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Zhao W, Li Q, Wen S, Li Y, Bai Y, Tian Z. Novel biomarkers of inflammation-associated immunity in cervical cancer. Front Oncol 2024; 14:1351736. [PMID: 38532933 PMCID: PMC10964772 DOI: 10.3389/fonc.2024.1351736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024] Open
Abstract
Background Cervical cancer (CC) is a highly malignant gynecological cancer with a direct causal link to inflammation, primarily resulting from persistent high-risk human papillomavirus (HPV) infection. Given the challenges in early detection and mid to late-stage treatment, our research aims to identify inflammation-associated immune biomarkers in CC. Methods Using a bioinformatics approach combined with experimental validation, we integrated two CC datasets (GSE39001 and GSE63514) in the Gene Expression Omnibus (GEO) to eliminate batch effects. Immune-related inflammation differentially expressed genes (DGEs) were obtained by R language identification. Results This analysis identified 37 inflammation-related DEGs. Subsequently, we discussed the different levels of immune infiltration between CC cases and controls. Weighted gene co-expression network analysis (WGCNA) identified seven immune infiltration-related modules in CC. We identified 15 immune DEGs associated with inflammation at the intersection of these findings. In addition, we constructed a protein interaction network using the String database and screened five hub genes using "CytoHubba": CXC chemokine ligand 8 (CXCL8), CXC chemokine ligand 10 (CXCL10), CX3C chemokine receptor 1 (CX3CR1), Fc gamma receptors 3B (FCGR3B), and SELL. The expression of these five genes in CC was determined by PCR experiments. In addition, we assessed their diagnostic value and further analyzed the association of immune cells with them. Conclusions Five inflammation- and immune-related genes were identified, aiming to provide new directions for early diagnosis and mid to late-stage treatment of CC from multiple perspectives.
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Affiliation(s)
- Weihong Zhao
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qi Li
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Songquan Wen
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Yaqin Li
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Ying Bai
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Zhiyu Tian
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
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2
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Liu Y, Wu G. The utilization of single-cell sequencing technology in investigating the immune microenvironment of ccRCC. Front Immunol 2023; 14:1276658. [PMID: 38090562 PMCID: PMC10715415 DOI: 10.3389/fimmu.2023.1276658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
The growth and advancement of ccRCC are strongly associated with the presence of immune infiltration and the tumor microenvironment, comprising tumor cells, immune cells, stromal cells, vascular cells, myeloid-derived cells, and extracellular matrix (ECM). Nevertheless, as a result of the diverse and constantly evolving characteristics of the tumor microenvironment, prior advanced sequencing methods have frequently disregarded specific less prevalent cellular traits at varying intervals, thereby concealing their significance. The advancement and widespread use of single-cell sequencing technology enable us to comprehend the source of individual tumor cells and the characteristics of a greater number of individual cells. This, in turn, minimizes the impact of intercellular heterogeneity and temporal heterogeneity of the same cell on experimental outcomes. This review examines the attributes of the tumor microenvironment in ccRCC and provides an overview of the progress made in single-cell sequencing technology and its particular uses in the current focus of immune infiltration in ccRCC.
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Affiliation(s)
| | - Guangzhen Wu
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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3
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Di Gianfrancesco L, Crestani A, Amodeo A, Corsi P, De Marchi D, Miglioranza E, Lista G, Simonetti F, Busetto GM, Maggi M, Pierconti F, Martini M, Montagner IM, Tormen D, Scapinello A, Marino F, Porreca A. The Role of Checkpoint Inhibitor Expression Directly on Exfoliated Cells from Bladder Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:3119. [PMID: 37835862 PMCID: PMC10572290 DOI: 10.3390/diagnostics13193119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Bladder cancer (BCa) is a common type of cancer that affects the urinary bladder. The early detection and management of BCa is critical for successful treatment and patient outcomes. In recent years, researchers have been exploring the use of biomarkers as a non-invasive and effective tool for the detection and monitoring of BCa. One such biomarker is programmed death-ligand 1 (PD-L1), which is expressed on the surface of cancer cells and plays a crucial role in the evasion of the immune system. Studies have shown that the PD-L1 expression is higher in BCa tumors than in healthy bladder tissue. Additionally, PD-L1 expression might even be detected in urine samples in BCa patients, in addition to the examination of a histological sample. The technique is being standardized and optimized. We reported how BCa patients had higher urinary PD-L1 levels than controls by considering BCa tumors expressing PD-L1 in the tissue specimen. The expression of PD-L1 in urinary BCa cells might represent both a diagnostic and a prognostic tool, with the perspective that the PD-L1 expression of exfoliate urinary cells might reveal and anticipate eventual BCa recurrence or progression. Further prospective and longitudinal studies are needed to assess the expression of PD-L1 as a biomarker for the monitoring of BCa patients. The use of PD-L1 as a biomarker for the detection and monitoring of BCa has the potential to significantly improve patient outcomes by allowing for earlier detection and more effective management of the disease.
