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Teuwen LA, Roets E, D’Hoore P, Pauwels P, Prenen H. Comprehensive Genomic Profiling and Therapeutic Implications for Patients with Advanced Cancers: The Experience of an Academic Hospital. Diagnostics (Basel) 2023; 13:1619. [PMID: 37175010 PMCID: PMC10177779 DOI: 10.3390/diagnostics13091619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Next-generation sequencing (NGS) can be used to detect tumor-specific genomic alterations. This retrospective single-center study aims to assess the application of an extensive NGS panel to identify actionable alterations and initiate matched targeted treatment for patients with advanced cancer. We analyzed genomic alterations in solid tumor biopsies from 464 patients with advanced cancer with the Foundation Medicine assay (FoundationOne®CDx). Therapeutic implications were determined using the Memorial Sloan Kettering Precision Oncology Knowledge Base (OncoKB) classification. The FoundationOne®CDx was successfully applied in 464/521 patients (89%). The most common altered genes were TP53 (61%), KRAS (20%), CDKN2A (20%), TERT (16%), and APC (16%). Among the 419 patients with successfully analyzed tumor mutational burden (TMB), 43 patients presented with a high TMB (≥10 mutations/megabase). Out of the 126 patients with an actionable target, 40 patients received matched treatment (32%) of which 17 were within a clinical trial. This study shows that the application of NGS is feasible in an academic center and increases the detection of actionable alterations and identification of patients eligible for targeted treatment or immunotherapy regardless of tumor histology. Strategies such as early referral for NGS, inclusion in clinical (basket) trials, and the development of new targeted drugs are necessary to improve the matched treatment rate.
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Affiliation(s)
- Laure-Anne Teuwen
- Department of Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (L.-A.T.); (E.R.); (P.D.)
| | - Evelyne Roets
- Department of Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (L.-A.T.); (E.R.); (P.D.)
| | - Pieter D’Hoore
- Department of Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (L.-A.T.); (E.R.); (P.D.)
| | - Patrick Pauwels
- Department of Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium;
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Hans Prenen
- Department of Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (L.-A.T.); (E.R.); (P.D.)
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Super-Responders in Moderate–Severe Psoriasis under Guselkumab Treatment: Myths, Realities and Future Perspectives. Life (Basel) 2022; 12:life12091412. [PMID: 36143449 PMCID: PMC9505180 DOI: 10.3390/life12091412] [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: 08/17/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
A fast skin clearance is the main goal to achieve in psoriasis treatment. Patients that present a fast and exceptional improvement with treatment are called super-responders (SR). There is no consensus on the definition of SR with respect to psoriasis. Included herein is a retrospective analysis of a multicenter, observational study of real clinical practices including patients with moderate-to-severe plaque PSO undergoing treatment with Guselkumab (GUS). This cross-sectional analysis includes information on patients between February 2019 to February 2022. A SR is a patient that achieved a PASI = 0 at weeks 12 and 24. Analyses have been performed “as observed” using GraphPad Prism version 8.3.0 for Windows (GraphPad Software, San Diego, CA, USA, At baseline, the PASI is significantly correlated with VAS_pruritus, BSA, and DLQI, while DLQI is significantly correlated with VAS_pruritus. Significant correlations increase in number and magnitude over the follow-up time. In relation to the univariate logistic models carried out, only three variables showed a significant association with the super-responder variable: depression, VAS_pruritus, and DLQI.SR patients, who show a faster evolution in PASI and BSA improvement than non-SRs. Based on the results obtained, it would be possible to also include DLQI and VAS_pruritus in the broader concept of the SR.
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Ruiz-Villaverde R, Domínguez-Cruz J, Navarro-Triviño FJ, Galán-Gutiérrez M, Armario-Hita JC, Pereyra-Rodriguez JJ. Atopic Dermatitis: Background, Objectives and Future Perspectives (Superresponders). Life (Basel) 2022; 12:1192. [PMID: 36013371 PMCID: PMC9410156 DOI: 10.3390/life12081192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 01/02/2023] Open
Abstract
In this Special Issue entitled Atopic Dermatitis: New Perspectives, we have tried to collect research of special interest related mainly to the incorporation of pathophysiological aspects and therapeutic novelties in this regard [...].
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Affiliation(s)
- Ricardo Ruiz-Villaverde
- Dermatology Department, Hospital Universitario San Cecilio, H.U. San Cecilio, Avda. Conocimiento 33, 18016 Granada, Spain
| | - Javier Domínguez-Cruz
- Dermatology Department, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Francisco J. Navarro-Triviño
- Dermatology Department, Hospital Universitario San Cecilio, H.U. San Cecilio, Avda. Conocimiento 33, 18016 Granada, Spain
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Abstract
The high prices of new anticancer drugs and the marginal added benefit perceived by some stakeholders have fuelled a debate on the value of anticancer drugs in the European Union, even though an agreed definition of what constitutes a drug's value does not exist. In this Perspective, we discuss the value of drugs from different viewpoints and objectives of decision makers: for regulators, assessment of the benefit-risk balance of a drug is a cornerstone for approval; payers rely on cost-effectiveness analyses carried out by health technology assessment agencies for reimbursement decisions; for patients, treatment choices are based on personal preferences and attitudes to risk; and clinicians can use several scales (such as the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS)) that have been developed as an attempt to measure value objectively. Although a unique definition that fully captures the concept of value is unlikely to emerge, herein we discuss the importance of understanding different perspectives, and how regulators can help to inform different decision makers.
