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Krieger T, Pearson I, Bell J, Doherty J, Robbins P. Targeted literature review on use of tumor mutational burden status and programmed cell death ligand 1 expression to predict outcomes of checkpoint inhibitor treatment. Diagn Pathol 2020; 15:6. [PMID: 32000815 PMCID: PMC6990470 DOI: 10.1186/s13000-020-0927-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
Background To achieve optimal outcomes, an individual approach is needed in the treatment and care of patients. The potential value of tumor mutational burden (TMB) status and/or programmed cell death ligand 1 (PD-L1) expression as biomarkers to predict which patients are most likely to respond to checkpoint inhibitors has been explored in many studies. The goal of this targeted literature review is to identify data available for TMB status and/or PD-L1 expression that predict response to checkpoint inhibitors and/or anti–cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) antibodies. Methods Targeted literature searches were performed using electronic medical databases (MEDLINE, Embase, and BIOSIS) and internet searches of specified sites. Bibliographies of key systematic literature reviews and meta-analyses also were reviewed for studies of interest. Results The review identified 27 studies of non-small cell lung cancer (NSCLC), 40 studies of melanoma, 10 studies of urothelial cancer, and 5 studies of renal cell cancer indications. Studies also were identified in other cancer types, e.g., colorectal, breast, gastric, and Merkel cell cancer and squamous-cell carcinoma of the head and neck. Twelve trials, including six in NSCLC and four in melanoma, evaluated TMB as a predictor of outcomes. A TMB of ≥10 mutations per megabase was shown to be an effective biomarker in the CheckMate 227 study. PD-L1 expression was included in the majority of identified studies and was found to predict response in in melanoma and in all types of NSCLC. Prediction of response was not a prespecified analysis in some studies; others had small sample sizes and wide confidence intervals. A clear predictive trend for PD-L1 expression was not identified in renal, breast, gastric, or Merkel cell cancer. Conclusion Based on data contained in this review, assessment of TMB status and PD-L1 expression may help enhance the prediction of response to checkpoint inhibition in some tumors, such as NSCLC and melanoma. In this rapidly growing area of research, further exploratory biomarkers are being investigated including tumor-infiltrating lymphocytes, immune profiling (e.g., effector T cells or regulatory T cells), epigenetic signatures, T-cell receptor repertoire, proteomics, microbiome, and metabolomics.
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Affiliation(s)
- Tina Krieger
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK.
| | - Isobel Pearson
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
| | - Judith Bell
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
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Parakh S, King D, Gan HK, Scott AM. Current Development of Monoclonal Antibodies in Cancer Therapy. Recent Results Cancer Res 2019; 214:1-70. [PMID: 31473848 DOI: 10.1007/978-3-030-23765-3_1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Exploiting the unique specificity of monoclonal antibodies has revolutionized the treatment and diagnosis of haematological and solid organ malignancies; bringing benefit to millions of patients over the past decades. Recent achievements include conjugating antibodies with toxic payloads resulting in superior efficacy and/or reduced toxicity, development of molecular imaging techniques targeting specific antigens for use as predictive and prognostic biomarkers, the development of novel bi- and tri-specific antibodies to enhance therapeutic benefit and abrogate resistance and the success of immunotherapy agents. In this chapter, we review an overview of antibody structure and function relevant to cancer therapy and provide an overview of pivotal clinical trials which have led to regulatory approval of monoclonal antibodies in cancer treatment. We further discuss resistance mechanisms and the unique side effects of each class of antibody and provide an overview of emerging therapeutic agents.
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Affiliation(s)
- Sagun Parakh
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Dylan King
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Hui K Gan
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia. .,School of Cancer Medicine, La Trobe University, Melbourne, Australia. .,Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
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3
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Lin J, Bunn V, Liu R. Practical Considerations for Subgroups Quantification, Selection and Adaptive Enrichment in Confirmatory Trials. Stat Biopharm Res 2019. [DOI: 10.1080/19466315.2018.1560360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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4
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Frederickson AM, Arndorfer S, Zhang I, Lorenzi M, Insinga R, Arunachalam A, Burke TA, Simon GR. Pembrolizumab plus chemotherapy for first-line treatment of metastatic nonsquamous non-small-cell lung cancer: a network meta-analysis. Immunotherapy 2019; 11:407-428. [DOI: 10.2217/imt-2018-0193] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: A systematic review and network meta-analysis were conducted to evaluate the efficacy of pembrolizumab + pemetrexed + platinum relative to other regimens in metastatic nonsquamous non-small-cell lung cancer (NSq-NSCLC). Patients & methods: Eligible studies evaluated first-line regimens in NSq-NSCLC patients without known targetable mutations. Relative treatment effects were synthesized with random effects proportional hazards Bayesian network meta-analyses. Results: The hazard ratio (HR) for overall survival (OS) for pembrolizumab + pemetrexed + platinum was statistically significant over all platinum-doublet (HR range: 0.42–0.61), platinum-doublet + bevacizumab (HR range: 0.44–0.53) and platinum-doublet + atezolizumab regimens (HR range: 0.56–0.62). Additionally, pembrolizumab + pemetrexed + platinum numerically improved OS over atezolizumab + paclitaxel + carboplatin + bevacizumab (HR: 0.65; 95% credible interval: 0.43, 1.01). Pembrolizumab + pemetrexed + platinum had 95.6% probability of being the best treatment regimen for OS. Conclusion: Pembrolizumab + pemetrexed + platinum is likely the most efficacious first-line regimen for metastatic NSq-NSCLC.
