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Mortier L, Villabona L, Lawrence B, Arance A, Butler MO, Beylot-Barry M, Saiag P, Samimi M, Ascierto PA, Spada F, De Pontville M, Maio M, Berrocal A, Espinosa E, Capdevila J, Levin M, Das D, Krepler C, Grebennik D, Chiarion-Sileni V. Pembrolizumab for the First-Line Treatment of Recurrent Locally Advanced or Metastatic Merkel Cell Carcinoma: Results from the Single-Arm, Open-Label, Phase III KEYNOTE-913 Study. Am J Clin Dermatol 2024:10.1007/s40257-024-00885-w. [PMID: 39377880 DOI: 10.1007/s40257-024-00885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND The phase III KEYNOTE-913 study was conducted to evaluate the efficacy and safety of pembrolizumab as first-line therapy in patients with advanced Merkel cell carcinoma (MCC). OBJECTIVE The aim was to report results from the primary analysis of KEYNOTE-913. PATIENTS AND METHODS Patients with recurrent locally advanced or metastatic MCC received pembrolizumab 200 mg intravenously every 3 weeks for up to 35 treatments (~ 2 years). The primary end point was objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) by blinded independent central review (BICR). Secondary end points were duration of response (DOR) and progression-free survival (PFS) per RECIST v1.1 by BICR, overall survival (OS), and safety and tolerability. RESULTS Fifty-five patients were treated with pembrolizumab. The median time from first dose to data cutoff (February 15, 2024) was 50.3 months (range 38.7-59.4). The ORR was 49% (95% confidence interval [CI] 35-63), with 12 complete responses and 15 partial responses. The median DOR was 39.8 months (range 4.8-52.5+), and the 24-month DOR rate was 69%. The median PFS was 9.3 months (95% CI 3-26), and the 24-month PFS rate was 39%. The median OS was 24.3 months (95% CI 12.4 to not reached), and the 24-month OS rate was 51%. Any-grade treatment-related adverse events (AEs) occurred in 38 patients (69%); 13 patients (24%) experienced grade 3-5 AEs. The most common treatment-related AEs were fatigue (n = 12 [22%]), pruritus (n = 12 [22%]), and lipase increase (n = 10 [18%]). One patient died of treatment-related Guillain-Barré syndrome. CONCLUSIONS Pembrolizumab provided durable antitumor activity and promising survival and had a manageable safety profile in patients with recurrent locally advanced or metastatic MCC, supporting its use in this population. TRIAL REGISTRATION Clinicaltrials.gov, NCT03783078.
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Affiliation(s)
- Laurent Mortier
- Université Lille, CHRU Lille, 42 Rue Paul Duez, Lille, France.
| | - Lisa Villabona
- Karolinska University Hospital, Akademiska stråket 13, G4:04, 17176, Stockholm, Sweden
| | - Ben Lawrence
- University of Auckland, 85 Park Rd, Auckland City Hospital 2 Park Rd, Auckland, New Zealand
| | - Ana Arance
- Hospital Clinic Barcelona and IDIBAPS, C. de Villarroel, 170, Barcelona, Spain
| | - Marcus O Butler
- Departments of Medicine and Immunology, University of Toronto, 610 University Avenue, Toronto, ON, Canada
| | - Marie Beylot-Barry
- Centre Hospitalier Universitaire de Bordeaux, INSERM 1312, 1 Rue Jean Burguet, Bordeaux, France
| | - Philippe Saiag
- Hôpital Ambroise Paré, APHP & EA4340, University of Versailles-SQY, and Paris-Saclay University, 9 Av. Charles de Gaulle, Boulogne-Billancourt, France
| | - Mahtab Samimi
- University of Tours, France; ISP1282 INRA University of Tours, 60 Rue du Plat d'Étain, Tours, France
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 53, Naples, Italy
| | - Francesca Spada
- Istituto Europeo di Oncologia (IEO) IRCCS, Via Giuseppe Ripamonti, 435, Milan, Italy
| | - Michel De Pontville
- Centre Hospitalier Universitaire de Caen-Hôpital Côte de Nacre, Av. de la Côte de Nacre CS 30001, Caen, France
| | - Michele Maio
- University of Siena and Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Alfonso Berrocal
- Hospital General Universitario de Valencia, Avda. Tres Cruces, 2, Valencia, Spain
| | - Enrique Espinosa
- Service of Oncology, Hospital Universitario La Paz, Universidad Autónoma de Madrid - CIBERONC, P. Castellana, 261-Madrid, Spain
| | - Jaume Capdevila
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Pg. de la Vall d'Hebron, 119, Barcelona, Spain
| | - Max Levin
- University of Gothenburg and Sahlgrenska University Hospital, Universitetsplatsen 1, Gothenburg, Sweden
| | - Debasmita Das
- Merck & Co., Inc., 126 E. Lincoln Ave, Rahway, NJ, USA
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Silva V, Matos C. Recent updates in the therapeutic uses of Pembrolizumab: a brief narrative review. Clin Transl Oncol 2024; 26:2431-2443. [PMID: 38658461 DOI: 10.1007/s12094-024-03491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Treatment of cancer has been improved with the discovery of biological drugs that act as immune checkpoint inhibitors. In 2017, FDA designated pembrolizumab, an immune checkpoint inhibitor employed in immunotherapy, as the first tissue-agnostic cancer treatment. OBJECTIVES To review pembrolizumab's use in oncology, gather and examine the latest discoveries regarding the effectiveness of pembrolizumab in cancer treatment. METHODOLOGY A literature review was conducted through PubMed(Medline) from January 2015 to December 2023 using "pembrolizumab", "cancer" and "treatment" as search terms. RESULTS Pembrolizumab demonstrated effectiveness as primary treatment for metastatic nonsmall cell lung cancer, unresectable esophageal cancer, head and neck squamous cell carcinoma and alternative treatment for notable triple-negative breast cancer, biliary, colorectal, endometrial, renal cell, cervical carcinoma, and high microsatellite instability or mismatch repair deficiencies tumors. Pediatric applications include treatment for refractory Hodgkin lymphoma. CONCLUSION Evolving research on pembrolizumab allows a deeper clinical understanding, despite challenges as variable patient responses. Pembrolizumab has emerged as a pivotal breakthrough in cancer treatment, improving patient outcomes and safety.
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Affiliation(s)
- Vítor Silva
- Centro Hospitalar e Universitário de Coimbra, EPE, 3004-561, Coimbra, Portugal
| | - Cristiano Matos
- QLV Research Consulting, 3030-199, Coimbra, Portugal.
- Polytechnic Institute of Coimbra, ESTESC-Coimbra Health School Pharmacy, 3046-854, Coimbra, Portugal.
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3
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Luke JJ, Long GV, Robert C, Carlino MS, Choueiri TK, Haas NB, O'Brien M, Paz-Ares L, Peters S, Powles T, Leiby MA, Lin J, Zhao Y, Krepler C, Perini RF, Catherine Pietanza M, Samkari A, Gruber T, Ibrahim N, Eggermont AMM. Safety of pembrolizumab as adjuvant therapy in a pooled analysis of phase 3 clinical trials of melanoma, non-small cell lung cancer, and renal cell carcinoma. Eur J Cancer 2024; 207:114146. [PMID: 38838446 DOI: 10.1016/j.ejca.2024.114146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The safety profile of adjuvant pembrolizumab was evaluated in a pooled analysis of 4 phase 3 clinical trials. METHODS Patients had completely resected stage IIIA, IIIB, or IIIC melanoma per American Joint Committee on Cancer, 7th edition, criteria (AJCC-7; KEYNOTE-054); stage IIB or IIC melanoma per AJCC-8 (KEYNOTE-716); stage IB, II, or IIIA non-small cell lung cancer per AJCC-7 (PEARLS/KEYNOTE-091); or postnephrectomy/metastasectomy clear cell renal cell carcinoma at increased risk of recurrence (KEYNOTE-564). Patients received adjuvant pembrolizumab 200 mg (2 mg/kg up to 200 mg for pediatric patients) or placebo every 3 weeks for approximately 1 year. Adverse events (AEs) were summarized for patients who received ≥ 1 dose of treatment. RESULTS Data were pooled from 4125 patients treated with pembrolizumab (n = 2060) or placebo (n = 2065). Median (range) duration of treatment was 11.1 months (0.0-18.9) with pembrolizumab and 11.2 months (0.0-18.1) with placebo. Treatment-related AEs occurred in 78.6 % (1620/2060) of patients in the pembrolizumab group (grade 3-5, 16.3 % [336/2060]) and 58.7 % (1212/2065) in the placebo group (grade 3-5, 3.5 % [72/2065]). Immune-mediated AEs (e.g. adrenal insufficiency, hypophysitis, and thyroiditis) occurred in 36.2 % (746/2060) of patients in the pembrolizumab group (grade 3-5, 8.6 % [177/2060]) and 8.4 % (174/2065) in the placebo group (grade 3-5, 1.1 % [23/2065]). Of patients with ≥ 1 immune-mediated AE or infusion reaction, systemic corticosteroids were required for 35.2 % (268/761) and 20.2 % (39/193) of patients in the pembrolizumab and placebo groups, respectively. CONCLUSIONS Adjuvant pembrolizumab demonstrated a manageable safety profile that was comparable to prior reports in advanced disease.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/pathology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Melanoma/drug therapy
- Melanoma/pathology
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Male
- Female
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Chemotherapy, Adjuvant
- Aged
- Middle Aged
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Clinical Trials, Phase III as Topic
- Adult
- Young Adult
- Aged, 80 and over
- Adolescent
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Affiliation(s)
- Jason J Luke
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA 15232, USA.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, and Mater Hospital, 40 Rocklands Road, North Sydney, NSW 2065, Australia
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, 114 Rue Edouard Vaillant, Paris, Villejuif, France
| | - Matteo S Carlino
- Westmead and Blacktown Hospitals, Melanoma Institute Australia, and The University of Sydney, 40 Rocklands Road, North Sydney, NSW 2065, Australia
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Naomi B Haas
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Mary O'Brien
- Royal Marsden Hospital and Imperial College, Downs Rd, Sutton, SM2 5PT London, United Kingdom
| | - Luis Paz-Ares
- Complutense University, Cancer Network Biomedical Research Center Consortium (CIBERONC), Spanish National Caner Research Center (CNIO) and Hospital 12 de Octubre, Madrid, Spain
| | - Solange Peters
- Lausanne University Hospital Center (CHUV) and University of Lausanne, Quartier Centre, 1015 Lausanne, Switzerland
| | - Thomas Powles
- St Bartholomew's Hospital, West Smithfield, London EC1A 7B, United Kingdom
| | - Melanie A Leiby
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | - Jianxin Lin
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | - Yujie Zhao
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | - Clemens Krepler
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | | | | | - Ayman Samkari
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | - Todd Gruber
- Merck & Co., Inc., 126 E Lincoln Avenue, Rahway, NJ 07065, USA
| | | | - Alexander M M Eggermont
- Department of Medical Oncology, Institut de Cancérologie Gustave Roussy, Université Paris-Sud, 114 Rue Edouard Vaillant, Villejuif, France
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4
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Koch EAT, Petzold A, Dippel E, Erdmann M, Gesierich A, Gutzmer R, Hassel JC, Haferkamp S, Kähler KC, Kreuzberg N, Leiter U, Loquai C, Meier F, Meissner M, Mohr P, Pföhler C, Rahimi F, Schell B, Terheyden P, Thoms KM, Ugurel S, Ulrich J, Utikal J, Weichenthal M, Ziller F, Berking C, Heppt MV. Optimizing immune checkpoint blockade in metastatic uveal melanoma: exploring the association of overall survival and the occurrence of adverse events. Front Immunol 2024; 15:1395225. [PMID: 38915414 PMCID: PMC11194381 DOI: 10.3389/fimmu.2024.1395225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Despite recent advancements in the treatment of metastatic uveal melanoma (UM), the availability of further treatment options remains limited and the prognosis continues to be poor in many cases. In addition to tebentafusp, immune checkpoint blockade (ICB, PD-1 (+/-) CTLA-4 antibodies) is commonly used for metastatic UM, in particular in HLA-A 02:01-negative patients. However, ICB comes at the cost of potentially severe immune-related adverse events (irAE). Thus, the selection of patient groups that are more likely to benefit from ICB is desirable. Methods In this analysis, 194 patients with metastatic UM undergoing ICB were included. Patients were recruited from German skin cancer sites and the ADOReg registry. To investigate the association of irAE occurrence with treatment response, progression-free survival (PFS), and overall survival (OS) two cohorts were compared: patients without irAE or grade 1/2 irAE (n=137) and patients with grade 3/4 irAE (n=57). Results In the entire population, the median OS was 16.4 months, and the median PFS was 2.8 months. Patients with grade 3/4 irAE showed more favorable survival than patients without or grade 1/2 irAE (p=0.0071). IrAE occurred in 44.7% (87/194), and severe irAE in 29.4% (57/194) of patients. Interestingly, irColitis and irHepatitis were significantly associated with longer OS (p=0.0031 and p=0.011, respectively). Conclusions This data may indicate an association between irAE and favorable survival outcomes in patients with metastatic UM undergoing ICB treatment and suggests that a reduced tolerance to tumor antigens could be linked to reduced tolerance to self-antigens.
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Affiliation(s)
- Elias A. T. Koch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Minden, Department of Dermatology, Mühlenkreiskliniken AöR, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Hospital Heidelberg, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Katharina C. Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicole Kreuzberg
- Department of Dermatology and Venereology, Skin Cancer Center at the Center of Integrated Oncology (CIO) Köln Bonn, University Hospital of Cologne, Cologne, Germany
| | - Ulrike Leiter
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
- Department of Dermatology, Klinikum Bremen-Ost, Bremen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Goethe University, Frankfurt am Main, Germany
| | - Peter Mohr
- Department of Dermatology, Elbeklinikum, Buxtehude, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg, Germany
| | - Farnaz Rahimi
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Munich, Germany
| | - Beatrice Schell
- Department of Dermatology, SRH Wald-Klinikum Gera, Gera, Germany
| | | | - Kai-Martin Thoms
- Department of Dermatology, University Medical Center Goettingen, Goettingen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jens Ulrich
- Department of Dermatology, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fabian Ziller
- Department of Dermatology, DRK Krankenhaus Rabenstein, Chemnitz, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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5
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Voisin A, Terret C, Schiffler C, Bidaux AS, Vanacker H, Perrin-Niquet M, Barbery M, Vinceneux A, Eberst L, Stéphan P, Garin G, Spaggiari D, Pérol D, Grinberg-Bleyer Y, Cassier PA. Xevinapant Combined with Pembrolizumab in Patients with Advanced, Pretreated, Colorectal and Pancreatic Cancer: Results of the Phase Ib/II CATRIPCA Trial. Clin Cancer Res 2024; 30:2111-2120. [PMID: 38502104 DOI: 10.1158/1078-0432.ccr-23-2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/19/2023] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Xevinapant is an orally available inhibitor of apoptosis proteins (IAP) inhibitor. Preclinical data suggest that IAP antagonism may synergize with immune checkpoint blockers by modulating the NFκB pathway in immune cells. PATIENTS AND METHODS Adult patients with non-high microsatellite instability advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) or colorectal cancer were enrolled in this phase Ib/II study and received pembrolizumab 200 mg every 3 weeks intravenously, and ascending doses of oral xevinapant (100, 150, and 200 mg daily for 14 days on/7 days off). Dose escalation followed a 3+3 design with a 21-day dose-limiting toxicity (DLT) evaluation period. Following the determination of the recommended phase II dose (RP2D), 14 patients with PDAC and 14 patients with colorectal cancer were enrolled in expansion cohorts to assess preliminary efficacy. RESULTS Forty-one patients (26 males) with a median age of 64 years were enrolled: 13 in the dose escalation and 28 in the two expansion cohorts. No DLT was observed during dose escalation. The RP2D was identified as xevinapant 200 mg/day + pembrolizumab 200 mg every 3 weeks. The most common adverse events (AE) were fatigue (37%), gastrointestinal AE (decreased appetite in 37%, nausea in 24%, stomatitis in 12%, and diarrhea and vomiting in 10% each), and cutaneous AE (pruritus, dry skin, and rash seen in 20%, 15%, and 15% of patients, respectively). The best overall response according to RECIST1.1 was partial response (confirmed) in 1 (3%), stable disease in 4 (10%), and progressive disease in 35 (88%). CONCLUSIONS Xevinapant combined with pembrolizumab was well tolerated with no unexpected AEs. However, antitumor activity was low.