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Abstract
PURPOSE OF REVIEW Since its approval in November 2018, venetoclax with a hypomethylating agent backbone has shown promising efficacy for older, newly diagnosed acute myeloid leukemia (AML) patients who are unfit for standard intensive induction chemotherapy. This regimen is well tolerated, allows for deep and durable responses and may be increasing the prevalence of the disease. Although there is justifiable excitement, it remains to be seen to what extent venetoclax-based regimens, as they are currently administered, will have a long-term impact on the treatment of AML. This review aims to evaluate the strengths of the regimen that deserve enthusiasm as well as its shortcomings, which should be viewed as opportunities for improvement. RECENT FINDINGS The clinical efficacy as well as the novel mechanism of venetoclax with hypomethylating agents will be described here. SUMMARY Venetoclax with hypomethylating agents do not represent the holy grail for AML, but this regimen is a promising step in the right direction, and proof of principle that a low-intensity therapy can have a major impact on this disease.
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Strohbehn GW, Ratain MJ. Precision and Accuracy in the Brave New World of Basket Trials. JCO Precis Oncol 2019; 3:1-5. [DOI: 10.1200/po.19.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Garth W. Strohbehn
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Mark J. Ratain
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
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Drug repurposing for breast cancer therapy: Old weapon for new battle. Semin Cancer Biol 2019; 68:8-20. [PMID: 31550502 PMCID: PMC7128772 DOI: 10.1016/j.semcancer.2019.09.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022]
Abstract
Despite tremendous resources being invested in prevention and treatment, breast cancer remains a leading cause of cancer deaths in women globally. The available treatment modalities are very costly and produces severe side effects. Drug repurposing that relate to new uses for old drugs has emerged as a novel approach for drug development. Repositioning of old, clinically approved, off patent non-cancer drugs with known targets, into newer indication is like using old weapons for new battle. The advances in genomics, proteomics and information computational biology has facilitated the process of drug repurposing. Repositioning approach not only fastens the process of drug development but also offers more effective, cheaper, safer drugs with lesser/known side effects. During the last decade, drugs such as alkylating agents, anthracyclins, antimetabolite, CDK4/6 inhibitor, aromatase inhibitor, mTOR inhibitor and mitotic inhibitors has been repositioned for breast cancer treatment. The repositioned drugs have been successfully used for the treatment of most aggressive triple negative breast cancer. The literature review suggest that serendipity plays a major role in the drug development. This article describes the comprehensive overview of the current scenario of drug repurposing for the breast cancer treatment. The strategies as well as several examples of repurposed drugs are provided. The challenges associated with drug repurposing are discussed.
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Exceptional Responders in Oncology: A Systematic Review and Meta-Analysis of Patient Level Data. Am J Clin Oncol 2019; 42:624-635. [PMID: 31313679 DOI: 10.1097/coc.0000000000000572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We aim to systematically review and analyze the available literature on "exceptional responders" in oncology. We hypothesize that survival or patients with an exceptional response may be predicted based on clinical factors. MATERIALS AND METHODS A PICOS/PRISMA/MOOSE selection protocol was used to find studies that reported oncology patients with an exceptional response. A total of 333 initial articles were screened, and 76 articles were included, accounting for 85 patients. The primary outcome was survival after exceptional response therapy (ERT). The secondary outcome was survival since diagnosis. Univariate and multivariate analyses were conducted for both outcomes with 17 covariates. RESULTS The median age was 52 years (interquartile range, 35-66 y), 51.8% were male individuals, 18 (21.2%) had lung cancer, and 1 patient (1%) met all National Cancer Institute criteria for exceptional response. The most common treatment resulting in exceptional response was a form of chemotherapy (49.2%) followed by targeted therapy (26.8%) and radiation therapy (7.7%). The median time from diagnosis to initiation of ERT was 7.92 months (interquartile range, 0-24.72 mo). On multivariate analysis of survival after initiation of ERT, there were no predictors of exceptional response. On multivariate analysis of survival since diagnosis, predictors of prolonged survival included time between diagnosis and ERT initiation (hazard ratio, 0.52; 95% confidence interval, 0.32-0.87; P=0.0124) and single prior surgery versus none (0.08; 95% confidence interval, 0.01-0.98; P=0.04853). CONCLUSIONS There were no clinically apparent patient or treatment factors that predicted favorable survival following ERT; instead, reporting of exceptional response appears to be biased.
