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Pascal M, Bax HJ, Bergmann C, Bianchini R, Castells M, Chauhan J, De Las Vecillas L, Hartmann K, Álvarez EI, Jappe U, Jimenez-Rodriguez TW, Knol E, Levi-Schaffer F, Mayorga C, Poli A, Redegeld F, Santos AF, Jensen-Jarolim E, Karagiannis SN. Granulocytes and mast cells in AllergoOncology-Bridging allergy to cancer: An EAACI position paper. Allergy 2024. [PMID: 39036854 DOI: 10.1111/all.16246] [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: 04/25/2024] [Revised: 06/23/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
Derived from the myeloid lineage, granulocytes, including basophils, eosinophils, and neutrophils, along with mast cells, play important, often disparate, roles across the allergic disease spectrum. While these cells and their mediators are commonly associated with allergic inflammation, they also exhibit several functions either promoting or restricting tumor growth. In this Position Paper we discuss common granulocyte and mast cell features relating to immunomodulatory functions in allergy and in cancer. We highlight key mechanisms which may inform cancer treatment and propose pertinent areas for future research. We suggest areas where understanding the communication between granulocytes, mast cells, and the tumor microenvironment, will be crucial for identifying immune mechanisms that may be harnessed to counteract tumor development. For example, a comprehensive understanding of allergic and immune factors driving distinct neutrophil states and those mechanisms that link mast cells with immunotherapy resistance, might enable targeted manipulation of specific subpopulations, leading to precision immunotherapy in cancer. We recommend specific areas of investigation in AllergoOncology and knowledge exchange across disease contexts to uncover pertinent reciprocal functions in allergy and cancer and allow therapeutic manipulation of these powerful cell populations. These will help address the unmet needs in stratifying and managing patients with allergic diseases and cancer.
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Affiliation(s)
- Mariona Pascal
- Immunology Department, CDB, Hospital Clínic de Barcelona; Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- RETICS Asma, reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Heather J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences & KHP Centre for Translational Medicine, King's College London, London, UK
| | - Christoph Bergmann
- Department of Otorhinolaryngology, RKM740 Interdisciplinary Clinics, Düsseldorf, Germany
| | - Rodolfo Bianchini
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Drug Hypersensitivity and Desensitization Center, Mastocytosis Center, Brigham and Women's Hospital; Harvard Medical School, Boston, USA
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences & KHP Centre for Translational Medicine, King's College London, London, UK
| | | | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Elena Izquierdo Álvarez
- Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Madrid, Spain
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Leibniz Lung Center, German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany
| | | | - Edward Knol
- Departments Center of Translational Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francesca Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, Institute for Drug Research, School of Pharmacy, Faculty of Medicine. The Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel
| | - Cristobalina Mayorga
- RETICS Asma, reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Allergy Unit and Research Laboratory, Hospital Regional Universitario de Málaga-HRUM, Instituto de investigación Biomédica de Málaga -IBIMA-Plataforma BIONAND, Málaga, Spain
| | - Aurélie Poli
- Neuro-Immunology Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Frank Redegeld
- Division of Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences & KHP Centre for Translational Medicine, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, UK
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2
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Brand CL, Hunger RE, Seyed Jafari SM. Eosinophilic granulocytes as a potential prognostic marker for cancer progression and therapeutic response in malignant melanoma. Front Oncol 2024; 14:1366081. [PMID: 38756652 PMCID: PMC11096470 DOI: 10.3389/fonc.2024.1366081] [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: 01/05/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
The importance of eosinophilic granulocytes in cancer has been widely discussed in recent years. The current study reviews the evidence on the role of eosinophilic granulocytes in melanoma as a prognostic marker for cancer progression and the efficacy of treatment with modern immune checkpoint inhibitors. A total of 33 human clinical studies were included in the review, with heterogeneous data due to differences in patients populations, study design and inclusion of small study groups. However, 28 of the 33 studies suggested that eosinophilic granulocytes could be used as a prognostic biomarker for outcome and/or potential response to systemic treatment and/or occurrence of adverse events in melanoma patients. Nevertheless, the exact role of eosinophils remains to be elucidated. Further prospective, larger and better controlled studies are warranted to clarify the significance of eosinophilic granulocytes in patients with melanoma, in more details.
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Affiliation(s)
| | | | - Seyed Morteza Seyed Jafari
- Department of Dermatology and Venerology, University Hospital of Bern, University Bern, Bern, Switzerland
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3
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Eikenes G, Liszkay G, Balatoni T, Czirbesz K, Hunyadi K, Kozéki Z, Kispál MT, Baranyai F, Danyi T, Bőcs K, Kenessey I. Therapeutic and Adverse Effect of Anti-PD1 Immunotherapy in Melanoma: A Retrospective, Single-Institute Study of 222 Patients. Cancers (Basel) 2023; 15:3966. [PMID: 37568785 PMCID: PMC10417734 DOI: 10.3390/cancers15153966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The introduction of immuno- and targeted therapeutic modalities meant a breakthrough step in the therapy of melanoma. As a checkpoint inhibitor, the more effective and less toxic anti-PD1 therapy followed an anti-CTLA4 approach. METHODS From our patient pool, 222 advanced melanoma cases were selected, where anti-PD1 (pembrolizumab, nivolumab) therapy was initiated between March 2015 and December 2020. During our retrospective analysis, the efficacy and safety of the therapy were assessed. RESULTS The median follow-up was 16 months (interval: 0-64 months), and 150 patients (67.6%) received therapy in the first line, while second and third line therapy was performed among 72 patients (32.4%) for the median of 7.0 months (0-60). In 50 cases, BRAF mutations were detected. Ninety-six patients showed objective response (11.3% CR, 32.0% PR). The median PFS was 10.0 months (0-60), and the median OS was 23.0 months (0-64). Autoimmune side effects were found in 79 patients (35.5%); grade 3 occurred in 6.3% of the cases, while 1 patient died due to fulminant pneumonitis (0.25%). CONCLUSION Although the range of immunotherapeutic options is getting wider, in the management of melanoma patients, anti-PD1 monotherapy remains an important, effective, and safe method. However, significant correlation was found between the immune-related side effects and therapeutic efficacy.