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Affiliation(s)
| | - Stella Arndorfer
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Ina Zhang
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Maria Lorenzi
- Evidence Synthesis & Decision Modeling, Precision Xtract, Oakland, CA 94612, USA
| | - Ralph Insinga
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Ashwini Arunachalam
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Thomas A Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - George R Simon
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77005, USA
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5
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Subgrouping breast cancer patients based on immune evasion mechanisms unravels a high involvement of transforming growth factor-beta and decoy receptor 3. PLoS One 2018; 13:e0207799. [PMID: 30513096 PMCID: PMC6279052 DOI: 10.1371/journal.pone.0207799] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022] Open
Abstract
In the era of immunotherapy and personalized medicine, there is an urgent need for advancing the knowledge of immune evasion in different cancer types and identifying reliable biomarkers that guide both therapy selection and patient inclusion in clinical trials. Given the differential immune responses and evasion mechanisms in breast cancer, we expect to identify different breast cancer groups based on their expression of immune-related genes. For that, we used the sequential biclustering method on The Cancer Genome Atlas RNA-seq breast cancer data and identified 7 clusters. We found that 77.4% of the clustered tumor specimens evade through transforming growth factor-beta (TGF-β) immunosuppression, 57.7% through decoy receptor 3 (DcR3) counterattack, 48.0% through cytotoxic T-lymphocyte-associated protein 4 (CTLA4), and 34.3% through programmed cell death-1 (PD-1). TGF-β and DcR3 are potential novel drug targets for breast cancer immunotherapy. Targeting TGF-β and DcR3 may provide a powerful approach for treating breast cancer because 57.7% of patients overexpressed these two molecules. Furthermore, triple-negative breast cancer (TNBC) patients clustered equally into two subgroups: one with impaired antigen presentation and another with high leukocyte recruitment but four different evasion mechanisms. Thus, different TNBC patients may be treated with different immunotherapy approaches. We identified biomarkers to cluster patients into subgroups based on immune evasion mechanisms and guide the choice of immunotherapy. These findings provide a better understanding of patients’ response to immunotherapies and shed light on the rational design of novel combination therapies.
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6
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Ancevski Hunter K, Socinski MA, Villaruz LC. PD-L1 Testing in Guiding Patient Selection for PD-1/PD-L1 Inhibitor Therapy in Lung Cancer. Mol Diagn Ther 2018; 22:1-10. [PMID: 29119407 DOI: 10.1007/s40291-017-0308-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Immunotherapy with programmed death 1 (PD-1)- and programmed death-ligand 1 (PD-L1)-targeted monoclonal antibodies has dramatically changed the therapeutic and prognostic landscape for several types of malignancy. PD-1 and PD-L1 are immune checkpoint proteins whose binding ultimately result in T cell exhaustion and self-tolerance. Blocking this pathway 'releases the brakes' on the immune system and allows for attack of tumor cells that express PD-L1. The clinical trials that led to the US Food and Drug Administration (FDA) approval of these agents used different immunohistochemical (IHC) platforms with various PD-L1 antibodies to assess for PD-L1 expression on either tumor cells or tumor-infiltrating immune cells. There are four PD-L1 IHC assays registered with the FDA, using four different PD-L1 antibodies (22C3, 28-8, SP263, SP142), on two different IHC platforms (Dako and Ventana), each with their own scoring systems. Attempts at harmonization of PD-L1 IHC antibodies and staining platforms are underway. While PD-L1 IHC can be used to predict the likelihood of response to anti-PD-1 or anti-PD-L1 therapy, a proportion of patients that are negative can have a response and identification of alternative biomarkers is critical to further refine selection of patients most likely to respond to these therapies.
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Affiliation(s)
| | | | - Liza C Villaruz
- University of Pittsburgh Cancer Institute, 5150 Centre Ave, Pittsburgh, PA, 15232, USA.
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Brahmer JR, Govindan R, Anders RA, Antonia SJ, Sagorsky S, Davies MJ, Dubinett SM, Ferris A, Gandhi L, Garon EB, Hellmann MD, Hirsch FR, Malik S, Neal JW, Papadimitrakopoulou VA, Rimm DL, Schwartz LH, Sepesi B, Yeap BY, Rizvi NA, Herbst RS. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). J Immunother Cancer 2018; 6:75. [PMID: 30012210 PMCID: PMC6048854 DOI: 10.1186/s40425-018-0382-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/27/2018] [Indexed: 12/19/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for over 85% of all cases. Until recently, chemotherapy – characterized by some benefit but only rare durable responses – was the only treatment option for patients with NSCLC whose tumors lacked targetable mutations. By contrast, immune checkpoint inhibitors have demonstrated distinctly durable responses and represent the advent of a new treatment approach for patients with NSCLC. Three immune checkpoint inhibitors, pembrolizumab, nivolumab and atezolizumab, are now approved for use in first- and/or second-line settings for selected patients with advanced NSCLC, with promising benefit also seen in patients with stage III NSCLC. Additionally, durvalumab following chemoradiation has been approved for use in patients with locally advanced disease. Due to the distinct features of cancer immunotherapy, and rapid progress in the field, clinical guidance is needed on the use of these agents, including appropriate patient selection, sequencing of therapies, response monitoring, adverse event management, and biomarker testing. The Society for Immunotherapy of Cancer (SITC) convened an expert Task Force charged with developing consensus recommendations on these key issues. Following a systematic process as outlined by the National Academy of Medicine, a literature search and panel voting were used to rate the strength of evidence for each recommendation. This consensus statement provides evidence-based recommendations to help clinicians integrate immune checkpoint inhibitors into the treatment plan for patients with NSCLC. This guidance will be updated following relevant advances in the field.
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Affiliation(s)
- Julie R Brahmer
- Bloomberg Kimmel Immunotherapy Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, 21231, USA
| | | | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Sarah Sagorsky
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD, 21231, USA
| | - Marianne J Davies
- Yale Comprehensive Cancer Center, Yale University School of Nursing, New Haven, CT, 06520, USA
| | - Steven M Dubinett
- University of California Los Angeles Lung Cancer Research Program, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | | | - Leena Gandhi
- Department of Medicine, New York University, Perlmutter Cancer Center, NYU School of Medicine, New York, NY, 10016, USA
| | - Edward B Garon
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90404, USA
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Fred R Hirsch
- University of Colorado Denver School of Medicine, Denver, CO, 80011, USA
| | - Shakuntala Malik
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Rockville, USA
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York City, NY, 10032, USA
| | - Boris Sepesi
- Thoracic Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Beow Yong Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Naiyer A Rizvi
- Columbia University Medical Center, New York, NY, 10028, USA
| | - Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, 333 Cedar Street, WWW221, New Haven, CT, 06520-8028, USA.