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Affiliation(s)
- Luca Di Gianfrancesco
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Alessandro Crestani
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Antonio Amodeo
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Paolo Corsi
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Davide De Marchi
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Eugenio Miglioranza
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Giuliana Lista
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Francesca Simonetti
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | | | - Martina Maggi
- Department of Urology, Sapienza University, 00185 Rome, Italy;
| | - Francesco Pierconti
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, 00168 Rome, Italy;
| | - Maurizio Martini
- Department of Pathology, University of Messina, 98122 Messina, Italy;
| | - Isabella Monia Montagner
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Debora Tormen
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Antonio Scapinello
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, 00168 Rome, Italy;
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
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Monjaras-Avila CU, Lorenzo-Leal AC, Luque-Badillo AC, D'Costa N, Chavez-Muñoz C, Bach H. The Tumor Immune Microenvironment in Clear Cell Renal Cell Carcinoma. Int J Mol Sci 2023; 24:ijms24097946. [PMID: 37175653 PMCID: PMC10178526 DOI: 10.3390/ijms24097946] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/15/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is a type of kidney cancer that arises from the cells lining the tubes of the kidney. The tumor immune microenvironment (TIME) of ccRCC is a complex interplay of various immune cells, cytokines, and signaling pathways. One of the critical features of the ccRCC TIME is the presence of infiltrating immune cells, including T cells, B cells, natural killer cells, dendritic cells, and myeloid-derived suppressor cells. Among these cells, CD8+ T cells are particularly important in controlling tumor growth by recognizing and killing cancer cells. However, the TIME of ccRCC is also characterized by an immunosuppressive environment that hinders the function of immune cells. Several mechanisms contribute to the immunosuppressive nature of the ccRCC TIME. For instance, ccRCC cells produce cytokines such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β), which suppress immune cell activation and promote the differentiation of regulatory T cells (Tregs). Tregs, in turn, dampen the activity of effector T cells and promote tumor growth. In addition, ccRCC cells can express programmed death-ligand 1 (PD-L1), which interacts with the programmed cell death protein 1 (PD-1) receptor on T cells to inhibit their function. In addition, other immune checkpoint proteins, such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and lymphocyte activation gene 3 (LAG-3), also contribute to the immunosuppressive milieu of the ccRCC TIME. Finally, the hypoxic and nutrient-poor microenvironment of ccRCC can stimulate the production of immunosuppressive metabolites, such as adenosine and kynurenine, which further impair the function of immune cells. Understanding the complex interplay between tumor cells and the immune system in the ccRCC TIME is crucial for developing effective immunotherapies to treat this disease.
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Affiliation(s)
- Cesar U Monjaras-Avila
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Ana C Lorenzo-Leal
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Ana C Luque-Badillo
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Ninadh D'Costa
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Claudia Chavez-Muñoz
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Horacio Bach
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
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Wang P, Shi Y, Zhang J, Shou J, Zhang M, Zou D, Liang Y, Li J, Tan Y, Zhang M, Bi X, Zhou L, Ci W, Li X. UCseek: ultrasensitive early detection and recurrence monitoring of urothelial carcinoma by shallow-depth genome-wide bisulfite sequencing of urinary sediment DNA. EBioMedicine 2023; 89:104437. [PMID: 36758479 PMCID: PMC9941055 DOI: 10.1016/j.ebiom.2023.104437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Current methods for the detection and surveillance of urothelial carcinomas (UCs) are often invasive, costly, and not effective for low-grade, early-stage, and minimal residual disease (MRD) tumors. We aimed to develop and validate a model from urine sediments to predict different grade and stage UCs with low cost and high accuracy. METHODS We collected 167 samples, including 90 tumors and 77 individuals without tumors, as a discovery cohort. We assessed copy number variations and methylation values for them and constructed a diagnostic classifier to detect UC, UCseek, by using an individual read-based method and support vector machine. The performance of UCseek was validated in an independent cohort derived from three hospitals (n = 206) and a relapse cohort (n = 42) for monitoring recurrence. FINDINGS We constructed UCseek, which could predict UCs with high sensitivity (92.7%), high specificity (90.7%), and high accuracy (91.7%) in the independent validation set. The accuracy of UCseek in low-grade and early-stage patients reached 91.8% and 94.3%, respectively. Notably, UCseek retained great performance at ultralow sequencing depths (0.3X-0.5X). It also demonstrated a powerful ability to monitor recurrence in a surveillance cohort compared with cystoscopy (90.91% vs. 59.09%). INTERPRETATION We optimized an improved approach named UCseek for the noninvasive diagnosis and monitoring of UCs in both low- and high-grade tumors and in early- and advanced-stage tumors, even at ultralow sequencing depths, which may reduce the burden of cystoscopy and blind second surgery. FUNDING A full list of funding bodies that contributed to this study can be found in the Acknowledgments section.
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Affiliation(s)
- Ping Wang
- Department of Urology, Peking University First Hospital, Beijing, 100034, China; CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yue Shi
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
| | - Jianye Zhang
- Department of Urology, Peking University First Hospital, Beijing, 100034, China; Institute of Urology, Peking University, Beijing, 100034, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Mingxin Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Daojia Zou
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yuan Liang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
| | - Juan Li
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yezhen Tan
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Mei Zhang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, 100034, China; Institute of Urology, Peking University, Beijing, 100034, China; National Urological Cancer Center, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China.
| | - Weimin Ci
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, 100034, China; Institute of Urology, Peking University, Beijing, 100034, China; National Urological Cancer Center, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China.
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6
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Hietala A, Joutsen J, Vaarala S, Säily M. A rare and complete response to combination therapy with radiation and nivolumab in a patient with metastatic urothelial cancer. BMJ Case Rep 2022; 15:e246653. [PMID: 35580957 PMCID: PMC9115022 DOI: 10.1136/bcr-2021-246653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/26/2022] Open
Abstract
According to the current understanding, radiotherapy can enhance the effectiveness of cancer immunotherapy due to radiation-induced release of tumour-associated antigens. Here, we present a case with a metastatic urothelial carcinoma who received nivolumab and palliative radiotherapy to a residual tumour in the vagina and to a large metastatic visceral lymph node. The treatment resulted in a rapid and virtually complete response for the time being in all metastases and in the large parailiac tumour mass. Follow up continues. The presented case demonstrates that the combinatory treatment with radiotherapy and immunotherapy can result in an exceptional response for the benefit of the patient with urothelial cancer. To our knowledge, this is one of the largest metastatic masses to disappear with a combination of immuno-oncologic (nivolumab) and radiation therapies.