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Affiliation(s)
- Grethe Eikenes
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Gabriella Liszkay
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
- National Tumor Laboratory Project, H1122 Budapest, Hungary;
| | - Tímea Balatoni
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Kata Czirbesz
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
- National Tumor Laboratory Project, H1122 Budapest, Hungary;
| | - Karen Hunyadi
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Zsófia Kozéki
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Mihály Tamás Kispál
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
- National Tumor Laboratory Project, H1122 Budapest, Hungary;
| | - Fanni Baranyai
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Tímea Danyi
- Department of Dermato-Oncology, National Institute of Oncology, H1122 Budapest, Hungary; (G.E.); (T.B.); (K.C.); (K.H.); (Z.K.); (M.T.K.); (F.B.); (T.D.)
| | - Katalin Bőcs
- Department of Diagnostic Radiology, National Institute of Oncology, H1122 Budapest, Hungary;
| | - István Kenessey
- National Tumor Laboratory Project, H1122 Budapest, Hungary;
- National Cancer Registry, National Institute of Oncology, H1122 Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, H1091 Budapest, Hungary
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4
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Zhang C, Zhang C, Wang H. Immune-checkpoint inhibitor resistance in cancer treatment: Current progress and future directions. Cancer Lett 2023; 562:216182. [PMID: 37076040 DOI: 10.1016/j.canlet.2023.216182] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
Cancer treatment has been advanced with the advent of immune checkpoint inhibitors (ICIs) exemplified by anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), anti-programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1) drugs. Patients have reaped substantial benefit from ICIs in many cancer types. However, few patients benefit from ICIs whereas the vast majority undergoing these treatments do not obtain survival benefit. Even for patients with initial responses, they may encounter drug resistance in their subsequent treatments, which limits the efficacy of ICIs. Therefore, a deepening understanding of drug resistance is critically important for the explorations of approaches to reverse drug resistance and to boost ICI efficacy. In the present review, different mechanisms of ICI resistance have been summarized according to the tumor intrinsic, tumor microenvironment (TME) and host classifications. We further elaborated corresponding strategies to battle against such resistance accordingly, which include targeting defects in antigen presentation, dysregulated interferon-γ (IFN-γ) signaling, neoantigen depletion, upregulation of other T cell checkpoints as well as immunosuppression and exclusion mediated by TME. Moreover, regarding the host, several additional approaches that interfere with diet and gut microbiome have also been described in reversing ICI resistance. Additionally, we provide an overall glimpse into the ongoing clinical trials that utilize these mechanisms to overcome ICI resistance. Finally, we summarize the challenges and opportunities that needs to be addressed in the investigation of ICI resistance mechanisms, with the aim to benefit more patients with cancer.
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Affiliation(s)
- Chenyue Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai Medical College, Shanghai, China
| | - Chenxing Zhang
- Department of Nephrology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
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5
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Artham S, Chang CY, McDonnell DP. Eosinophilia in cancer and its regulation by sex hormones. Trends Endocrinol Metab 2023; 34:5-20. [PMID: 36443206 PMCID: PMC10122120 DOI: 10.1016/j.tem.2022.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
Gender differences in the functionality of the immune system have been attributed, in part, to direct and indirect effects of sex steroids, especially estrogens, on immune cell repertoire and activity. Notable are studies that have defined roles for estrogens in the regulation of the biology of dendritic cells (DCs), macrophages, T cells and natural killer (NK) cells. Although estrogens can modulate eosinophil function, the mechanisms by which this occurs and how it contributes to the pathobiology of different diseases remains underexplored. Furthermore, although the importance of eosinophils in infection is well established, it remains unclear as to how these innate immune cells, which are present in different tumors, impact the biology of cancer cells and/or response to therapeutics. The observation that eosinophilia influences the efficacy of immune checkpoint blockers (ICBs) is significant considering the role of estrogens as regulators of eosinophil function and recent studies suggesting that response to ICBs is impacted by gender. Thus, in this review, we consider what is known about the roles of estrogen(s) in regulating tissue eosinophilia/eosinophil function and how this influences the pathobiology of breast cancer (in particular). This information provides the context for a discussion of how estrogens/the estrogen receptor (ER) signaling axis can be targeted in eosinophils and how this would be expected to influence the activity of standard-of-care interventions and contemporary immunotherapy regimens in cancer(s).
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Affiliation(s)
- Sandeep Artham
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Ching-Yi Chang
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA.