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Schuler M, Paz-Ares L, Sequist LV, Hirsh V, Lee KH, Wu YL, Lu S, Zhou C, Feng J, Ellis SH, Samuelsen CH, Tang W, Märten A, Ehrnrooth E, Park K, Yang JCH. First-line afatinib for advanced EGFRm+ NSCLC: Analysis of long-term responders in the LUX-Lung 3, 6, and 7 trials. Lung Cancer 2019; 133:10-19. [PMID: 31200814 DOI: 10.1016/j.lungcan.2019.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In patients with advanced epidermal growth factor receptor mutation-positive (EGFRm+) non-small cell lung cancer (NSCLC), first-line afatinib significantly improved progression-free survival (PFS) and objective response vs. platinum-doublet chemotherapy in the phase III LUX-Lung 3 and LUX-Lung 6 trials, and significantly improved PFS, time to treatment failure and objective response vs. gefitinib in the phase IIb LUX-Lung 7 trial. We report post-hoc analyses of efficacy, safety and patient-reported outcomes (PROs) in afatinib long-term responders (LTRs) in these trials. METHODS Treatment-naïve patients with stage IIIB/IV EGFRm + NSCLC randomized to afatinib in LUX-Lung 3/LUX-Lung 6/LUX-Lung 7 were included in the analysis. Patients treated with afatinib for ≥ 3 years were defined as LTRs. RESULTS In LUX-Lung 3, LUX-Lung 6, and LUX-Lung 7, 24/229 (10%), 23/239 (10%) and 19/160 (12%) afatinib-treated patients were LTRs. Baseline characteristics were similar to the study populations, except for the proportions of women (LUX-Lung 3/LUX-Lung 6 only; 92/78% vs. 64% overall) and Del19-positive patients (63-79% vs. 49-58% overall). Median treatment duration among LTRs was 50, 56 and 42 months, and median PFS was 49.5, 55.5, and 42.2 months in LUX-Lung 3/LUX-Lung 6/LUX-Lung 7, respectively. Median overall survival could not be estimated. Frequency of afatinib dose reduction was consistent with the LUX-Lung 3/LUX-Lung 6/LUX-Lung 7 overall populations. PROs were stable in LTRs, with slight improvements after 3 years of afatinib treatment vs. baseline scores. CONCLUSIONS In the LUX-Lung 3/LUX-Lung 6/LUX-Lung 7 trials, 10-12% of afatinib-treated patients were LTRs. Long-term afatinib treatment was independent of tolerability-guided dose adjustment and had no detrimental impact on safety or PROs.
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Affiliation(s)
- Martin Schuler
- West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Luis Paz-Ares
- Hospital Universitario Doce de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain.
| | - Lecia V Sequist
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Cheongju, South Korea.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Shun Lu
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Shanghai, China.
| | - Jifeng Feng
- Jiangsu Provincial Tumor Hospital, Nanjing, Jiangsu, China.
| | | | | | - Wenbo Tang
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
| | - Angela Märten
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany.
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan.
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Hoste G, Slembrouck L, Jongen L, Punie K, Matton T, Vander Borght S, Vanden Bempt I, Menten J, Wildiers H, Floris G, Arteaga C, Neven P. Unexpected Benefit from Alpelisib and Fulvestrant in a Woman with Highly Pre-treated ER-Positive, HER2-Negative PIK3CA Mutant Metastatic Breast Cancer. Clin Drug Investig 2018; 38:1071-1075. [PMID: 30187361 DOI: 10.1007/s40261-018-0696-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We present the case of a postmenopausal patient with a secondary metastatic ER-positive, HER2-negative breast cancer who was successfully treated with fulvestrant and alpelisib following six lines of therapy. The tumour showed two uncommon PIK3CA mutations, and with the combination of alpelisib and fulvestrant the patient went from ECOG grade 3, before the start of this therapy, to ECOG grade 1 during treatment until progressive disease after 6 months. This unexpected benefit emphasizes the importance of performing a Next Generation Sequencing (NGS)-based assay to screen for several cancer genes in the metastatic setting, even after more than four lines of therapy and a high ECOG grade. Moreover, the use of alpelisib may be beneficial for uncommon PIK3CA mutations.
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Affiliation(s)
- Griet Hoste
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Laurence Slembrouck
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Lynn Jongen
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Kevin Punie
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Tom Matton
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Sara Vander Borght
- Department of Pathology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Johan Menten
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Radiotherapy, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Hans Wildiers
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Giuseppe Floris
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Imaging and Pathology, Laboratory of Translational Cell and Tissue Research, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Carlos Arteaga
- University of Texas Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Patrick Neven
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
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Rieke DT, Lamping M, Schuh M, Le Tourneau C, Basté N, Burkard ME, Metzeler KH, Leyvraz S, Keilholz U. Comparison of Treatment Recommendations by Molecular Tumor Boards Worldwide. JCO Precis Oncol 2018; 2:1-14. [DOI: 10.1200/po.18.00098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Precision oncology holds the promise of improving patient outcome. It is based on the idea that the testing of genomic biomarkers can lead to the recommendation of a treatment option tailored to the specific patient. To derive treatment recommendations from molecular profiles, interdisciplinary molecular tumor boards (MTBs) have been established recently in many academic institutions. The recommendation process in MTBs, however, has not been well defined, which limits applicability to larger clinical trials and patient populations. Methods We created four fictional patients on the basis of recent real cases with genomic information on mutations, fusions, copy numbers, and gene expression. We identified 29 tumor boards from nine countries worldwide and asked them to provide treatment recommendations for the sample patients. In addition, a questionnaire regarding the setup and methods used by MTBs was circulated. Results Five MTBs from four countries provided treatment recommendations and answered the questionnaire. For one patient, three tumor board treatment recommendations were identical, and two tumor boards had identical treatment strategies for the other three patients. There was heterogeneity in the interpretation of tumor and germline aberrations as well as in standards of prioritization. Conclusion Differences in the interpretation and recommendation process contribute to heterogeneity in MTB recommendations. Additional comparative analyses of recommendations could help improve rational decision making and lead to standardization.