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Affiliation(s)
- Aki Hietala
- Department of Surgery, Division of Urology, Lapland Central Hospital, Rovaniemi, Finland
- Department of Urology, Oulu University, Oulu, Finland
| | - Jenny Joutsen
- Department of Pathology, Lapland Central Hospital, Rovaniemi, Finland
| | - Svea Vaarala
- Department of Oncology, Lapland Central Hospital, Rovaniemi, Finland
| | - Matti Säily
- Department of Surgery, Division of Urology, Lapland Central Hospital, Rovaniemi, Finland
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7
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Yang L, Sun HF, Guo LQ, Cao HB. MiR-10a-5p: A Promising Biomarker for Early Diagnosis and Prognosis Evaluation of Bladder Cancer. Cancer Manag Res 2021; 13:7841-7850. [PMID: 34703308 PMCID: PMC8523317 DOI: 10.2147/cmar.s326732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction MiRNAs play a critical role in carcinogenesis, among which miR-10a-5p has been reported in several types of human cancer. Nevertheless, the role of miR-10a-5p remain uncovered in bladder cancer (BCa). Methods We recruited 88 BCa patients and 36 healthy controls (HC) to form the training cohort, and other 120 BCa patients to form the validation cohort. The clinical samples were collected for analysis. The expression level of miR-10a-5p was evaluated using RT-qPCR. Receiver operating characteristic (ROC) curves were utilized to calculate diagnostic accuracy. Survival curves were generated to analyze survival outcomes. CCK-8 and transwell assays were conducted to test the cell proliferation, migration, and invasion capacities. Results MiR-10a-5p was upregulated in human BCa tissues and closely associated with advanced clinicopathological features, including advanced tumor grade, histological grade, and T stage. High expression of miR-10a-5p was associated with worse survival outcomes in BCa patients. Circulating plasma miR-10a-5p expression had the great performance power to discriminate BCa patients form HC patients before surgery, and to differentiate muscle invasive bladder cancer (MIBC) from non-muscle invasive bladder cancer (NMIBC). In addition, overexpression of miR-10a-5p could promote BCa cell proliferation, migration, and invasion. Conclusion This study indicates that miR-10a-5p is a crucial diagnostic and prognostic biomarker for BCa patients, and miR-10a-5p exerted a tumor promoting role during BCa cell progression.
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Affiliation(s)
- Lei Yang
- Department of Urology, Wuxi No.2 Chinese Medicine Hospital, Wuxi City, Jiangsu Province, 214121, People's Republic of China
| | - Hong-Fang Sun
- Department of Urology, Wuxi No.2 Chinese Medicine Hospital, Wuxi City, Jiangsu Province, 214121, People's Republic of China
| | - Lin-Qing Guo
- Department of Urology, Wuxi No.2 Chinese Medicine Hospital, Wuxi City, Jiangsu Province, 214121, People's Republic of China
| | - Hai-Bing Cao
- Department of Urology, Wuxi No.2 Chinese Medicine Hospital, Wuxi City, Jiangsu Province, 214121, People's Republic of China
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8
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Rubino S, Kim Y, Zhou J, Dhilon J, Li R, Spiess P, Poch M, Manley BJ, Pow-Sang J, Gilbert S, Sexton W, Zhang J. Positive Ki-67 and PD-L1 expression in post-neoadjuvant chemotherapy muscle-invasive bladder cancer is associated with shorter overall survival: a retrospective study. World J Urol 2020; 39:1539-1547. [PMID: 32656671 PMCID: PMC10091226 DOI: 10.1007/s00345-020-03342-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE There is an unmet need to develop prognostic biomarkers in post-neoadjuvant chemotherapy (NAC) muscle-invasive bladder cancer (MIBC) patients. We examine whether Ki-67 and PD-L1 expression can be used to guide adjuvant therapy. METHODS Tissue microarrays were constructed from 130 post-NAC radical cystectomy samples. Up to 5 cores per sample were included. Expressions of Ki-67 and PD-L1 were evaluated using immunohistochemistry (IHC). RESULTS Using a Cox regression model, positive Ki-67 expression in post-NAC radical cystectomy samples was associated with poorer overall survival (OS) (HR = 2.412, 95% CI, 1.076-5.408), independent of the pathological lymph node/N-stage. Positive Ki-67 expression was also associated with lack of tumor downstaging in a multivariable logistic regression model analysis (OR = 0.081, 95% CI, 0.014-0.464). PD-L1- and PD-L1+ expression was associated with a median OS of 49.8 months and 26.9 months, respectively, which did not reach statistical significance. Patients with Ki-67/PD-L1 double-negative tumors had a significantly longer median OS of 98.2 months versus 29.9 and 26.9 months in PD-L1-/Ki-67+ and PD-L1+/Ki-67+ tumors, respectively. Lack of tumor downstaging was significantly associated with positive Ki-67 and positive PD-L1 expression. CONCLUSION Positive Ki-67 and PD-L1 expression in post-NAC radical cystectomy samples was associated with inferior OS and absence of tumor downstaging. IHC on Ki-67 and PD-L1 would help to select patients for adjuvant therapy in post-NAC muscle-invasive bladder cancer.
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Affiliation(s)
- Selene Rubino
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Junmin Zhou
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jasreman Dhilon
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Roger Li
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Philippe Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Michael Poch
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Brandon J Manley
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Scott Gilbert
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Wade Sexton
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA
| | - Jingsong Zhang
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, WCB-GU, Tampa, FL, 33612, USA.