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Affiliation(s)
- Allison Voisin
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
| | - Catherine Terret
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Camille Schiffler
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Anne-Sophie Bidaux
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Hélène Vanacker
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Marlène Perrin-Niquet
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
| | - Maud Barbery
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Lauriane Eberst
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Stéphan
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
| | - Gwenaële Garin
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - David Pérol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Yenkel Grinberg-Bleyer
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe A Cassier
- Molecular Regulation of Cancer Immunity, Cancer Research Center of Lyon, Labex DEV2CAN, Centre Léon Bérard, INSERM U1052, CNRS UMR5286, Université Claude Bernard Lyon 1, Lyon, France
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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6
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Luke JJ, Ascierto PA, Khattak MA, de la Cruz Merino L, Del Vecchio M, Rutkowski P, Spagnolo F, Mackiewicz J, Chiarion-Sileni V, Kirkwood JM, Robert C, Grob JJ, de Galitiis F, Schadendorf D, Carlino MS, Wu XL, Fukunaga-Kalabis M, Krepler C, Eggermont AM, Long GV. Pembrolizumab Versus Placebo as Adjuvant Therapy in Resected Stage IIB or IIC Melanoma: Final Analysis of Distant Metastasis-Free Survival in the Phase III KEYNOTE-716 Study. J Clin Oncol 2024; 42:1619-1624. [PMID: 38452313 PMCID: PMC11095869 DOI: 10.1200/jco.23.02355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Pembrolizumab adjuvant therapy was shown to significantly improve recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) in patients with resected stage IIB or IIC melanoma in earlier analyses of the randomized, double-blind, phase III KEYNOTE-716 study (ClinicalTrials.gov identifier: NCT03553836). We report results of the protocol-specified final analysis of DMFS for KEYNOTE-716. Overall, 976 patients were randomly allocated to pembrolizumab (n = 487) or placebo (n = 489). As of January 4, 2023, median follow-up was 39.4 months (range, 26.0-51.4 months). The median DMFS was not reached in either treatment group, and the estimated 36-month DMFS was 84.4% for pembrolizumab and 74.7% for placebo (hazard ratio [HR], 0.59 [95% CI, 0.44 to 0.79]). The median RFS was not reached in either treatment group, and the estimated 36-month RFS was 76.2% for pembrolizumab and 63.4% for placebo (HR, 0.62 [95% CI, 0.49 to 0.79]). DMFS and RFS results were consistent across most prespecified subgroups, including stage IIB and stage IIC melanoma. The safety profile of pembrolizumab was manageable and consistent with previous reports. These results continue to support the use of pembrolizumab adjuvant therapy in patients with resected stage IIB or IIC melanoma.
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Affiliation(s)
- Jason J. Luke
- UPMC Hillman Cancer Center and University of Pittsburgh, Pittsburgh, PA
| | | | | | - Luis de la Cruz Merino
- Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain
- Department of Clinical Oncology, Hospital University Virgen Macarena, Seville, Spain
| | | | - Piotr Rutkowski
- Maria Sklodowska–Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jacek Mackiewicz
- Poznan University of Medical Sciences and Greater Poland Cancer Center, Poznan, Poland
| | | | - John M. Kirkwood
- UPMC Hillman Cancer Center and University of Pittsburgh, Pittsburgh, PA
| | - Caroline Robert
- Gustave Roussy, Villejuif, France
- Paris-Saclay University, Paris, France
| | - Jean-Jacques Grob
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | | | - Dirk Schadendorf
- University Hospital Essen and German Cancer Consortium Partner Site, Essen, Germany
- National Center for Tumor Diseases (NCT)-West, Campus Essen, Research Alliance Ruhr, Research Center One Health, and University Duisburg-Essen, Essen, Germany
| | - Matteo S. Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Westmead and Blacktown Hospitals, Sydney, NSW, Australia
| | | | | | | | - Alexander M.M. Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands
- Comprehensive Cancer Center Munich of the Technical University Munich and the Ludwig Maximilian University, Munich, Germany
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital and Mater Hospital, Sydney, NSW, Australia
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7
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Suijkerbuijk KPM, van Eijs MJM, van Wijk F, Eggermont AMM. Clinical and translational attributes of immune-related adverse events. NATURE CANCER 2024; 5:557-571. [PMID: 38360861 DOI: 10.1038/s43018-024-00730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
With immune checkpoint inhibitors (ICIs) becoming the mainstay of treatment for many cancers, managing their immune-related adverse events (irAEs) has become an important part of oncological care. This Review covers the clinical presentation of irAEs and crucial aspects of reversibility, fatality and long-term sequelae, with special attention to irAEs in specific patient populations, such as those with autoimmune diseases. In addition, the genetic basis of irAEs, along with cellular and humoral responses to ICI therapy, are discussed. Detrimental effects of empirically used high-dose steroids and second-line immunosuppression, including impaired ICI effectiveness, call for more tailored irAE-treatment strategies. We discuss open therapeutic challenges and propose potential avenues to accelerate personalized management strategies and optimize outcomes.
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Affiliation(s)
- Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Mick J M van Eijs
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands
- Comprehensive Cancer Center Munich of the Technical University of Munich and the Ludwig Maximilian University, Munich, Germany
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8
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Xu S, Wang Q, Ma W. Cytokines and soluble mediators as architects of tumor microenvironment reprogramming in cancer therapy. Cytokine Growth Factor Rev 2024; 76:12-21. [PMID: 38431507 DOI: 10.1016/j.cytogfr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Navigating the intricate landscape of the tumor microenvironment (TME) unveils a pivotal arena for cancer therapeutics, where cytokines and soluble mediators emerge as double-edged swords in the fight against cancer. This review ventures beyond traditional perspectives, illuminating the nuanced interplay of these elements as both allies and adversaries in cancer dynamics. It critically evaluates the evolving paradigms of TME reprogramming, spotlighting innovative strategies that target the sophisticated network of cytokines and mediators. Special focus is placed on unveiling the therapeutic potential of novel cytokines and mediators, particularly their synergistic interactions with extracellular vesicles, which represent underexplored conduits for therapeutic targeting. Addressing a significant gap in current research, we explore the untapped potential of these biochemical players in orchestrating immune responses, tumor proliferation, and metastasis. The review advocates for a paradigm shift towards exploiting these dynamic interactions within the TME, aiming to transcend conventional treatments and pave the way for a new era of precision oncology. Through a critical synthesis of recent advancements, we highlight the imperative for innovative approaches that harness the full spectrum of cytokine and mediator activities, setting the stage for breakthrough therapies that offer heightened specificity, reduced toxicity, and improved patient outcomes.
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Affiliation(s)
- Suling Xu
- Department of Dermatology, The First Affiliated Hospital of Ningbo University School of Medicine, Ningbo, Zhejiang 315020, China.
| | - Qingqing Wang
- Institute of Immunology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Wenxue Ma
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center, and Sanford Stem Cell Institute, University of California San Diego, La Jolla, CA 92093, USA.
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9
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Brahmer JR, Long GV, Hamid O, Garon EB, Herbst RS, Andre T, Armand P, Bajorin D, Bellmunt J, Burtness B, Choueiri TK, Cohen EEW, Diaz LA, Shitara K, Kulkarni G, McDermott D, Shah M, Tabernero J, Vogel A, Zinzani PL, Jafari N, Bird S, Snyder E, Gause C, Bracco OL, Pietanza MC, Gruber T, Ribas A. Safety profile of pembrolizumab monotherapy based on an aggregate safety evaluation of 8937 patients. Eur J Cancer 2024; 199:113530. [PMID: 38295556 PMCID: PMC11227881 DOI: 10.1016/j.ejca.2024.113530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Pembrolizumab has a manageable safety profile as described in its label, which was primarily based on 2799 patients who participated in clinical trials for melanoma or non-small cell lung cancer. Here, we evaluated the safety of pembrolizumab in a broader population of patients from 31 advanced cancer clinical trials across 19 cancer types. METHODS Safety was analyzed in patients who received at least one dose of pembrolizumab (200 mg every 3 weeks [Q3W], 10 mg/kg Q2W or Q3W, or 2 mg/kg Q3W). Adverse events (AEs) and immune-mediated AEs and infusion reactions were evaluated. RESULTS Safety data from 8937 patients in 31 trials of pembrolizumab monotherapy were pooled (median, seven administrations; range, 1-59). Median duration on treatment was 4.1 months (range, 0.03-40.1). AEs occurred in 96.6% of patients. Grade 3-5 AEs occurred in 50.6% of patients. AEs led to pembrolizumab discontinuation in 12.7% of patients and death in 5.9%. Immune-mediated AEs and infusion reactions occurred in 23.7% of patients (4.6% experienced multiple immune-mediated AEs/infusion reactions) and led to pembrolizumab discontinuation in 3.6% and death in 0.2%. Grade 3-5 immune-mediated AEs occurred in 6.3% of patients. Serious immune-mediated AEs and infusion reactions occurred in 6.0% of patients. Median time to immune-mediated AE onset was 85 days (range, 13-163). Of 2657 immune-mediated AEs, 22.3% were initially treated with prednisone ≥ 40 mg/day or equivalent, and 8.3% were initially treated with lower steroid doses. CONCLUSIONS This pooled analysis of 31 clinical trials showed that pembrolizumab has a consistent safety profile across indications.
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Affiliation(s)
- Julie R Brahmer
- Johns Hopkins Kimmel Cancer Center, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, 40 Rocklands Road North Sydney, Sydney, NSW 2060, Australia.
| | - Omid Hamid
- Cedars-Sinai The Angeles Clinic and Research Institute, 11800 Wilshire Blvd #300, Los Angeles, CA 90025, USA.
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
| | - Roy S Herbst
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Thierry Andre
- Sorbonne Université and Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, Paris 75012, France.
| | - Philippe Armand
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and IMIM Lab, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Barbara Burtness
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Ezra E W Cohen
- Moores Cancer Center, UC San Diego Health, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Luis A Diaz
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Kohei Shitara
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Chiba 277-8577, Japan.
| | - Girish Kulkarni
- Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON MG5 2C4, Canada.
| | - David McDermott
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02186, USA.
| | - Manish Shah
- Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA.
| | - Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Pg. de la Vall d'Hebron 119, Barcelona 08035, Spain.
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, Canada; Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada; Hannover Medical School, Hannover, Germany.
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | - Antoni Ribas
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
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McKenzie J, Sneath E, Trinh A, Nolan M, Spain L. Updates in the pathogenesis and management of immune-related enterocolitis, hepatitis and cardiovascular toxicities. IMMUNO-ONCOLOGY TECHNOLOGY 2024; 21:100704. [PMID: 38357008 PMCID: PMC10865026 DOI: 10.1016/j.iotech.2024.100704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Immune checkpoint inhibitors (ICIs) have become a cornerstone of treatment for many solid organ malignancies. Alongside increasing use, the occurrence of immune-related adverse events (irAEs) has also increased and remains a significant challenge when treating patients with ICI. The underlying pathophysiology of irAE development for many organ systems is yet to be elucidated, but may involve unmasking of latent autoimmunity, increased T-cell recognition of shared antigens on cancer and normal tissue and ICI-triggered immune dysregulation with overactivation of proinflammatory pathways and suppression of immune control pathways. Management strategies for irAEs have historically been borrowed from paradigms for conventional autoimmune conditions such as inflammatory bowel disease and autoimmune hepatitis; however, recent translational efforts have clearly demonstrated key differences in underlying immune signalling pathways. As we begin to understand these differences, we must adapt a more targeted approach to immunosuppression and exercise a more nuanced approach with the multiple biologic agents available to mitigate ICI-related toxicity without reversing the antitumour effect of ICI. In this review, we focus on three key immune-related toxicities where recent clinical and translational work has provided nuanced insights into pathogenesis and treatment strategies: enterocolitis, hepatitis and cardiovascular toxicity including myocarditis.
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Affiliation(s)
- J. McKenzie
- Department of Medical Oncology, Melbourne, Australia
| | - E. Sneath
- Department of Medical Oncology, Melbourne, Australia
| | - A. Trinh
- Department of Gastroenterology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - M. Nolan
- Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L. Spain
- Department of Medical Oncology, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
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11
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Virtanen S, Pihlman H, Silvoniemi M, Vihinen P, Jaakkola P, Mattila KE. Reasons for Treatment Discontinuation and Their Effect on Outcomes of Immunotherapy in Southwest Finland: A Retrospective, Real-World Cohort Study. Cancers (Basel) 2024; 16:709. [PMID: 38398099 PMCID: PMC10887274 DOI: 10.3390/cancers16040709] [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: 12/23/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Immune checkpoint inhibitors (ICI) have improved survival in several cancer types. Still, most patients develop disease progression during or after treatment. We evaluated the reasons for treatment discontinuation and their effect on treatment outcomes in adult patients with advanced cancer with ICI in the first or later treatment lines in Southwest Finland between 1 January 2015 and 31 December 2021. Baseline characteristics and treatment outcomes were retrospectively obtained from the electronic medical records. There were 317 patients with 15 different cancer types, most commonly non-small cell lung cancer, melanoma, and kidney cancer, treated with ICI outside clinical trials. During follow-up, 94% of the patients had discontinued treatment. A total of 62% was due to disease progression, 17% due to immune-related adverse events (irAEs), 12% after achieving disease control or radiological response, and 9% due to poor performance status. The median progression-free survival (mPFS) was 5.4 months and the median overall survival (mOS) was 20.3 months in the whole cohort. Longer mPFS and mOS were observed in patients who discontinued ICI due to irAEs (24.3 and 49.2 months) and after disease control (49.7 months and not reached). In total, 46% of the patients who discontinued ICI after irAEs or disease control remained alive and progression-free during follow-up.