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6
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Kudura K, Basler L, Nussbaumer L, Foerster R. Sex-Related Differences in Metastatic Melanoma Patients Treated with Immune Checkpoint Inhibition. Cancers (Basel) 2022; 14:cancers14205145. [PMID: 36291928 PMCID: PMC9600302 DOI: 10.3390/cancers14205145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: We aimed to investigate sex-related differences in patients with advanced melanoma treated with ICI by linking the assessment of inflammatory response in peripheral blood, onset of immune-related adverse events IRAEs during therapy and treatment response in short- and long-term. Methods: For the purpose of this single-center retrospective study metastatic melanoma patients treated with ICI were included. Baseline patient characteristics, blood sample tests and the onset of immune-related adverse events IRAEs were documented based on clinical records. The short-term treatment response was assessed with 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT scans performed six months after initiation of ICI. The overall survival OS and progression-free survival PFS were used as endpoints to assess the long-term response to immunotherapy. Results: In total, 103 patients with advanced melanoma (mean age 68 ± 13.83 years) were included, 29 women (mean age 60.41 ± 14.57 years) and 74 men (mean age 65.66 ± 13.34 years). The primary tumor was located on a lower extremity in one out of three women and on the head/neck in one out of three men (p < 0.001). While the superficial spreading (41%) and nodular (36%) melanoma subtypes represented together 77% of the cases in male population, women showed a more heterogenous distribution of melanoma subtypes with the superficial spreading (35%), nodular (23%), acral lentiginous (19%) and mucosal (12%) melanoma subtypes being most frequent in female population (p < 0.001). Most differences between women and men with regards to inflammatory parameters were observed six months after initiation of ICI with a higher median NLR (p = 0.038), lower counts of lymphocytes (p = 0.004) and thrombocytes (p = 0.089) in addition to lower counts of erythrocytes (p < 0.001) and monocytes (p < 0.001) in women towards men. IRAEs were more frequent in women towards men (p = 0.013). Women were more likely to display endocrinological IRAEs, such as thyroiditis being the most frequent adverse event in women. Interestingly IRAEs of the gastrointestinal tract were the most frequent ones in men. Finally, men with advanced melanoma showed a significantly better response to immunotherapy in short- (p = 0.015) and long-term (OS p = 0.015 and PFS p < 0.001) than women. In fact, every fourth man died during the course of the disease, while every second woman did not survive. (p = 0.001). Conclusion: Men with advanced melanoma showed a significantly better response to immunotherapy in short- and long-term than women. Higher immune activation in peripheral blood before and after initiation ICI might be linked to favorable treatment response during and after ICI in favor of men and decoupled from the onset of IRAEs. Given the significantly higher immunotoxicity and worse outcome experienced by women compared to men the use of ICI should be chosen carefully in women with advanced melanoma.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence:
| | - Lucas Basler
- Institute of Radiooncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Lukas Nussbaumer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland
| | - Robert Foerster
- Institute of Radiooncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
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Elumalai T, Croxford W, Buijtenhuijs B, Conroy R, Sanderson B, Enting D, Aversa C, Doss G, Das A, Vasudev NS, Kitetere E, Tolan S, Law A, Hoskin P, Mistry H, Choudhury A. Using Real-world Data to Define a Validated Nomogram for Advanced Bladder Cancer Patients Who Respond to Immunotherapy. Clin Oncol (R Coll Radiol) 2022; 34:642-652. [PMID: 35282933 DOI: 10.1016/j.clon.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/03/2022]
Abstract
AIMS Immune checkpoint inhibitors (ICIs) are used in incurable urothelial cancers, both in chemo-naïve and platinum-refractory patients. Efficacy and toxicity data published outside controlled clinical trials are limited. We report overall survival, progression-free survival and toxicities of ICIs in locally advanced (LABC) or metastatic bladder cancer (MBC). We aimed to develop and validate a prognostic model for these patients. MATERIALS AND METHODS A multicentre real-world individual patient-level data study (n = 272) evaluating ICIs in the first-line platinum-ineligible or platinum-refractory setting for LABC/MBC between March 2017 and February 2020 was undertaken. Cox regression analyses evaluated the association of prognostic factors with overall survival. Data were split to create a training (n = 208) and validation (n = 64) cohort. The backward elimination method with a P-value cut-off of 0.05 was used to develop a reduced prognostic model using the training data set. The concordance index and assessment of observed versus predicted survival probabilities were used to evaluate the final model. RESULTS The median follow-up was 18.9 (15.8-21.5) months. The median overall survival and progression-free survival in the training cohort were 9.2 (95% confidence interval 7.4-10.5) and 4.5 months (3.5-5.7), respectively. The most common grade 1/2 adverse events recorded were fatigue (47.8%) and infection (19.9%). Five key prognostic factors found in the training set were low haemoglobin, high neutrophil count, choice of immunotherapy favouring pembrolizumab, presence of liver metastasis and steroid use within 30 days of treatment. The concordance index for the training and validation cohorts was 0.66 (standard error = 0.05) and 0.64 (standard error = 0.04), respectively, for the final model. A nomogram was developed to calculate the expected survival probabilities based on risk factors. CONCLUSIONS Real-world data were used to produce a validated prognostic model for overall survival in LABC/MBC treated with ICIs. This model could assist in patient stratification, interpreting and framing future trials incorporating PD-1/PD-L1 inhibitors in LABC/MBC.
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Affiliation(s)
- T Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - W Croxford
- The Christie NHS Foundation Trust, Manchester, UK.