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8
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Huang Q, Zhang H, Hai J, Socinski MA, Lim E, Chen H, Stebbing J. Impact of PD-L1 expression, driver mutations and clinical characteristics on survival after anti-PD-1/PD-L1 immunotherapy versus chemotherapy in non-small-cell lung cancer: A meta-analysis of randomized trials. Oncoimmunology 2018; 7:e1396403. [PMID: 30524878 DOI: 10.1080/2162402x.2017.1396403] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose: To investigate the impact of programmed death-ligand 1 (PD-L1) expression, oncogenic mutations, and clinical characteristics on survival after treatment with anti-PD-1/PD-L1 antibodies versus chemotherapy in non-small cell lung cancer (NSCLC). Patients and Methods: This meta-analysis included randomized trials comparing anti-PD-1/PD-L1 antibodies with chemotherapy. Hazard ratios (HRs) and 95% confidence interval (CI) for overall survival (OS) for the trial population and prespecified subgroups were extracted. We calculated pooled estimates of treatment efficacy using the fixed-effects or random-effects model when appropriate. All statistical tests were two sided. Results: Seven trials involving 3871 patients were included. The pooled results showed that anti-PD-1/PD-L1 immunotherapy significantly prolonged OS (HR: 0.73; 95% CI, 0.63 to 0.84) and PFS (HR: 0.84; 95% CI, 0.71 to 0.99) compared to chemotherapy. OS benefit from immunotherapy were observed in all PD-L1 expression subgroups (negative: HR, 0.79; 95% CI, 0.67 to 0.93; weak-positive: HR, 0.80; 95% CI, 0.67 to 0.95; strong-positive: HR, 0.61; 95% CI, 0.47 to 0.78). Strong-positive PD-L1 expression showed a trend towards more benefit compared to weak-positive PD-L1 expression (interaction P = 0.08). KRAS mutant (HR: 0.60; 95% CI, 0.39 to 0.93), EGFR wild-type (HR: 0.73; 95% CI, 0.61 to 0.87) and smoker (HR: 0.70; 95% CI, 0.60 to 0.83) subgroups achieved significant OS benefit from immunotherapy compared to corresponding subgroups. Survival benefit to immunotherapy was not significantly associated with histology, CNS metastases, age, gender and performance status. Conclusion: This study confirmed that treatment with anti-PD-1/PD-L1 improves overall survival compared with chemotherapy. Benefit was seen, regardless of PD-L1 expression levels; however, PD-L1 strong-positive patients trended to have greatest benefit. Patients with a KRAS mutant or EGFR wild-type tumor have improved survival benefit from immunotherapy compared with KRAS wild-type or EGFR mutant NSCLC, respectively.
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Affiliation(s)
- Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Zhang
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Josephine Hai
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Socinski
- Thoracic Oncology Program, Florida Hospital Cancer Institute, Orlando, Florida, USA
| | - Eric Lim
- Imperial College London and The Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK
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9
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The Era of Checkpoint Blockade in Lung Cancer: Taking the Brakes Off the Immune System. Ann Am Thorac Soc 2018; 14:1248-1260. [PMID: 28613923 DOI: 10.1513/annalsats.201702-152fr] [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: 12/12/2022] Open
Abstract
Despite recent advances with targeted kinase inhibitors and better-tolerated chemotherapy, the treatment of metastatic non-small-cell lung cancer remains suboptimal. One recent advance that holds great promise is immunotherapy-an approach that enhances a patient's immune system to better recognize and react to abnormal cells. The most successful immunotherapeutic strategy to date uses antibodies to block inhibitory receptors (also called "checkpoints") that are up-regulated on the T cells that infiltrate the tumor. Two examples of such molecules are programmed cell death-1 (PD1) and cytotoxic T lymphocyte-associated protein-4. With more than a dozen clinical trials in non-small-cell lung cancer completed, checkpoint blockade targeting PD1 has demonstrated durable responses and superior survival compared with traditional chemotherapy agents when used as first-line therapy in individuals with more than 50% PD1 ligand (PDL1) expression by immunohistochemical staining and as second-line therapy independent of PDL1 status. Antibodies to PDL1 have shown similar activity. Combinations of anti-PD1 and anti-PDL1 with anti-cytotoxic T lymphocyte-associated protein-4 and chemotherapy are being actively tested. These agents have generally tolerable safety profiles; pneumonitis, although rare, remains the most feared adverse effect. PDL1 expression on tumors has been identified as a biomarker predictive of response. Although PDL1 expression has traditionally been measured on resected tumor specimens, the pulmonologist has a growing role in obtaining samples for testing via minimally invasive means.
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10
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Li D, Cheng S, Zou S, Zhu D, Zhu T, Wang P, Zhu X. Immuno-PET Imaging of 89Zr Labeled Anti-PD-L1 Domain Antibody. Mol Pharm 2018; 15:1674-1681. [PMID: 29502426 DOI: 10.1021/acs.molpharmaceut.8b00062] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recently, various immuno-PET tracers based on monoclonal antibodies (mAbs), engineered scaffold proteins, and peptides were developed to target either programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1), showing promise in assessment of immune checkpoints. We sought to develop an immunotherapeutic agent based PET probe that enables real-time assessment of PD-L1 expression and evaluation of antibody drug biodistribution to select eligible candidates for anti-PD-1/PD-L1 immunotherapies. KN035, a 79.6 kDa size anti-PD-L1 domain antibody under analysis in clinical trials, was used to develop the immuno-PET probe, 89Zr-Df-KN035. Immuno-PET studies were performed to monitor PD-L1 levels in nude mice bearing LN229 xenografts with positive expression for PD-L1, and to evaluate the whole-body biodistribution in healthy non-human primates (NHPs). LN229 xenografts were markedly visualized from 24 h after injection of 89Zr-Df-KN035, with elevated accumulation persisting for up to 120 h. Tumor radioactivity was notably reduced in the presence of excess KN035. Mouse ex vivo biodistribution studies performed at 24 and 120 h revealed tumor-to-muscle ratios as high as 5.64 ± 0.65 and 7.70 ± 1.37, respectively. In the NHP model, PET imaging demonstrated low background. The liver and kidney showed moderate accumulation with the highest SUVmean value of 1.15 ± 0.15 and 2.13 ± 0.10 at 72 h, respectively. The spleen, lymph nodes, and salivary glands were also slightly visualized. In conclusion, 89Zr-Df-KN035, a novel anti-PD-L1 domain antibody-based probe, shows the feasibility of noninvasive in vivo evaluation of PD-L1 expression. This work further provides a template for immunotherapeutic agent based imaging to evaluate human PD-L1 expression and to augment our understanding of therapeutic agent biodistribution, leading to better therapeutic strategies in the future.