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Affiliation(s)
- Saana Virtanen
- Department of Oncology and Radiotherapy, Fican West Cancer Centre, Turku University Hospital, University of Turku, 20521 Turku, Finland; (S.V.); (H.P.); (P.V.); (P.J.)
| | - Heidi Pihlman
- Department of Oncology and Radiotherapy, Fican West Cancer Centre, Turku University Hospital, University of Turku, 20521 Turku, Finland; (S.V.); (H.P.); (P.V.); (P.J.)
| | - Maria Silvoniemi
- Department of Respiratory Medicine, Turku University Hospital, University of Turku, 20521 Turku, Finland;
| | - Pia Vihinen
- Department of Oncology and Radiotherapy, Fican West Cancer Centre, Turku University Hospital, University of Turku, 20521 Turku, Finland; (S.V.); (H.P.); (P.V.); (P.J.)
| | - Panu Jaakkola
- Department of Oncology and Radiotherapy, Fican West Cancer Centre, Turku University Hospital, University of Turku, 20521 Turku, Finland; (S.V.); (H.P.); (P.V.); (P.J.)
| | - Kalle E. Mattila
- Department of Oncology and Radiotherapy, Fican West Cancer Centre, Turku University Hospital, University of Turku, 20521 Turku, Finland; (S.V.); (H.P.); (P.V.); (P.J.)
- InFLAMES Research Flagship Center, University of Turku, 20521 Turku, Finland
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12
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Varey AHR, Li I, El Sharouni MA, Simon J, Dedeilia A, Ch'ng S, Saw RPM, Spillane AJ, Shannon KF, Pennington TE, Rtshiladze M, Stretch JR, Nieweg OE, van Akkooi A, Sullivan RJ, Boland GM, Gershenwald JE, van Diest PJ, Scolyer RA, Long GV, Thompson JF, Lo SN. Predicting Recurrence-Free and Overall Survival for Patients With Stage II Melanoma: The MIA Calculator. J Clin Oncol 2024:JCO2301020. [PMID: 38315961 DOI: 10.1200/jco.23.01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/30/2023] [Accepted: 11/09/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Improvements in recurrence-free survival (RFS) were demonstrated in two recent randomized trials for patients with sentinel node (SN)-negative stage IIB or IIC melanoma receiving adjuvant systemic therapy (pembrolizumab/nivolumab). However, adverse events also occurred. Accurate individualized prognostic estimates of RFS and overall survival (OS) would allow patients to more accurately weigh the risks and benefits of adjuvant therapy. Since the current American Joint Committee on Cancer eighth edition (AJCC-8) melanoma staging system focuses on melanoma-specific survival, we developed a multivariable risk prediction calculator that provides estimates of 5- and 10-year RFS and OS for these patients. METHODS Data were extracted from the Melanoma Institute Australia (MIA) database for patients diagnosed with stage II (clinical or pathological) melanoma (n = 3,220). Survival prediction models were developed using multivariable Cox regression analyses (MIA models) and externally validated twice using data sets from the United States and the Netherlands. Each model's performance was assessed using C-statistics and calibration plots and compared with Cox models on the basis of AJCC-8 staging (stage models). RESULTS The 5-year and 10-year RFS C-statistics were 0.70 and 0.73 (MIA-model) versus 0.61 and 0.60 (stage-model), respectively. For OS, the 5-year and 10-year C-statistics were 0.71 and 0.75 (MIA-model) compared with 0.62 and 0.61 (stage-model), respectively. The MIA models were well calibrated and externally validated. CONCLUSION The MIA models offer accurate and personalized estimates of both RFS and OS in patients with stage II melanoma even in the absence of pathological staging with SN biopsy. These models were robust on external validations and may be used in everyday practice both with (ideally) and without performing SN biopsy to identify high-risk patients for further management strategies. An online tool will be available at the MIA website (Risk Prediction Tools).
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Affiliation(s)
- Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Isabel Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary-Ann El Sharouni
- Departments of Dermatology and Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Julie Simon
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexander van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul J van Diest
- Departments of Dermatology and Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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13
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Takada H, Yamashita K, Osawa L, Komiyama Y, Muraoka M, Suzuki Y, Sato M, Kobayashi S, Yoshida T, Takano S, Maekawa S, Enomoto N. Significance of the autoantibody assay in predicting the development of immune-related adverse events in patients receiving atezolizumab plus bevacizumab combination therapy for unresectable hepatocellular carcinoma. Hepatol Res 2024; 54:162-173. [PMID: 37740643 DOI: 10.1111/hepr.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
AIM Atezolizumab plus bevacizumab (AB) combination therapy is the first-line treatment for unresectable hepatocellular carcinoma (u-HCC). The management of immune-related adverse events (irAEs) is an important issue associated with achieving a good therapeutic response in patients receiving AB therapy. However, few studies have reported irAE development in patients receiving AB therapy. This study focused on the association between irAE development and autoantibodies at baseline in patients receiving AB therapy. METHODS Sixty-one patients receiving AB therapy were enrolled. For autoantibodies, the following antibodies were tested before the start of AB therapy: antinuclear antibodies, rheumatoid factor (RF), anti-thyroglobulin antibodies, thyroid peroxidase antibodies, anti-thyroid stimulating hormone receptor antibodies, and acetylcholine receptor antibodies. A patient was considered to have pre-existing antibodies if any of the listed antibodies were present at baseline. RESULTS Ten patients (16%) developed irAEs during the observation period. The irAEs included liver injury, hypothyroidism, adrenal insufficiency, adrenocorticotropic hormone deficiency, and rhabdomyolysis. Patients with irAE (n = 10) were more likely to be positive for any autoantibody (hazard ratio [HR] 3.7, p = 0.047) and RF at baseline (HR 5.4, p = 0.035) and to achieve complete response (HR 5.8, p = 0.027) than those without. The presence of autoantibodies at baseline was an independent factor associated with irAE development. CONCLUSION In the real world, 16% of patients receiving AB therapy for u-HCC developed irAEs. Patients with autoantibodies at baseline are at high risk of developing irAEs and require cautious follow-up.
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Affiliation(s)
- Hitomi Takada
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Koji Yamashita
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Leona Osawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yasuyuki Komiyama
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masaru Muraoka
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuichiro Suzuki
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Mitsuaki Sato
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shoji Kobayashi
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takashi Yoshida
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinichi Takano
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinya Maekawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Nobuyuki Enomoto
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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14
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Su J, Fu Y, Cui Z, Abidin Z, Yuan J, Zhang X, Li R, Zhao C. Relatlimab: a novel drug targeting immune checkpoint LAG-3 in melanoma therapy. Front Pharmacol 2024; 14:1349081. [PMID: 38269271 PMCID: PMC10806167 DOI: 10.3389/fphar.2023.1349081] [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: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Relatlimab is a type of human immunoglobulin G4 monoclonal blocking antibody. It is the world's first Lymphocyte-Activation Gene-3 (LAG-3) inhibitor and the third immune checkpoint inhibitor with clinical application, following PD-1 and CTLA-4. Relatlimab can bind to the LAG-3 receptor which blocks the interaction between LAG-3 and its ligand to reduce LAG-3 pathway-mediated immunosuppression and promote T-cell proliferation, inducing tumor cell death. On 18 March 2022, the U.S. FDA approved the fixed-dose combination of relatlimab developed by Bristol Myers Squibb with nivolumab, under the brand name Opdualag for the treatment of unresectable or metastatic melanoma in adult and pediatric patients aged 12 and older. This study comprehensively describes the mechanism of action and clinical trials of relatlimab and a brief overview of immune checkpoint drugs currently used for the treatment of melanoma.
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Affiliation(s)
- Jingjing Su
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Yiting Fu
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Zitong Cui
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Zain Abidin
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Jingsong Yuan
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Xinmiao Zhang
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Runmin Li
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
| | - Chunzhen Zhao
- Key Laboratory of Molecular Pharmacology and Translational Medicine and Department of Pharmacology, College of Pharmacy, Weifang Medical University, Weifang, China
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15
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Du Y, Dai J, Mao L, Wei X, Bai X, Chen L, Lin J, Chi Z, Cui C, Sheng X, Lian B, Tang B, Wang X, Yan X, Li S, Zhou L, Guo J, Chen Y, Si L. Phase Ib study of anlotinib in combination with anti-PD-L1 antibody (TQB2450) in patients with advanced acral melanoma. J Eur Acad Dermatol Venereol 2024; 38:93-101. [PMID: 37625814 DOI: 10.1111/jdv.19467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Acral melanoma, the most common subtype of melanoma in Asians, is often diagnosed at an advanced stage and responds poorly to current programmed cell death protein 1 (PD-1) inhibitors. OBJECTIVES To evaluate the safety and efficacy of TQB2450 and anlotinib in patients with advanced acral melanoma in a phase Ib study (NCT03991975). METHODS Patients received TQB2450 (1200 mg every 3 weeks) and anlotinib (10 mg or 12 mg once daily, 2-week on/1-week off) in the dose-escalation and dose-expansion phases. The primary endpoints were dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and objective response rate (ORR). RESULTS Nineteen patients were enrolled between June 2019 and June 2022. The majority of patients (16 of 19 patients) received anlotinib and TQB2450 as first-line treatment. No DLTs were observed, and MTD was not reached. Eighteen (94.7%) out of 19 patients experienced treatment-related adverse events (TRAEs), but most were grade 1 or 2. Grade 3 or greater TRAEs occurred in seven patients (36.8%). The ORR was 26.3% (two complete responses and three partial responses). The disease control rate was 73.7%. The median duration of response was 30.3 months [95% confidence interval (CI): 5.8-NA]. The median progression-free survival (PFS) was 5.5 months (95% CI: 2.8-NA), and median overall survival was 20.3 months (95% CI: 14.8-NA). Whole-exome sequencing suggested that acquired drug resistance might be attributed to activation of the MAPK signalling pathway and transformation to an immunosuppressive tumour environment. CONCLUSIONS TQB2450 combined with anlotinib showed favourable tolerance and promising anti-tumour activity with a prolonged PFS compared with anti-PD1 monotherapy in patients with advanced acral melanoma.
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Affiliation(s)
- Yu Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ling Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jing Lin
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yu Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
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16
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Pavlick AC, Ariyan CE, Buchbinder EI, Davar D, Gibney GT, Hamid O, Hieken TJ, Izar B, Johnson DB, Kulkarni RP, Luke JJ, Mitchell TC, Mooradian MJ, Rubin KM, Salama AK, Shirai K, Taube JM, Tawbi HA, Tolley JK, Valdueza C, Weiss SA, Wong MK, Sullivan RJ. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of melanoma, version 3.0. J Immunother Cancer 2023; 11:e006947. [PMID: 37852736 PMCID: PMC10603365 DOI: 10.1136/jitc-2023-006947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 10/20/2023] Open
Abstract
Since the first approval for immune checkpoint inhibitors (ICIs) for the treatment of cutaneous melanoma more than a decade ago, immunotherapy has completely transformed the treatment landscape of this chemotherapy-resistant disease. Combination regimens including ICIs directed against programmed cell death protein 1 (PD-1) with anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) agents or, more recently, anti-lymphocyte-activation gene 3 (LAG-3) agents, have gained regulatory approvals for the treatment of metastatic cutaneous melanoma, with long-term follow-up data suggesting the possibility of cure for some patients with advanced disease. In the resectable setting, adjuvant ICIs prolong recurrence-free survival, and neoadjuvant strategies are an active area of investigation. Other immunotherapy strategies, such as oncolytic virotherapy for injectable cutaneous melanoma and bispecific T-cell engager therapy for HLA-A*02:01 genotype-positive uveal melanoma, are also available to patients. Despite the remarkable efficacy of these regimens for many patients with cutaneous melanoma, traditional immunotherapy biomarkers (ie, programmed death-ligand 1 expression, tumor mutational burden, T-cell infiltrate and/or microsatellite stability) have failed to reliably predict response. Furthermore, ICIs are associated with unique toxicity profiles, particularly for the highly active combination of anti-PD-1 plus anti-CTLA-4 agents. The Society for Immunotherapy of Cancer (SITC) convened a panel of experts to develop this clinical practice guideline on immunotherapy for the treatment of melanoma, including rare subtypes of the disease (eg, uveal, mucosal), with the goal of improving patient care by providing guidance to the oncology community. Drawing from published data and clinical experience, the Expert Panel developed evidence- and consensus-based recommendations for healthcare professionals using immunotherapy to treat melanoma, with topics including therapy selection in the advanced and perioperative settings, intratumoral immunotherapy, when to use immunotherapy for patients with BRAFV600-mutated disease, management of patients with brain metastases, evaluation of treatment response, special patient populations, patient education, quality of life, and survivorship, among others.
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Affiliation(s)
| | - Charlotte E Ariyan
- Department of Surgery Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Diwakar Davar
- Hillman Cancer Center, University of Pittsburg Medical Center, Pittsburgh, Pennsylvania, USA
| | - Geoffrey T Gibney
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Omid Hamid
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, California, USA
| | - Tina J Hieken
- Department of Surgery and Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin Izar
- Department of Medicine, Division of Hematology/Oncology, Columbia University Medical Center, New York, New York, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rajan P Kulkarni
- Departments of Dermatology, Oncological Sciences, Biomedical Engineering, and Center for Cancer Early Detection Advanced Research, Knight Cancer Institute, OHSU, Portland, Oregon, USA
- Operative Care Division, VA Portland Health Care System (VAPORHCS), Portland, Oregon, USA
| | - Jason J Luke
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tara C Mitchell
- Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Meghan J Mooradian
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Krista M Rubin
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - April Ks Salama
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, Carolina, USA
| | - Keisuke Shirai
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Janis M Taube
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J Keith Tolley
- Patient Advocate, Melanoma Research Alliance, Washington, DC, USA
| | - Caressa Valdueza
- Cutaneous Oncology Program, Weill Cornell Medicine, New York, New York, USA
| | - Sarah A Weiss
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Michael K Wong
- Patient Advocate, Melanoma Research Alliance, Washington, DC, USA
| | - Ryan J Sullivan
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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17
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Tian JC, Liu H, Yan LJ, Ding ZN, Han CL, Tian BW, Tan SY, Dong ZR, Wang DX, Xue JS, Mao XC, Yan YC, Li T. Adverse events of immune checkpoint inhibitors in hepatocellular carcinoma: a systemic review and meta-analysis. Clin Exp Med 2023; 23:2115-2129. [PMID: 36385419 DOI: 10.1007/s10238-022-00938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
The introduction of immune checkpoint inhibitors (ICIs) has reshaped the therapy of hepatocellular carcinoma (HCC). ICIs are a novel therapy with frequent adverse events (AEs), including treatment-related adverse events (trAEs) and immune-related adverse events (irAEs). However, no comprehensive overview of the toxicity spectrum of ICIs in HCC patients has been provided. Electronic databases were searched to identify eligible studies. A meta-analysis of the incidence rate of AEs in HCC patients treated with ICIs was performed. Lastly, the prognostic value of irAEs in HCC patients treated with ICIs was verified. Forty-seven studies with 6472 participations met the inclusion criteria. The pooled all-grade trAEs incidence rate was 83.4% (95% confidence interval [95% CI] 77.0-89.1%), ≥ grade 3 trAEs incidence rate was 33.0% (95% CI 26.9-39.5%), all-grade irAEs incidence rate was 34% (95% CI 22-47%), and ≥ grade 3 irAEs incidence rate was 9% (95% CI 5-14%). Aspartate aminotransferase (AST) increase (38%, 95% CI 35-40%) is the most common trAEs. Fatigue (14%, 95% CI 7-23%) is the most common irAEs. The pooled results also showed that 18.8% (95% CI 13.2-25.2%) of patients required systemic steroid therapy due to AEs, while 6.6% (95% CI 4.6-9.0%) of patients withdrew from treatment due to AEs. Additionally, patients experiencing irAEs may have a better progression-free survival (PFS) (multivariate analysis: hazard ratio [HR] = 0.41, 95% CI 0.27-0.61, I2 = 36.3%) but not overall survival (OS) (multivariate analysis: HR = 0.54, 95% CI 0.22-1.36, I2 = 83.2%) than those with no irAEs. Our study presents a systemic assessment of the AEs profile in HCC patients receiving ICIs, providing important reference for clinicians on toxicity profile. Besides, patients with irAEs may have a better PFS. More large-scale and prospective studies are needed to confirm our conclusions.