| | | | - R Conroy
- The Christie NHS Foundation Trust, Manchester, UK
| | - B Sanderson
- The Christie NHS Foundation Trust, Manchester, UK; Royal Preston Hospital, Rosemere Cancer Centre, Preston, UK
| | - D Enting
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Aversa
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Doss
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Das
- St James's Institute of Oncology, Leeds, UK
| | | | - E Kitetere
- Royal Marsden NHS Foundation Trust, London, UK
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - A Law
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - P Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - H Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
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8
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Kudura K, Nussbaumer L, Foerster R, Basler L. Inflammatory Blood Parameters as Biomarkers for Response to Immune Checkpoint Inhibition in Metastatic Melanoma Patients. Biomedicines 2022; 10:biomedicines10092135. [PMID: 36140238 PMCID: PMC9496082 DOI: 10.3390/biomedicines10092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives: We aimed to investigate whether inflammatory parameters in peripheral blood at baseline and during the first six months of treatment could predict the short- and long-term outcomes of metastatic melanoma patients treated with immune checkpoint inhibitors (ICIs). Methods: This single-center retrospective study considered patients with metastatic melanoma treated with either single or dual checkpoint inhibition. Blood sample tests were scheduled together with 18F-2-fluor-2-desoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) scans at baseline and at three and six months after initiation of ICI treatment. The short-term response to ICIs was assessed using FDG-PET/CT scans. The long-term response to ICIs was assessed using the overall survival OS and progression-free survival PFS as endpoints. Results: A total of 100 patients with metastatic melanoma were included (female, n = 31; male, n = 69). The median age was 68 years (interquartile range (IQR): 53−74 years). A total of 82% of the cohort displayed a disease control (DC), while 18% presented a progressive disease (PD) after six months of ICIs. Patients with DC after six months of ICIs showed a lower median of the neutrophils-to-lymphocytes ratio (NLR) toward patients with PD, with no significant prediction power of NLR neither in the short nor in the long term. The count of neutrophils at the baseline time point (TP 0) (p = 0.037) and erythrocytes three months after treatment start (TP 1) (p = 0.010) were strong predictive parameters of a DC six months after treatment start. Erythrocytes (p < 0.001) and lymphocytes (p = 0.021) were strong biomarkers predictive of a favorable OS. Erythrocytes (p = 0.013) and lymphocytes (p = 0.017) also showed a significant prediction power for a favorable PFS. Conclusions: Inflammatory blood parameters predicted the short- and long-term response to ICIs with a strong predictive power. Our results suggested the validation of inflammatory blood parameters as biomarkers that predict immunotherapies’ efficacity in metastatic melanoma patients. However, confounding factors that interfere with myelopoiesis should also be taken into consideration.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland
- Correspondence:
| | - Lukas Nussbaumer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland
| | - Robert Foerster
- Institute of Radiooncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Lucas Basler
- Institute of Radiooncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
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9
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Akış S, Öztürk UK, Keleş E, Alınca CM, Api M, Kabaca C. The percentage of peripheral eosinophils as a sensitive marker for differentiating FIGO grade in endometrial adenocarcinomas. J Turk Ger Gynecol Assoc 2022; 23:99-105. [PMID: 35263838 PMCID: PMC9161002 DOI: 10.4274/jtgga.galenos.2022.2021-9-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Studies on eosinophils have mostly been directed to parasitic infections and allergic diseases, but the role of eosinophils in oncology has been largely ignored. Eosinophils are an important modulator of the immune response and components of the inflammatory process against the tumor. This study was performed to investigate the pre-operative peripheral blood eosinophil percentages in patients with a histopathologically diagnosed pure endometrioid type endometrial carcinoma. Material and Methods: Patients’ data were analyzed in two groups as present/absent according to whether there are tumor metastases in the adnexes, lymph nodes, cervical stroma, and whether there was lymphovascular space invasion. FIGO grade was taken as the basis of the tumor grade: Low-grade equated to grade 1 or 2, and high-grade equated to grade 3. The requirement for lymph node dissection was based on the Mayo criteria. Results: The data of a total of 268 patients were included. The mean percentage of eosinophils in high-grade patients (n=29) was 2.75±0.35, and was significantly higher than the mean percentage of eosinophils of found in low-grade patients (n=239), which was 1.79±0.09 (p=0.013). Receiver operator curve analysis showed that a cut-off eosinophil percentage of 1.95% resulted in a sensitivity of 62% and specificity of 67% (p=0.004). Conclusion: Eosinophil percentages, which are a simple, easily accessible, and inexpensive can be an important pre-operative predictive tool. Eosinophil percentages can be used in determining the need for surgical staging in endometrial cancer.
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10
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Tímár J, Ladányi A. Molecular Pathology of Skin Melanoma: Epidemiology, Differential Diagnostics, Prognosis and Therapy Prediction. Int J Mol Sci 2022; 23:5384. [PMID: 35628196 PMCID: PMC9140388 DOI: 10.3390/ijms23105384] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022] Open
Abstract
Similar to other malignancies, TCGA network efforts identified the detailed genomic picture of skin melanoma, laying down the basis of molecular classification. On the other hand, genome-wide association studies discovered the genetic background of the hereditary melanomas and the susceptibility genes. These genetic studies helped to fine-tune the differential diagnostics of malignant melanocytic lesions, using either FISH tests or the myPath gene expression signature. Although the original genomic studies on skin melanoma were mostly based on primary tumors, data started to accumulate on the genetic diversity of the progressing disease. The prognostication of skin melanoma is still based on staging but can be completed with gene expression analysis (DecisionDx). Meanwhile, this genetic knowledge base of skin melanoma did not turn to the expected wide array of target therapies, except the BRAF inhibitors. The major breakthrough of melanoma therapy was the introduction of immune checkpoint inhibitors, which showed outstanding efficacy in skin melanoma, probably due to their high immunogenicity. Unfortunately, beyond BRAF, KIT mutations and tumor mutation burden, no clinically validated predictive markers exist in melanoma, although several promising biomarkers have been described, such as the expression of immune-related genes or mutations in the IFN-signaling pathway. After the initial success of either target or immunotherapies, sooner or later, relapses occur in the majority of patients, due to various induced genetic alterations, the diagnosis of which could be developed to novel predictive genetic markers.
