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Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14246063. [PMID: 36551550 PMCID: PMC9775536 DOI: 10.3390/cancers14246063] [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: 10/18/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Many clinical trials have investigated the role of ICIs in PM, with contrasting results. We performed a systematic review and meta-analysis of clinical trials testing single-agent anti-Programmed Death -1 (PD-1)/Programmed Death-Ligand 1 (PD-L1), anti-Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) or combined treatment in PM patients, analyzing response and survival rate as well as safety data. We selected 17 studies including 2328 patients. Both OS and PFS rates were significantly higher with combined ICI treatments than with single agent anti-PD-1/PD-L1 (p < 0.001 and p = 0.006, respectively) or anti CTLA-4 (p < 0.001) treatments. ORR and DCR for all ICI treatments were 20% (95% CI 13−27%) and 56% (95% CI 45−67%), respectively, and they did not significantly differ between combined and single agent treatments (p = 0.088 and p = 0.058, respectively). The 12-month OS and 6-month PFS rates did not differ significantly (p = 0.0545 and p = 0.1464, respectively) among pre-treated or untreated patients. Combined ICI treatments had a significantly higher rate of Adverse Events (AEs) (p = 0.01). PD-L1-positive patients had a higher probability of response and survival. In conclusion, combined ICI treatments have higher efficacy than single agents but are limited by higher toxicity. Efficacy was independent of treatment line, so a customized sequential strategy should still be speculated. PD-L1 expression could influence response to ICIs; however, reliable biomarkers are warranted.
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Song Y, Baxter SS, Dai L, Sanders C, Burkett S, Baugher RN, Mellott SD, Young TB, Lawhorn HE, Difilippantonio S, Karim B, Kadariya Y, Pinto LA, Testa JR, Shoemaker RH. Mesothelioma Mouse Models with Mixed Genomic States of Chromosome and Microsatellite Instability. Cancers (Basel) 2022; 14:3108. [PMID: 35804881 PMCID: PMC9264972 DOI: 10.3390/cancers14133108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022] Open
Abstract
Malignant mesothelioma (MMe) is a rare malignancy originating from the linings of the pleural, peritoneal and pericardial cavities. The best-defined risk factor is exposure to carcinogenic mineral fibers (e.g., asbestos). Genomic studies have revealed that the most frequent genetic lesions in human MMe are mutations in tumor suppressor genes. Several genetically engineered mouse models have been generated by introducing the same genetic lesions found in human MMe. However, most of these models require specialized breeding facilities and long-term exposure of mice to asbestos for MMe development. Thus, an alternative model with high tumor penetrance without asbestos is urgently needed. We characterized an orthotopic model using MMe cells derived from Cdkn2a+/-;Nf2+/- mice chronically injected with asbestos. These MMe cells were tumorigenic upon intraperitoneal injection. Moreover, MMe cells showed mixed chromosome and microsatellite instability, supporting the notion that genomic instability is relevant in MMe pathogenesis. In addition, microsatellite markers were detectable in the plasma of tumor-bearing mice, indicating a potential use for early cancer detection and monitoring the effects of interventions. This orthotopic model with rapid development of MMe without asbestos exposure represents genomic instability and specific molecular targets for therapeutic or preventive interventions to enable preclinical proof of concept for the intervention in an immunocompetent setting.
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Affiliation(s)
- Yurong Song
- Cancer ImmunoPrevention Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (S.S.B.); (L.D.); (L.A.P.)
| | - Shaneen S. Baxter
- Cancer ImmunoPrevention Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (S.S.B.); (L.D.); (L.A.P.)
| | - Lisheng Dai
- Cancer ImmunoPrevention Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (S.S.B.); (L.D.); (L.A.P.)
| | - Chelsea Sanders
- Animal Research Technical Support of Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (C.S.); (S.D.)
| | - Sandra Burkett
- Mouse Cancer Genetics Program, National Cancer Institute, Frederick, MD 21702, USA;
| | - Ryan N. Baugher
- CLIA Molecular Diagnostics Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (R.N.B.); (S.D.M.); (T.B.Y.); (H.E.L.)
| | - Stephanie D. Mellott
- CLIA Molecular Diagnostics Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (R.N.B.); (S.D.M.); (T.B.Y.); (H.E.L.)
| | - Todd B. Young
- CLIA Molecular Diagnostics Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (R.N.B.); (S.D.M.); (T.B.Y.); (H.E.L.)
| | - Heidi E. Lawhorn
- CLIA Molecular Diagnostics Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (R.N.B.); (S.D.M.); (T.B.Y.); (H.E.L.)
| | - Simone Difilippantonio
- Animal Research Technical Support of Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (C.S.); (S.D.)