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Affiliation(s)
- Jin-Cheng Tian
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lun-Jie Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zi-Niu Ding
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Cheng-Long Han
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Bao-Wen Tian
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Si-Yu Tan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhao-Ru Dong
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Dong-Xu Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jun-Shuai Xue
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xin-Cheng Mao
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yu-Chuan Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Tao Li
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China.
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18
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Boutros C, Belkadi-Sadou D, Marchand A, Roy S, Routier E, Robert C. Cured or Not? Long-term Outcomes of Immunotherapy Responders. Focus on Melanoma. Curr Oncol Rep 2023; 25:989-996. [PMID: 37266890 DOI: 10.1007/s11912-023-01429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitors (ICIs) demonstrated robust antitumor activity and tolerable safety in advanced melanoma. Data on long-term outcome of patients who benefited from this therapy and who are still free of progression despite ICI discontinuation is now available. We review here the characteristics of long-term ICI responders and address the critical question of cure. RECENT FINDINGS Long-term outcome of patients with metastatic melanoma enrolled in large phase 2 and phase 3 clinical trials evaluating ICI in metastatic melanoma is now available. Durable responses, with more than 6 years of median follow-up, may persist after discontinuation. They occur more frequently in patients who achieved a complete response rather than in patients who had partial response or stable disease. Although long-term clinical benefit is more frequent in patients with high PDL-1 expression and smaller tumor burden, durable response may also be observed regardless of baseline characteristics. In patients with asymptomatic brain metastasis, combined immunotherapy (ipilimumab plus nivolumab) may also lead to long-term remission. Clinical trials confirm the durable antitumor activity of ICI. Although the hope for cure seems reasonable for many patients in this situation, late relapses may occur and no relapse-predictive biomarkers have been identified yet. Long-term responders who relapse can respond to a rechallenge of ICI although data are limited concerning the rate and the duration of this new response.
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Affiliation(s)
- Céline Boutros
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
- Outpatient Clinic, Department of Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Djaouida Belkadi-Sadou
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Marchand
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Séverine Roy
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Emilie Routier
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Caroline Robert
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
- University Paris-Saclay, Faculty of Medicine, Kremlin-Bicêtre, France.
- INSERM Unit U981, Villejuif, France.
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19
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Dirks I, Keyaerts M, Dirven I, Neyns B, Vandemeulebroucke J. Development and Validation of a Predictive Model for Metastatic Melanoma Patients Treated with Pembrolizumab Based on Automated Analysis of Whole-Body [ 18F]FDG PET/CT Imaging and Clinical Features. Cancers (Basel) 2023; 15:4083. [PMID: 37627111 PMCID: PMC10452475 DOI: 10.3390/cancers15164083] [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: 07/04/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Antibodies that inhibit the programmed cell death protein 1 (PD-1) receptor offer a significant survival benefit, potentially cure (i.e., durable disease-free survival following treatment discontinuation), a substantial proportion of patients with advanced melanoma. Most patients however fail to respond to such treatment or acquire resistance. Previously, we reported that baseline total metabolic tumour volume (TMTV) determined by whole-body [18F]FDG PET/CT was independently correlated with survival and able to predict the futility of treatment. Manual delineation of [18F]FDG-avid lesions is however labour intensive and not suitable for routine use. A predictive survival model is proposed based on automated analysis of baseline, whole-body [18F]FDG images. METHODS Lesions were segmented on [18F]FDG PET/CT using a deep-learning approach and derived features were investigated through Kaplan-Meier survival estimates with univariate logrank test and Cox regression analyses. Selected parameters were evaluated in multivariate Cox survival regressors. RESULTS In the development set of 69 patients, overall survival prediction based on TMTV, lactate dehydrogenase levels and presence of brain metastases achieved an area under the curve of 0.78 at one year, 0.70 at two years. No statistically significant difference was observed with respect to using manually segmented lesions. Internal validation on 31 patients yielded scores of 0.76 for one year and 0.74 for two years. CONCLUSIONS Automatically extracted TMTV based on whole-body [18F]FDG PET/CT can aid in building predictive models that can support therapeutic decisions in patients treated with immune-checkpoint blockade.
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Affiliation(s)
- Ine Dirks
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- IMEC, 3001 Leuven, Belgium
| | - Marleen Keyaerts
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
| | - Iris Dirven
- Department of Medical Oncology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium; (I.D.); (B.N.)
| | - Bart Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium; (I.D.); (B.N.)
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- IMEC, 3001 Leuven, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
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20
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Profili NI, Castelli R, Gidaro A, Merella A, Manetti R, Palmieri G, Maioli M, Delitala AP. Endocrine Side Effects in Patients Treated with Immune Checkpoint Inhibitors: A Narrative Review. J Clin Med 2023; 12:5161. [PMID: 37568563 PMCID: PMC10419837 DOI: 10.3390/jcm12155161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Checkpoint inhibitors are monoclonal antibodies that elicit an anti-tumor response by stimulating immune system. Their use has improved the treatment of different types of cancer such as melanoma, breast carcinoma, lung, stomach, colon, liver, renal cell carcinoma, and Hodgkin's lymphoma, but several adverse events have been reported. Although the etiology of these effects is not completely understood, an uncontrolled activation of the immune system has been postulated. Indeed, some studies showed a cross reactivity of T cells, which acted against tumor antigens as well as antigens in the tissues of patients who developed immune-related adverse events. Despite the known possibility of developing immune-related adverse events, early diagnosis, monitoring during therapy, and treatment are fundamental for the best supportive care and administration of immune checkpoint inhibitors. The aim of this review is to guide the clinician in early diagnosis, management, and treatment of the endocrinological adverse effects in the major endocrine glands (thyroid, pituitary, adrenal, endocrine pancreas, and parathyroid).
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Affiliation(s)
- Nicia I. Profili
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Roberto Castelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Alessandro Merella
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Roberto Manetti
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giuseppe Palmieri
- Department of Biochemical Science, University of Sassari, 07100 Sassari, Italy
| | - Margherita Maioli
- Department of Biochemical Science, University of Sassari, 07100 Sassari, Italy
| | - Alessandro P. Delitala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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21
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Verheijden RJ, van Eijs MJM, May AM, van Wijk F, Suijkerbuijk KPM. Immunosuppression for immune-related adverse events during checkpoint inhibition: an intricate balance. NPJ Precis Oncol 2023; 7:41. [PMID: 37173424 PMCID: PMC10182067 DOI: 10.1038/s41698-023-00380-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have changed perspectives for patients with cancer, but come with severe immune-related adverse events (irAEs). To prevent fatality or chronicity, these irAEs are often promptly treated with high-dose immunosuppressants. Until recently, evidence on the effects of irAE management on ICI efficacy has been sparse. As a result, algorithms for irAE management are mostly expert-opinion based and barely consider possible detrimental effects of immunosuppressants on ICI efficacy. However, recent growing evidence suggests that vigorous immunosuppressive management of irAEs comes with unfavourable effects on ICI efficacy and survival. With expansion of the indications of ICIs, evidence-based treatment of irAEs without hampering tumour control becomes more and more important. In this review, we discuss novel evidence from pre-clinical and clinical studies on the effects of different irAE management regimens including corticosteroids, TNF inhibition and tocilizumab on cancer control and survival. We provide recommendations for pre-clinical research, cohort studies and clinical trials that can help clinicians in tailored irAE management, minimising patients' burden while maintaining ICI efficacy.
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Affiliation(s)
- Rik J Verheijden
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Mick J M van Eijs
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Naidoo J, Murphy C, Atkins MB, Brahmer JR, Champiat S, Feltquate D, Krug LM, Moslehi J, Pietanza MC, Riemer J, Robert C, Sharon E, Suarez-Almazor ME, Suresh K, Turner M, Weber J, Cappelli LC. Society for Immunotherapy of Cancer (SITC) consensus definitions for immune checkpoint inhibitor-associated immune-related adverse events (irAEs) terminology. J Immunother Cancer 2023; 11:jitc-2022-006398. [PMID: 37001909 PMCID: PMC10069596 DOI: 10.1136/jitc-2022-006398] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
Immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICI) therapy may vary substantially in their clinical presentation, including natural history, outcomes to treatment, and patterns. The application of clinical guidelines for irAE management can be challenging for practitioners due to a lack of common or consistently applied terminology. Furthermore, given the growing body of clinical experience and published data on irAEs, there is a greater appreciation for the heterogeneous natural histories, responses to treatment, and patterns of these toxicities, which is not currently reflected in irAE guidelines. Furthermore, there are no prospective trial data to inform the management of the distinct presentations of irAEs. Recognizing a need for uniform terminology for the natural history, response to treatment, and patterns of irAEs, the Society for Immunotherapy of Cancer (SITC) convened a consensus panel composed of leading international experts from academic medicine, industry, and regulatory agencies. Using a modified Delphi consensus process, the expert panel developed clinical definitions for irAE terminology used in the literature, encompassing terms related to irAE natural history (ie, re-emergent, chronic active, chronic inactive, delayed/late onset), response to treatment (ie, steroid unresponsive, steroid dependent), and patterns (ie, multisystem irAEs). SITC developed these definitions to support the adoption of a standardized vocabulary for irAEs, which will have implications for the uniform application of irAE clinical practice guidelines and to enable future irAE clinical trials.
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Affiliation(s)
- Jarushka Naidoo
- Oncology, Beaumont RCSI Cancer Centre, Dublin, Ireland
- RCSI university of Health Sciences, Beaumont RSCI Cancer Centre, Dublin, Ireland
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Murphy
- Department of Oncology, St Vincents University Hospital, Dublin, Ireland
- Department of Oncology, Beaumont Hospital, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Michael B Atkins
- Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Julie R Brahmer
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | | | | | | | | | | | - Joanne Riemer
- Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Caroline Robert
- Institut Gustave-Roussy, Villejuif, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Elad Sharon
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Karthik Suresh
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Michelle Turner
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Jeffrey Weber
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Laura C Cappelli
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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23
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Biomarkers for Outcome in Metastatic Melanoma in First Line Treatment with Immune Checkpoint Inhibitors. Biomedicines 2023; 11:biomedicines11030749. [PMID: 36979727 PMCID: PMC10044937 DOI: 10.3390/biomedicines11030749] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: A high proportion of metastatic melanoma patients do not respond to immune checkpoint inhibitors (ICI), and until now, no validated biomarkers for response and survival have been known. Methods: We performed a retrospective analysis of outcomes in patients with metastatic melanoma treated with first-line ICI at the Institute of Oncology Ljubljana from January 2018 to December 2020. The immune-related adverse events (irAEs) and serum immune-inflammation parameters (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (LR), systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV)) were analyzed as potential biomarkers for response and survival. Survival rates were calculated using the Kaplan–Meier method and then compared with the log-rank test. Multivariate regression Cox analysis was used to determine independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Results: Median follow-up was 22.5 months. The estimated median progression-free survival (PFS) was 15 months (95% CI 3.3–26.2). The two-year survival rate (OS) was 66.6%. Among 129 treated patients, 24 (18.6%) achieved complete response, 28 (21.7%) achieved partial response, 26 (20.2%) had stable disease and 51 (39.5%) patients experienced a progressive disease. There was a higher response rate in patients with irAEs (p < 0.001) and high NLR before the second cycle of ICI (p = 0.052). Independent prognostic factors for PFS were irAE (HR 0.41 (95% CI 0.23–0.71)), SII before the first cycle of ICI (HR 1.94 (95% CI 1.09–3.45)) and PLR before the second cycle of ICI (HR 1.71 (95% CI 1.03–2.83)). The only independent prognostic factor for OS was SII before the first cycle of ICI (HR 2.60 (95% CI 0.91–7.50)). Conclusions: Patients with high pre-treatment levels of SII had a higher risk of progression and death; however, patients with irAEs in the high-SII group might respond well to ICI. Patients who develop irAEs and have high NLRs before the second ICI application have higher rates of CR and PR, which implicates their use as early biomarkers for responsiveness to ICI.
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24
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Liu X, Song J, Zhang H, Liu X, Zuo F, Zhao Y, Zhao Y, Yin X, Guo X, Wu X, Zhang H, Xu J, Hu J, Jing J, Ma X, Shi H. Immune checkpoint HLA-E:CD94-NKG2A mediates evasion of circulating tumor cells from NK cell surveillance. Cancer Cell 2023; 41:272-287.e9. [PMID: 36706761 DOI: 10.1016/j.ccell.2023.01.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/22/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023]
Abstract
Circulating tumor cells (CTCs), shed by primary malignancies, function as "seeds" for distant metastasis. However, it is still largely unknown how CTCs escape immune surveillance. Here, we characterize the transcriptomes of human pancreatic ductal adenocarcinoma CTCs, primary, and metastatic lesions at single-cell scale. Cell-interaction analysis and functional studies in vitro and in vivo reveal that CTCs and natural killer (NK) cells interact via the immune checkpoint molecule pair HLA-E:CD94-NKG2A. Disruption of this interaction by blockade of NKG2A or knockdown of HLA-E expression enhances NK-mediated tumor cell killing in vitro and prevents tumor metastasis in vivo. Mechanistic studies indicate that platelet-derived RGS18 promotes the expression of HLA-E through AKT-GSK3β-CREB signaling, and overexpression of RGS18 facilitates pancreatic tumor hepatic metastasis. In conclusion, platelet-derived RGS18 protects CTCs from NK-mediated immune surveillance by engaging the immune checkpoint HLA-E:CD94-NKG2A. Interruption of the suppressive signaling prevents tumor metastasis in vivo by immune elimination of CTCs.
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Affiliation(s)
- Xiaowei Liu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Jinen Song
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Hao Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xinyu Liu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Fengli Zuo
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Yunuo Zhao
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yujie Zhao
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Xiaomeng Yin
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xinyu Guo
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Xi Wu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Hu Zhang
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Jie Xu
- Institutes of Biological Sciences, Zhongshan-Xuhui Hospital, Fudan University, Shanghai 200032, China
| | - Jianping Hu
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu, Sichuan 610106, China
| | - Jing Jing
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China
| | - Xuelei Ma
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Hubing Shi
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan 610041, China.