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Affiliation(s)
- József Tímár
- 2nd Department of Pathology, Semmelweis University, 1191 Budapest, Hungary
| | - Andrea Ladányi
- Department of Surgical and Molecular Pathology and the National Tumor Biology Laboratory, National Institute of Oncology, 1122 Budapest, Hungary;
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11
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Li Y, Meng Y, Sun H, Ye L, Zeng F, Chen X, Deng G. The Prognostic Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Melanoma Patients Receiving Immunotherapy. J Immunother 2022; 45:43-50. [PMID: 34510106 PMCID: PMC8654256 DOI: 10.1097/cji.0000000000000392] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
Immunotherapy has revolutionized the treatment in metastatic melanoma, but alternative biomarkers that are economical, simple and reliable still need to be clarified. In this study, we aimed to comprehensively analyze the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) in melanoma patients with immunotherapy. We searched PubMed, Embase, and Cochrane Library until September 16, 2020. Hazard ratio (HR) and 95% confidence intervals (CIs) were pooled to investigate the association of baseline NLR with overall survival (OS) and progression-free survival (PFS). Sensitivity analysis, subgroup analyses, publication bias assessment, and the Duval and Tweedie trim-and-fill method were used to evaluate the stability of results. A total of 18 studies including 2054 patients were included in our analysis. Pooled data demonstrated that higher baseline NLR was associated with a poorer OS (HR=2.46, 95% CI=1.77, 3.43) and PFS (HR=2.38, 95% CI=1.95, 2.89) of melanoma patients receiving immunotherapy. Subgroup analysis according to immunotherapy type showed that the prognostic effects of baseline NLR existed in all the subtypes of immunotherapy, including anticytotoxic T lymphocyte-associated protein 4 therapy (OS HR=2.26, 95% CI=1.43, 3.59; PFS HR=2.68, 95% CI=1.79, 4.02), antiprogrammed cell death-1 therapy (OS HR=3.08, 95% CI=2.21, 4.27; PFS HR=2.01, 95% CI=1.64, 2.47), and combination therapy (OS HR=1.75, 95% CI=1.13, 2.72; PFS HR=3.13, 95% CI=1.63, 6.03). Conclusions were still consistent in subgroup analyses stratified by study year, region, study type, sample size, analysis of HR and cuttoff of baseline NLR. Altogether, baseline NLR is a promising prognostic biomarker for melanoma patients receiving immunotherapy.
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Affiliation(s)
- Yayun Li
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
| | - Yu Meng
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
| | - Huiyan Sun
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
| | - Lin Ye
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
| | - Furong Zeng
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
| | - Guangtong Deng
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders
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12
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Santos-Briz A, Cañueto J, Carmen SD, Barrios B, Yuste M, Bellido L, Ludeña MD, Román C. Value of PD-L1, PD-1, and CTLA-4 Expression in the Clinical Practice as Predictors of Response to Nivolumab and Ipilimumab in Monotherapy in Patients With Advanced Stage Melanoma. Am J Dermatopathol 2021; 43:423-428. [PMID: 33395045 DOI: 10.1097/dad.0000000000001856] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The introduction of immune checkpoint inhibitors (ICI) has improved the survival outcomes of patients with advanced melanoma. To date, only a few studies have evaluated the immunohistochemical (IHC) expression of PD-1 and CTLA-4 in tumor-infiltrating lymphocytes (TILs) as predictive markers of response to ICI, most of them in the context of clinical trials. Moreover, the predictive value of PD-L1 in melanoma cells in the response to immunotherapy is unclear. The aim of our study was to assess the IHC expression of PD-L1, PD-1, and CTLA-4 in samples of patients with advanced melanoma and to establish their prognostic value as predictors of ICI response in a university hospital. METHODS The expression of PD-L1, PD-1, and CTLA-4 was evaluated in pretreatment tumor samples in a series of 35 patients, 21 patients treated with nivolumab and 14 patients with ipilimumab in monotherapy. RESULTS In the nivolumab group, 4 tumors (19%) were positive for PD-L1 and all of them showed a partial response to the treatment. However, 4 patients whose tumors did not express PD-L1 also responded to nivolumab. PD-1 expression was not associated with better progression-free survival (PFS). In the ipilimumab group, 5 patients (35.7%) showed expression of CTLA-4. Positive cases showed a better PFS; however, one negative case responded to ipilimumab. CONCLUSIONS Nivolumab produces a better response compared with ipilimumab in patients with melanoma. The IHC expression of PD-L1 and CTLA-4 are associated with a higher response rate to nivolumab and ipilimumab, respectively, and better PFS, but the existence of responder patients with negative expression suggests that they are not adequate biomarkers to select candidate patients for ICI in the clinical practice.
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Affiliation(s)
- Angel Santos-Briz
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - Javier Cañueto
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; and
| | - Sofía Del Carmen
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - Beatriz Barrios
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
- Servicio de Oncología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Manuela Yuste
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; and
| | - Lorena Bellido
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
- Servicio de Oncología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - María Dolores Ludeña
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - Concepción Román
- Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; and
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13
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Strudel M, Festino L, Vanella V, Beretta M, Marincola FM, Ascierto PA. Melanoma: Prognostic Factors and Factors Predictive of Response to Therapy. Curr Med Chem 2020; 27:2792-2813. [PMID: 31804158 DOI: 10.2174/0929867326666191205160007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A better understanding of prognostic factors and biomarkers that predict response to treatment is required in order to further improve survival rates in patients with melanoma. Prognostic Factors: The most important histopathological factors prognostic of worse outcomes in melanoma are sentinel lymph node involvement, increased tumor thickness, ulceration and higher mitotic rate. Poorer survival may also be related to several clinical factors, including male gender, older age, axial location of the melanoma, elevated serum levels of lactate dehydrogenase and S100B. Predictive Biomarkers: Several biomarkers have been investigated as being predictive of response to melanoma therapies. For anti-Programmed Death-1(PD-1)/Programmed Death-Ligand 1 (PD-L1) checkpoint inhibitors, PD-L1 tumor expression was initially proposed to have a predictive role in response to anti-PD-1/PD-L1 treatment. However, patients without PD-L1 expression also have a survival benefit with anti-PD-1/PD-L1 therapy, meaning it cannot be used alone to select patients for treatment, in order to affirm that it could be considered a correlative, but not a predictive marker. A range of other factors have shown an association with treatment outcomes and offer potential as predictive biomarkers for immunotherapy, including immune infiltration, chemokine signatures, and tumor mutational load. However, none of these have been clinically validated as a factor for patient selection. For combined targeted therapy (BRAF and MEK inhibition), lactate dehydrogenase level and tumor burden seem to have a role in patient outcomes. CONCLUSION With increasing knowledge, the understanding of melanoma stage-specific prognostic features should further improve. Moreover, ongoing trials should provide increasing evidence on the best use of biomarkers to help select the most appropriate patients for tailored treatment with immunotherapies and targeted therapies.