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Pal SK, Bajorin D, Dizman N, Hoffman-Censits J, Quinn DI, Petrylak DP, Galsky MD, Vaishampayan U, De Giorgi U, Gupta S, Burris HA, Soifer HS, Li G, Wang H, Dambkowski CL, Moran S, Daneshmand S, Rosenberg JE. Infigratinib in upper tract urothelial carcinoma versus urothelial carcinoma of the bladder and its association with comprehensive genomic profiling and/or cell-free DNA results. Cancer 2020; 126:2597-2606. [PMID: 32208524 DOI: 10.1002/cncr.32806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Infigratinib (BGJ398) is a potent and selective fibroblast grown factor receptor 1 to 3 (FGFR1-3) inhibitor with significant activity in patients with advanced or metastatic urothelial carcinoma bearing FGFR3 alterations. Given the distinct biologic characteristics of upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB), the authors examined whether infigratinib had varying activity in these settings. METHODS Eligible patients had metastatic urothelial carcinoma with activating FGFR3 mutations and/or fusions. Comprehensive genomic profiling was performed on formalin-fixed, paraffin-embedded tissues. Blood was collected for cell-free DNA analysis using a 600-gene panel. Patients received infigratinib at a dose of 125 mg orally daily (3 weeks on/1 week off) until disease progression or intolerable toxicity occurred. The overall response rate (ORR; partial response [PR] plus complete response [CR]) and disease control rate (DCR; CR plus PR plus stable disease [SD]) were characterized. RESULTS A total of 67 patients were enrolled; the majority (70.1%) had received ≥2 prior antineoplastic therapies. In 8 patients with UTUC, 1 CR and 3 PRs were observed (ORR, 50%); the remaining patients achieved a best response of SD (DCR, 100%). In patients with UCB, 13 PRs were observed (ORR, 22%), and 22 patients had a best response of SD (DCR, 59.3%). Notable differences in genomic alterations between patients with UTUC and those with UCB included higher frequencies of FGFR3-TACC3 fusions (12.5% vs 6.8%) and FGFR3 R248C mutations (50% vs 11.9%), and a lower frequency of FGFR3 S249C mutations (37.5% vs 59.3%). CONCLUSIONS Differences in the cumulative genomic profile were observed between patients with UTUC and those with UCB in the current FGFR3-restricted experience, underscoring the distinct biology of these diseases. These results support a planned phase 3 adjuvant study predominantly performed in this population.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Dean Bajorin
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jean Hoffman-Censits
- Departments of Medical Oncology and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David I Quinn
- University of Southern California Norris Comprehensive Cancer Center Keck School of Medicine at USC, Los Angeles, California
| | - Daniel P Petrylak
- Department of Medicine, Division of Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Matthew D Galsky
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, The Mount Sinai Hospital, New York, New York
| | - Ulka Vaishampayan
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Ugo De Giorgi
- Department of Medical Oncology, Scientific Institute of Romagna for the Study and Treatment of Cancer, IRCCS, Meldola, Italy
| | - Sumati Gupta
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Howard A Burris
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, Tennessee
| | - Harris S Soifer
- Department of Translational Medicine, QED Therapeutics Inc, San Francisco, California
| | - Gary Li
- Department of Translational Medicine, QED Therapeutics Inc, San Francisco, California
| | - Hao Wang
- Department of Biostatistics and Data Management, QED Therapeutics Inc, San Francisco, California
| | - Carl L Dambkowski
- Department of Strategy and Operations, QED Therapeutics Inc, San Francisco, California
| | - Susan Moran
- Department of Clinical Development, QED Therapeutics Inc, San Francisco, California
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Hsu MM, Balar AV. PD-1/PD-L1 Combinations in Advanced Urothelial Cancer: Rationale and Current Clinical Trials. Clin Genitourin Cancer 2019; 17:e618-e626. [PMID: 31005473 DOI: 10.1016/j.clgc.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/14/2019] [Accepted: 03/17/2019] [Indexed: 12/27/2022]
Abstract
Chemotherapy is no longer the only viable option for patients with locally advanced or metastatic urothelial carcinoma. Immunotherapy, as checkpoint inhibition, has received United States Food and Drug Administration approval in the preceding several years, both in the second-line and first-line for cisplatin-ineligible patients. Those who respond often do so durably; however, response rates in the first line are 23% to 24%, and are lower in the second line. With a focus on urothelial carcinoma, this review discusses the tumor microenvironment and its negative influence on anti-tumor immunity, as well as measures to counteract immune suppression or evasion. The review then describes a range of current clinical trials implementing these measures in the form of programmed death-combination therapy, specifically in advanced bladder and urothelial cancers.
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Affiliation(s)
- Miles M Hsu
- New York University School of Medicine, New York, NY.
| | - Arjun V Balar
- New York University Perlmutter Cancer Center, New York, NY
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11
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Fiorentini C, Grisanti S, Cosentini D, Abate A, Rossini E, Berruti A, Sigala S. Molecular Drivers of Potential Immunotherapy Failure in Adrenocortical Carcinoma. JOURNAL OF ONCOLOGY 2019; 2019:6072863. [PMID: 31057613 PMCID: PMC6463568 DOI: 10.1155/2019/6072863] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/13/2019] [Indexed: 12/27/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare, highly aggressive cancer, often insensitive to conventional chemotherapeutics agents. Early diagnosis, followed by radical surgical resection plus/minus adjuvant mitotane therapy, is nowadays the only valuable option. Unfortunately, one out of four patients has metastatic disease at diagnosis and most of radically resected ACC patients are destined to recur with local or metastatic disease. Numerous efforts aimed at identifying molecular alterations crucial for ACC pathogenesis have been extensively conducted, with the hope to develop new treatments. Indeed, multiple genes and pathways have been identified as potentially targetable in ACC patients; however, despite the strong preclinical rationale, translational findings to clinical trials led to date to disappointing results. The immunotherapeutic intervention targeting T-cell checkpoint molecules has been proposed as well, but results obtained in early studies indicate that ACC patients would be unlikely to benefit from immunotherapy. Genetic alterations of different pathways involved in ACC carcinogenesis are also known substrates of resistance to immunotherapy. Among them, β-catenin gene CTNNB1 and TP53 gene are frequently mutated in ACC samples. Overactivation of the β-catenin pathway and loss of p53 protein function are potential tumor-intrinsic factors that, impacting on the ability of ACC cells to recruit dendritic cells, leading to T-cell exclusion, put this tumor among those that are potentially resistant to immunotherapy. Moreover, the steroid phenotype, which implies glucocorticoids hypersecretion in a subset of ACC, contributes to generating an immunosuppressive microenvironment. Here, we review clinical results of immunotherapy in ACC and we highlight molecular mechanisms driving immunotherapy failure in ACC, suggesting possible approaches to overcome resistance.
