy were screened and paired by the matching of clinical characteristics as mirror groups. Data Extraction and Synthesis Three investigators independently extracted data from each study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. Trial names, first author, year of publication, study design, National Clinical Trial identifier number, blinding status, study phase, pathologic characteristics, number of patients, patients' age and sex distribution, Eastern Cooperative Oncology Group Performance Status, lines of treatment, study drugs, biomarker status, follow-up time, incidence of adverse events, and hazard ratios (HRs) with 95% CIs for overall survival and progression-free survival were extracted. A random-effects model was applied for data analysis. Main Outcomes and Measures Differences in OS between anti-PD-1 and anti-PD-L1 across different cancer types were assessed. An effect size was derived from each mirror group and then pooled across all groups using a random-effects model. Results Nineteen randomized clinical trials involving 11 379 patients were included in the meta-analysis. Overall, anti-PD-1 exhibited superior overall survival (HR, 0.75; 95% CI, 0.65-0.86; P < .001) and progression-free survival (HR, 0.73; 95% CI, 0.56-0.96; P = .02) compared with anti-PD-L1. No significant difference was observed in their safety profiles. Sensitivity analysis presented consistency in the overall estimates across these analyses. Consistent results were observed through frequentist and bayesian approaches with the same studies. Conclusions and Relevance Comprehensive analysis suggests that anti-PD-1 exhibited favorable survival outcomes and a safety profile comparable to that of anti-PD-L1, which may provide a useful guide for clinicians.
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Affiliation(s)
- Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Longgang Cui
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Xiaochen Zhao
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shangli Cai
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Guoqiang Wang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Zhengyi Zhao
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Jing Zhao
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Shiqing Chen
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Jia Song
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Chuang Qi
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Qing Wang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Mengli Huang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Yuzi Zhang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Depei Huang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Yuezong Bai
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Feng Sun
- School of Public Health, Department of Epidemiology and Biostatistics, Peking University Health Science Centre, Beijing, China
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Hack SP, Zhu AX, Wang Y. Augmenting Anticancer Immunity Through Combined Targeting of Angiogenic and PD-1/PD-L1 Pathways: Challenges and Opportunities. Front Immunol 2020; 11:598877. [PMID: 33250900 PMCID: PMC7674951 DOI: 10.3389/fimmu.2020.598877] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
Cancer immunotherapy (CIT) with antibodies targeting the programmed cell death 1 protein (PD-1)/programmed cell death 1 ligand 1 (PD-L1) axis have changed the standard of care in multiple cancers. However, durable antitumor responses have been observed in only a minority of patients, indicating the presence of other inhibitory mechanisms that act to restrain anticancer immunity. Therefore, new therapeutic strategies targeted against other immune suppressive mechanisms are needed to enhance anticancer immunity and maximize the clinical benefit of CIT in patients who are resistant to immune checkpoint inhibition. Preclinical and clinical studies have identified abnormalities in the tumor microenvironment (TME) that can negatively impact the efficacy of PD-1/PD-L1 blockade. Angiogenic factors such as vascular endothelial growth factor (VEGF) drive immunosuppression in the TME by inducing vascular abnormalities, suppressing antigen presentation and immune effector cells, or augmenting the immune suppressive activity of regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages. In turn, immunosuppressive cells can drive angiogenesis, thereby creating a vicious cycle of suppressed antitumor immunity. VEGF-mediated immune suppression in the TME and its negative impact on the efficacy of CIT provide a therapeutic rationale to combine PD-1/PD-L1 antibodies with anti-VEGF drugs in order to normalize the TME. A multitude of clinical trials have been initiated to evaluate combinations of a PD-1/PD-L1 antibody with an anti-VEGF in a variety of cancers. Recently, the positive results from five Phase III studies in non-small cell lung cancer (adenocarcinoma), renal cell carcinoma, and hepatocellular carcinoma have shown that combinations of PD-1/PD-L1 antibodies and anti-VEGF agents significantly improved clinical outcomes compared with respective standards of care. Such combinations have been approved by health authorities and are now standard treatment options for renal cell carcinoma, non-small cell lung cancer, and hepatocellular carcinoma. A plethora of other randomized studies of similar combinations are currently ongoing. Here, we discuss the principle mechanisms of VEGF-mediated immunosuppression studied in preclinical models or as part of translational clinical studies. We also discuss data from recently reported randomized clinical trials. Finally, we discuss how these concepts and approaches can be further incorporated into clinical practice to improve immunotherapy outcomes for patients with cancer.