| | - Baktiar Karim
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA;
| | - Yuwaraj Kadariya
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (Y.K.); (J.R.T.)
| | - Ligia A. Pinto
- Cancer ImmunoPrevention Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (S.S.B.); (L.D.); (L.A.P.)
| | - Joseph R. Testa
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (Y.K.); (J.R.T.)
| | - Robert H. Shoemaker
- Chemopreventive Agent Development Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA;
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HDAC Inhibition with Valproate Improves Direct Cytotoxicity of Monocytes against Mesothelioma Tumor Cells. Cancers (Basel) 2022; 14:cancers14092164. [PMID: 35565292 PMCID: PMC9100202 DOI: 10.3390/cancers14092164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Tumor-associated macrophages and monocyte myeloid-derived immunosuppressive cells are associated with bad prognosis in malignant pleural mesothelioma (MPM). This study shows that peripheral blood monocytes can, nevertheless, be cytotoxic for MPM tumor cells. This cytotoxic activity that involves direct cell-to-cell contact can be improved with a lysine deacetylase inhibitor (VPA), opening new prospects for further improvement of still unsatisfactory MPM therapies. Abstract The composition of the tumor microenvironment (TME) mediates the outcome of chemo- and immunotherapies in malignant pleural mesothelioma (MPM). Tumor-associated macrophages (TAMs) and monocyte myeloid-derived immunosuppressive cells (M-MDSCs) constitute a major fraction of the TME. As central cells of the innate immune system, monocytes exert well-characterized functions of phagocytosis, cytokine production, and antibody-dependent cell-mediated cytotoxicity (ADCC). The objective of this study was to evaluate the ability of monocytes to exert a direct cytotoxicity by cell-to-cell contact with MPM cells. The experimental model is based on cocultures between human blood-derived monocytes sorted by negative selection and mesothelioma cell lines. Data show (i) that blood-derived human monocytes induce tumor cell death by direct cell-to-cell contact, (ii) that VPA is a pharmacological enhancer of this cytotoxic activity, (iii) that VPA increases monocyte migration and their aggregation with MPM cells, and (iv) that the molecular mechanisms behind VPA modulation of monocytes involve a downregulation of the membrane receptors associated with the M2 phenotype, i.e., CD163, CD206, and CD209. These conclusions, thus, broaden our understanding about the molecular mechanisms involved in immunosurveillance of the tumor microenvironment and open new prospects for further improvement of still unsatisfactory MPM therapies
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Shah R, Klotz LV, Glade J. Current Management and Future Perspective in Pleural Mesothelioma. Cancers (Basel) 2022; 14:1044. [PMID: 35205798 PMCID: PMC8869935 DOI: 10.3390/cancers14041044] [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: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Pleural mesothelioma is an aggressive malignancy arising from pleural mesothelial cell lining, predominantly associated with prior exposure to asbestos. The ban on asbestos use has led to its lower incidence in many countries, but globally the disease burden is expected to rise. Therefore, well-planned research is needed to develop more effective, tolerable and affordable drugs. The development of novel treatment has been too slow, with only two regimens of systemic therapy with robust phase 3 data approved formally to date. The treatment scenario for resectable disease remains controversial. However, recent developments in the understanding of disease and clinical trials have been encouraging, and may add better treatment options in the coming years. In this review, we discuss the current treatment options for pleural mesothelioma and shed light on some recent studies and ongoing trials.