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Affiliation(s)
- Martina Strudel
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Lucia Festino
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Massimiliano Beretta
- Centro di Riferimento Oncologico, Department of Medical Oncology, Aviano (PN), Italy
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
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14
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Onesti CE, Josse C, Boulet D, Thiry J, Beaumecker B, Bours V, Jerusalem G. Blood eosinophilic relative count is prognostic for breast cancer and associated with the presence of tumor at diagnosis and at time of relapse. Oncoimmunology 2020; 9:1761176. [PMID: 32923121 PMCID: PMC7458605 DOI: 10.1080/2162402x.2020.1761176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Cancer outcome is associated with circulating immune cells, including eosinophils. Here we analyze the relative eosinophil count (REC) in different breast cancer subtypes. Methods Stage I–III breast cancer patients were included in the study and classified as REC-high vs low (cutoff 1.5%) or relative lymphocyte count (RLC)-high vs low (cutoff 17.5%). The co-primary endpoints were the breast cancer-specific survival (BCSS) or the time to treatment failure (TTF) in the REC groups. Results Overall 930 patients were included in the study. We observed a benefit for REC-high vs REC-low in TTF (HR 0.610, 95% CI 0.458–0.812), and in BCSS (HR 0.632, 95% CI 0.433–0.923). Similarly, we observed a better TTF (HR 0.421, 95% CI 0.262–0.677) and BCSS (HR 0.350, 95% CI 0.200–0.614) in RLC-high vs low. A lower relapse rate was observed in the REC-high vs REC-low group (17.1% vs 24.7%, p = 0.005), not confirmed in the multivariate analysis. A lower median REC at baseline and at relapse was observed compared to REC after surgery and during cancer-free follow-up (p < .0001). Conclusions REC could be a new promising, affordable and accessible predictive and prognostic biomarker in all breast cancer subtypes.
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Affiliation(s)
- Concetta Elisa Onesti
- Medical Oncology Department, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium.,Laboratory of Human Genetics, GIGA Institute, Liège, Belgium
| | - Claire Josse
- Medical Oncology Department, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium.,Laboratory of Human Genetics, GIGA Institute, Liège, Belgium
| | - Delphine Boulet
- Laboratory of Human Genetics, GIGA Institute, Liège, Belgium
| | - Jérôme Thiry
- Laboratory of Human Genetics, GIGA Institute, Liège, Belgium
| | | | - Vincent Bours
- Laboratory of Human Genetics, GIGA Institute, Liège, Belgium.,Department of Human Genetics, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium.,Faculty of Medicine, Liège University, Liège, Belgium
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15
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Pistillo MP, Carosio R, Grillo F, Fontana V, Mastracci L, Morabito A, Banelli B, Tanda E, Cecchi F, Dozin B, Gualco M, Salvi S, Spagnolo F, Poggi A, Queirolo P. Phenotypic characterization of tumor CTLA-4 expression in melanoma tissues and its possible role in clinical response to Ipilimumab. Clin Immunol 2020; 215:108428. [PMID: 32344017 DOI: 10.1016/j.clim.2020.108428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/21/2020] [Accepted: 04/17/2020] [Indexed: 01/13/2023]
Abstract
The expression of the immune checkpoint molecule CTLA-4 has been almost exclusively studied in the T cell lineage, but increasing evidence has shown its expression on tumors with implications for immunotherapy. To date, the degree of expression of CTLA-4 on tumor cells as a predictive biomarker of response to immune checkpoint inhibitors has not been studied. In this report, we analyzed this issue in melanoma patients treated with CTLA-4 inhibitor Ipilimumab (IPI). We show that the level of CTLA-4 expression on melanoma cells is higher than that on tumor infiltrating lymphocytes (TIL) and it is associated with clinical response to IPI therapy supporting the idea of its possible role as a predictive biomarker.
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Affiliation(s)
- Maria Pia Pistillo
- IRCCS Ospedale Policlinico San Martino, Tumor Epigenetics Unit, Genova, Italy.