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Affiliation(s)
- Damian T. Rieke
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Mario Lamping
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Marissa Schuh
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Christophe Le Tourneau
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Neus Basté
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Mark E. Burkard
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Klaus H. Metzeler
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Serge Leyvraz
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
| | - Ulrich Keilholz
- Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité–Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint
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A comprehensive review of exceptional responders to anticancer drugs in the biomedical literature. Eur J Cancer 2018; 101:143-151. [PMID: 30059818 DOI: 10.1016/j.ejca.2018.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 01/08/2023]
Abstract
IMPORTANCE There is broad interest in patients who have exceptional responses to cancer drugs and only one prior systematic review of published case reports. OBJECTIVE To systematically summarise case reports of patients who have had a super response to a cancer drug and determine patterns and completeness of documentation. DESIGN, SETTING AND PARTICIPANTS This is a systematic search of biomedical literature and hand searches of seven prominent oncology journals. All cases were adults with cancer in the metastatic or unresectable setting and who were classified as having a remarkable response to a drug therapy were included. Our study was conducted between January 2017 and April 2017. MAIN OUTCOMES AND MEASURES We extracted patient and tumour characteristics, characteristics surrounding the exceptional response and pertinent oncologic history. Additionally, we noted authors' financial conflicts of interest, if given. RESULTS We found 180 cases of exceptional response. The most common malignancy was breast cancer (28/180), and the most common class of drug therapy used was targeted therapies (161/274). The median year of publication was 2015. Depth of response included 33% (61/180) complete response, 55% (100/180) partial response and 7.7% (14/180) stable disease. The median length of response to the drug was 14 months. Fifty-nine percent (107/180) reported a driver mutation, and only 52% (56/107) reported two or more correlative studies. Only 14% (26/180) reported a denominator or total number treated to observe this response. Of cases that reported duration of response to a previous drug given in the unresectable setting, 49% demonstrated a progression-free survival ratio of exceptional response to prior line of 1.3 or greater (Von Hoff ratio). CONCLUSIONS AND RELEVANCE Our survey found that exceptional responders tended to have solid organ malignancies and most received targeted therapies. Many of our cases of exceptional responders were missing important information about the response and key oncologic history. Standardised criteria should be used to maximise usefulness of these case reports in the future.
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Post G, Geldmann J. Exceptional responders in conservation. CONSERVATION BIOLOGY : THE JOURNAL OF THE SOCIETY FOR CONSERVATION BIOLOGY 2018; 32:576-583. [PMID: 28856730 DOI: 10.1111/cobi.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/09/2017] [Accepted: 08/27/2017] [Indexed: 06/07/2023]
Abstract
Conservation operates within complex systems with incomplete knowledge of the system and the interventions utilized. This frequently results in the inability to find generally applicable methods to alleviate threats to Earth's vanishing wildlife. One approach used in medicine and the social sciences has been to develop a deeper understanding of positive outliers. Where such outliers share similar characteristics, they may be considered exceptional responders. We devised a 4-step framework for identifying exceptional responders in conservation: identification of the study system, identification of the response structure, identification of the threshold for exceptionalism, and identification of commonalities among outliers. Evaluation of exceptional responders provides additional information that is often ignored in randomized controlled trials and before-after control-intervention experiments. Interrogating the contextual factors that contribute to an exceptional outcome allow exceptional responders to become valuable pieces of information leading to unexpected discoveries and novel hypotheses.
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Affiliation(s)
- Gerald Post
- The Veterinary Cancer Center, 129 Glover Avenue, Norwalk, CT 06850, U.S.A
| | - Jonas Geldmann
- Conservation Science Group, Department of Zoology, University of Cambridge, Downing Street, Cambridge CB2 3EJ, U.K
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Vitali F, Marini S, Pala D, Demartini A, Montoli S, Zambelli A, Bellazzi R. Patient similarity by joint matrix trifactorization to identify subgroups in acute myeloid leukemia. JAMIA Open 2018; 1:75-86. [PMID: 31984320 PMCID: PMC6951984 DOI: 10.1093/jamiaopen/ooy008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Abstract
Objective Computing patients’ similarity is of great interest in precision oncology since it supports clustering and subgroup identification, eventually leading to tailored therapies. The availability of large amounts of biomedical data, characterized by large feature sets and sparse content, motivates the development of new methods to compute patient similarities able to fuse heterogeneous data sources with the available knowledge. Materials and Methods In this work, we developed a data integration approach based on matrix trifactorization to compute patient similarities by integrating several sources of data and knowledge. We assess the accuracy of the proposed method: (1) on several synthetic data sets which similarity structures are affected by increasing levels of noise and data sparsity, and (2) on a real data set coming from an acute myeloid leukemia (AML) study. The results obtained are finally compared with the ones of traditional similarity calculation methods. Results In the analysis of the synthetic data set, where the ground truth is known, we measured the capability of reconstructing the correct clusters, while in the AML study we evaluated the Kaplan-Meier curves obtained with the different clusters and measured their statistical difference by means of the log-rank test. In presence of noise and sparse data, our data integration method outperform other techniques, both in the synthetic and in the AML data. Discussion In case of multiple heterogeneous data sources, a matrix trifactorization technique can successfully fuse all the information in a joint model. We demonstrated how this approach can be efficiently applied to discover meaningful patient similarities and therefore may be considered a reliable data driven strategy for the definition of new research hypothesis for precision oncology. Conclusion The better performance of the proposed approach presents an advantage over previous methods to provide accurate patient similarities supporting precision medicine.