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Affiliation(s)
- Stephen P. Hack
- Product Development (Oncology), Genentech, Inc., South San Francisco, CA, United States
| | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, United States
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China
| | - Yulei Wang
- Product Development (Oncology), Genentech, Inc., South San Francisco, CA, United States
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Xie T, Wang S, Xing P. [Analysis of the Correlation between Molecular Structural Differences of PD-1/PD-L1 Inhibitors and Adverse Events]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:603-608. [PMID: 32702794 PMCID: PMC7406435 DOI: 10.3779/j.issn.1009-3419.2020.102.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
针对程序性死亡受体1(programmed cell death protein 1, PD-1)及程序性死亡配体1(programmed cell death ligand 1, PD-L1)的免疫治疗作为一种新兴的方法在恶性肿瘤的治疗中起到越来越大的作用,相较于传统的化学治疗体现出更好的疗效。然而在应用针对PD-1/PD-L1的免疫检查点抑制剂的过程中也出现了许多不良反应,并且这些不良反应在不同药物中的发生率也不完全相同。由于区分不同药物的一个重要指标是它们的分子结构,故本文将从不同PD-1/PD-L1免疫检查点抑制剂的结构出发,通过综述不良反应的meta分析以及回顾性研究的结果解析分子结构与不良反应发生情况之间的相关性。
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Affiliation(s)
- Tongji Xie
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shouzheng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Puyuan Xing
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Huang S, Yang J, Fong S, Zhao Q. Artificial intelligence in cancer diagnosis and prognosis: Opportunities and challenges. Cancer Lett 2019; 471:61-71. [PMID: 31830558 DOI: 10.1016/j.canlet.2019.12.007] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
Cancer is an aggressive disease with a low median survival rate. Ironically, the treatment process is long and very costly due to its high recurrence and mortality rates. Accurate early diagnosis and prognosis prediction of cancer are essential to enhance the patient's survival rate. Developments in statistics and computer engineering over the years have encouraged many scientists to apply computational methods such as multivariate statistical analysis to analyze the prognosis of the disease, and the accuracy of such analyses is significantly higher than that of empirical predictions. Furthermore, as artificial intelligence (AI), especially machine learning and deep learning, has found popular applications in clinical cancer research in recent years, cancer prediction performance has reached new heights. This article reviews the literature on the application of AI to cancer diagnosis and prognosis, and summarizes its advantages. We explore how AI assists cancer diagnosis and prognosis, specifically with regard to its unprecedented accuracy, which is even higher than that of general statistical applications in oncology. We also demonstrate ways in which these methods are advancing the field. Finally, opportunities and challenges in the clinical implementation of AI are discussed. Hence, this article provides a new perspective on how AI technology can help improve cancer diagnosis and prognosis, and continue improving human health in the future.
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Affiliation(s)
- Shigao Huang
- Cancer Center, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao, China
| | - Jie Yang
- Department of Computer and Information Science, University of Macau, Taipa, Macau, China; Chongqing Industry&Trade Polytechnic, Chongqing, China
| | - Simon Fong
- Department of Computer and Information Science, University of Macau, Taipa, Macau, China; Zhuhai Institute of Advanced Technology Chinese Academy of Sciences, Zhuhai, China.
| | - Qi Zhao
- Cancer Center, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao, China.
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Prognostic factors of patients with spinal malignant melanoma after surgical intervention: a case series of 21 patients and literature review. J Neurooncol 2019; 142:119-127. [PMID: 30607707 DOI: 10.1007/s11060-018-03071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal malignant melanoma (SMM) is a rare type of tumor that can cause nerve roots or spinal cord compression. Patients often suffer from fierce pain and paralyzation. And the estimated survival time were less than 6 months. Surgical interventions to remove the tumor and decompress the nearby nerve roots and spinal cord are effective management. Unfortunately, there lack a thorough and persuasive surgical guideline that specifically aims for this disease. It is necessary to obtain some clinical prognostic factors that predict the recurrence rate and overall survival (OS) of patients with SMM who underwent surgical interventions. METHODS 21 patients with SMM who underwent surgical intervention were retrospectively reviewed. Related patients factors, treatment factors and tumor factors were acquired and subjected into survive analyses using Kaplan-Meier method and the log-rank test. Further Cox proportional hazards model was used to identify independent prognostic factors. Literature regarding surgical interventions on SMM patients were reviewed and summarized as well. RESULTS Surgical approach total en-bloc spondylectomy (TES/Piecemeal) (p = 0.015, B 0.029, 95%CI 0.002-0.508), preoperative Frankel grade (A-C/D-E) (p = 0.021, B 15.041, 95%CI 1.492-151.669) and tumor metastases (Yes/No) (p = 0.013, B 16.667, 95%CI 1.805-153.897) are independent prognostic factors for recurrence free survival (RFS). Preoperative Frankel grade (A-C/D-E) (p = 0.031, B 10.676, 95%CI 1.241-91.877) is independent prognostic factors for OS. 12 literatures have been reviewed, including 11 case reports and one retrospective study. CONCLUSIONS Surgical interventions for patients with SMM are beneficial. Surgical approach (TES/piecemeal), tumor origin (primary/metastasis) and preoperative Frankel grade (A-C/D-E) are independent risk factors in predicting RFS. Preoperative Frankel grade (A-C/D-E) is independent prognostic factor in predicting OS.
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