| | - Roberta Carosio
- IRCCS Ospedale Policlinico San Martino, Tumor Epigenetics Unit, Genova, Italy
| | - Federica Grillo
- University of Genova, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova, Italy; IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy
| | - Vincenzo Fontana
- IRCCS Ospedale Policlinico San Martino, Clinical Epidemiology Unit, Genova, Italy
| | - Luca Mastracci
- University of Genova, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genova, Italy; IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy
| | - Anna Morabito
- IRCCS Ospedale Policlinico San Martino, Tumor Epigenetics Unit, Genova, Italy
| | - Barbara Banelli
- IRCCS Ospedale Policlinico San Martino, Tumor Epigenetics Unit, Genova, Italy
| | - Enrica Tanda
- IRCCS Ospedale Policlinico San Martino, Skin Cancer Unit, Genova, Italy
| | - Federica Cecchi
- IRCCS Ospedale Policlinico San Martino, Skin Cancer Unit, Genova, Italy
| | - Beatrice Dozin
- IRCCS Ospedale Policlinico San Martino, Clinical Epidemiology Unit, Genova, Italy
| | - Marina Gualco
- Ospedale Villa Scassi, ASL3, Anatomic Pathology Unit, Genova, Italy
| | - Sandra Salvi
- IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy
| | | | - Alessandro Poggi
- IRCCS Ospedale Policlinico San Martino, Molecular Oncology and Angiogenesis Unit, Genova, Italy
| | - Paola Queirolo
- IEO, Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology IRCCS, Milan, Italy
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16
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Chauhan A, Kabir T, Wu J, Wei J, Cook M, Kunos CA. Prognostic and predictive factors associated with ipilimumab-related adverse events: a retrospective analysis of 11 NCI-sponsored phase I clinical trials. Oncotarget 2020; 11:1427-1434. [PMID: 32363000 PMCID: PMC7185063 DOI: 10.18632/oncotarget.27537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We review factors impacting ipilimumab-associated adverse events through the experience from National Cancer Institute (NCI)-sponsored phase I immunotherapy clinical trials. MATERIALS AND METHODS Attributable ipilimumab-related adverse events from NCI-sponsored phase I immunotherapy clinical trials were queried retrospectively by anonymized patient experience reports for observed adverse events like decreased hematological cell counts, blood electrolytes or proteins, or reduced patient performance status. The prevalence of ipilimumab-related toxicity was associated by patient to the duration of ipilimumab exposure, radiographic responses, progression-free survival, and overall survival. RESULTS 373 patients from 11 phase 1 ipilimumab clinical trials were analyzed. Patients experiencing at least one grade 3 or 4 adverse event associated with observed radiographic response were included. The average number of grade 3/4 adverse events in responders was 1.167 versus 0.645 in non-responders (p = 0.001). Patient performance status did not significantly impact observed toxicity grade. Pretherapy lymphocyte count or chemistries were not associated with ipilimumab-associated toxicity. The number of agents combined with ipilimumab on trial was associated with average number of grade 3/4 toxicities-ipilimumab monotherapy (0.631) versus ipilimumab + 1 agent (0.877) versus ipilimumab + 2 agents (1.408) (p = 0.014). Number of low grade (grade 1/2) toxicities was associated with duration of treatment, Pearson correlation coefficient r = 0.456 (p < 0.0001); whereas the number of high grade (grade 3/4) toxicities was not, r = 0.032 (p = 0.546). CONCLUSIONS Ipilimumab-attributed grade 3/4 toxicity was associated with therapeutic response. The number of co-administered agents added to ipilimumab significantly raised the likelihood of toxicity. Extended duration of treatment increased the incidence of low but not high-grade toxicity.
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Affiliation(s)
- Aman Chauhan
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Tanvir Kabir
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jianrong Wu
- Markey Cancer Center, Biostatistics and Bioinformatics Shared Resource Facility, University of Kentucky, Lexington, KY, USA
| | - Jing Wei
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - Mary Cook
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
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17
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Mastracci L, Fontana V, Queirolo P, Carosio R, Grillo F, Morabito A, Banelli B, Tanda E, Boutros A, Dozin B, Gualco M, Salvi S, Romani M, Spagnolo F, Poggi A, Pistillo MP. Response to ipilimumab therapy in metastatic melanoma patients: potential relevance of CTLA-4 + tumor infiltrating lymphocytes and their in situ localization. Cancer Immunol Immunother 2020; 69:653-662. [PMID: 32025849 DOI: 10.1007/s00262-020-02494-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
Abstract
Immune checkpoint inhibitors, including ipilimumab (IPI), achieve a clinical benefit in a small proportion of melanoma patients highlighting the need to investigate predictive biomarkers. In this study, we characterized tumor infiltrating lymphocytes (TILs), focusing on the CTLA-4+ subset, and evaluated their possible predictive significance. We characterized TIL density, cell type, and localization in 40 melanoma lesions from 17 patients treated with IPI. Associations of TILs with IPI timing, tissue localization, and response to IPI were estimated using a linear mixed-effects modelling approach. We found that most of TIL subsets increased in situ upon IPI therapy, with particular reference to FoxP3+ cells. TILs and TIL subsets, such as CD3+, CD45RO+, CTLA-4+, CD4+, CD8+ T cells, CD20+ B cells, and NKp46+ NK cells, showed significantly different spatial distributions in the tumor microenvironment being higher at the invasive margin (IM) as compared to the tumor center (TC) (P value < 0.001 for TIL score and P value < 0.05 for all subsets). Remarkably, high TIL score and density of CD3+, CD8+ T cells, and CTLA-4+ immune cells were significantly associated with a better response to IPI (P values = 0.002, 0.023, 0.007, and 0.001, respectively, for responders vs non-responders). In conclusion, we provide a detailed analysis of CTLA-4+ TIL distribution in melanoma tissues taking into account localization, relationship with CD3+/CD8+ TILs, and changes in response to IPI treatment. We identified that CTLA-4+ TILs may represent a marker of IPI response, alone or with CD3+/CD8+ subsets, although this requires confirmation in larger studies.
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Affiliation(s)
- Luca Mastracci
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberta Carosio
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Federica Grillo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Morabito
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Barbara Banelli
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Enrica Tanda
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Boutros
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Beatrice Dozin
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marina Gualco
- Anatomic Pathology Unit, Ospedale Villa Scassi, ASL3, Genoa, Italy
| | - Sandra Salvi
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimo Romani
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | | | - Alessandro Poggi
- Molecular Oncology and Angiogenesis Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Pia Pistillo
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
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18
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Prelaj A, Ferrara R, Rebuzzi SE, Proto C, Signorelli D, Galli G, De Toma A, Randon G, Pagani F, Viscardi G, Brambilla M, Trevisan B, Ganzinelli M, Martinetti A, Gallucci R, Di Mauro RM, Molino G, Zilembo N, Torri V, de Braud FM, Garassino MC, Lo Russo G. EPSILoN: A Prognostic Score for Immunotherapy in Advanced Non-Small-Cell Lung Cancer: A Validation Cohort. Cancers (Basel) 2019; 11:E1954. [PMID: 31817541 PMCID: PMC6966664 DOI: 10.3390/cancers11121954] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Beyond programmed death ligand 1 (PD-L1), no other biomarkers for immunotherapy are used in daily practice. We previously created EPSILoN (Eastern Cooperative Oncology Group performance status (ECOG PS), smoking, liver metastases, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR)) score, a clinical/biochemical prognostic score, in 154 patients treated with second/further-line immunotherapy. This study's aim was to validate EPSILoN score in a different population group. METHODS 193 patients were included at National Cancer Institute of Milan (second-line immunotherapy, 61%; further-line immunotherapy, 39%). Clinical/laboratory parameters such as neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels were collected. Kaplan-Meier and Cox hazard methods were used for survival analysis. RESULTS Overall median progression-free survival and median overall survival were 2.3 and 7.6 months, respectively. Multivariate analyses for Progression-Free Survival (PFS) identified heavy smokers (hazard ratio (HR) 0.71, p = 0.036) and baseline LDH < 400 mg/dL (HR 0.66, p = 0.026) as independent positive factors and liver metastases (HR 1.48, p = 0.04) and NLR ≥ 4 (HR 1.49, p = 0.029) as negative prognostic factors. These five factors were included in the EPSILoN score which was able to stratify patients in three different prognostic groups, high, intermediate and low, with PFS of 6.0, 3.8 and 1.9 months, respectively (HR 1.94, p < 0.001); high, intermediate and low prognostic groups had overall survival (OS) of 24.5, 8.9 and 3.4 months, respectively (HR 2.40, p < 0.001). CONCLUSIONS EPSILoN, combining five baseline clinical/blood parameters (ECOG PS, smoking, liver metastases, LDH, NLR), may help to identify advanced non-small-cell lung cancer (aNSCLC) patients who most likely benefit from immune checkpoint inhibitors (ICIs).