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Affiliation(s)
- F Vitali
- Center for Biomedical Informatics and Biostatistics, The University of Arizona, Tucson, Arizona, USA.,BIO5 Institute, The University of Arizona, Tucson, Arizona, USA.,Department of Medicine, The University of Arizona, Tucson, AZ, USA
| | - S Marini
- Department of Computational Biology and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - D Pala
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, PV, Italy
| | - A Demartini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, PV, Italy.,Centre for Health Technologies, University of Pavia, PV, Italy
| | - S Montoli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, PV, Italy.,Centre for Health Technologies, University of Pavia, PV, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, BG, Italy
| | - R Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, PV, Italy.,Centre for Health Technologies, University of Pavia, PV, Italy.,IRCCS Istituti Clinici Scientifici Maugeri, Pavia, PV, Italy
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Cagan R, Meyer P. Rethinking cancer: current challenges and opportunities in cancer research. Dis Model Mech 2017; 10:349-352. [PMID: 28381596 PMCID: PMC5399574 DOI: 10.1242/dmm.030007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cancer therapeutics currently have the lowest clinical trial success rate of all major diseases. Partly as a result of the paucity of successful anti-cancer drugs, cancer will soon be the leading cause of mortality in developed countries. As a disease embedded in the fundamentals of our biology, cancer presents difficult challenges that would benefit from uniting experts from a broad cross-section of related and unrelated fields. Combining extant approaches with novel ones could help in tackling this challenging health problem, enabling the development of therapeutics to stop disease progression and prolong patient lives. This goal provided the inspiration for a recent workshop titled ‘Rethinking Cancer’, which brought together a group of cancer scientists who work in the academic and pharmaceutical sectors of Europe, America and Asia. In this Editorial, we discuss the main themes emerging from the workshop, with the aim of providing a snapshot of key challenges faced by the cancer research community today. We also outline potential strategies for addressing some of these challenges, from understanding the basic evolution of cancer and improving its early detection to streamlining the thorny process of moving promising drug targets into clinical trials. Summary: Pablo Meyer and Ross Cagan discuss the main themes emerging from a recent workshop ‘Rethinking Cancer’, highlighting the key challenges faced by the research community and outlining potential strategies to promote translation of basic findings.
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Affiliation(s)
- Ross Cagan
- Icahn School of Medicine at Mount Sinai, Annenberg 25-40, Campus Box 1020, 1468 Madison Avenue, New York, NY 10029, USA
| | - Pablo Meyer
- Icahn School of Medicine at Mount Sinai, Annenberg 25-40, Campus Box 1020, 1468 Madison Avenue, New York, NY 10029, USA .,Thomas J. Watson Computational Biology Center, IBM, Yorktown Heights, NY 10598, USA
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16
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Precision medicine for urothelial bladder cancer: update on tumour genomics and immunotherapy. Nat Rev Urol 2017; 15:92-111. [PMID: 29133939 DOI: 10.1038/nrurol.2017.179] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective management of advanced urothelial bladder cancer is challenging. New discoveries that improve our understanding of molecular bladder cancer subtypes have revealed numerous potentially targetable genomic alterations and demonstrated the efficacy of treatments that harness the immune system. These findings have begun to change paradigms of bladder cancer therapy. For example, DNA repair pathway mutations in genes such as ERCC2, FANCC, ATM, RB1, and others can predict responses to neoadjuvant platinum-based chemotherapies and to targeted therapies on the basis of mutation status. Furthermore, an increasing number of pan-cancer clinical trials (commonly referred to as basket or umbrella trials) are enrolling patients on the basis of molecular and genetic predictors of response. These studies promise to provide improved insight into the true utility of personalized medicine in the treatment of bladder cancer and many other cancer types. Finally, therapies that modulate immune responses have shown great benefit in many cancer types. Several immune checkpoint inhibitors that target programmed cell death protein 1 (PD1), its ligand PDL1, and cytotoxic T lymphocyte-associated protein 4 (CTLA4) have already been approved for use in bladder cancer, representing the most important change to the urological oncologist's tool-kit in over a decade. These advances also provide opportunities for personalization of bladder cancer therapy.
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17
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Functional precision cancer medicine-moving beyond pure genomics. Nat Med 2017; 23:1028-1035. [PMID: 28886003 DOI: 10.1038/nm.4389] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
Abstract
The essential job of precision medicine is to match the right drugs to the right patients. In cancer, precision medicine has been nearly synonymous with genomics. However, sobering recent studies have generally shown that most patients with cancer who receive genomic testing do not benefit from a genomic precision medicine strategy. Although some call the entire project of precision cancer medicine into question, I suggest instead that the tools employed must be broadened. Instead of relying exclusively on big data measurements of initial conditions, we should also acquire highly actionable functional information by perturbing-for example, with cancer therapies-viable primary tumor cells from patients with cancer.