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Affiliation(s)
- Rajiv Shah
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Laura V. Klotz
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, 69126 Heidelberg, Germany;
| | - Julia Glade
- Institute for Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
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Popat S, Baas P, Faivre-Finn C, Girard N, Nicholson AG, Nowak AK, Opitz I, Scherpereel A, Reck M. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2022; 33:129-142. [PMID: 34861373 DOI: 10.1016/j.annonc.2021.11.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- S Popat
- Royal Marsden Hospital NHS Foundation Trust, Section of Clinical Studies, Institute of Cancer Research, London, UK; National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK
| | - P Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - C Faivre-Finn
- Department of Clinical Oncology, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - N Girard
- Thorax Institute Curie Montsouris, Institut Curie, Paris, France
| | - A G Nicholson
- National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK; Department of Histopathology, Royal Brompton & Harefield Hospitals, London, UK
| | - A K Nowak
- National Centre for Asbestos Related Diseases, Centre for Respiratory Health, University of Western Australia, Nedlands, Australia; Medical School, University of Western Australia, Nedlands, Australia
| | - I Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - A Scherpereel
- Department of Pulmonary and Thoracic Oncology, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | - M Reck
- Department of Thoracic Oncology, LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany
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Tagliamento M, Bironzo P, Curcio H, De Luca E, Pignataro D, Rapetti SG, Audisio M, Bertaglia V, Paratore C, Bungaro M, Olmetto E, Artusio E, Reale ML, Zichi C, Capelletto E, Carnio S, Buffoni L, Passiglia F, Novello S, Scagliotti GV, Di Maio M. A systematic review and meta-analysis of trials assessing PD-1/PD-L1 immune checkpoint inhibitors activity in pre-treated advanced stage malignant mesothelioma. Crit Rev Oncol Hematol 2022; 172:103639. [DOI: 10.1016/j.critrevonc.2022.103639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/29/2022] Open
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CONFIRM trial: what is the real efficacy of second-line immunotherapy in mesothelioma? Lancet Oncol 2022; 23:e13. [DOI: 10.1016/s1470-2045(21)00702-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 01/08/2023]
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Aigner C, Brüning T, Eberhardt WEE, Härter M, Kaelberlah HP, Metzenmacher M, Shah R, Taube C, Thomas M. [The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper]. Pneumologie 2021; 75:776-794. [PMID: 33946118 PMCID: PMC8523221 DOI: 10.1055/a-1404-1562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022]
Abstract
Asbestos-related mesotheliomas belong to the group of the most frequent occupational diseases in Germany, reaching about 1,000 new cases per year. The disease has a dismal prognosis because most tumors remain asymptomatic for a long time and therefore are diagnosed as incidental findings at later stages.During the last decade the German Social Accident Insurance (DGUV) has made considerable efforts to prepone the diagnosis in order to detect the disease at earliest possible stages. These efforts resulted in new findings showing that, in a high-risk group, a combination of the biomarkers calretinin and mesothelin was able to advance the diagnosis up to 12 months.Ideally, the diagnosis of a mesothelioma at an early stage has to be accompanied by the best possible individualized therapy. Standard therapeutic strategies are surgery and chemotherapy, added by radiotherapy and psycho-oncology. In recent years, several new therapeutic avenues are being explored. This review comprehensively presents both old and new therapeutic options in mesothelioma, based on international Leitlinien and new studies.
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Affiliation(s)
- C Aigner
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen - Ruhrlandklinik
| | - T Brüning
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (DGUV) - Institut der Ruhr-Universität Bochum
| | - W E E Eberhardt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
| | - M Härter
- Institut und Poliklinik für Medizinische Psychologie und Institut für Psychotherapie (IfP), Universitätsklinikum Hamburg-Eppendorf
| | | | - M Metzenmacher
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
| | - R Shah
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik - Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik
| | - M Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik - Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
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Abstract
PURPOSE OF REVIEW Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM including diagnosis, staging, biomarkers, and treatment strategies. RECENT FINDINGS Molecular markers such as programmed death-ligand 1 (PDL-1), Breast Cancer gene 1-associated protein gene, and cyclin-dependent kinase inhibitor 2A (CDKN2A) have prognostic impact and should be considered for assessment in patient samples. In addition to histological subtype and tumor pattern, tumor volumetry plays an increasing important role in staging, assessment of treatment response, and prediction of survival. Several new blood-based biomarkers have been recently reported including peripheral blood DNA methylation, microRNAs, fibulin, and high-mobility group box 1, but have not been established in clinical routine use yet. Regarding treatment, targeted therapies, immunotherapy, and vaccination are considered as new promising strategies. Moreover, extended pleurectomy/decortication is favored over extrapleural pneumonectomy (EPP) and intensity-modulated radiotherapy represents a possible approach in combination with EPP and pleurectomy/decortication. Intracavitary treatment options are promising and deserve further investigations. SUMMARY Overall, there has not been a real breakthrough in the treatment of MPM. Further research and clinical trials are needed to evaluate outcome and to identify new potential treatment candidates.