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Affiliation(s)
- Dan Li
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , 430030 , China
| | - Siyuan Cheng
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , 430030 , China
| | - Sijuan Zou
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , 430030 , China
| | - Dongling Zhu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , 430030 , China
| | | | - Pilin Wang
- Alphamab Co. Ltd ., Suzhou , 215000 , China
| | - Xiaohua Zhu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , 430030 , China
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11
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Taube JM, Galon J, Sholl LM, Rodig SJ, Cottrell TR, Giraldo NA, Baras AS, Patel SS, Anders RA, Rimm DL, Cimino-Mathews A. Implications of the tumor immune microenvironment for staging and therapeutics. Mod Pathol 2018; 31:214-234. [PMID: 29192647 PMCID: PMC6132263 DOI: 10.1038/modpathol.2017.156] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/06/2017] [Accepted: 09/24/2017] [Indexed: 02/06/2023]
Abstract
Characterizing the tumor immune microenvironment enables the identification of new prognostic and predictive biomarkers, the development of novel therapeutic targets and strategies, and the possibility to guide first-line treatment algorithms. Although the driving elements within the tumor microenvironment of individual primary organ sites differ, many of the salient features remain the same. The presence of a robust antitumor milieu characterized by an abundance of CD8+ cytotoxic T-cells, Th1 helper cells, and associated cytokines often indicates a degree of tumor containment by the immune system and can even lead to tumor elimination. Some of these features have been combined into an 'Immunoscore', which has been shown to complement the prognostic ability of the current TNM staging for early stage colorectal carcinomas. Features of the immune microenvironment are also potential therapeutic targets, and immune checkpoint inhibitors targeting the PD-1/PD-L1 axis are especially promising. FDA-approved indications for anti-PD-1/PD-L1 are rapidly expanding across numerous tumor types and, in certain cases, are accompanied by companion or complimentary PD-L1 immunohistochemical diagnostics. Pathologists have direct visual access to tumor tissue and in-depth knowledge of the histological variations between and within tumor types and thus are poised to drive forward our understanding of the tumor microenvironment. This review summarizes the key components of the tumor microenvironment, presents an overview of and the challenges with PD-L1 antibodies and assays, and addresses newer candidate biomarkers, such as CD8+ cell density and mutational load. Characteristics of the local immune contexture and current pathology-related practices for specific tumor types are also addressed. In the future, characterization of the host antitumor immune response using multiplexed and multimodality biomarkers may help predict which patients will respond to immune-based therapies.
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Affiliation(s)
- Janis M Taube
- Department of Dermatology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
| | - Jérôme Galon
- INSERM, Laboratory of Integrative Cancer Immunology, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, Centre de Recherche des Cordeliers, Paris, France
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tricia R Cottrell
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
| | - Nicolas A Giraldo
- Department of Dermatology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
| | - Alexander S Baras
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
| | - Sanjay S Patel
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert A Anders
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins University SOM and Bloomberg-Kimmel Institute for Immunotherapy, Baltimore, MD, USA
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12
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Tackling Cancer Resistance by Immunotherapy: Updated Clinical Impact and Safety of PD-1/PD-L1 Inhibitors. Cancers (Basel) 2018; 10:cancers10020032. [PMID: 29370105 PMCID: PMC5836064 DOI: 10.3390/cancers10020032] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Cancer therapy has been constantly evolving with the hope of finding the most effective agents with the least toxic effects to eradicate tumors. Cancer immunotherapy is currently among the most promising options, fulfilling this hope in a wide range of tumors. Immunotherapy aims to activate immunity to fight cancer in a very specific and targeted manner; however, some abnormal immune reactions known as immune-related adverse events (IRAEs) might occur. Therefore, many researchers are aiming to define the most proper protocols for managing these complications without interfering with the anticancer effect. One of these targeted approaches is the inhibition of the interaction between the checkpoint protein, programmed death-receptor 1 (PD-1), and its ligand, programmed death-ligand 1 (PD-L1), via a class of antibodies known as PD-1/PD-L1 inhibitors. These antibodies achieved prodigious success in a wide range of malignancies, including those where optimal treatment is not yet fully identified. In this review, we have critically explored and discussed the outcome of the latest PD-1 and PD-L1 inhibitor studies in different malignancies compared to standard chemotherapeutic alternatives with a special focus on the clinical efficacy and safety. The approval of the clinical applications of nivolumab, pembrolizumab, atezolizumab, avelumab, and durvalumab in the last few years clearly highlights the hopeful future of PD-1/PD-L1 inhibitors for cancer patients. These promising results of PD-1/PD-L1 inhibitors have encouraged many ongoing preclinical and clinical trials to explore the extent of antitumor activity, clinical efficacy and safety as well as to extend their applications.
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13
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Zou T, Awad MM. More valuable than platinum: first-line pembrolizumab in advanced stage non-small-cell lung cancer. Ann Oncol 2018; 28:685-687. [PMID: 28327984 DOI: 10.1093/annonc/mdx083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- T Zou
- Dana Farber Cancer Institute, Medical Oncology
| | - M M Awad
- Dana Farber Cancer Institute, Medical Oncology
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Khunger M, Jain P, Rakshit S, Pasupuleti V, Hernandez AV, Stevenson J, Pennell NA, Velcheti V. Safety and Efficacy of PD-1/PD-L1 Inhibitors in Treatment-Naive and Chemotherapy-Refractory Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. Clin Lung Cancer 2018; 19:e335-e348. [PMID: 29433902 DOI: 10.1016/j.cllc.2018.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 12/20/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors show significant clinical activity in non-small-cell lung carcinoma (NSCLC). However, there is a relative lack of data on comparative efficacy of these drugs in the first-line setting versus chemotherapy-treated patients. We compared the efficacy and toxicity of these drugs in these 2 distinct groups of patients. MATERIALS AND METHODS Electronic databases (PubMed-Medline, EMBASE, Scopus) and major conference proceedings were systematically searched for all phase I to III clinical trials in NSCLC using PD-1/PD-L1 inhibitors. Objective response rate (ORR) and progression-free survival (PFS) data were collected and combined using DerSimonian and Laird random effects model meta-analysis. The I2 statistic was used to assess heterogeneity. RESULTS Seventeen distinct trials (8 with treatment-naive patients [n = 937]; 14 with chemotherapy-treated patients [n = 3620]; 5 with separate treatment-naive and previously treated arms) were included. Treatment-naive patients had a statistically significant higher ORR (30.2%; 95% confidence interval [CI], 22.70-38.2) than patients previously treated with chemotherapy (ORR, 20.1%; 95% CI, 17.5-22.9; P = .02). No significant differences in PFS were observed between the 2 groups. Treatment-naive patients had statistically significant higher rates of all grade pneumonitis compared with previously treated patients (4.9%; 95% CI, 3.4-6.7 vs. 3.0%; 95% CI, 2.0-4.1; P = .04); however, no significant differences in any other immune-related adverse events were observed. CONCLUSION PD-1/PD-L1 inhibitor therapy for advanced NSCLC has a significantly higher ORR and a higher rate of immune-mediated pneumonitis when used in the first-line setting compared with chemotherapy treated patients.