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Abstract
The design of modern oncology clinical trials seeks to match patients' cancer molecular biomarkers with medications that specifically target those biomarkers, a general paradigm shift in cancer care coined clinical cancer biology. This approach exploits the synthetic lethality between a specific genetic alteration in the cancer cell and a drug: rapid termination of exaggerated kinase activity exemplifies this phenomenon. Synthetic lethality-based investigations are driven by rapidly evolving technologies for cancer molecular profiling. As these technologies evolve, future clinical trials will test drugs' activity based on the molecular mechanisms rather than by the tumor's appearance under a microscope.
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Affiliation(s)
- Igor Astsaturov
- Department of Hematology and Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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19
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Current-day precision oncology: from cancer prevention, screening, drug development, and treatment - have we fallen short of the promise? Curr Opin Oncol 2017; 28:441-6. [PMID: 27428363 DOI: 10.1097/cco.0000000000000318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Precision oncology has been a strategy of prevention, screening, and treatment. Although much has been invested, have the results fallen so far short of the promise? The advancement of technology and research has opened new doors, yet a variety of pitfalls are present. This review presents the successes, failures, and opportunities of precision oncology in the current landscape. RECENT FINDINGS The use of targeted gene sequencing and the overwhelming results of superresponders have generated much excitement and support for precision oncology from the medical community. Despite notable successes, many challenges still pave the way of precision oncology: intratumoral heterogeneity, the need for serial biopsies, availability of treatments, target prioritization, ethical issues with germline incidental findings, medical education, clinical trial design, and costs. SUMMARY Precision oncology shows much potential through the use of next-generation sequencing and molecular advances, but does this potential warrant the investment? There are many obstacles on the way of this technology that should make us question if the investment (both monetary and man-hours) will live up to the promise. The review aims to not criticize this technology, but to give a realistic view of where we are, especially regarding cancer treatment and prevention.
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Holch JW, Metzeler KH, Jung A, Riedmann K, Jost PJ, Weichert W, Kirchner T, Heinemann V, Westphalen CB. Universal Genomic Testing: The next step in oncological decision-making or a dead end street? Eur J Cancer 2017. [PMID: 28648701 DOI: 10.1016/j.ejca.2017.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The concept of 'personalised medicine' aims at allocating patients to different treatment options based on individual characteristics to optimise treatment benefit and side effects. In oncology, personalised treatments coupled to biomarkers have led to the approval of targeted agents with high anti-tumour activity. However, these therapies are often limited to narrow, molecularly defined subsets of patients with a specific morphomolecular tumour profile. Recently, it became obvious that the same molecular alteration might drive oncogenesis in many different tumours, and it might be beneficial to target the alteration in a histology informed but entity-overarching way. Consequently, Universal Genomic Testing (UGT) of tumours encompassing panel sequencing to whole-exome and transcriptome sequencing is propagated to revolutionise oncology. This article will describe the developments leading to identification and application of potential biomarkers using UGT. On this basis, it will review the clinical evidence of this approach and summarise recommendations for the ongoing evaluation of UGT as the next step in oncological decision-making.
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Affiliation(s)
- Julian Walter Holch
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - Klaus Hans Metzeler
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - Andreas Jung
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institute of Pathology, Ludwig-Maximilians-Universität München, Thalkirchnerstr. 36, 80337 Munich, Germany.
| | - Kristina Riedmann
- III. Medical Department, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
| | - Philipp Jakob Jost
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany; III. Medical Department, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institute for Pathology and Pathological Anatomy, Technische Universität München, Trogerstraße 18, 81675 Munich, Germany.
| | - Thomas Kirchner
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institute of Pathology, Ludwig-Maximilians-Universität München, Thalkirchnerstr. 36, 80337 Munich, Germany.
| | - Volker Heinemann
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - Christoph Benedikt Westphalen
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
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Moonshots and metastatic disease: the need for a multi-faceted approach when studying atypical responses. NPJ Breast Cancer 2017. [PMID: 28649647 PMCID: PMC5460258 DOI: 10.1038/s41523-017-0010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clinical research generally focuses on results involving a statistical mean with little attention in trial design to patients who respond considerably better or worse than average. Exploring the reasons underlying an “atypical response” will increase understanding of the mechanisms involved in cancer progression and treatment resistance, accelerate biomarker identification, and improve precision medicine by allowing clinicians to prospectively select optimal treatments. Based on our review, we suggest two ways to move this field forward. First, we suggest that clear categorization of “atypical responders” is needed. This encompasses three sub-categories of patients: “exceptional responders” (those with an unusually favorable treatment response), “rapid progressors” (patients demonstrating an unusually poor or no therapeutic response), and “exceptional survivors” (patients who have far outlived their initial prognosis). Such categorization may depend upon the clinical context and disease subtype. Second, we suggest that atypical responses may be due not only to somatic mutations in tumors, but also to inherited polymorphisms in non-tumor tissue, host and tumor environments, lifestyle factors, co-morbidities, use of complementary and integrative medicine, and the interaction among these components. Here, we summarize new research initiatives exploring atypical responses, the potential reasons for atypical responses, and a strategic call to action. Rigorous studies of normal and atypical responses to treatment will be needed to strengthen understanding of the role of non-tumor factors. Clinical trial design for targeted and other types of therapies should be enhanced to collect data in a standardized manner beyond tumor genetics, resulting in more thorough study of the whole patient.