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Yap TA, Nakagawa K, Fujimoto N, Kuribayashi K, Guren TK, Calabrò L, Shapira-Frommer R, Gao B, Kao S, Matos I, Planchard D, Chatterjee A, Jin F, Norwood K, Kindler HL. Efficacy and safety of pembrolizumab in patients with advanced mesothelioma in the open-label, single-arm, phase 2 KEYNOTE-158 study. THE LANCET RESPIRATORY MEDICINE 2021; 9:613-621. [PMID: 33836153 DOI: 10.1016/s2213-2600(20)30515-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) has few treatment options. Pembrolizumab showed preliminary clinical benefit in programmed death ligand 1 (PD-L1)-positive MPM. We evaluated the efficacy and safety of pembrolizumab monotherapy in patients with previously treated MPM irrespective of PD-L1 status in the KEYNOTE-158 study. METHODS The ongoing open-label, multicohort, single-arm, phase 2 KEYNOTE-158 study enrolled eligible adults (≥18 years) with MPM who had progression on or intolerance to standard therapy, Eastern Cooperative Oncology Group performance status 0-1, and biomarker-evaluable tumour samples. Individuals were enrolled from 35 academic facilities and community-based institutions across 14 countries in Australia, North America, Europe, and Asia. Participants received pembrolizumab 200 mg intravenously every 3 weeks for up to 35 cycles. The primary efficacy endpoint was objective response per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, based on radiological imaging every 9 weeks for the first year of the study and every 12 weeks thereafter and assessed by independent central review. Efficacy and safety were analysed in all patients who received at least one dose of pembrolizumab. This trial is registered with ClinicalTrials.gov, NCT02628067. FINDINGS Patients were enrolled in the MPM cohort between Feb 9, 2016, and Aug 16, 2016. As of June 27, 2019, 118 patients had been enrolled and received at least one dose of pembrolizumab. Ten (8% [95% CI 4-15]) patients had an objective response. Median duration of objective response was 14·3 months (range 4·0 to 33·9+), and 60% of objective responses were ongoing at 12 months. Objective responses were observed in six (8%) of 77 patients with PD-L1-positive MPM (median response duration 17·7 months [range 5·8 to 33·9+]) and four (13%) of 31 patients with PD-L1-negative MPM (10·2 months [4·0-16·6]). Median overall survival was 10·0 months (95% CI 7·6-13·4) and median progression-free survival was 2·1 months (2·1-3·9). Treatment-related adverse events occurred in 82 (69%) of 118 patients and serious adverse events that were considered to be treatment-related occurred in 14 (12%) of 118 patients. 19 (16%) patients had grade 3-4 treatment-related events, and most common of these were colitis (three patients), hyponatraemia (three), and pneumonitis (two). One patient died from treatment-related apnoea. By the end of the trial, 113 (96%) patients had discontinued pembrolizumab and progressive disease was the most common reason for discontinuation. INTERPRETATION Pembrolizumab showed durable antitumour activity and manageable toxicity in patients with advanced MPM, regardless of PD-L1 status. Our data support the programmed death 1 (PD-1) and PD-L1 pathway as a potential therapeutic target in some patients with previously treated mesothelioma but biomarkers that can effectively identify such patients are yet to be elucidated. FUNDING Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc, Kenilworth, NJ, USA.
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Affiliation(s)
- Timothy A Yap
- Drug Development Unit, Royal Marsden Hospital, London, UK.
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Hospital, Osaka, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Kozo Kuribayashi
- Department of Respiratory Medicine and Hematology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Luana Calabrò
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | | - Bo Gao
- Blacktown Hospital, Blacktown, NSW, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Ignacio Matos
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - David Planchard
- Department of Medical Oncology, Thoracic Unit, Gustave Roussy, Villejuif, France
| | | | - Fan Jin
- Merck & Co, Inc, Kenilworth, NJ, USA
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Xu C, Hu Y, Chen B, Li D, Liang R, Shen M, Wu M, Tao M. Metastasis-associated gene 1 (MTA1) enhances cisplatin resistance of malignant pleural mesothelioma by ATR-Chk1-mediated DNA repair. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:670. [PMID: 33987368 PMCID: PMC8106096 DOI: 10.21037/atm-21-941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Malignant pleural mesothelioma (MPM) chemoresistance remains a challenge to oncologists. In our previous study, we demonstrated that the aberrant expression of metastasis-associated gene 1 (MTA1) is associated with carcinogenesis and metastasis in MPM. The aim of the present study was to investigate the mechanism of MTA1 and chemo-resistance in MPM. Methods Western blotting and real-time polymerase chain reaction were used to analyze the protein and mRNA levels. A stable clone with a knockdown of MTA1 was generated with shRNA via lentivirus technology in MPM cell lines. Cell Counting Kit-8 assay and crystal violet assay were used to measure cell viability. Immunochemical staining was employed to detect MTA1 expression in MPM tissues. The cell cycle of MPM cells was determined by phosphohistone H3 staining and flow cytometric analysis. Results The MTA1 protein was upregulated and enhanced cisplatin resistance in MPM. Cisplatin stabilized the expression of the MTA1 protein by inhibiting its ubiquitination, and MTA1 enhanced G2/M cell cycle delay and regulated and protected the tumor genome from chemotherapeutic drugs via participating in the phosphorylation of the ataxia telangiectasia mutated and rad3 related-checkpoint kinase 1 (ATR-Chk1) pathway. Conclusions These data suggest that MTA1 enhances cisplatin resistance by ATR-Chk1-mediated DNA damage repairment and cisplatin stabilizes MTA1 expression via affecting on the ubiquitination pathway of MTA1 in MPM. Our findings indicate that MTA1 could serve as a novel therapeutic target to overcome chemoresistance in MPM.