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Affiliation(s)
- Monica Khunger
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Prantesh Jain
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH
| | - Sagar Rakshit
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - James Stevenson
- Department of Hematology and Oncology, Tausig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Nathan A Pennell
- Department of Hematology and Oncology, Tausig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Vamsidhar Velcheti
- Department of Hematology and Oncology, Tausig Cancer Institute, Cleveland Clinic, Cleveland, OH.
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Savić I, Oprić D. PD-1/PD-L1: A novel target for immunotherapy in patients with advanced and metastatic non-small cell lung cancer. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fujimoto D, Sato Y, Uehara K, Ishida K, Fukuoka J, Morimoto T, Kawachi H, Mori R, Ito M, Teraoka S, Nagata K, Nakagawa A, Otsuka K, Imai Y, Tomii K. Predictive Performance of Four Programmed Cell Death Ligand 1 Assay Systems on Nivolumab Response in Previously Treated Patients with Non-Small Cell Lung Cancer. J Thorac Oncol 2017; 13:377-386. [PMID: 29233789 DOI: 10.1016/j.jtho.2017.11.123] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Nivolumab has demonstrated efficacy against metastatic NSCLC. Four programmed cell death ligand 1 (PD-L1) immunohistochemistry (IHC) assay systems are available for identification of responders among patients with NSCLC, and these assays show some differing characteristics. Accordingly, in this study, we evaluated the ability of these assays to identify responders to nivolumab therapy. METHODS We retrospectively analyzed patients with previously treated advanced NSCLC, who received nivolumab between January 2016 and September 2016. Specimens were stained using four PD-L1 IHC assays (28-8, 22C3, SP142, and SP263). We classified patients as having test results that were strongly positive (tumor proportion score [TPS] ≥50%), weakly positive (TPS 1%-49%), or negative (TPS <1%). RESULTS A total of 40 patients with NSCLC and their specimens were analyzed. Analytical comparisons demonstrated good concordance of PD-L1-stained tumor cells among the 28-8, 22C3, and SP263 assays (weighted κ coefficient 0.64-0.71), whereas the SP142 assay showed lower concordance with other assays (weighted κ coefficient 0.39-0.55). Progression-free survival in patients showing strongly positive PD-L1 staining classified by 28-8, 22C3, and SP263 assays was significantly longer than that in patients with a negative result for PD-L1 staining. Predictive performance of response to nivolumab, as assessed by receiver operating characteristic analysis, was also equivalent among the 28-8, 22C3, and SP263 assays (area under the curve 0.75-0.82), whereas the SP142 assay exhibited lower predictive performance (area under the curve 0.68). CONCLUSIONS The 28-8, 22C3, and SP263 PD-L1 IHC assays showed equivalent predictive performance, whereas the SP142 assay showed lower predictive performance.
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Affiliation(s)
- Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keiichiro Uehara
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kaori Ishida
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Morimoto
- Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hayato Kawachi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryobu Mori
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Munehiro Ito
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shunsuke Teraoka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Sánchez de Cos Escuín J. New Immunotherapy and Lung Cancer. Arch Bronconeumol 2017; 53:682-687. [PMID: 28823733 DOI: 10.1016/j.arbres.2017.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 02/03/2023]
Abstract
Recent research on the relationship between the immune system and cancer has revealed the molecular mechanisms by which cancer cells co-opt certain T cell receptors which block the cytotoxic response to defend themselves from the antitumor immune attack. These findings have helped identify specific targets (T cell receptors or their corresponding ligands) for the design of monoclonal antibodies that can unlock the immune response. These drugs, known as immune checkpoint inhibitors, have shown efficacy in metastatic melanoma and kidney cancer, and have been successfully tested in non-small cell lung cancer in recent trials. Immune checkpoint inhibitors were included in clinical practice as a second-line option after an initial chemotherapy (CT) regimen, and in the last year positive results have been reported from randomized trials in which they were compared in first line with standard CT. Responses have been surprising and durable, but less than 20%-25% in unselected patients, so it is essential that factors predicting efficacy be identified. One such biomarker is PD-L1, but the different methods used to detect it have produced mixed results. This non-systematic review discusses the results of the latest trials, the possibilities of incorporating these drugs in first-line regimens, the criteria for patient selection, adverse effects, and the prospects of combinations with conventional treatment modalities, such as CT, radiation therapy, and antiangiogenic agents.
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MESH Headings
- Abatacept/therapeutic use
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- CTLA-4 Antigen/antagonists & inhibitors
- CTLA-4 Antigen/immunology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/immunology
- Carcinoma, Small Cell/therapy
- Clinical Trials, Phase III as Topic
- Combined Modality Therapy
- Cost-Benefit Analysis
- Forecasting
- Humans
- Immunologic Surveillance
- Immunotherapy/economics
- Immunotherapy/methods
- Lung Neoplasms/drug therapy
- Lung Neoplasms/immunology
- Lung Neoplasms/therapy
- Molecular Targeted Therapy/economics
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Radiotherapy, Adjuvant
- Randomized Controlled Trials as Topic
- Receptors, Antigen, T-Cell/immunology
- T-Lymphocytes, Cytotoxic/immunology
- Therapies, Investigational
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Mascaux C, Tomasini P, Greillier L, Barlesi F. Personalised medicine for nonsmall cell lung cancer. Eur Respir Rev 2017; 26:26/146/170066. [PMID: 29141962 DOI: 10.1183/16000617.0066-2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022] Open
Abstract
After years of standard care prescribed to cancer patients without any selection except the primary site and histology of the tumour, the era of precision medicine has revolutionised cancer care. Personalised medicine refers to the selection of patients for specific treatment based on the presence of specific biomarkers which indicate sensitivity to corresponding targeted therapies and/or lower toxicity risk, such that patients will have the greatest chance of deriving benefit from the treatments. Here, we review personalised medicine for nonsmall cell lung cancer.