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25
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Hana C, Rehman T, Park K, Carracedo Uribe C, Aung PP, Hunis B, Salzberg M, Zikria J, Hussein A. Pancreatic adverse events in patients treated with immune checkpoint inhibitors. JGH Open 2023; 7:204-207. [PMID: 36968572 PMCID: PMC10037034 DOI: 10.1002/jgh3.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
Background and Aim The inhibition of cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) and programmed cell death-1 (PD-1) has been a target for multiple drugs to enhance the T-cell antitumor activity. However, these immune checkpoint inhibitors (ICIs) come with a panel of immune-related adverse events (irAEs) that include mainly endocrine, skin, and gastrointestinal effects. We report seven cases of pancreatic irAEs in patients treated with ICIs at our institute. Methods This is a case series; data was collected through chart review by 3 different data collectors and was analyzed separately by 2 physicians. Results Of these seven cases, two had diabetic ketoacidosis (DKA), while five had pancreatitis diagnosed by a substantial rise in serum lipase. Pancreatitis was asymptomatic in two cases. A pancreatic biopsy in one case revealed type 2 autoimmune pancreatitis. The ICIs used included pembrolizumab, nivolumab, durvalumab, and avelumab. Treatment included steroids and holding the ICI therapy: three cases had complete resolution of pancreatitis while two cases required either a prolonged taper or a second course of prednisone for recurrence of pancreatitis. On the other hand, the DKA cases were treated with withdrawal of the ICI and starting insulin with no steroid therapy. Conclusions Pancreatitis and DKA are rare adverse events of ICIs that can be controlled by holding the ICI with or without starting steroids. Rechallenging the patient with the same ICI is possible in selected cases.
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Affiliation(s)
- Caroline Hana
- Memorial Healthcare System Pembroke Pines Florida USA
| | | | - Kyeeun Park
- Memorial Healthcare System Pembroke Pines Florida USA
| | | | - Pyi Phyo Aung
- Memorial Healthcare System Pembroke Pines Florida USA
| | - Brian Hunis
- Memorial Healthcare System Pembroke Pines Florida USA
| | | | | | - Atif Hussein
- Memorial Healthcare System Pembroke Pines Florida USA
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26
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Chen K, He J, Xu J, Chen J. Effectiveness of immunosuppressant use for the treatment of immune checkpoint inhibitor-induced liver injury: A systematic review and meta-analysis. Front Oncol 2023; 13:1088741. [PMID: 37035152 PMCID: PMC10080119 DOI: 10.3389/fonc.2023.1088741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Immune-mediated liver injury caused by checkpoint inhibitors (ILICI) is a challenging clinical management issue. Although immunosuppressants are widely used to manage ILICI, no large-scale studies have proved definitive evidence for the most effective form of patient management. Aim Analysis of the effectiveness of immunosuppression for immune-related liver injury. Methods We performed a systematic review and meta-analysis of the clinical outcomes of immunosuppressive treatment of ILICI patients. A literature search of PubMed, Ovid, and Cochrane Library was completed for dates from 2000 to January 1, 2022. The primary outcome was the response rate to immunosuppressive therapy for ILICI, with subgroup analysis based on the type of cancer, immune checkpoint inhibitor regimen, and severity of liver injury. The secondary outcome was the median time to recovery from ILICI with immunosuppressive therapy. Results A total of 30 studies that included 1120 patients were collected. The pooled ILICI response rate was 79% (95% CI 0.73-0.84) for treatment with corticosteroids and 93% (95% CI 0.79-1.0) for treatment with mycophenolate mofetil. For ILICI treated with corticosteroids, the median recovery time was 47.59 (95% CI 39.79-55.40) days compared to 37.74 (95% CI 31.12-44.35) days for all forms of immunosuppression. Conclusion Findings support the effectiveness of corticosteroids and mycophenolate mofetil for the treatment of ILICI. The identified median time to recovery is a beneficial guide for patients and physicians, allowing for realistic expectations and appropriate treatment management. Future prospective randomized controlled trials are required to define a standardized management approach to immunosuppressive therapy of ILICI. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022313454.
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Affiliation(s)
- Kefan Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Junhao He
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jing Xu
- Department of Pharmacy, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jie Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Jie Chen,
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27
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Fernandes MR, Aggarwal P, Costa RGF, Cole AM, Trinchieri G. Targeting the gut microbiota for cancer therapy. Nat Rev Cancer 2022; 22:703-722. [PMID: 36253536 DOI: 10.1038/s41568-022-00513-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
Growing evidence suggests that the gut microbiota modulates the efficacy and toxicity of cancer therapy, most notably immunotherapy and its immune-related adverse effects. The poor response to immunotherapy in patients treated with antibiotics supports this influential role of the microbiota. Until recently, results pertaining to the identification of the microbial species responsible for these effects were incongruent, and relatively few studies analysed the underlying mechanisms. A better understanding of the taxonomy of the species involved and of the mechanisms of action has since been achieved. Defined bacterial species have been shown to promote an improved response to immune-checkpoint inhibitors by producing different products or metabolites. However, a suppressive effect of Gram-negative bacteria may be dominant in some unresponsive patients. Machine learning approaches trained on the microbiota composition of patients can predict the ability of patients to respond to immunotherapy with some accuracy. Thus, interest in modulating the microbiota composition to improve patient responsiveness to therapy has been mounting. Clinical proof-of-concept studies have demonstrated that faecal microbiota transplantation or dietary interventions might be utilized clinically to improve the success rate of immunotherapy in patients with cancer. Here, we review recent advances and discuss emerging strategies for microbiota-based cancer therapies.
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Affiliation(s)
- Miriam R Fernandes
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Poonam Aggarwal
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Raquel G F Costa
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Alicia M Cole
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Giorgio Trinchieri
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA.
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28
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Watson AS, Goutam S, Stukalin I, Ewanchuk BW, Sander M, Meyers DE, Pabani A, Cheung WY, Heng DYC, Cheng T, Monzon JG, Navani V. Association of Immune-Related Adverse Events, Hospitalization, and Therapy Resumption With Survival Among Patients With Metastatic Melanoma Receiving Single-Agent or Combination Immunotherapy. JAMA Netw Open 2022; 5:e2245596. [PMID: 36480204 PMCID: PMC9856439 DOI: 10.1001/jamanetworkopen.2022.45596] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Immune-related adverse events (irAEs) due to immune checkpoint blockade (ICB) have been shown to be positively associated with survival. Among patients with metastatic melanoma, evidence supporting this association has been conflicting, while ipilimumab-nivolumab combination ICB has been examined only in small clinical cohorts. OBJECTIVE To examine the association between irAEs and survival among patients with metastatic melanoma, in particular for those receiving combination ICB. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort of 492 consecutive patients with metastatic melanoma treated with ICB at 2 tertiary and 4 regional cancer centers in Alberta, Canada, from August 1, 2013, to May 31, 2020, was observed. Patients were aged 18 years or older with metastatic melanoma agnostic to primary site, who received 1 or more doses of an anti-programmed cell death protein 1 agent as single or combination ICB. Clinically significant irAEs requiring systemic corticosteroids and/or treatment delay were captured. To minimize immortal time bias, only patients surviving 12 weeks after ICB initiation were included in survival analyses. Statistical analysis was conducted on December 10, 2021. EXPOSURES Development of irAEs requiring systemic corticosteroids and/or treatment delay. MAIN OUTCOMES AND MEASURES The primary outcome was overall survival (OS), with the association of irAE development with OS assessed via Kaplan-Meier and Cox proportional hazards regression analyses. The association of hospitalization for irAEs and ICB resumption after irAE with OS was examined. RESULTS Among 492 patients, the median age of those with irAEs was 61.8 years (IQR, 52.9-72.1 years), and the median age of those without irAEs was 65.5 years (IQR, 56.5-76.9 years), while sex distribution was comparable (137 of 198 men [69.2%] with irAEs vs 183 of 294 men [62.2%] without irAEs). There was an association between irAEs and OS both in the overall cohort (with irAEs: median OS, 56.3 months [95% CI, 38.2 months to not evaluable] vs without irAEs: median OS, 18.5 months [95% CI, 14.4-23.2 months]; P < .001) and in the 124 patients (25.2%) receiving combination ICB (with irAEs: median OS, 56.2 months [95% CI, 52.2 months to not evaluable] vs without irAEs: median OS, 19.0 months [95% CI, 6.6 months to not evaluable]; P < .001). Hospitalization for irAE did not alter this positive association with OS compared with outpatient treatment (median OS, not evaluable [95% CI, 31.5 months to not evaluable] vs median OS, 52.2 months [95% CI, 35.2 months to not evaluable]; P = .53), while resumption of ICB was associated with longer OS than not resuming ICB (median, 56.3 months [95% CI, 40.8 months to not evaluable] vs 31.5 months [95% CI, 21.0 months to not evaluable]; P = .009). A favorable independent association of irAEs with OS was confirmed in multivariable analysis (hazard ratio for death, 0.382 [95% CI, 0.254-0.576]; P < .001). CONCLUSIONS AND RELEVANCE This study suggests an association between irAEs and OS for patients with metastatic melanoma, including those treated with combination ICB and those with severe irAEs requiring hospitalization. The potential benefit associated with ICB resumption after irAEs warrants further investigation.
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Affiliation(s)
- Alexander S. Watson
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Igor Stukalin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Sander
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel E. Meyers
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y. Cheung
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Y. C. Heng
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jose G. Monzon
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Vishal Navani
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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29
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Silk AW, O’Day SJ, Kaufman HL, Bryan J, Norrell JT, Imbergamo C, Portal D, Zambrano-Acosta E, Palmeri M, Fein S, Wu C, Guerreiro L, Medina D, Bommareddy PK, Zloza A, Fox BA, Ballesteros-Merino C, Ren Y, Shafren D, Grose M, Vieth JA, Mehnert JM. A phase 1b single-arm trial of intratumoral oncolytic virus V937 in combination with pembrolizumab in patients with advanced melanoma: results from the CAPRA study. Cancer Immunol Immunother 2022; 72:1405-1415. [DOI: 10.1007/s00262-022-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Background
CAPRA (NCT02565992) evaluated Coxsackievirus A21 (V937) + pembrolizumab for metastatic/unresectable stage IIIB–IV melanoma.
Methods
Patients received intratumoral V937 on days 1, 3, 5, and 8 (then every 3 weeks [Q3W]) and intravenous pembrolizumab 2 mg/kg Q3W from day 8. Primary endpoint was safety.
Results
Median time from first dose to data cutoff was 32.0 months. No dose-limiting toxicities occurred; 14% (5/36) of patients experienced grade 3‒5 treatment-related adverse events. Objective response rate was 47% (complete response, 22%). Among 17 responders, 14 (82%) had responses ≥ 6 months. Among 8 patients previously treated with immunotherapy, 3 responded (1 complete, 2 partial). Responses were associated with increased serum CXCL10 and CCL22, suggesting viral replication contributes to antitumor immunity. For responders versus nonresponders, there was no difference in baseline tumor PD-L1 expression, ICAM1 expression, or CD3+ infiltrates. Surprisingly, the baseline cell density of CD3+CD8− T cells in the tumor microenvironment was significantly lower in responders compared with nonresponders (P = 0.0179).
Conclusions
These findings suggest responses to this combination may be seen even in patients without a typical “immune-active” microenvironment.
Trial registration number
NCT02565992.
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30
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Si L, Zhang X, Shu Y, Pan H, Wu D, Liu J, Mao L, Wang X, Wen X, Gu Y, Zhu L, Lan S, Cai X, Diede SJ, Dai H, Niu C, Li J, Guo J. Pembrolizumab in Chinese patients with advanced melanoma: 3-year follow-up of the KEYNOTE-151 study. Front Immunol 2022; 13:882471. [PMID: 36304457 PMCID: PMC9593700 DOI: 10.3389/fimmu.2022.882471] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
Survival is generally poor for Chinese patients with advanced melanoma because of high rates of acral and mucosal melanoma and limited therapeutic options. The first analysis of the phase 1b KEYNOTE-151 study showed second-line pembrolizumab was well tolerated and had clinically meaningful antitumor activity in Chinese patients with advanced melanoma. Three-year follow-up is presented. Eligible patients were of Chinese descent and had unresectable stage III/IV melanoma that progressed after first-line therapy. Patients received pembrolizumab 2 mg/kg every 3 weeks for ≤35 cycles. Primary end points were safety and objective response rate (ORR). Secondary end points included duration of response (DOR), progression-free survival (PFS), and overall survival (OS). Response was assessed per RECIST v1.1 by blinded independent central review. Subgroup analyses were conducted by melanoma subtype and BRAF and PD-L1 status (acral melanoma only). 103 patients were enrolled; median follow-up duration (time from first dose to data cutoff [July 13, 2020]) was 44.6 months (IQR, 39.1–46.2). Any-grade treatment-related adverse events (TRAEs) occurred in 85.4% of patients, and grade 3/4 TRAEs in 12.6%. No grade 5 TRAEs occurred. Three patients discontinued pembrolizumab because of TRAEs (immune-mediated hepatitis, pneumonia, and arthritis). Immune-mediated AEs and infusion reactions occurred in 34.0% (grade 3/4, 2.9%). ORR was 17.6% (95% CI, 10.8–26.4; 1 complete response/17 partial responses), and median DOR was 13.8 months (range, 2.7–37.4+). Median PFS was 2.8 months (95% CI, 2.7–3.5) and 36-month PFS rate was 5.0%. Median OS was 13.2 months (95% CI, 10.4–16.5) and 36-month OS rate was 22.3%. Median OS for patients with known melanoma subtype was 14.8 months for acral, 13.5 months for nonacral cutaneous, and 7.4 months for mucosal melanoma. Among the acral subgroup, median OS was 22.8 months for PD-L1–positive disease, 8.4 months for PD-L1–negative disease, 18.5 months for BRAF wild-type disease, and 5.8 months for BRAF-mutant disease. Over 3 years’ follow-up, second-line pembrolizumab continued to show manageable safety, clinically meaningful antitumor activity, and durable responses in Chinese patients with advanced melanoma. Subgroup analysis suggested particular benefit in PD-L1–positive and BRAF wild-type acral melanoma, although small subgroup sizes preclude definitive conclusions.