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Affiliation(s)
- Caihua Xu
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yufeng Hu
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Chen
- Department of Cardiovascular Surgery, Wuxi No. 2 People's Hospital, Wuxi, China
| | - Dapeng Li
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rongrui Liang
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng Shen
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengyao Wu
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Tao
- Department of Oncology of the First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Oncology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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Ghirardelli P, Franceschini D, D'Aveni A, Dominici L, Ravasio A, Marzo M, Villa E, Di Noia V, Scorsetti M, Vavassori V, Ceresoli GL. Salvage radiotherapy for oligo-progressive malignant pleural mesothelioma. Lung Cancer 2020; 152:1-6. [PMID: 33310300 DOI: 10.1016/j.lungcan.2020.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES No standard treatment option is available for patients with unresectable malignant pleural mesothelioma (MPM) progressing after upfront chemotherapy. We aimed to explore the role of focal radiotherapy (FRT) as a treatment modality for oligo-progressive MPM. MATERIALS AND METHODS In this retrospective study, consecutive patients pretreated with ≥1 lines of chemotherapy were included. Oligo-progressive MPM was defined as an unresectable disease with radiological progression at ≤3 sites according to a chest-abdominal contrast-enhanced computed tomography. Patients were treated with either stereotactic body radiotherapy (SBRT, ≥5 Gy per fraction) or hypo-fractionated radiotherapy (hypoRT, <5 Gy per fraction). Time to further systemic therapy (TFST) and local control (LC) after FRT were the primary endpoints. Biologically effective dose (BED) was calculated using three different alpha/beta models (1.5 Gy, 3 Gy and 10 Gy). RESULTS From April 2006 to March 2019, 37 patients were treated on 43 pleural lesions; 16/37 (43 %) had undergone upfront multimodality treatment (MMT) including surgery. FRT was given in 22/37 (59.5 %) after one line of chemotherapy. SBRT was delivered for 26/43 lesions (60.5 %), hypoRT for 17/43 (39.5 %). Median TFST was 6 months (95 % CI 4.9-7.1). LC at 6 months and 1 year was 84 % and 76 %, respectively. Median TFST was longer in patients treated after 1 vs >1 line of chemotherapy (9 vs 4 months, p = 0.001) and in patients pretreated with MMT (6 vs 3 months, p = 0.021). Six-month LC was better in patients treated with a BED > 100 using alpha/beta 1.5 and 3. No ≥ G3 acute or late toxicities were reported. CONCLUSION FRT was feasible in selected patients with oligo-progressive MPM, allowing delay of further systemic therapies, with no severe toxicity. FRT was more effective when performed at progression after one line of systemic therapy. Our results suggest a radio-resistant behavior of MPM.
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Affiliation(s)
- Paolo Ghirardelli
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Davide Franceschini
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro D'Aveni
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy
| | - Luca Dominici
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Ravasio
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Marco Marzo
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Villa
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Vincenzo Di Noia
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy
| | - Marta Scorsetti
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Vittorio Vavassori
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Giovanni L Ceresoli
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy.
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13
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Antibody-Drug Conjugates in Thoracic Malignancies: Clinical Trials Reveal Both Promise and Challenges. Target Oncol 2020; 15:429-448. [PMID: 32725438 DOI: 10.1007/s11523-020-00740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Thoracic malignancies are the main cause of cancer-related deaths worldwide. The need to develop new therapies is therefore urgent. The recognition of new potential therapeutic targets in thoracic malignancies has prompted the development of a number of antibody-drug conjugates. This new class of potent anticancer agents is supposed to more specifically and directly target the tumor while limiting toxicity for healthy tissues by delivering a toxic payload to tumor cells that are recognized by the presence of specific cell surface antigens. Progress in the development of antibody-drug conjugates over the last decade has been significant, with several promising advances. Unfortunately, many failures have also been encountered, often because of unexpectedly severe toxicities that contradicted the assumed mechanism of action, and major challenges remain. Various techniques to reduce the toxicities associated with antibody-drug conjugates are being studied, and the panorama of antibody-drug conjugates in clinical stages continues to increase and evolve. Current efforts in the conjugation and linker chemistries could result in the successful construction of clinically effective compounds. The future clinical development of antibody-drug conjugates could benefit from the identification of such payloads that can provide more safe and effective derivatives. Highly potent compounds with reasonable aqueous solubility, non-immunogenic profile, and stability in storage and the bloodstream should be important aspects of research into cytotoxic payloads.