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23
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Arina A, Karrison T, Galka E, Schreiber K, Weichselbaum RR, Schreiber H. Transfer of Allogeneic CD4+ T Cells Rescues CD8+ T Cells in Anti-PD-L1-Resistant Tumors Leading to Tumor Eradication. Cancer Immunol Res 2017; 5:127-136. [PMID: 28077434 DOI: 10.1158/2326-6066.cir-16-0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 12/19/2022]
Abstract
Adoptively transferred CD8+ T cells can stabilize the size of solid tumors over long periods of time by exclusively recognizing antigen cross-presented on tumor stroma. However, these tumors eventually escape T-cell-mediated growth control. The aim of this study was to eradicate such persistent cancers. In our model, the SIYRYYGL antigen is expressed by cancer cells that lack the MHC-I molecule Kb needed for direct presentation, but the antigen is picked up and cross-presented by tumor stroma. A single injection of antigen-specific 2C CD8+ T cells caused long-term inhibition of tumor growth, but without further intervention, tumors started to progress after approximately 3 months. Escape was associated with reduced numbers of circulating 2C cells. Tumor-infiltrating 2C cells produced significantly less TNFα and expressed more of the "exhaustion" markers PD-1 and Tim-3 than T cells from lymphoid organs. High-dose local ionizing radiation, depletion of myeloid-derived suppressor cells, infusions of additional 2C cells, and antibodies blocking PD-L1 did not prevent tumor escape. In contrast, adoptive transfer of allogeneic CD4+ T cells restored the numbers of circulating Ag-specific CD8+ T cells and their intratumoral function, resulting in tumor eradication. These CD4+ T cells had no antitumor effects in the absence of CD8+ T cells and recognized the alloantigen cross-presented on tumor stroma. CD4+ T cells might also be effective in cancer patients when PD-1/PD-L1 blockade does not rescue intratumoral CD8+ T-cell function and tumors persist. Cancer Immunol Res; 5(2); 127-36. ©2017 AACR.
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Affiliation(s)
- Ainhoa Arina
- Department of Pathology, The University of Chicago, Chicago, Illinois.
| | - Theodore Karrison
- Department of Health Studies, The University of Chicago, Chicago, Illinois
| | - Eva Galka
- Department of Radiation and Cellular Oncology and Ludwig Center for Metastasis Research, The University of Chicago, Chicago, Illinois
| | - Karin Schreiber
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology and Ludwig Center for Metastasis Research, The University of Chicago, Chicago, Illinois
| | - Hans Schreiber
- Department of Pathology, The University of Chicago, Chicago, Illinois
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Storme G, Dhaese S, Corens D, De Ridder M. The cost of cancer care is not related to its outcomes. Ecancermedicalscience 2016; 10:687. [PMID: 27994643 PMCID: PMC5130330 DOI: 10.3332/ecancer.2016.687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Indexed: 12/02/2022] Open
Abstract
Solid tumours make up 90% of all proliferative diseases and the main action for cure remains surgery, removing the visible tumour as well as the surrounding tissue. Radiotherapy is an added value for eliminating local microscopic as well as regional disease. Systemic treatment has a small impact on the outcome but has a cost, which is as much as all the other actions such as diagnostic tools and treatments.
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Affiliation(s)
- Guy Storme
- Department of Radiation Oncology, UZ Brussel, Belgium
| | - S Dhaese
- Department of Radiation Oncology, UZ Brussel, Belgium
| | - D Corens
- Financial Department, UZ Brussel, Belgium
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Prasad V, Gale RP. Precision medicine in acute myeloid leukemia: Hope, hype or both? Leuk Res 2016; 48:73-7. [PMID: 27497757 DOI: 10.1016/j.leukres.2016.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 07/22/2016] [Indexed: 01/27/2023]
Abstract
Precision medicine is interchangeably used with personalized medicine, genomic medicine and individualized medicine. Collectively, these terms refer to at least 5 distinct concepts in the context of AML. 1st, using molecular or omics data (e.g. genomics, epigenomics, transcriptomics, proteomics) to delineate or define subtypes of AML. 2nd, using these data to select the best therapy for someone with an AML subtype, such as a person with a FLT3-mutation. 3rd, using these data to monitor therapy-response such as measurable residual disease [MRD]-testing. 4th, using results of MRD-testing to select from amongst therapy-options such as additional chemotherapy or a haematopoietic cell transplant. And 5th, using these data to identify persons with hereditary forms of AML with potential therapy and surveillance implications. Here, we review these 5 conceptions and delineate where precision medicine is likely to afford greatest hope and where instead our rhetoric may constitute hype.