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Affiliation(s)
- Céline Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France .,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
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Ferrara R, Mezquita L, Auclin E, Chaput N, Besse B. Immunosenescence and immunecheckpoint inhibitors in non-small cell lung cancer patients: Does age really matter? Cancer Treat Rev 2017; 60:60-68. [DOI: 10.1016/j.ctrv.2017.08.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 01/04/2023]
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20
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Mansour M, Teo ZL, Luen SJ, Loi S. Advancing Immunotherapy in Metastatic Breast Cancer. Curr Treat Options Oncol 2017; 18:35. [PMID: 28534250 DOI: 10.1007/s11864-017-0478-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Despite many advances in the treatment of breast cancer, the development of metastatic disease remains an incurable and frequent cause of cancer death for women worldwide. An improved understanding of the role of host immunosurveillance in modulating breast cancer disease biology, as well as impressive survival benefits seen to checkpoint blockade in other malignancies have provided great hope for an expanding role of immunotherapies in breast cancer management. While these novel therapies are currently being investigated in clinical trials, signals of efficacy, and tolerability in early phase studies suggest these will eventually make their way into standard practice algorithms. Ongoing research has highlighted a high degree of intertumoural heterogeneity in tumour lymphocytic infiltrates, suggesting some tumours or subtypes are more immunogenic than others. Furthermore, tumour intrinsic mechanisms of immune evasion are beginning to be uncovered, potentially representing key therapeutic targets to use in combination with checkpoint blockade, exemplifying the emerging concept of personalised medicine approaches to immune therapies. Subsequently, different immunotherapeutic strategies may be required based on stratification by these factors-for the minority of tumours with a high level of pre-existing immunity, immune checkpoint blockade monotherapy may be sufficient. However, for the majority of tumours with lower levels of pre-existing immunity, combination approaches will likely be required to achieve maximal therapeutic effect. Results of ongoing clinical trials including combinations with chemotherapy, radiation therapy, and targeted therapies are eagerly awaited.
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Affiliation(s)
- Mariam Mansour
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, 305 Grattan St, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, 3010, Australia
| | - Zhi Ling Teo
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, 305 Grattan St, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, 3010, Australia
| | - Stephen J Luen
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, 305 Grattan St, Melbourne, Victoria, 3000, Australia. .,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, 3010, Australia.
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Grizzi G, Caccese M, Gkountakos A, Carbognin L, Tortora G, Bria E, Pilotto S. Putative predictors of efficacy for immune checkpoint inhibitors in non-small-cell lung cancer: facing the complexity of the immune system. Expert Rev Mol Diagn 2017; 17:1055-1069. [DOI: 10.1080/14737159.2017.1393333] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Giulia Grizzi
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mario Caccese
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Luisa Carbognin
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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22
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Ascierto PA, Daniele B, Hammers H, Hirsh V, Kim J, Licitra L, Nanda R, Pignata S. Perspectives in immunotherapy: meeting report from the "Immunotherapy Bridge", Napoli, November 30th 2016. J Transl Med 2017; 15:205. [PMID: 29020960 PMCID: PMC5637331 DOI: 10.1186/s12967-017-1309-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/30/2017] [Indexed: 12/26/2022] Open
Abstract
The complex interactions between the immune system and tumors lead the identification of key molecules that govern these interactions: immunotherapeutics were designed to overcome the mechanisms broken by tumors to evade immune destruction. After the substantial advances in melanoma, immunotherapy currently includes many other type of cancers, but the melanoma lesson is essential to progress in other type of cancers, since immunotherapy is potentially improving clinical outcome in various solid and haematologic malignancies. Monotherapy in pre-treated NSCLC is studied and the use of nivolumab, pembrolizumab and atezolizumab as second-line of advanced NSCLC is demonstrated as well as first line monotherapy and combination therapy in metastatic NSCLC studied. Patients with HNSCC have immunotherapeutic promises as well: the FDA recently approved moAbs targeting immune checkpoint receptors. Nivolumab in combination with ipilumumab showed acceptable safety and encouraging antitumor activity in metastatic renal carcinoma. HCCs have significant amounts of genomic heterogeneity and multiple oncogenic pathways can be activated: the best therapeutic targets identification is ongoing. The treatment of advanced/relapsed EOC remain clearly an unmet need: a better understanding of the relevant immuno-oncologic pathways and their corresponding biomarkers are required. UC is an immunotherapy-responsive disease: after atezolizumab, three other PD-L1/PD-L1 inhibitors (nivolumab, durvalumab, and avelumab) were approved for treatment of platinum-refractory metastatic urothelial carcinoma. Anti-PD-1/PD-L1 monotherapy is associated with a modest response rate in metastatic breast cancer; the addition of chemotherapy is associated with higher response rates. Immunotherapy safety profile is advantageous, although, in contrast to conventional chemotherapy: boosting the immune system leads to a unique constellation of inflammatory toxicities known as immune-related Adverse Events (irAEs) that may warrant the discontinuation of therapy and/or the administration of immunosuppressive agents. Research should explore better combination with less side effects, the right duration of treatments, combination or sequencing treatments with target therapies. At present, treatment decision is based on patient's characteristics.