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14
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Dudek AZ, Wang X, Gu L, Duong S, Stinchcombe TE, Kratzke R, Borghaei H, Vokes EE, Kindler HL. Randomized Study of Maintenance Pemetrexed Versus Observation for Treatment of Malignant Pleural Mesothelioma: CALGB 30901. Clin Lung Cancer 2020; 21:553-561.e1. [PMID: 32727707 DOI: 10.1016/j.cllc.2020.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The role of maintenance therapy for malignant pleural mesothelioma (MPM) is unknown. We performed a randomized phase II trial to determine if continuation of pemetrexed after first-line pemetrexed and platinum would improve progression-free survival (PFS). PATIENTS AND METHODS Eligible patients with unresectable MPM, without disease progression following 4 to 6 cycles of pemetrexed and platinum were randomized 1:1 to observation or continuation of pemetrexed until progression, stratified by number of cycles (< 6 or 6), cis- or carboplatin containing regimen, and histology. Study size was calculated based on the assumption that observation would produce a median PFS of 3 months and pemetrexed would yield median PFS of 6 months. RESULTS A total of 72 patients were registered from December 2010 to June 2016. The study closed early after 53 patients were randomized; 49 eligible (22 on the observation arm and 27 on the pemetrexed arm) were included in the analysis. The median PFS was 3 months (95% confidence interval [CI], 2.6-11.9 months) on observation and 3.4 months (95% CI, 2.8-9.8 months) on pemetrexed (hazard ratio [HR], 0.99; 95% CI, 0.51-1.90; P = .9733). The median overall survival (OS) was 11.8 months (95% CI, 9.3-28.7 months) for observation, and 16.3 months (95% CI, 10.5-26.0 months) for pemetrexed (HR, 0.86; 95% CI, 0.44-1.71; P = .6737). Grade 3 or 4 toxicities on the pemetrexed arm included anemia (8%), lymphopenia (8%), neutropenia (4%), and fatigue (4%). A higher baseline level of soluble mesothelin-related peptide was associated with worse PFS (HR, 1.86; 95% CI, 1.00-3.46; P = .049). CONCLUSION Maintenance pemetrexed following initial pemetrexed and platinum chemotherapy does not improve PFS in patients with MPM.
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Affiliation(s)
| | - Xiaofei Wang
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | - Lin Gu
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | - Stephanie Duong
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | | | - Robert Kratzke
- Division of Hematology, Oncology and Transplantation, University of Minnesota/Masonic Cancer Center, Minneapolis, MN
| | | | - Everett E Vokes
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Hedy L Kindler
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL
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15
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Marchevsky AM, Khoor A, Walts AE, Nicholson AG, Zhang YZ, Roggli V, Carney J, Roden AC, Tazelaar HD, Larsen BT, LeStang N, Chirieac LR, Klebe S, Tsao MS, De Perrot M, Pierre A, Hwang DM, Hung YP, Mino-Kenudson M, Travis W, Sauter J, Beasley MB, Galateau-Sallé F. Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel. Mod Pathol 2020; 33:281-296. [PMID: 31485011 PMCID: PMC10428660 DOI: 10.1038/s41379-019-0352-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Abstract
Localized malignant mesotheliomas (LMM) is an uncommon and poorly recognized neoplasm. Its pathologic diagnosis is often surprising in patients with serosal/subserosal based localized tumors that are clinically suspicious for metastatic lesions or primary sarcomas. Once a tumor is diagnosed as "mesothelioma", LMM is often mistaken for diffuse malignant mesothelioma (DMM). Best currently available evidence about LMM was collected from the literature and cases diagnosed by members of the International Mesothelioma Panel (IMP). One hundred and one (101) LMM have been reported in the English literature. Patients had localized tumors with identical histopathologic features to DMM. Patients ranged in age from 6 to 82 years; 75% were men. Most (82%) of the tumors were intrathoracic. Others presented as intrahepatic, mesenteric, gastric, pancreatic, umbilical, splenic, and abdominal wall lesions. Tumors varied in size from 0.6 to 15 cm. Most patients underwent surgical resection and/or chemotherapy or radiation therapy. Median survival in a subset of patients was 29 months. Seventy two additional LMM from IMP institutions ranged in age from 28 to 95 years; 58.3% were men. Sixty tumors (83.3%) were intrathoracic, others presented in intraabdominal sites. Tumors varied in size from 1.2 to 19 cm. Median survival for 51 cases was 134 months. Best evidence was used to formulate guidelines for the diagnosis of LMM. It is important to distinguish LMM from DMM as their treatment and prognosis is different. A multidisciplinary approach is needed for the diagnosis of LMM as it shows identical histopathology and immunophenotype to DMM.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Child