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Affiliation(s)
- Arsela Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Roberto Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy;
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giulia Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Alessandro De Toma
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giovanni Randon
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuseppe Viscardi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Benedetta Trevisan
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Monica Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Antonia Martinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Rosaria Gallucci
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Rosa Maria Di Mauro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuliano Molino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Nicoletta Zilembo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Valter Torri
- Pharmacological Research Institute IRCSS Mario Negri, Via La Masa 19, 20156 Milan, Italy;
| | - Filippo Maria de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Marina Chiara Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
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Ménétrier-Caux C, Ray-Coquard I, Blay JY, Caux C. Lymphopenia in Cancer Patients and its Effects on Response to Immunotherapy: an opportunity for combination with Cytokines? J Immunother Cancer 2019; 7:85. [PMID: 30922400 PMCID: PMC6437964 DOI: 10.1186/s40425-019-0549-5] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 12/12/2022] Open
Abstract
Quantitative lymphocyte alterations are frequent in patients with cancer, and strongly impact prognosis and survival. The development of cancers in immunosuppressed patients has demonstrated the contribution of different T cell populations, including CD4+ cells, in the control of cancer occurrence.Whereas absolute numbers of neutrophils, platelets and red blood cells are routinely monitored in clinic following treatments, because of possible short-term complications, absolute lymphocyte counts (ALC), their subpopulations or diversity (phenotype, TCR) are rarely analyzed and never used to choose therapy or as prognostic criteria. The recent identification of immune checkpoint inhibitors (ICPi) as powerful therapeutic agents has revitalized immunotherapy of cancer in a broader group of diseases than anticipated. The status of the immune system is now recognized as an important biomarker for response to these novel treatments. Blood ALC values, along with tumor infiltration by CD8+T cells, and ICPi and ICPi-ligand expression, are likely to be a potential marker of sensitivity to anti-ICPi therapy.In this article, we review the current knowledge on the incidence and significance of lymphopenia in cancer patients, and discuss therapeutic strategies to restore lymphocyte numbers.
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Affiliation(s)
- Christine Ménétrier-Caux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France. .,Innovation in Immuno-monitoring and Immunotherapy Platform (PI3), Centre Léon Bérard, F-69008, Lyon, France.
| | | | - Jean-Yves Blay
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France.,Medical Oncology department, Centre Léon Bérard, F-69008, Lyon, France
| | - Christophe Caux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France.,Innovation in Immuno-monitoring and Immunotherapy Platform (PI3), Centre Léon Bérard, F-69008, Lyon, France
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Szostak B, Machaj F, Rosik J, Pawlik A. CTLA4 antagonists in phase I and phase II clinical trials, current status and future perspectives for cancer therapy. Expert Opin Investig Drugs 2018; 28:149-159. [PMID: 30577709 DOI: 10.1080/13543784.2019.1559297] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In cancer, the immune response to tumor antigens is often suppressed by inhibitors and ligands. Checkpoint blockade, considered one of the most promising frontiers for anti-cancer therapy, aims to stimulate the immune anti-cancer response. Agents such as cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors offer prolonged survival with manageable side effects. AREAS COVERED We summarize the recent clinical successes of CTLA-4 inhibitors and place a strong emphasis on those in early phase clinical trials, often in combination with other immune check-point inhibitors, i.e., programmed cell death protein 1 (PD-1) and BRAF/mitogen-activated protein kinase inhibitors. EXPERT OPINION Recent phase I and phase II clinical trials confirm the efficacy of anti-CTLA-4 therapy for treatment of cancers such as renal cell carcinoma. These studies also indicated increased efficacy with combined immune checkpoint blockade with PD-1 or Ras/Raf/mitogen-activated protein kinase/ERK kinase (MEK)/extracellular-signal-regulated kinase (ERK) inhibitors. Researchers must search for new immune targets that may enable more effective and safe immune checkpoint blockade and cancer therapy. This goal may be achieved by next-generation combination therapies to overcome immune checkpoint therapy resistance.
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Affiliation(s)
- Bartosz Szostak
- a Department of Physiology , Pomeranian Medical University , Szczecin , Poland
| | - Filip Machaj
- a Department of Physiology , Pomeranian Medical University , Szczecin , Poland
| | - Jakub Rosik
- a Department of Physiology , Pomeranian Medical University , Szczecin , Poland
| | - Andrzej Pawlik
- a Department of Physiology , Pomeranian Medical University , Szczecin , Poland
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