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Affiliation(s)
- Lu Si
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China
- *Correspondence: Lu Si,
| | - Xiaoshi Zhang
- Sun Yat-sen University Cancer Centre, Guangzhou, China
| | | | - Hongming Pan
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Di Wu
- The First Hospital of Jilin University, Changchun, China
| | - Jiwei Liu
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xizhi Wen
- Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Yanhong Gu
- Jiangsu Province Hospital, Nanjing, China
| | | | - Shijie Lan
- The First Hospital of Jilin University, Changchun, China
| | - Xin Cai
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | | | | | | | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China
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De Risi I, Sciacovelli AM, Guida M. Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment? Biomedicines 2022; 10:2424. [PMID: 36289687 PMCID: PMC9599026 DOI: 10.3390/biomedicines10102424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibition (ICI) has significantly improved the survival of metastatic melanoma (MM) with a significant proportion of patients obtaining long-lasting responses. However, ICI also exposes patients to new, heavy, and sometimes irreversible toxicities. Thus, identifying the minimal amount of treatment time is extremely urgent. METHODS We researched English peer-reviewed literature from electronic databases (MEDLINE and PubMed) until July 2022 with the aim of evaluating the clinical outcomes after the cessation of ICI therapy due to elective study plans, clinician-patient sharing, and adverse events. RESULTS Although most of the data are from retrospective studies, considering that most patients with major responses maintain it after treatment cessation, it is proposed that for complete response (CR)/near CR, a further six months of therapy after best response may be considered enough. For partial response (PR) or stable disease (SD), treatment must be continued for at least 2 years and, in some cases, indefinitely, based on residual disease, the patient's will, and the toxic profile. Of note, in spite of the best response, 25-30% of patients relapsed, and, when retreated, responded far less than in front-line treatment. CONCLUSIONS Most of the data being from retrospective and heterogeneous experiences, their grade of evidence is limited and no consensus has been reached on the optimal treatment duration. Controlled prospective studies are needed.
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Affiliation(s)
| | | | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori “Giovanni Paolo II”, 70124 Bari, Italy
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Sun Q, Sun H, Wu N, Hu Y, Zhang F, Cong X. Patients with melanoma treated with immune checkpoint inhibitors who had non-thyroid endocrine and skin immune-related adverse events have better prognosis: A systematic review and meta-analysis. Front Oncol 2022; 12:976224. [PMID: 36185176 PMCID: PMC9515964 DOI: 10.3389/fonc.2022.976224] [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] [Received: 06/23/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several studies have reported an association between the occurrence of immune-related adverse events (irAEs) and prognosis in patients with melanoma treated with immune checkpoint inhibitors (ICIs), but the results remain controversial. We conducted a systematic review and meta-analysis to investigate the association between irAEs and survival in patients with melanoma treated with ICIs. Methods We searched the PubMed, Web of Science, and China National Knowledge Infrastructure databases through May 5, 2022 for clinical studies evaluating the association between irAEs and in melanoma patients treated with ICIs. Combined hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were calculated using fixed- or random-effects models based on heterogeneity. Results A total of 60 articles were included, with 16,520 patients. In patients with melanoma treated with ICIs, the occurrence of irAEs was significantly associated with better OS (HR, 0.58; 95% confidence interval [CI], 0.51–0.66; P<0.00001) and PFS (HR, 0.61; 95%CI, 0.51–0.72; P<0.00001). Endocrine irAEs (OS, HR, 0.81; 95%CI, 0.72–0.92; P=0.001; PFS: HR, 0.84; 95%CI, 0.73–0.96, P=0.009), skin irAEs (OS, HR, 0.59; 95%CI, 0.41–0.85; P=0.004; PFS: HR, 0.43; 95%CI, 0.36–0.52; P<0.00001), vitiligo (OS, HR, 0.22; 95%CI, 0.15–0.31; P<0.00001; PFS, HR, 0.33; 95%CI, 0.25–0.44; P<0.00001), and grade 1–2 irAEs (OS, HR, 0.67; 95%CI, 0.58–0.78; P<0.00001; PFS, HR, 0.62; 95%CI, 0.51–0.76; P<0.00001) showed similar results. However, thyroid, lung, gastrointestinal, liver, and grade 3–4 irAEs were not significantly associated with OS and PFS. The occurrence of non-thyroid endocrine irAEs was significantly associated with better OS (HR, 0.22; 95%CI, 0.15–0.31; P<0.00001). In patients with melanoma treated with anti-programmed cell death protein 1 (OS, HR, 0.61; 95%CI, 0.51–0.72; P<0.00001; PFS, HR, 0.59; 95%CI, 0.47–0.74; P<0.00001), the association between irAEs and clinical benefit was clearer than in patients treated with anti-cytotoxic T-lymphocyte-associated protein 4 (OS, HR, 0.68; 95%CI, 0.52–0.89; P=0.005; PFS, HR, 0.93; 95%CI, 0.49–1.78; P=0.83). Conclusion Among patients with melanoma treated with ICIs, those who developed non-thyroid endocrine irAEs and cutaneous irAEs have better prognosis. This suggests that non-thyroid endocrine irAEs and cutaneous irAEs may be a prognostic biomarker for patients with melanoma treated with ICIs. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022338308.
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Affiliation(s)
- Qian Sun
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hongyan Sun
- Department of Biobank, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Nan Wu
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yue Hu
- Department of Biobank, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fangqing Zhang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xianling Cong
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Biobank, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Xianling Cong,
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Yu J, Wu X, Song J, Zhao Y, Li H, Luo M, Liu X. Loss of MHC-I antigen presentation correlated with immune checkpoint blockade tolerance in MAPK inhibitor-resistant melanoma. Front Pharmacol 2022; 13:928226. [PMID: 36091815 PMCID: PMC9459091 DOI: 10.3389/fphar.2022.928226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Immune checkpoint blockade and MAPK-targeted combined therapy is a promising regimen for advanced melanoma patients. However, the clinical benefit from this combo regimen remains limited, especially in patients who acquired resistance to MAPK-targeted therapy. Here, we systematically characterized the immune landscape during MAPK-targeted therapy in patients and mouse melanoma models. We observed that both the abundance of tumor-infiltrated T cells and the expression of immune-related genes were upregulated in the drug-responsive period, but downregulated in the resistance period, implying that acquired drug resistance dampens the antitumor immune response. Further transcriptomic dissection indicated that loss of MHC-I antigen presentation on tumor cells plays a critical role in the reduction of T cell infiltration during drug resistance. Survival analysis demonstrates that loss of antigen presentation and reduction of T-cell infiltration during acquired drug resistance are associated with poorer clinical response and prognosis of anti-PD-1 therapy in melanoma patients. In addition, we identified that alterations in the MAPK inhibitor resistance-related oncogenic signaling pathway closely correlated with deficiency of MHC-I antigen presentation, including activation of the PI3K-mTOR, MAPK, and Wnt pathways. In conclusion, our research illuminates that decreased infiltration of T cells is associated with acquired drug resistance during MAPK-targeted therapy, which may underlie the cross-resistance to immune checkpoint blockade.
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Affiliation(s)
- Jing Yu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
| | - Xi Wu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
| | - Jinen Song
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
| | - Yujie Zhao
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
| | - Huifang Li
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Luo
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
- *Correspondence: Xiaowei Liu, ; Min Luo,
| | - Xiaowei Liu
- Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China
- *Correspondence: Xiaowei Liu, ; Min Luo,
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Dalal F, Dalal H, Baltz B. Pembrolizumab-Induced Myocarditis and Delayed Acute Inflammatory Demyelinating Polyradiculoneuropathy. Cureus 2022; 14:e27112. [PMID: 36004023 PMCID: PMC9392481 DOI: 10.7759/cureus.27112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/07/2022] Open
Abstract
Pembrolizumab is an immunotherapeutic agent used in various malignancies including metastatic melanoma. While immunotherapies are effective in treating several malignancies, they do come at the expense of inadvertent side effects. The numerous side effects of pembrolizumab, including, but not limited to, adrenal insufficiency, myocarditis, and pancreatitis, are well documented in clinical literature. In this case report, we describe a unique presentation of myocarditis and acute inflammatory demyelinating polyradiculoneuropathy secondary to pembrolizumab. While both side effects of pembrolizumab are well known, the delayed presentation of symptoms is of particular interest in our case report. We hope to inform the clinical community on the pharmacokinetics of pembrolizumab causing the delayed onset of symptoms.
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Anti-PD-1 Monotherapy in Advanced Melanoma—Real-World Data from a 77-Month-Long Retrospective Observational Study. Biomedicines 2022; 10:biomedicines10071737. [PMID: 35885042 PMCID: PMC9313334 DOI: 10.3390/biomedicines10071737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022] Open
Abstract
Real-world evidence plays an important role in the assessment of efficacy and safety of novel therapies. The increasing use of immune checkpoint inhibitors (ICIs) in patients with advanced melanoma has led to notably improved clinical outcomes, while they are also associated with immune-related adverse events (irAEs). The majority of the available data are based on clinical trials, where the investigated subjects often do not adequately represent the general patient population of the everyday practice. Although there is a niche of objective biomarkers for the future treatment response of ICIs, certain studies suggest that irAEs may be predictive. The aim of this study was to carry out a retrospective analysis of treatment data from patients with advanced melanoma, treated with a single anti-PD-1 agent (pembrolizumab or nivolumab) during a 77-month-long period. Treatment efficacy and occurrence of adverse events were analyzed to identify potential predictive markers. Primary and secondary endpoints were the overall survival (OS) and progression-free survival (PFS). In our cohort, we demonstrated that the occurrence of more than one irAE showed a correlation with response to PD-1 ICI therapy and improved the OS and PFS. Our study suggests, that the grade of toxicity of the irAE may affect the survival rate.
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36
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Poliosis Is Associated with Response to Checkpoint-Inhibitor Therapy: A Case Report of Two Patients with Multifocal Metastatic Melanoma. IMMUNO 2022. [DOI: 10.3390/immuno2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The advent of immune-checkpoint inhibitors (ICIs) led to significant improvements in the treatment of patients with advanced melanoma and resulted in durable tumor responses in a considerable number of advanced melanoma patients. Next to the immune-mediated anti-neoplastic effects, ICIs may cause various immune-related adverse events (irAEs), often requiring early discontinuation of therapy. By contrast, cutaneous irAE rarely enforce treatment discontinuation but may represent simple and robust predictive markers for treatment response. The relevance of irAEs as clinical markers for an improved response to immunotherapy is still debated. We report here on two patients with multifocal metastatic melanoma who developed the rare event of generalized poliosis during combined immunotherapy with ipilimumab plus nivolumab, followed by a near-complete and durable response. Our observations suggest that poliosis may be a useful and simple clinical indicator of anti-tumor immunity, clinical response and favorable survival outcome in advanced melanoma patients treated with ICI.
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Ernst M, Giubellino A. The Current State of Treatment and Future Directions in Cutaneous Malignant Melanoma. Biomedicines 2022; 10:822. [PMID: 35453572 PMCID: PMC9029866 DOI: 10.3390/biomedicines10040822] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant melanoma is the leading cause of death among cutaneous malignancies. While its incidence is increasing, the most recent cancer statistics show a small but clear decrease in mortality rate. This trend reflects the introduction of novel and more effective therapeutic regimens, including the two cornerstones of melanoma therapy: immunotherapies and targeted therapies. Immunotherapies exploit the highly immunogenic nature of melanoma by modulating and priming the patient's own immune system to attack the tumor. Treatments combining immunotherapies with targeted therapies, which disable the carcinogenic products of mutated cancer cells, have further increased treatment efficacy and durability. Toxicity and resistance, however, remain critical challenges to the field. The present review summarizes past treatments and novel therapeutic interventions and discusses current clinical trials and future directions.
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Affiliation(s)
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA;
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38
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39
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McNeel DG, Eickhoff JC, Wargowski E, Johnson LE, Kyriakopoulos CE, Emamekhoo H, Lang JM, Brennan MJ, Liu G. Phase 2 trial of T-cell activation using MVI-816 and pembrolizumab in patients with metastatic, castration-resistant prostate cancer (mCRPC). J Immunother Cancer 2022; 10:jitc-2021-004198. [PMID: 35277461 PMCID: PMC8919462 DOI: 10.1136/jitc-2021-004198] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background We previously reported a trial using a DNA vaccine encoding prostatic acid phosphatase (MVI-816, pTVG-HP), given over 12 weeks concurrently or sequentially with pembrolizumab, in patients with mCRPC. We report the final analysis of this trial following two additional treatment arms in which patients with mCRPC continued concurrent treatment until progression. Materials and methods Patients with mCRPC were treated with MVI-816 and pembrolizumab every 3 weeks (arm 3, n=20) or MVI-816 every 2 weeks and pembrolizumab every 4 weeks (arm 4, n=20). The primary objectives were safety, 6-month progression-free survival (PFS), median time to radiographic progression, and objective response rates. Secondary objectives included immunological evaluations. Results In 25 patients with measurable disease, there were no complete response and one confirmed partial response in a patient who subsequently found to have an MSIhi tumor. 4/40 patients (10%) had a prostate-specific antigen decline >50%. The estimated overall radiographic PFS rate at 6 months was 47.2% (44.4% arm 3, 61.5% arm 4). Accounting for all off-study events, overall median time on treatment was 5.6 months (95% CI: 5.4 to 10.8 months), 5.6 months for arm 3 and 8.1 months for arm 4 (p=0.64). Thirty-two per cent of patients remained on trial beyond 6 months without progression. Median overall survival was 22.9 (95% CI: 16.2 to 25.6) months. One grade 4 event (hyperglycemia) was observed. Immune-related adverse events (irAEs) >grade 1 were observed in 42% of patients overall. Interferon-γ and/or granzyme B immune response to prostatic acid phosphatase was detected in 2/20 patients in arm 3 and 6/20 patients in arm 4. Plasma cytokines associated with immune activation and CD8+ T-cell recruitment were augmented at weeks 6 and 12. The development of irAE was significantly associated with a prolonged time on treatment (HR=0.42, p=0.003). Baseline DNA homologous recombination repair mutations were not associated with longer time to progression. Conclusions Findings here demonstrate that combining programmed cell death 1 blockade with MVI-816 is safe, can augment tumor-specific T cells, and can result in a favorable 6-month disease control rate. Correlative studies suggest T-cell activation by vaccination is critical to the mechanism of action of this combination. Future randomized clinical trials are needed to validate these findings. Trial registration number NCT02499835.
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Affiliation(s)
- Douglas G McNeel
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ellen Wargowski
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura E Johnson
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Christos E Kyriakopoulos
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Hamid Emamekhoo
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joshua M Lang
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mary Jane Brennan
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Glenn Liu
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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40
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McCulloch JA, Davar D, Rodrigues RR, Badger JH, Fang JR, Cole AM, Balaji AK, Vetizou M, Prescott SM, Fernandes MR, Costa RGF, Yuan W, Salcedo R, Bahadiroglu E, Roy S, DeBlasio RN, Morrison RM, Chauvin JM, Ding Q, Zidi B, Lowin A, Chakka S, Gao W, Pagliano O, Ernst SJ, Rose A, Newman NK, Morgun A, Zarour HM, Trinchieri G, Dzutsev AK. Intestinal microbiota signatures of clinical response and immune-related adverse events in melanoma patients treated with anti-PD-1. Nat Med 2022; 28:545-556. [PMID: 35228752 PMCID: PMC10246505 DOI: 10.1038/s41591-022-01698-2] [Citation(s) in RCA: 186] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Ample evidence indicates that the gut microbiome is a tumor-extrinsic factor associated with antitumor response to anti-programmed cell death protein-1 (PD-1) therapy, but inconsistencies exist between published microbial signatures associated with clinical outcomes. To resolve this, we evaluated a new melanoma cohort, along with four published datasets. Time-to-event analysis showed that baseline microbiota composition was optimally associated with clinical outcome at approximately 1 year after initiation of treatment. Meta-analysis and other bioinformatic analyses of the combined data show that bacteria associated with favorable response are confined within the Actinobacteria phylum and the Lachnospiraceae/Ruminococcaceae families of Firmicutes. Conversely, Gram-negative bacteria were associated with an inflammatory host intestinal gene signature, increased blood neutrophil-to-lymphocyte ratio, and unfavorable outcome. Two microbial signatures, enriched for Lachnospiraceae spp. and Streptococcaceae spp., were associated with favorable and unfavorable clinical response, respectively, and with distinct immune-related adverse effects. Despite between-cohort heterogeneity, optimized all-minus-one supervised learning algorithms trained on batch-corrected microbiome data consistently predicted outcomes to programmed cell death protein-1 therapy in all cohorts. Gut microbial communities (microbiotypes) with nonuniform geographical distribution were associated with favorable and unfavorable outcomes, contributing to discrepancies between cohorts. Our findings shed new light on the complex interaction between the gut microbiome and response to cancer immunotherapy, providing a roadmap for future studies.