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Affiliation(s)
- Vinay Prasad
- Division of Hematology and Medical Oncology, Knight Cancer Institute, and Department of Public Health and Preventive Medicine, and The Center for Ethics in Health Care, Oregon Health and Science University, United states.
| | - Robert Peter Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
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Evrard S. Moins de cibles et plus de processus ou une petite digression poliorcétique à l’usage de l’oncologue médical. Bull Cancer 2016; 103:607-9. [DOI: 10.1016/j.bulcan.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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Prasad V, Fojo T, Brada M. Precision oncology: origins, optimism, and potential. Lancet Oncol 2016; 17:e81-e86. [PMID: 26868357 DOI: 10.1016/s1470-2045(15)00620-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 01/04/2023]
Abstract
Imatinib, the first and arguably the best targeted therapy, became the springboard for developing drugs aimed at molecular targets deemed crucial to tumours. As this development unfolded, a revolution in the speed and cost of genetic sequencing occurred. The result--an armamentarium of drugs and an array of molecular targets--set the stage for precision oncology, a hypothesis that cancer treatment could be markedly improved if therapies were guided by a tumour's genomic alterations. Drawing lessons from the biological basis of cancer and recent empirical investigations, we take a more measured view of precision oncology's promise. Ultimately, the promise is not our concern, but the threshold at which we declare success. We review reports of precision oncology alongside those of precision diagnostics and novel radiotherapy approaches. Although confirmatory evidence is scarce, these interventions have been widely endorsed. We conclude that the current path will probably not be successful or, at a minimum, will have to undergo substantive adjustments before it can be successful. For the sake of patients with cancer, we hope one form of precision oncology will deliver on its promise. However, until confirmatory studies are completed, precision oncology remains unproven, and as such, a hypothesis in need of rigorous testing.
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Affiliation(s)
- Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Department of Public Health and Preventive Medicine, and Center for Health Care Ethics, Oregon Health and Science University, Portland, OR, USA
| | - Tito Fojo
- Columbia University and James J Peters Veterans Affairs Medical Center, New York, NY, USA.
| | - Michael Brada
- Department of Molecular and Clinical Cancer Medicine & Department of Radiation Oncology University of Liverpool Clatterbridge Cancer Centre NHS Foundation Trust Bebington, UK
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Abstract
INTRODUCTION Next-Generation-Sequencing (NGS) has enabled gene mutation profiling - cataloguing sequence variants and modifications in clinical assays encompassing tens to thousands of genes in tumors and in germlines. The clinical benefit of applying multi-gene NGS to diverse applications in various malignancies remains to be demonstrated. AREAS COVERED Applications of gene mutation profiling in oncology include screening cancer-prone families, classification of malignancies, treatment selection, and monitoring the response to treatment of solid tumors (the 'liquid biopsy'). Google Scholar was used to search PubMed for the period 2011-2016 using combinations of the following search terms: 'clinical utility', NGS, 'molecular diagnostics'. Expert commentary: Clinical studies are in progress pairing mutation profiling with streamlined new trial designs to speed identification of promising drug-target combinations and to see if genotype-informed treatment selection will improve outcome across a spectrum of histologies. The analytical advantages and falling cost of NGS make focused gene panels likely to become the dominant modality in molecular diagnostic testing even if trials eventually discourage use of large panels to test all malignancies.
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Affiliation(s)
- Loren Joseph
- a Department of Pathology, Beth Israel Deaconess Medical Center, Molecular Diagnostics Laboratory , Harvard Medical School , Boston , MA , USA
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Kim C, Prasad V. Strength of Validation for Surrogate End Points Used in the US Food and Drug Administration's Approval of Oncology Drugs. Mayo Clin Proc 2016; 91:S0025-6196(16)00125-7. [PMID: 27236424 PMCID: PMC5104665 DOI: 10.1016/j.mayocp.2016.02.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/21/2016] [Accepted: 02/09/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the strength of the surrogate-survival correlation for cancer drug approvals based on a surrogate. PARTICIPANTS AND METHODS We performed a retrospective study of the US Food and Drug Administration (FDA) database, with focused searches of MEDLINE and Google Scholar. Among cancer drugs approved based on a surrogate end point, we examined previous publications assessing the strength of the surrogate-survival correlation. Specifically, we identified the percentage of surrogate approvals lacking any formal analysis of the strength of the surrogate-survival correlation, and when conducted, the strength of such correlations. RESULTS Between January 1, 2009, and December 31, 2014, the FDA approved marketing applications for 55 indications based on a surrogate, of which 25 were accelerated approvals and 30 were traditional approvals. We could not find any formal analyses of the strength of the surrogate-survival correlation in 14 out of 25 accelerated approvals (56%) and 11 out of 30 traditional approvals (37%). For accelerated approvals, just 4 approvals (16%) were made where a level 1 analysis (the most robust way to validate a surrogate) had been performed, with all 4 studies reporting low correlation (r≤0.7). For traditional approvals, a level 1 analysis had been performed for 15 approvals (50%): 8 (53%) reported low correlation (r≤0.7), 4 (27%) medium correlation (r>0.7 to r<0.85), and 3 (20%) high correlation (r≥0.85) with survival. CONCLUSIONS The use of surrogate end points for drug approval often lacks formal empirical verification of the strength of the surrogate-survival association.
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Affiliation(s)
- Chul Kim
- Medical Oncology Service, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Vinay Prasad
- Department of Medicine, Division of Hematology Oncology/Knight Cancer Institute, Oregon Health & Science University, Portland.
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Affiliation(s)
- Tito Fojo
- Columbia University Medical Center, New York, NY.
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