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Affiliation(s)
- Chiara Fiorentini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Salvatore Grisanti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Deborah Cosentini
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Andrea Abate
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, Brescia, Italy
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12
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Rui X, Gu TT, Pan HF, Zhang HZ. Evaluation of PD-L1 biomarker for immune checkpoint inhibitor (PD-1/PD-L1 inhibitors) treatments for urothelial carcinoma patients: A meta-analysis. Int Immunopharmacol 2019; 67:378-385. [DOI: 10.1016/j.intimp.2018.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/21/2018] [Accepted: 12/07/2018] [Indexed: 01/22/2023]
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13
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Foth M, Ismail NFB, Kung JSC, Tomlinson D, Knowles MA, Eriksson P, Sjödahl G, Salmond JM, Sansom OJ, Iwata T. FGFR3 mutation increases bladder tumourigenesis by suppressing acute inflammation. J Pathol 2018; 246:331-343. [PMID: 30043421 PMCID: PMC6334176 DOI: 10.1002/path.5143] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 12/15/2022]
Abstract
Recent studies of muscle-invasive bladder cancer show that FGFR3 mutations are generally found in a luminal papillary tumour subtype that is characterised by better survival than other molecular subtypes. To better understand the role of FGFR3 in invasive bladder cancer, we examined the process of tumour development induced by the tobacco carcinogen OH-BBN in genetically engineered models that express mutationally activated FGFR3 S249C or FGFR3 K644E in the urothelium. Both occurrence and progression of OH-BBN-driven tumours were increased in the presence of an S249C mutation compared to wild-type control mice. Interestingly, at an early tumour initiation stage, the acute inflammatory response in OH-BBN-treated bladders was suppressed in the presence of an S249C mutation. However, at later stages of tumour progression, increased inflammation was observed in S249C tumours, long after the carcinogen administration had ceased. Early-phase neutrophil depletion using an anti-Ly6G monoclonal antibody resulted in an increased neutrophil-to-lymphocyte ratio at later stages of pathogenesis, indicative of enhanced tumour pathogenesis, which supports the hypothesis that suppression of acute inflammation could play a causative role. Statistical analyses of correlation showed that while initial bladder phenotypes in morphology and inflammation were FGFR3-dependent, increased levels of inflammation were associated with tumour progression at the later stage. This study provides a novel insight into the tumour-promoting effect of FGFR3 mutations via regulation of inflammation at the pre-tumour stage in the bladder. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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MESH Headings
- Animals
- Butylhydroxybutylnitrosamine
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/immunology
- Cell Transformation, Neoplastic/metabolism
- Cholecystitis, Acute/chemically induced
- Cholecystitis, Acute/genetics
- Cholecystitis, Acute/immunology
- Cholecystitis, Acute/metabolism
- Disease Models, Animal
- Disease Progression
- Female
- Genetic Predisposition to Disease
- Lymphocytes/immunology
- Lymphocytes/metabolism
- Lymphocytes/pathology
- Male
- Mice, Inbred C57BL
- Mice, Transgenic
- Mutation
- Neutrophil Infiltration
- Neutrophils/immunology
- Neutrophils/metabolism
- Neutrophils/pathology
- Phenotype
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Time Factors
- Tumor Microenvironment
- Urinary Bladder/immunology
- Urinary Bladder/metabolism
- Urinary Bladder/pathology
- Urinary Bladder Neoplasms/chemically induced
- Urinary Bladder Neoplasms/genetics
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/metabolism
- Urothelium/immunology
- Urothelium/metabolism
- Urothelium/pathology
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Affiliation(s)
- Mona Foth
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- Cancer Research UK Beatson InstituteGlasgowUK
| | - Nur Faezah Binti Ismail
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Jeng Sum Charmaine Kung
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Darren Tomlinson
- Leeds Institute of Cancer and PathologySt James's University HospitalLeedsUK
| | - Margaret A Knowles
- Leeds Institute of Cancer and PathologySt James's University HospitalLeedsUK
| | - Pontus Eriksson
- Division of Oncology and Pathology, Department of Clinical SciencesLund UniversityLundSweden
| | - Gottfrid Sjödahl
- Division of Urological Research, Department of Translational MedicineLund University, Skåne University HospitalMalmöSweden
| | | | - Owen J Sansom
- Cancer Research UK Beatson InstituteGlasgowUK
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowUK
| | - Tomoko Iwata
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
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14
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Gopalakrishnan D, Koshkin VS, Ornstein MC, Papatsoris A, Grivas P. Immune checkpoint inhibitors in urothelial cancer: recent updates and future outlook. Ther Clin Risk Manag 2018; 14:1019-1040. [PMID: 29892196 PMCID: PMC5993034 DOI: 10.2147/tcrm.s158753] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bladder cancer is the sixth most common cancer in the US and most tumors have urothelial (transitional cell) histology. Platinum-based chemotherapy has long been the standard of care in advanced disease, but long-term outcomes have largely remained poor. Since the peak incidence of bladder cancer is in the eighth decade of life and beyond, medical comorbidities may often limit the use of chemotherapy. Immune checkpoint inhibitors with their favorable toxicity profiles and notable antitumor activity have ushered in a new era in the treatment of advanced urothelial cancer (UC) with five agents targeting the PD-1/PD-L1 pathway being recently approved by the US Food and Drug administration. A plethora of clinical trials are ongoing in diverse disease settings, employing agents targeting PD-1/PD-L1 and related immune checkpoint pathways. While reactivating anti-tumor immunity, these agents may lead to a unique constellation of immune-related adverse events, which may warrant discontinuation of therapy and potential use of immunosuppression. Novel combinations with various treatment modalities and optimal sequencing of active therapies are being investigated in prospective clinical trials and retrospective registries. At the era of precision molecular medicine, and since patients do not respond uniformly to these agents, there is a growing need for identification and validation of biomarkers that can accurately predict treatment response and assist in patient selection. This review discusses current updates and future directions of immunotherapy in advanced UC.