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Affiliation(s)
- John A McCulloch
- Genetics and Microbiome Core, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Diwakar Davar
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard R Rodrigues
- Genetics and Microbiome Core, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Jonathan H Badger
- Genetics and Microbiome Core, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer R Fang
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Alicia M Cole
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Ascharya K Balaji
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Marie Vetizou
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Stephanie M Prescott
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Miriam R Fernandes
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Raquel G F Costa
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Wuxing Yuan
- Genetics and Microbiome Core, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Rosalba Salcedo
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Erol Bahadiroglu
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Soumen Roy
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Richelle N DeBlasio
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Morrison
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joe-Marc Chauvin
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Quanquan Ding
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bochra Zidi
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ava Lowin
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saranya Chakka
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wentao Gao
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ornella Pagliano
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scarlett J Ernst
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Rose
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nolan K Newman
- College of Pharmacy, Oregon State University, Corvallis, OR, USA
| | - Andrey Morgun
- College of Pharmacy, Oregon State University, Corvallis, OR, USA
| | - Hassane M Zarour
- Department of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Giorgio Trinchieri
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| | - Amiran K Dzutsev
- Cancer Immunobiology Section, Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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Schmid P, Cortes J, Dent R, Pusztai L, McArthur H, Kümmel S, Bergh J, Denkert C, Park YH, Hui R, Harbeck N, Takahashi M, Untch M, Fasching PA, Cardoso F, Andersen J, Patt D, Danso M, Ferreira M, Mouret-Reynier MA, Im SA, Ahn JH, Gion M, Baron-Hay S, Boileau JF, Ding Y, Tryfonidis K, Aktan G, Karantza V, O'Shaughnessy J. Event-free Survival with Pembrolizumab in Early Triple-Negative Breast Cancer. N Engl J Med 2022; 386:556-567. [PMID: 35139274 DOI: 10.1056/nejmoa2112651] [Citation(s) in RCA: 499] [Impact Index Per Article: 249.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The addition of pembrolizumab to neoadjuvant chemotherapy led to a significantly higher percentage of patients with early triple-negative breast cancer having a pathological complete response (defined as no invasive cancer in the breast and negative nodes) at definitive surgery in an earlier analysis of this phase 3 trial of neoadjuvant and adjuvant therapy. The primary results regarding event-free survival in this trial have not been reported. METHODS We randomly assigned, in a 2:1 ratio, patients with previously untreated stage II or III triple-negative breast cancer to receive neoadjuvant therapy with four cycles of pembrolizumab (at a dose of 200 mg) or placebo every 3 weeks plus paclitaxel and carboplatin, followed by four cycles of pembrolizumab or placebo plus doxorubicin-cyclophosphamide or epirubicin-cyclophosphamide. After definitive surgery, patients received adjuvant pembrolizumab (pembrolizumab-chemotherapy group) or placebo (placebo-chemotherapy group) every 3 weeks for up to nine cycles. The primary end points were pathological complete response (the results for which have been reported previously) and event-free survival, defined as the time from randomization to the date of disease progression that precluded definitive surgery, local or distant recurrence, occurrence of a second primary cancer, or death from any cause. Safety was also assessed. RESULTS Of the 1174 patients who underwent randomization, 784 were assigned to the pembrolizumab-chemotherapy group and 390 to the placebo-chemotherapy group. The median follow-up at this fourth planned interim analysis (data cutoff, March 23, 2021) was 39.1 months. The estimated event-free survival at 36 months was 84.5% (95% confidence interval [CI], 81.7 to 86.9) in the pembrolizumab-chemotherapy group, as compared with 76.8% (95% CI, 72.2 to 80.7) in the placebo-chemotherapy group (hazard ratio for event or death, 0.63; 95% CI, 0.48 to 0.82; P<0.001). Adverse events occurred predominantly during the neoadjuvant phase and were consistent with the established safety profiles of pembrolizumab and chemotherapy. CONCLUSIONS In patients with early triple-negative breast cancer, neoadjuvant pembrolizumab plus chemotherapy, followed by adjuvant pembrolizumab after surgery, resulted in significantly longer event-free survival than neoadjuvant chemotherapy alone. (Funded by Merck Sharp and Dohme, a subsidiary of Merck; KEYNOTE-522 ClinicalTrials.gov number, NCT03036488.).
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Affiliation(s)
- Peter Schmid
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Javier Cortes
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Rebecca Dent
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Lajos Pusztai
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Heather McArthur
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Sherko Kümmel
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Jonas Bergh
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Carsten Denkert
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Yeon Hee Park
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Rina Hui
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Nadia Harbeck
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Masato Takahashi
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Michael Untch
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Peter A Fasching
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Fatima Cardoso
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Jay Andersen
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Debra Patt
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Michael Danso
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Marta Ferreira
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Marie-Ange Mouret-Reynier
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Seock-Ah Im
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Jin-Hee Ahn
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Maria Gion
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Sally Baron-Hay
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Jean-François Boileau
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Yu Ding
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Konstantinos Tryfonidis
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Gursel Aktan
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Vassiliki Karantza
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
| | - Joyce O'Shaughnessy
- From Barts Cancer Institute, Queen Mary University of London, London (P.S.); International Breast Cancer Center, Quironsalud Group, and Vall d'Hebron Institute of Oncology, Barcelona (J.C.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid (J.C.), and Ramon y Cajal University Hospital (M.G.), Madrid; the National Cancer Center Singapore, Duke-National University of Singapore Medical School, Singapore (R.D.); Yale School of Medicine, Yale Cancer Center, New Haven, CT (L.P.); the University of Texas Southwestern Medical Center (H.M.), and Baylor University Medical Center, Texas Oncology, U.S. Oncology Network (J.O.), Dallas, and Texas Oncology, U.S. Oncology Network, Austin (D.P.); the Breast Unit, Kliniken Essen-Mitte, Essen, Charité-Universitätsmedizin Berlin, the Department of Gynecology with Breast Center (S.K.) and the Breast Cancer Center, Helios Klinikum Berlin-Buch (M.U.), Berlin, the Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg (C.D.), the Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich (N.H.), and the Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen (P.A.F.) - all in Germany; the Department of Oncology-Pathology, Karolinska Institutet, and Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Solna, Sweden (J.B.); Samsung Medical Center, Sungkyunkwan University School of Medicine (Y.H.P.), Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (S.-A.I.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.A.) - all in Seoul, South Korea; Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney (R.H.), and Royal North Shore Hospital (S.B.-H.) - both in Sydney; Hokkaido Cancer Center, Sapporo, Japan (M.T.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon (F.C.), and Instituto Português de Oncologia do Porto Francisco Gentil, Porto (M.F.) - both in Portugal; Compass Oncology, U.S. Oncology Network, Portland, OR (J.A.); Virginia Oncology Associates, U.S. Oncology Network, Norfolk (M.D.); Centre Jean-Perrin, Clermont-Ferrand, France (M.-A.M.-R.); McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal (J.-F.B.); and Merck, Kenilworth, NJ (Y.D., K.T., G.A., V.K.)
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Aamdal E, Jacobsen KD, Straume O, Kersten C, Herlofsen O, Karlsen J, Hussain I, Amundsen A, Dalhaug A, Nyakas M, Schuster C, Hagene KT, Holmsen K, Russnes HG, Skovlund E, Kaasa S, Aamdal S, Kyte JA, Guren TK. Ipilimumab in a real-world population: A prospective Phase IV trial with long-term follow-up. Int J Cancer 2022; 150:100-111. [PMID: 34449877 DOI: 10.1002/ijc.33768] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
Ipilimumab was the first treatment that improved survival in advanced melanoma. Efficacy and toxicity in a real-world setting may differ from clinical trials, due to more liberal eligibility criteria and less intensive monitoring. Moreover, high costs and lack of biomarkers have raised cost-benefit concerns about ipilimumab in national healthcare systems and limited its use. Here, we report the prospective, interventional study, Ipi4 (NCT02068196), which aimed to investigate the toxicity and efficacy of ipilimumab in a real-world population with advanced melanoma. This national, multicentre, phase IV trial included 151 patients. Patients received ipilimumab 3 mg/kg intravenously and were followed for at least 5 years or until death. Treatment interruption or cessation occurred in 38%, most frequently due to disease progression (19%). Treatment-associated grade 3 to 4 toxicity was observed in 28% of patients, and immune-related toxicity in 56%. The overall response rate was 9%. Median overall survival was 12.1 months (95% CI: 8.3-15.9); and progression-free survival 2.7 months (95% CI: 2.6-2.8). After 5 years, 20% of patients were alive. In a landmark analysis from 6 months, improved survival was associated with objective response (HR 0.16, P = .001) and stable disease (HR 0.49, P = .005) compared to progressive disease. Poor performance status, elevated lactate dehydrogenase and C-reactive protein were identified as biomarkers. This prospective trial represents the longest reported follow-up of a real-world melanoma population treated with ipilimumab. Results indicate safety and efficacy comparable to phase III trials and suggest that the use of ipilimumab can be based on current cost-benefit estimates.
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Affiliation(s)
- Elin Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Kari D Jacobsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Oddbjørn Straume
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Oluf Herlofsen
- Department of Oncology, Ålesund Hospital, Ålesund, Norway
| | - Jarle Karlsen
- The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Israr Hussain
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Anita Amundsen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Norway
| | - Marta Nyakas
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cornelia Schuster
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Kjersti Holmsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Hege G Russnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steinar Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon A Kyte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tormod K Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Yang F, Wang JF, Wang Y, Liu B, Molina JR. Comparative Analysis of Predictive Biomarkers for PD-1/PD-L1 Inhibitors in Cancers: Developments and Challenges. Cancers (Basel) 2021; 14:cancers14010109. [PMID: 35008273 PMCID: PMC8750062 DOI: 10.3390/cancers14010109] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The development of immune checkpoint inhibitors (ICIs) has greatly changed the treatment landscape of multiple malignancies. However, the wide administration of ICIs is mainly obstructed by the low response rate and several life-threatening adverse events. Thus, there is an urgent need to identify sets of biomarkers to predict which patients will respond to ICIs. In this review, we discuss the recently investigated molecular and clinical determinants of ICI response, from the aspects of tumor features, clinical features, as well as tumor microenvironment. Abstract Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) have dramatically changed the landscape of cancer therapy. Both remarkable and durable responses have been observed in patients with melanoma, non-small-cell lung cancer (NSCLC), and other malignancies. However, the PD-1/PD-L1 blockade has demonstrated meaningful clinical responses and benefits in only a subset of patients. In addition, several severe and life-threatening adverse events were observed in these patients. Therefore, the identification of predictive biomarkers is urgently needed to select patients who are more likely to benefit from ICI therapy. PD-L1 expression level is the most commonly used biomarker in clinical practice for PD-1/PD-L1 inhibitors. However, negative PD-L1 expression cannot reliably exclude a response to a PD-1/PD-L1 blockade. Other factors, such as tumor microenvironment and other tumor genomic signatures, appear to impact the response to ICIs. In this review, we examine emerging data for novel biomarkers that may have a predictive value for optimizing the benefit from anti-PD-1/PD-L1 immunotherapy.
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Affiliation(s)
- Fang Yang
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing 210008, China;
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Baorui Liu
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing 210008, China;
- Correspondence: (B.L.); (J.R.M.)
| | - Julian R. Molina
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: (B.L.); (J.R.M.)
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Bastacky ML, Wang H, Fortman D, Rahman Z, Mascara GP, Brenner T, Najjar YG, Luke JJ, Kirkwood JM, Zarour HM, Davar D. Immune-Related Adverse Events in PD-1 Treated Melanoma and Impact Upon Anti-Tumor Efficacy: A Real World Analysis. Front Oncol 2021; 11:749064. [PMID: 34900695 PMCID: PMC8662734 DOI: 10.3389/fonc.2021.749064] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
Background Anti-PD-1 immune checkpoint inhibitor (ICI) therapy has revolutionized the treatment of melanoma by producing durable long-term responses in a subset of patients. ICI-treated patients develop unique toxicities - immune related adverse events (irAEs) – that arise from unrestrained immune activation. The link between irAE development and clinical outcome in melanoma and other cancers is inconsistent; and little data exists on the occurrence of multiple irAEs. We sought to characterize development of single and multiple irAEs, and association of irAE(s) development with clinical variables and impact upon outcomes in advanced melanoma patients treated with anti-PD-1 ICIs. Methods We conducted a retrospective study of 190 patients with metastatic melanoma treated with single-agent anti-PD-1 ICI therapy between June 2014 and August 2020 at a large integrated network cancer center identified through retrospective review of pharmacy records. irAEs were graded based on the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results 190 patients were evaluated of whom 114 patients (60.0%) experienced ≥1 irAE, including 30 (15.8%) with grade 3/4 irAEs. The occurrence of any irAE was strongly associated with the development of investigator-assessed response to anti-PD-1 therapy (p < 0.0001); whether evaluated by current (p=0.0082) or best (p=0.0001) response. In patients with ≥2 irAEs, distinct patterns were observed. Median progression-free survival (PFS) and overall survival (OS) were greater in those with any irAE compared to those without (PFS, 28 months vs. 5 months, p < 0.0001; OS, not reached vs. 9 months, p < 0.0001). Development of ≥2 irAEs had a trend towards improved PFS and OS compared to those who developed a single irAE, although this did not reach statistical significance (p=0.2555, PFS; p=0.0583, OS). Obesity but not age or gender was distinctly associated with irAE development. Conclusions In this study, we demonstrated that irAE occurrence was significantly associated with response to anti-PD-1 therapy and improved PFS/OS. Those who developed multiple irAEs had a trend towards improved PFS and OS compared to those who developed only a single irAE. Increased BMI but neither age nor gender were associated with irAE development. Distinct patterns of irAEs observed suggest shared etiopathogenetic mechanisms.