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Affiliation(s)
- Paolo A. Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Bruno Daniele
- Department of Oncology and Medical Oncology Unit, G. Rummo Hospital, Benevento, Italy
| | | | - Vera Hirsh
- McGill Department of Oncology, McGill University, Montreal, Canada
| | - Joseph Kim
- Medical Oncology, Yale School of Medicine, New Haven, CT USA
| | - Lisa Licitra
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rita Nanda
- Section of Hematology–Oncology, Department of Medicine, The University of Chicago, Chicago, IL USA
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori “Fondazione G. Pascale”, Naples, Italy
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Pillai RN, Behera M, Owonikoko TK, Kamphorst AO, Pakkala S, Belani CP, Khuri FR, Ahmed R, Ramalingam SS. Comparison of the toxicity profile of PD-1 versus PD-L1 inhibitors in non-small cell lung cancer: A systematic analysis of the literature. Cancer 2017; 124:271-277. [PMID: 28960263 DOI: 10.1002/cncr.31043] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Monoclonal antibodies against programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) are effective therapies in patients with non-small cell lung cancer (NSCLC). Herein, the authors performed a systematic review investigating differences in the toxicities of PD-1 and PD-L1 inhibitors. METHODS An electronic literature search was performed of public databases (MEDLINE, Excerpta Medica dataBASE [EMBASE], and Cochrane) and conference proceedings for trials using PD-1 inhibitors (nivolumab and pembrolizumab) and PD-L1 inhibitors (atezolizumab, durvalumab, and avelumab) in patients with NSCLC. A formal systematic analysis was conducted with Comprehensive Meta-Analysis software (version 2.2). Clinical and demographic characteristics, response, and toxicity data were compared between both groups. RESULTS A total of 23 studies reported between 2013 and 2016 were eligible for analysis. The total number of patients evaluated for toxicities was 3284 patients in the PD-1 group and 2460 patients in the PD-L1 group. The baseline patient characteristics of the 2 groups were similar, although there was a trend toward increased squamous histology in the group treated with PD-L1 (32% vs 25%; P = .6). There was no difference in response rate noted between PD-1 (19%) and PD-L1 (18.6%) inhibitors (P = .17). The incidence of overall adverse events (AEs) was comparable between the PD-1 and PD-L1 inhibitors (64% [95% confidence interval (95% CI), 63%-66%] vs 66% [95% CI, 65%-69%]; P = .8). Fatigue was the most frequently reported AE with both classes of drugs. Patients treated with PD-1 inhibitors were found to have a slightly increased rate of immune-related AEs (16% [95% CI, 14%-17%] vs 11% [95% CI, 10%-13%]; P = .07) and pneumonitis (4% [95% CI, 3%-5%] vs 2% [95% CI, 1%-3%]; P = .01) compared with patients who received PD-L1 inhibitors. CONCLUSIONS In this systematic review involving 5744 patients with NSCLC, the toxicity and efficacy profiles of PD-1 and PD-L1 inhibitors appear to be similar. Cancer 2018;124:271-7. © 2017 American Cancer Society.
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Affiliation(s)
- Rathi N Pillai
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Madhusmita Behera
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Alice O Kamphorst
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University, Atlanta, Georgia
| | - Suchita Pakkala
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Chandra P Belani
- Pennsylvania University, Penn State Hershey Cancer Institute, Hershey, Pennsylvania
| | - Fadlo R Khuri
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Rafi Ahmed
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Thunnissen E, de Langen AJ, Smit EF. PD-L1 IHC in NSCLC with a global and methodological perspective. Lung Cancer 2017; 113:102-105. [PMID: 29110835 DOI: 10.1016/j.lungcan.2017.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/27/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
In summary, the PD-L1 biomarker discussed here highlights the importance of understanding the practice of IHC. This can be used to the patients advantage, with appropriate usage. The currently available literature on PD-L1 IHC from a methodologic point of view has not shown that different assays are comparable. The route of laboratory developed test and commercial test validation is the same: challenging and complex. Executing this process along proper methodologic lines is needed to ensure that patients receive the most accurate and representative test outcomes.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands
| | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands; Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
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25
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Janzic U, Kern I, Janzic A, Cavka L, Cufer T. PD-L1 Expression in Squamous-cell Carcinoma and Adenocarcinoma of the Lung. Radiol Oncol 2017; 51:357-362. [PMID: 28959173 PMCID: PMC5612001 DOI: 10.1515/raon-2017-0037] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/09/2017] [Indexed: 12/26/2022] Open
Abstract
Background With introduction of immunotherapy (IT) into the treatment of advanced non-small-cell lung cancer (NSCLC), a need for predictive biomarker became apparent. Programmed death ligand 1 (PD-L1) protein expression is most widely explored predictive marker for response to IT. We assessed PD-L1 expression in tumor cells (TC) and immune cells (IC) of squamous-cell carcinoma (SCC) and adenocarcinoma (AC) patients. Patients and methods We obtained 54 surgically resected tumor specimens and assessed PD-L1 expression by immunohistochemistry after staining them with antibody SP142 (Ventana, USA). Clinicopathological characteristics were acquired from the hospital registry database. Results were analyzed according to cut-off values of ≥ 5% and ≥ 10% of PD-L1 expression on either TC or IC. Results 29 (54%) samples were AC and 25 (46%) were SCC. PD-L1 expression was significantly higher in TC of SCC compared to AC at both cut-off values (52% vs. 17%, p = 0.016 and 52% vs. 14%, p = 0.007, respectively) no difference in PD-L1 expression in IC of SCC and AC was found. In AC alone, PD-L1 expression was significantly higher in IC compared to TC at both cut-off values (72% vs. 17%, p < 0.001 and 41% vs. 14%, p = 0.008, respectively), while no significant difference between IC and TC PD-L1 expression was revealed in SCC. Conclusions Our results suggest a significantly higher PD-L1 expression in TC of SCC compared to AC, regardless of the cut-off value. PD-L1 expression in IC is high in both histological subtypes of NSCLC, and adds significantly to the overall positivity of AC but not SCC.
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Affiliation(s)
- Urska Janzic
- Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia
| | - Izidor Kern
- Department of Pathology, University Clinic Golnik, Golnik, Slovenia
| | - Andrej Janzic
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Luka Cavka
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Tanja Cufer
- Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia
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26
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Kumar SS, Higgins KA, McGarry RC. Emerging Therapies for Stage III Non-Small Cell Lung Cancer: Stereotactic Body Radiation Therapy and Immunotherapy. Front Oncol 2017; 7:197. [PMID: 28929083 PMCID: PMC5591326 DOI: 10.3389/fonc.2017.00197] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 12/25/2022] Open
Abstract
The current standard of care for locally advanced non-small cell lung cancer (NSCLC) includes radiation, chemotherapy, and surgery in certain individualized cases. In unresectable NSCLC, chemoradiation has been the standard of care for the past three decades. Local and distant failure remains high in this group of patients, so dose escalation has been studied in both single institution and national clinical trials. Though initial studies showed a benefit to dose escalation, phase III studies examining dose escalation using standard fractionation or hyperfractionation have failed to show a benefit. Over the last 17 years, stereotactic body radiation therapy (SBRT) has shown a high degree of safety and local control for stage I lung cancers and other localized malignancies. More recently, phase I/II studies using SBRT for dose escalation after conventional chemoradiation in locally advanced NSCLC have been promising with good apparent safety. Immunotherapy also offers opportunities to address distant disease and preclinical data suggest immunotherapy in tandem with SBRT may be a rational way to induce an “abscopal effect” although there are little clinical data as yet. By building on the proven concept of conventional chemoradiation for patients with locally advanced NSCLC with a subsequent radiation dose intensification to residual disease with SBRT concurrent with immunotherapy, we hope address the issues of metastatic and local failures. This “quadmodality” approach is still in its infancy but appears to be a safe and rational approach to the improving the outcome of NSCLC therapy.