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Affiliation(s)
| | - Vadim S Koshkin
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Moshe C Ornstein
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Athanasios Papatsoris
- Sismanoglio General Hospital, University of Athens School of Medicine, Athens, Greece
| | - Petros Grivas
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA
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15
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Sweis RF, Zha Y, Pass L, Heiss B, Chongsuwat T, Luke JJ, Gajewski TF, Szmulewitz R. Pseudoprogression manifesting as recurrent ascites with anti-PD-1 immunotherapy in urothelial bladder cancer. J Immunother Cancer 2018; 6:24. [PMID: 29618376 PMCID: PMC5883337 DOI: 10.1186/s40425-018-0334-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/07/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immunotherapies targeting the PD-1 checkpoint pathway have recently gained regulatory approval in numerous cancer types. With the widespread use of immune checkpoint therapies, varying patterns of responses and immune-related adverse events are being observed. CASE PRESENTATION In this case, we highlight a patient who developed recurrent, large-volume ascites, while simultaneously having a 49% reduction in peritoneal tumor lesion size by RECIST criteria. Sampling of the fluid revealed high levels of IL-6 and IL-15. Cytology revealed no malignant cells on 4 separate paracenteses over a period of 6 weeks. Cell counts revealed that 45% of cells were lymphocytes, and further analysis was performed by fluorescence-activated cell sorting (FACS). The majority of lymphocytes were CD8+, of which 78% were PD-1+ and 43% were HLA-DR+ indicating an activated phenotype. CONCLUSIONS In summary, treatment with anti-PD-1 therapy may result in pseudoprogression manifested by ascitic fluid accumulation due to the influx of activated T cells. Since worsening of ascites is typically associated with disease progression, it is important to consider the possibility of pesudoprogression in such patients undergoing therapy with immune checkpoint inhibitors.
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Affiliation(s)
- Randy F Sweis
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.
| | - Yuanyuan Zha
- Department of Pathology, University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Lomax Pass
- University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Brian Heiss
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Tara Chongsuwat
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Jason J Luke
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Thomas F Gajewski
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.,Department of Pathology, University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Russell Szmulewitz
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, 5841 S. South Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
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16
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Abstract
Precision medicine is designed to tailor treatments for individual patients by factoring in each person's specific biology and mechanism of disease. This paradigm shifted from a "one size fits all" approach to "personalized and precision care" requires multiple layers of molecular profiling of biomarkers for accurate diagnosis and prediction of treatment responses. Intensive studies are also being performed to understand the complex and dynamic molecular profiles of bladder cancer. These efforts involve looking bladder cancer mechanism at the multiple levels of the genome, epigenome, transcriptome, proteome, lipidome, metabolome etc. The aim of this short review is to outline the current technologies being used to investigate molecular profiles and discuss biomarker candidates that have been investigated as possible diagnostic and prognostic indicators of bladder cancer.
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Affiliation(s)
- Xuan-Mei Piao
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Joon Byun
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jayoung Kim
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, University of California, Los Angeles, CA, USA
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17
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Patel MR, Ellerton J, Infante JR, Agrawal M, Gordon M, Aljumaily R, Britten CD, Dirix L, Lee KW, Taylor M, Schöffski P, Wang D, Ravaud A, Gelb AB, Xiong J, Rosen G, Gulley JL, Apolo AB. Avelumab in metastatic urothelial carcinoma after platinum failure (JAVELIN Solid Tumor): pooled results from two expansion cohorts of an open-label, phase 1 trial. Lancet Oncol 2017; 19:51-64. [PMID: 29217288 DOI: 10.1016/s1470-2045(17)30900-2] [Citation(s) in RCA: 426] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The approval of anti-programmed death ligand 1 (PD-L1) and anti-programmed death 1 agents has expanded treatment options for patients with locally advanced or metastatic urothelial carcinoma. Avelumab, a human monoclonal anti-PD-L1 antibody, has shown promising antitumour activity and safety in this disease. We aimed to assess the safety profile in patients (both post-platinum therapy and cisplatin-naive) treated with avelumab and to assess antitumour activity of this drug in post-platinum patients. METHODS In this pooled analysis of two cohorts from the phase 1 dose-expansion JAVELIN Solid Tumor study, patients aged 18 years and older with histologically or cytologically confirmed locally advanced or metastatic urothelial carcinoma that had progressed after at least one previous platinum-based chemotherapy were enrolled from 80 cancer treatment centres or hospitals in the USA, Europe, and Asia. Eligible patients had adequate end-organ function, an Eastern Cooperative Oncology Group performance status of 0 or 1, life expectancy of at least 3 months, and at least one measurable lesion. Cisplatin-ineligible patients who might have been previously treated in the perioperative setting, including platinum-naive patients, were also eligible. Patients unselected for PD-L1 expression received avelumab (10 mg/kg, 1 h intravenous infusion) every 2 weeks until confirmed disease progression, unacceptable toxicity, or other criterion for withdrawal. The primary endpoint for this efficacy expansion cohort was confirmed best overall response (according to RECIST version 1.1), adjudicated by independent review. Safety analysis was done in all patients who received at least one dose of avelumab. Antitumour activity was assessed in post-platinum patients who received at least one dose of avelumab. This trial is registered with ClinicalTrials.gov, number NCT01772004; enrolment in this cohort of patients with metastatic urothelial carcinoma is closed and the trial is ongoing. FINDINGS Between Sept 3, 2014, and March 15, 2016, 329 patients with advanced metastatic urothelial carcinoma were screened for enrolment into this study; 249 patients were eligible and received treatment with avelumab for a median of 12 weeks (IQR 6·0-19·7) and followed up for a median of 9·9 months (4·3-12·1). Safety and antitumour activity were evaluated at data cutoff on June 9, 2016. In 161 post-platinum patients with at least 6 months of follow-up, a best overall response of complete or partial response was recorded in 27 patients (17%; 95% CI 11-24), including nine (6%) complete responses and 18 (11%) partial responses. The most frequent treatment-related adverse events (any grade in ≥10% patients) were infusion-related reaction (73 [29%]; all grade 1-2) and fatigue (40 [16%]). Grade 3 or worse treatment-related adverse events occurred in 21 (8%) of 249 patients, the most common of which were fatigue (four [2%]), and asthenia, elevated lipase, hypophosphataemia, and pneumonitis in two (1%) patients each. 19 (8%) of 249 patients had a serious adverse event related to treatment with avelumab, and one treatment-related death occurred (pneumonitis). INTERPRETATION Avelumab showed antitumour activity in the treatment of patients with platinum-refractory metastatic urothelial carcinoma; a manageable safety profile was reported in all avelumab-treated patients. These data provide the rationale for therapeutic use of avelumab in metastatic urothelial carcinoma and it has received accelerated US FDA approval in this setting on this basis. FUNDING Merck KGaA, and Pfizer Inc.