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Affiliation(s)
- Melissa L Bastacky
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hong Wang
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dylan Fortman
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Zahra Rahman
- University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Gerard P Mascara
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Timothy Brenner
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Yana G Najjar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Jason J Luke
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - John M Kirkwood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Hassane M Zarour
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Diwakar Davar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
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45
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Dietz H, Weinmann SC, Salama AK. Checkpoint Inhibitors in Melanoma Patients with Underlying Autoimmune Disease. Cancer Manag Res 2021; 13:8199-8208. [PMID: 34754240 PMCID: PMC8572012 DOI: 10.2147/cmar.s283217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022] Open
Abstract
The development of immune checkpoint inhibitors (ICI) has dramatically changed the clinical management of metastatic melanoma and other solid tumors. Despite exclusion from initial clinical trials, there is a growing body of retrospective data that suggest ICI can be used in patients with underlying autoimmune disease (AID) with a tolerable level of anticipated immune-related adverse events (irAEs) and a rate of severe irAEs comparable to that of patients without underlying AID. Coordination with other subspecialists and careful monitoring for irAEs is critical in safely managing these patients. Studies exploring novel approaches examining the use of targeted immunosuppressants in the prevention and management of irAEs, as well as multiple studies currently underway are aimed at establishing safe clinical practices when using ICI in patients with underlying AID.
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Affiliation(s)
- Hilary Dietz
- Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Sophia C Weinmann
- Division of Rheumatology and Immunology, Duke University, Durham, NC, USA
| | - April K Salama
- Division of Medical Oncology, Duke University, Durham, NC, USA
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Zhao Q, Wang Q, Wang T, Xu J, Li T, Liu Q, Yao Q, Wang P. Pattern Recognition Receptors (PRRs) in Macrophages Possess Prognosis and Immunotherapy Potential for Melanoma. Front Immunol 2021; 12:765615. [PMID: 34858419 PMCID: PMC8630683 DOI: 10.3389/fimmu.2021.765615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background Pattern recognition receptors (PRRs) family plays a vital role in the initial stage of innate immune response and the subsequent activation of adaptive immunity. Increasing evidences have indicated that several PRRs play critical roles in the progress of inflammation and tumorigenesis. However, the comprehensive significance of PRRs family in clinical prognosis of different cancers is still elusive. Methods We analyzed expression of 20 canonical PRRs in tumor samples from 9502 patients of 33 tumor types. Next, we used expression profiles of PRRs in skin cutaneous melanoma (SKCM) to build a Cox prognosis model. Then, we analyzed immune infiltration features and immune activity of high risk score and low risk score patients. Finally, we analyzed the single-cell sequencing data of different cancers and detected the expression of PRRs in mouse melanoma model to identify PRRs-expressing cell types. Results We found PRRs had a significantly positive correlation with prognosis in SKCM rather than other tumors, and PRR-based Cox model had a much better prognosis potential than any single PRR. Further analysis shows risk score could indicate immunocyte infiltration and immune activity in SKCM. We also found the expressions of some PRR genes were highly correlated with the expression of immune checkpoints molecules in SKCM, indicating they could be indicators for clinical immune therapy. Finally, we found only in SKCM samples, the expression of PRRs is especially high in a subpopulation of macrophages with a trait of CD206 low expression, probably explaining why PRRs have prognosis potential in melanoma. Conclusions Our study reveals PRR family in macrophages has a positive prognosis potential in melanoma and could be valuable for clinical prognosis and immune therapy.
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Affiliation(s)
- Qihang Zhao
- National Key Laboratory of Medical Immunology, Institute of Immunology, Navy Medical University, Shanghai, China
| | - Qiang Wang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tengjiao Wang
- Centre for Translational Medicine, Navy Medical University, Shanghai, China
| | - Junfang Xu
- National Key Laboratory of Medical Immunology, Institute of Immunology, Navy Medical University, Shanghai, China
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Li
- College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qiuyan Liu
- National Key Laboratory of Medical Immunology, Institute of Immunology, Navy Medical University, Shanghai, China
| | - Qinghua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
- Key Laboratory of Traditional Chinese Medicine Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Pin Wang
- National Key Laboratory of Medical Immunology, Institute of Immunology, Navy Medical University, Shanghai, China
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Bai X, Hu J, Betof Warner A, Quach HT, Cann CG, Zhang MZ, Si L, Tang B, Cui C, Yang X, Wei X, Pallan L, Harvey C, Manos MP, Ouyang O, Kim MS, Kasumova G, Cohen JV, Lawrence DP, Freedman C, Fadden RM, Rubin KM, Sharova T, Frederick DT, Flaherty KT, Rahma OE, Long GV, Menzies AM, Guo J, Shoushtari AN, Johnson DB, Sullivan RJ, Boland GM. Early Use of High-Dose Glucocorticoid for the Management of irAE Is Associated with Poorer Survival in Patients with Advanced Melanoma Treated with Anti-PD-1 Monotherapy. Clin Cancer Res 2021; 27:5993-6000. [PMID: 34376536 PMCID: PMC9401488 DOI: 10.1158/1078-0432.ccr-21-1283] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Programmed cell death receptor-1 (PD-1) inhibitors are frontline therapy in advanced melanoma. Severe immune-related adverse effects (irAEs) often require immunosuppressive treatment with glucocorticoids (GCCs), but GCC use and its correlation with patient survival outcomes during anti-PD-1 monotherapy remains unclear. EXPERIMENTAL DESIGN In this multicenter retrospective analysis, patients treated with anti-PD-1 monotherapy between 2009 and 2019 and detailed GCC use, data were identified from five independent cohorts, with median follow-up time of 206 weeks. IrAEs were tracked from the initiation of anti-PD-1 until disease progression, initiation of a new therapy, or last follow-up. Correlations between irAEs, GCC use, and survival outcomes were analyzed. RESULTS Of the entire cohort of 947 patients, 509 (54%) developed irAEs. In the MGH cohort [irAE(+) n = 90], early-onset irAE (within 8 weeks of anti-PD-1 initiation) with high-dose GCC use (≥60-mg prednisone equivalent once a day) was independently associated with poorer post-irAE PFS/OS (progression-free survival/overall survival) [post-irAE PFS: HR, 5.37; 95% confidence interval (CI), 2.10-13.70; P < 0.001; post-irAE OS: HR, 5.95; 95% CI, 2.20-16.09; P < 0.001] compared with irAEs without early high-dose GCC use. These findings were validated in the combined validation cohort [irAE(+) n = 419, post-irAE PFS: HR, 1.69; 95% CI, 1.04-2.76; P = 0.04; post-irAE OS: HR, 1.97; 95% CI, 1.15-3.39; P = 0.01]. Similar findings were also observed in the 26-week landmark analysis for post-irAE-PFS but not for post-irAE-OS. A sensitivity analysis using accumulated GCC exposure as the measurement achieved similar results. CONCLUSIONS Early high-dose GCC use was associated with poorer PFS and OS after irAE onset. Judicious use of GCC early during anti-PD-1 monotherapy should be considered. Further prospective randomized control clinical trials designed to explore alternative irAE management options are warranted.
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Affiliation(s)
- Xue Bai
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China.,Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jiani Hu
- Department of Data Sciences (Division of Biostatistics), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Allison Betof Warner
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Henry T. Quach
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher G. Cann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Z. Zhang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lu Si
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Bixia Tang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chuanliang Cui
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoling Yang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China.,Department of Medical Oncology, Shanxi Bethune Hospital, Shanxi, China
| | - Xiaoting Wei
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lalit Pallan
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Catriona Harvey
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Michael P. Manos
- Center for Immune-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Olivia Ouyang
- Center for Immune-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Justine V. Cohen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Donald P. Lawrence
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Christine Freedman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Riley M. Fadden
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Krista M. Rubin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tatyana Sharova
- Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennie T. Frederick
- Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keith T. Flaherty
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Senior authors at each site
| | - Osama E. Rahma
- Center for Immune-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Senior authors at each site
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia.,Senior authors at each site
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia.,Senior authors at each site
| | - Jun Guo
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, Beijing, China.,Senior authors at each site
| | - Alexander N. Shoushtari
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York.,Senior authors at each site
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Senior authors at each site
| | - Ryan J. Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Senior authors at each site
| | - Genevieve M. Boland
- Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Senior authors at each site.,Corresponding Author: Genevieve M. Boland, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Phone: 617-724-9913; Fax: 617-724-3895, E-mail:
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Pham JP, Star P, Phan K, Loh Y, Joshua AM, Smith A. Review BRAF inhibition and the spectrum of granulomatous reactions. J Am Acad Dermatol 2021; 87:605-613. [PMID: 34715287 DOI: 10.1016/j.jaad.2021.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BRAF-inhibitors have emerged as a promising targeted therapy for malignancies with BRAF mutations, particularly metastatic melanoma. However, granulomatous reactions including sarcoidosis and sarcoid-like-reactions have been reported as a consequence of BRAF-inhibition. It is important to adequately characterise these granulomatous reactions including cutaneous manifestations and systemic involvement, in order to guide investigations and management. A literature review was conducted to characterise the spectrum of granulomatous reactions associated with BRAF-inhibitors - identifying 55 reactions affecting 51 patients, with 37 reactions limited to cutaneous involvement. Further, possible correlation with cancer response, mechanisms of granuloma formation, as well as a proposed workup and management approach for these granulomatous reactions are presented.
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Affiliation(s)
- James P Pham
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Phoebe Star
- St. Vincent's Hospital, Sydney, NSW, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
| | - Yanni Loh
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Anthony M Joshua
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, Australia
| | - Annika Smith
- St. Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; The Mater Hospital, North Sydney, NSW, Australia
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Ksienski D, Truong PT, Croteau NS, Chan A, Sonke E, Patterson T, Clarkson M, Hackett S, Lesperance M. Immune related adverse events and treatment discontinuation in patients older and younger than 75 years with advanced melanoma receiving nivolumab or pembrolizumab. J Geriatr Oncol 2021; 13:220-227. [PMID: 34654653 DOI: 10.1016/j.jgo.2021.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/22/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Programmed cell-death 1 antibodies (PD-1 Ab) improve overall survival (OS) for patients with advanced melanoma in trials; however, safety data in patients ≥75 years are lacking. The prognostic significance of and risk factors for PD-1 Ab discontinuation due immune related adverse events (irAE) are also uncertain. METHODS Patients with advanced melanoma receiving frontline PD-1 Ab at British Columbia Cancer outside of clinical trials between 10/2015-10/2019 were retrospectively analyzed. The incidence and subtypes of irAE were compared between age subgroups <75 and ≥ 75 years. Univariable logistic regression identified variables associated with treatment discontinuation within four months of PD-1 Ab initiation. Cox proportional hazard regression models were used to determine factors significantly associated with OS. RESULTS 302 patients were identified, of whom 126 (41.7%) were ≥ 75 years. During all follow-up, 15.9% of patients experienced irAE grade 3/4 and 27.2% of the cohort stopped PD-1 Ab due to immune toxicity. irAE incidence, hospitalization, and need for steroids by the four-month landmark were similar amongst age groups. Advanced age was not associated with risk of PD-1 Ab discontinuation from irAE on logistic regression. For the entire cohort, pre-treatment factors associated with shorter OS on multivariable analysis were ECOG performance status ≥1, M1d stage, lactate dehydrogenase >224, and neutrophil/ lymphocyte ratio ≥ 5. On four-month landmark multivariable analysis, treatment discontinuation due to irAE was significantly associated with worse OS. CONCLUSION Patients aged ≥75 years experienced similar irAE rates and treatment discontinuation for immune toxicity compared to younger patients. As PD-1 Ab discontinuation due to irAE was associated with shorter OS, efforts to treat irAE early are warranted to potentially avoid therapy cessation.
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Affiliation(s)
- Doran Ksienski
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, British Columbia, Canada.
| | - Pauline T Truong
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, British Columbia, Canada
| | - Nicole S Croteau
- University of British Columbia, Department of Anesthesiology, Pharmacology, & Therapeutics, British Columbia, Canada
| | - Angela Chan
- University of British Columbia, British Columbia, Canada; BC Cancer-Surrey, British Columbia, Canada
| | - Eric Sonke
- University of British Columbia, Department of Internal Medicine, British Columbia, Canada
| | | | | | | | - Mary Lesperance
- University of Victoria, Department of Mathematics and Statistics, British Columbia, Canada
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50
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Hu H, Ling B, Shi Y, Wu H, Zhu B, Meng Y, Zhang GM. Plasma Exosome-Derived SENP1 May Be a Potential Prognostic Predictor for Melanoma. Front Oncol 2021; 11:685009. [PMID: 34422639 PMCID: PMC8374070 DOI: 10.3389/fonc.2021.685009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/16/2021] [Indexed: 01/06/2023] Open
Abstract
Objective To evaluate plasma exosome-derived SUMO-specific protease (SENP)1 levels and assess their prognostic value in melanoma. Patients and Methods We extracted exosomes from the plasma of 126 melanoma patients, and identified them with transmission electron microscopy, nanoparticle tracking analysis and western blotting. The plasma exosome-derived SENP1 levels of melanoma patients and healthy controls were detected with ELISA. Results Plasma exosome-derived SENP1 levels in melanoma patients were significantly upregulated than in healthy controls (P < 0.001). Plasma exosome-derived SENP1 levels in melanoma patients with tumor size >10 cm, located in the mucosa or viscera, with Clark level IV/V, with lymph node metastasis, and TNM stages IIb-IV were significantly higher than in patients in with tumor size <10 cm, located in the skin, with Clark level I-III, without lymph node metastasis, and TNM stages IIb-IV (all P < 0.05). Disease-free survival (DFS) and overall survival (OS) were worse in melanoma patients who had higher plasma exosome-derived SENP1 levels than lower plasma exosome-derived SENP1 levels (both P < 0.001). Area under the receiver operating characteristic curve (AUROC) of plasma exosome-derived SENP1 for predicting 3-year DFS of melanoma patients was 0.82 [95% confidence interval (CI): 0.74-0.88], with a sensitivity of 81.2% (95% CI: 69.9-89.6%) and specificity of 75.4% (95% CI: 62.2-85.9%). The AUROC of plasma exosome-derived SENP1 for predicting 3-year OS of melanoma patients was 0.76 (95% CI: 0.67-0.83), with a sensitivity of 95.7% (95% CI: 85.5-99.5%) and specificity of 62.0% (95% CI: 50.4-72.7%). Conclusions Melanoma patients with higher plasma exosome-derived SENP1 levels had worse DFS and OS. The plasma exosome-derived SENP1 levels may be a potential prognostic predictor for 3-year DFS and 3-year OS of melanoma.
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Affiliation(s)
- Hejuan Hu
- Suzhou Key Laboratory for Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
| | - Bai Ling
- Department of Pharmacy, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China.,Department of Pharmacy, The First People's Hospital of Yancheng City, Yancheng, China
| | - Yuhan Shi
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Haohao Wu
- Department of Oncology, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China.,Department of Oncology, The First People's Hospital of Yancheng City, Yancheng, China
| | - Bingying Zhu
- Suzhou Key Laboratory for Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
| | - Yiling Meng
- Suzhou Key Laboratory for Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
| | - Guo-Ming Zhang
- Department of Laboratory Medicine, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, China.,Department of Laboratory Medicine, Shuyang People's Hospital, Jiangsu, China
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