- Diagnosis, Differential
- Evidence-Based Medicine
- Female
- Humans
- Male
- Mesothelioma, Malignant/diagnostic imaging
- Mesothelioma, Malignant/mortality
- Mesothelioma, Malignant/pathology
- Mesothelioma, Malignant/therapy
- Middle Aged
- Pleural Neoplasms/diagnostic imaging
- Pleural Neoplasms/mortality
- Pleural Neoplasms/pathology
- Pleural Neoplasms/therapy
- Predictive Value of Tests
- Prognosis
- Solitary Fibrous Tumor, Pleural/diagnostic imaging
- Solitary Fibrous Tumor, Pleural/mortality
- Solitary Fibrous Tumor, Pleural/pathology
- Solitary Fibrous Tumor, Pleural/therapy
- Tumor Burden
- Young Adult
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Affiliation(s)
| | | | - Ann E Walts
- Departments of Pathology Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Yu Zhi Zhang
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Sonja Klebe
- Flinders University, Adelaide, SA, Australia
| | - Ming-Sound Tsao
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc De Perrot
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Pierre
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David M Hwang
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Yin P Hung
- Massachusetts General Hospital, Boston, MA, USA
| | | | - William Travis
- Sloan Kettering Memorial Cancer Center, New York, NY, USA
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16
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Metaxas Y, Früh M, Eboulet EI, Grosso F, Pless M, Zucali PA, Ceresoli GL, Mark M, Schneider M, Maconi A, Perrino M, Biaggi-Rudolf C, Froesch P, Schmid S, Waibel C, Appenzeller C, Rauch D, von Moos R. Lurbinectedin as second- or third-line palliative therapy in malignant pleural mesothelioma: an international, multi-centre, single-arm, phase II trial (SAKK 17/16). Ann Oncol 2020; 31:495-500. [PMID: 32085891 DOI: 10.1016/j.annonc.2019.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Systemic second- and third-line therapies for malignant pleural mesothelioma (MPM) result in a median progression-free survival (mPFS) of <2 months and median overall survival (mOS) of 6-9 months. Lurbinectedin binds to the DNA of the regulatory region while inhibiting tumour-associated macrophage transcription. In early trials, encouraging outcomes occurred in patients (pts) with MPM treated with lurbinectedin. We aimed to generate lurbinectedin efficacy and safety data among pts with progressive MPM. PATIENTS AND METHODS Pts with progressing MPM treated with first-line platinum-pemetrexed chemotherapy with or without immunotherapy received lurbinectedin monotherapy. Treatment was given intravenously at 3.2 mg/m2 dose every 3 weeks until progression or unacceptable toxicity. Using Simon's two-stage design, the primary endpoint, progression-free survival (PFS) at 12 weeks (PFS12wks), was met if achieved by ≥21 pts (p0 ≤35% versus p1 ≥55%). RESULTS Forty-two pts from nine centres across Switzerland and Italy were recruited. Histology was epithelioid in 33 cases, sarcomatoid in 5, and biphasic in 4. Overall 10/42 (23.8%) underwent prior immunotherapy and 14/42 (33.3%) had progressed ≤6 months after first-line chemotherapy. At data cut-off PFS12wks was met by 22/42 pts (52.4%; 90% confidence interval (CI): 38.7% to 63.5%; P = 0.015) with an mPFS of 4.1 months and mOS of 11.1 months. The best response was complete and partial remission observed in one patient each and stable disease in 20 pts. The duration of disease control was 6.6 months (95% CI: 5.2-7.4). No significant difference in PFS12wks, mPFS, and mOS was recorded in epithelioid versus non-epithelioid cases and pts with prior immunotherapy versus those without. Similar mPFS but shorter mOS were observed among pts who progressed within ≤6 months after first-line chemotherapy. Lurbinectedin-related grade 3-4 toxicity was seen in 21 pts, mostly being neutropenia (23.8%) and fatigue (16.7%). CONCLUSIONS The primary efficacy endpoint was reached with acceptable toxicity. Lurbinectedin showed promising activity regardless of histology, prior immunotherapy, or outcome on prior treatment. CLINICALTRIALS. GOV IDENTIFIER NCT03213301.