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Affiliation(s)
- Manish R Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL, USA
| | - John Ellerton
- Nevada Cancer Research Foundation, Las Vegas, NV, USA
| | - Jeffrey R Infante
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | | | - Michael Gordon
- Pinnacle Oncology Hematology, A Division of Arizona Center for Cancer Care, HonorHealth Research Institute Clinical Trials Program at the Virginia G Piper Cancer Center, University of Arizona College of Medicine, Phoenix, Scottsdale, AZ, USA
| | - Raid Aljumaily
- Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Carolyn D Britten
- Medical University of South Carolina, Division of Hematology/Oncology, Charleston, SC, USA
| | - Luc Dirix
- Sint-Augustinus Hospital, Oncology Center, Medical Oncology, Antwerpen, Belgium
| | - Keun-Wook Lee
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Mathew Taylor
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR, USA
| | - Patrick Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ding Wang
- Henry Ford Hospital, Detroit, MI, USA
| | - Alain Ravaud
- Groupe Hospitalier Saint André, Hôpital Saint André, CHU de Bordeaux, Bordeaux Cedex, France
| | - Arnold B Gelb
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA
| | - Junyuan Xiong
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA
| | - Galit Rosen
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Magnuson Clinical Center, Bethesda, MD, USA.
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18
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Aggen DH, Drake CG. Biomarkers for immunotherapy in bladder cancer: a moving target. J Immunother Cancer 2017; 5:94. [PMID: 29157296 PMCID: PMC5697433 DOI: 10.1186/s40425-017-0299-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/27/2017] [Indexed: 12/26/2022] Open
Abstract
Treatment options for metastatic urothelial carcinoma (mUC) remained relative unchanged over the last 30 years with combination chemotherapy as the mainstay of treatment. Within the last year the landscape for mUC has seismically shifted following the approval of five therapies targeting the programmed cell death protein (PD-1)/programmed cell death ligand 1 (PD-L1) axis. Notably, the anti-PD-1 antibody pembrolizumab demonstrated improved OS relative to chemotherapy in a randomized phase III study for second line treatment of mUC; this level 1 evidence led to approval from the U.S. Food and Drug Administration (FDA). The PD-1 antibody nivolumab also demonstrated an overall survival benefit, in this case in comparison to historical controls. Similarly, antibodies targeting PD-L1 including atezolizumab, durvalumab, and avelumab have now received accelerated approval from the FDA as second line treatments for mUC, with durable response lasting more than 1 year in some patients. Some of these agents are approved in the first line setting as well - based on single-arm phase II studies atezolizumab and pembrolizumab received accelerated approval for first-line treatment of cisplatin ineligible patients. Despite these multiple approvals, the development of clinically useful biomarkers to determine the optimal treatment for patients remains somewhat elusive. In this review, we examine key clinical trial results with anti-PD1/PD-L1 antibodies and discuss progress towards developing novel biomarkers beyond PD-L1 expression.
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Affiliation(s)
- David H. Aggen
- New York-Presbyterian/Columbia University Medical Center, Hematology/Oncology, 177 Fort Washington Avenue, 6GN-435, New York, NY 10032 USA
| | - Charles G. Drake
- New York-Presbyterian/Columbia University Medical Center, Hematology/Oncology, 177 Fort Washington Avenue, 6GN-435, New York, NY 10032 USA
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19
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PD-L1 expression in bladder cancer and metastasis and its influence on oncologic outcome after cystectomy. Oncotarget 2017; 8:66849-66864. [PMID: 28978000 PMCID: PMC5620140 DOI: 10.18632/oncotarget.19913] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/30/2017] [Indexed: 01/02/2023] Open
Abstract
Platinum-based chemotherapy is the standard of care in metastatic bladder cancer. With the approval of various checkpoint inhibitors, immunotherapy has revolutionized the traditional treatment modalities. The aim of the study was to evaluate whether PD-L1 expression on tumor cells (TCs) and tumor-infiltrating immune cells (ICs) can be used as biomarker to predict recurrence-free survival (RFS), overall survival (OS) and disease-specific survival (DSS) in bladder cancer patients after radical cystectomy (RC) developing disease recurrence followed by first-line chemotherapy. PD-L1 was measured on formalin-fixed, paraffin-embedded tissue sections of RC specimens in all patients (n=61) and in 27 matched metastatic biopsy samples by immunohistochemistry. PD-L1 expression on TCs was defined by the percentage of PD-L1 positive tumor cells (< 1%= IC0, ≥1% but <5%=IC1, ≥5 %=IC2/3), and was considered negative or positive for ICs. On 27 paired samples, IC1/2/3 score on TCs was homogeneous distributed with 59.3% in primary tumors and metastases, but with a high discordance rate of 44.4% of PD-L1 positivity on ICs. High PD-L1 expression (IC2/3) on TCs was more frequently seen in histologic subtypes of urothelial cancer compared to pure urothelial cancers (46.2% vs. 20.8%; p=0.002). PD-L1 expression on TCs in primary tumors (IC2/3 vs. IC0, median: 3.2 vs. 13.8 months, p=0.019) and metastatic sites (IC2/3 vs. IC0, median: 6.1 vs. 21.8 months, p=0.014) was associated with poor chemo-response, represented by significant shortened DSS. These results suggest that PD-L1 may be a potential target being involved in chemo-resistance mechanisms and poses potential for therapy stratification in the future.
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Sweis RF, Luke JJ. Mechanistic and pharmacologic insights on immune checkpoint inhibitors. Pharmacol Res 2017; 120:1-9. [PMID: 28323141 DOI: 10.1016/j.phrs.2017.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 01/05/2023]
Abstract
The concept of augmenting the immune system to eradicate cancer dates back at least a century. A major resurgence in cancer immunotherapy has occurred over the past decade since the identification and targeting of negative regulators with antibody therapies to augment the anti-tumor immune response. Unprecedented responses across a broad array of cancer types elevated this class of therapies to the forefront of cancer treatment. The most successful drugs to date target the cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and programmed cell death-1 (PD-1) pathways. The immune biology of these pathways was illuminated through thoughtful pre-clinical experiments over the past 20 years. The characterization of these negative immune regulators, also known as immune checkpoints, subsequently led to the successful clinical development four drugs in six different cancer types to date, and progress continues. Despite these successes, significant challenges remain including the development of predictive biomarkers, recognition and management of immune related toxicities, and elucidating and reversing mechanisms of primary and secondary resistance. Ongoing work is expected to build upon recent accomplishments and allow more patients to benefit from this class of therapies.
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Affiliation(s)
- Randy F Sweis
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637, USA
| | - Jason J Luke
- Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637, USA.
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21
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Abstract
Research efforts targeting the identification of bladder cancer biomarkers have been extensive during the past decade. Investigations have been performed at the genome, transcriptome, proteome, and metabolome levels and outputs have started appearing including the sketching of disease molecular subtypes. Proteins are directly linked to cell phenotype hence they accumulate special interest as both biomarkers and therapeutic targets. Multiple technical challenges exist, of the main, being the protein concentration vast dynamic range and presence of proteins in modified forms. The scope of this review is to summarize the contribution of proteomics research in this quest of bladder cancer biomarkers. To obtain an unbiased and comprehensive overview, the scientific literature was searched for manuscripts describing proteomic studies on urothelial cancer from the last ten years and those including independent verification studies in urine, tissue and blood are briefly presented. General observations include: a) in most cases, suboptimal experimental design including healthy controls in biomarker discovery and frequently biomarker verification, is followed; b) variability in protein findings between studies can be observed, to some extent reflecting complexity of experimental approaches and proteome itself; c) consistently reported biomarkers include mainly plasma proteins and d) compilation of protein markers into diagnostic panels appears the most promising way forward. Two main avenues of research can now be foreseen: targeting integration of the existing disparate data with proteomic findings being placed in the context of existing knowledge on bladder cancer subtypes and in parallel, accumulation of clinical samples to support proper validation studies of promising marker combinations.
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Affiliation(s)
| | - Antonia Vlahou
- Biomedical Research Foundation Academy of Athens , Biotechnology Division, Athens, Greece
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22
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Verkarre V, Roussel H, Granier C, Tartour E, Allory Y. [Immunotherapy in uropathology]. Ann Pathol 2017; 37:90-100. [PMID: 28111042 DOI: 10.1016/j.annpat.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
The algorithms for treatment of metastatic cancers are evolving due to positive results obtained with immunotherapy. Therapeutics approaches to stimulate the immune system have already been used in the treatment of kidney and bladder cancer, such as the administration of cytokines and BCG therapy, confirming the immunogenicity of these tumors. The aim of immunotherapies is not only to activate the immune system against tumor cells, but also to take into account the tumor-induced suppressive microenvironment, in particular by removing the anergy of T-cell lymphocytes, and by targeting the co-stimulation inhibitors molecules. Among the genito-urinary cancers, second-line clinical trials have clearly shown that kidney and bladder cancers are sensitive to the inhibition of PD-1/PD-L1 axis and have already achieved FDA approvals for some molecules. Numerous other clinical trials are underway, particularly in first-line treatment in bladder and renal cancers. Refractory testicular cancer could also benefit from these treatments. Other approaches using vaccine therapy especially in castration-resistant prostate cancer are also of interest. We will see, in this chapter dedicated to the urogenital cancers, the benefit of the immunotherapy by resituating it in the genetic and immunological context of each organ. We will also present briefly the therapeutic outlines and the place of biomarkers.
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Affiliation(s)
- Virginie Verkarre
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
| | - Hélène Roussel
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; Unité Inserm U970, Paris Cardiovascular Research Center, PARCC, 56, rue Leblanc, 75015 Paris, France
| | - Clémence Granier
- Unité Inserm U970, Paris Cardiovascular Research Center, PARCC, 56, rue Leblanc, 75015 Paris, France
| | - Eric Tartour
- Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; Unité Inserm U970, Paris Cardiovascular Research Center, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'immunologie biologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Yves Allory
- Service d'anatomie pathologique, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Faculté de médecine, université Paris-Est Créteil Val de Marne (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France
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23
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Making urothelial carcinomas less immune to immunotherapy. Urol Oncol 2016; 34:534-537. [PMID: 27836245 DOI: 10.1016/j.urolonc.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 12/26/2022]
Abstract
The success of immune checkpoint inhibitors in advanced urothelial carcinoma provides patients with the prospect for durable objective responses. However, the majority of patients do not respond to immune checkpoint blockade. Several potential predictive biomarkers of response have been evaluated in hopes of better identifying likely responders, though each has been shown to have limitations. Going forward, development of reliable predictive biomarkers is imperative. Likewise, innovative treatment combination approaches to convert non-responders to responders are essential to continue making progress in the field.
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