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Affiliation(s)
- Y Metaxas
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland.
| | - M Früh
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland
| | | | - F Grosso
- Mesothelioma Unit - Oncology, SS. Antonio and C. Arrigo Hospital, Alessandria, Italy
| | - M Pless
- Department of Medical Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - P A Zucali
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | - G L Ceresoli
- Oncology Unit, Humanitas Clinic Gavazzeni, Bergamo, Italy
| | - M Mark
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - A Maconi
- Scientific Research and Development Department, SS Antonio e Biagio e Cesare Arrigo, General Hospital, Alessandria, Italy
| | - M Perrino
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | | | - P Froesch
- Department of Oncology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - S Schmid
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - C Waibel
- Division of Haematology and Oncology, Kantonsspital Baden, Baden, Switzerland
| | - C Appenzeller
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - D Rauch
- Oncology Centre, Hospital STS AG, Thun, Switzerland
| | - R von Moos
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
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17
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Tsao MS, Carbone M, Galateau-Salle F, Moreira AL, Nicholson AG, Roden AC, Adjei AA, Aubry MC, Fennell DA, Gomez D, Harpole D, Hesdorffer M, Hirsch FR, Liu G, Malik S, Nowak A, Peikert T, Salgia R, Szlosarek P, Taioli E, Yang H, Tsao A, Mansfield AS. Pathologic Considerations and Standardization in Mesothelioma Clinical Trials. J Thorac Oncol 2019; 14:1704-1717. [PMID: 31260832 DOI: 10.1016/j.jtho.2019.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
The accurate diagnosis of mesothelioma is critical for the appropriate clinical management of this cancer. Many issues complicate making the diagnosis of mesothelioma including the presence of reactive mesothelial cells in benign pleural effusions, the heterogeneity of mesothelioma histopathology, the relatively high incidence of other epithelial malignancies that metastasize to the pleura, and primary sarcomas that arise within the pleura. Given the rapidly evolving field of molecular profiling and the need for translational correlates in mesothelioma clinical trials, the National Cancer Institute (NCI)-International Association for the Study of Lung Cancer-Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting was convened in March 2017 to develop a consensus on standard pathology guidelines for future NCI-sponsored clinical trials in mesothelioma. This consensus statement covers recommendations for specimen handling, pathologic classification and diagnosis, biobanking, and tissue correlative studies.
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Affiliation(s)
- Ming-Sound Tsao
- Department of Pathology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Michele Carbone
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alex A Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Dean A Fennell
- Mesothelioma Research Programme, Leicester Cancer Research Centre, Leicester, United Kingdom
| | - Daniel Gomez
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - David Harpole
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Mary Hesdorffer
- Mesothelioma Applied Research Foundation, Alexandria, Virginia
| | - Fred R Hirsch
- Mount Sinai Health System, Center for Thoracic Oncology/Tisch Cancer Center, New York, New York
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shakun Malik
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Anna Nowak
- National Centre for Asbestos Related Disease, University of Western Australia, Nedlands, Western Australia, Australia
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Peter Szlosarek
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Emanuela Taioli
- Department of Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Haining Yang
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Anne Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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18
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Ye L, Ma S, Robinson BW, Creaney J. Immunotherapy strategies for mesothelioma - the role of tumor specific neoantigens in a new era of precision medicine. Expert Rev Respir Med 2018; 13:181-192. [PMID: 30596292 DOI: 10.1080/17476348.2019.1563488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Immunotherapy has long been considered a potential therapy for malignant mesothelioma and is currently being pursued as such. Some of the early phase clinical trials involving immunomodulators have demonstrated encouraging results and numerous clinical trials are underway to further investigate this treatment approach in various treatment settings and larger patient cohorts. Areas covered: This review summarizes the current and emerging clinical evidence for checkpoint blockade and other immunotherapeutic strategies in mesothelioma. The mesothelioma tumor immune microenvironment and mutational landscape are also discussed, including their impact on treatment strategies. We also provide an evaluation of the current evidence for neoantigen targeted personalized immunotherapy. Expert opinion: Immune checkpoint inhibitors work by unleashing the host immune response against probable neoantigens. Despite impressive activity in a small subset of patients and the potential for prolonged responses, most patients experience treatment failure. Neoantigen vaccines provide a potential complementary therapeutic strategy by increasing the immunogenic antigen load, which can lead to an increased tumor specific immune response. Further research is needed explore this treatment option in mesothelioma and technological advances are required to translate this concept into clinical practice.
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Affiliation(s)
- Linda Ye
- a Department of Medical Oncology , Sir Charles Gairdner Hospital , Nedlands , Australia
| | - Shaokang Ma
- b National Centre for Asbestos Related Disease , University of Western Australia , Nedlands , Australia
| | - Bruce W Robinson
- b National Centre for Asbestos Related Disease , University of Western Australia , Nedlands , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , Australia
| | - Jenette Creaney
- b National Centre for Asbestos Related Disease , University of Western Australia , Nedlands , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , Australia.,d Institute of Respiratory Health , University of Western Australia , Nedlands , Australia
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