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Affiliation(s)
- Sameera S Kumar
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, United States
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, The Emory Clinic, Atlanta, GA, United States
| | - Ronald C McGarry
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, United States
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27
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Affiliation(s)
- Martin Reck
- From LungenClinic Grosshansdorf and Airway Research Center North, Grosshansdorf (M.R., K.F.R.), the German Center for Lung Research, Giessen (M.R., K.F.R.), University of Lübeck, Lübeck (M.R.), and Christian Albrechts University Kiel, Kiel (K.F.R.) - all in Germany
| | - Klaus F Rabe
- From LungenClinic Grosshansdorf and Airway Research Center North, Grosshansdorf (M.R., K.F.R.), the German Center for Lung Research, Giessen (M.R., K.F.R.), University of Lübeck, Lübeck (M.R.), and Christian Albrechts University Kiel, Kiel (K.F.R.) - all in Germany
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28
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Hanna N, Johnson D, Temin S, Masters G. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Summary. J Oncol Pract 2017; 13:832-837. [PMID: 28850309 DOI: 10.1200/jop.2017.026716] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nasser Hanna
- Indiana University Simon Cancer Center, Indianapolis, IN; University of Texas Southwestern Medical Center, Dallas, TX; American Society of Clinical Oncology, Alexandria, VA; Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - David Johnson
- Indiana University Simon Cancer Center, Indianapolis, IN; University of Texas Southwestern Medical Center, Dallas, TX; American Society of Clinical Oncology, Alexandria, VA; Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Sarah Temin
- Indiana University Simon Cancer Center, Indianapolis, IN; University of Texas Southwestern Medical Center, Dallas, TX; American Society of Clinical Oncology, Alexandria, VA; Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Gregory Masters
- Indiana University Simon Cancer Center, Indianapolis, IN; University of Texas Southwestern Medical Center, Dallas, TX; American Society of Clinical Oncology, Alexandria, VA; Helen F. Graham Cancer Center and Research Institute, Newark, DE
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29
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Flynn MJ, Larkin JM. Novel combination strategies for enhancing efficacy of immune checkpoint inhibitors in the treatment of metastatic solid malignancies. Expert Opin Pharmacother 2017; 18:1477-1490. [DOI: 10.1080/14656566.2017.1369956] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Michael J. Flynn
- Department of Medical Oncology, Royal Marsden Hospital, London, United Kingdom
| | - James M.G. Larkin
- Department of Medical Oncology, Royal Marsden Hospital, London, United Kingdom
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30
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Ott PA, Elez E, Hiret S, Kim DW, Morosky A, Saraf S, Piperdi B, Mehnert JM. Pembrolizumab in Patients With Extensive-Stage Small-Cell Lung Cancer: Results From the Phase Ib KEYNOTE-028 Study. J Clin Oncol 2017; 35:3823-3829. [PMID: 28813164 DOI: 10.1200/jco.2017.72.5069] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The safety and efficacy of pembrolizumab, a humanized monoclonal antibody against programmed death 1 (PD-1), were assessed in patients with programmed death ligand 1 (PD-L1)-expressing extensive-stage small-cell lung cancer (SCLC) in the multicohort, phase Ib open-label KEYNOTE-028 study ( ClinicalTrials.gov identifier: NCT02054806). Methods Patients with SCLC received pembrolizumab 10 mg/kg every 2 weeks for 24 months or until disease progression or intolerable toxicity occurred. PD-L1 expression was assessed by immunohistochemistry. PD-L1-positive patients had membranous PD-L1 expression in ≥ 1% of tumor and associated inflammatory cells or positive staining in stroma. Response was assessed by investigator per Response Evaluation Criteria in Solid Tumors version 1.1 every 8 weeks for the first 6 months and every 12 weeks thereafter. Adverse events (AEs) were reported per the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Primary end points were safety, tolerability, and objective response rate (ORR). Secondary end points included progression-free survival, overall survival, and duration of response. Results Twenty-four patients with PD-L1-expressing SCLC were enrolled and received at least one pembrolizumab dose. At the data cutoff date (June 20, 2016), the median follow-up duration was 9.8 months (range, 0.5 to 24 months). All 24 patients experienced AEs; the most common were asthenia (n = 7), fatigue (n = 7), and cough (n = 6). Two patients experienced grade 3 to 5 treatment-related AEs: one patient had elevated bilirubin, and one patient had asthenia, grade 5 colitis, and intestinal ischemia. One patient had a complete response, and seven patients had partial responses, resulting in an ORR of 33% (95% CI, 16% to 55%). Conclusion The safety of pembrolizumab was consistent with the known safety profile in other tumor types. Pembrolizumab demonstrated promising antitumor activity in patients with pretreated, PD-L1-expressing SCLC.
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Affiliation(s)
- Patrick A Ott
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Elena Elez
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sandrine Hiret
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Wan Kim
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Anne Morosky
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sanatan Saraf
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Bilal Piperdi
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janice M Mehnert
- Patrick A. Ott, Dana-Farber Cancer Institute, Boston, MA; Elena Elez, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Sandrine Hiret, ICO René Gauducheau, Nantes, France; Dong-Wan Kim, Seoul National University Hospital, Seoul, South Korea; Anne Morosky, Sanatan Saraf, and Bilal Piperdi, Merck & Co, Kenilworth; and Janice M. Mehnert, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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31
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Lievense LA, Sterman DH, Cornelissen R, Aerts JG. Checkpoint Blockade in Lung Cancer and Mesothelioma. Am J Respir Crit Care Med 2017; 196:274-282. [PMID: 28252315 DOI: 10.1164/rccm.201608-1755ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In the last decade, immunotherapy has emerged as a new treatment modality in cancer. The most success has been achieved with the class of checkpoint inhibitors (CPIs), antibodies that unleash the antitumor immune response. After the success in melanoma, numerous clinical trials are being conducted investigating CPIs in lung cancer and mesothelioma. The programmed death protein (PD) 1-PD ligand 1/2 pathway and cytotoxic T lymphocyte-associated protein 4 are currently the most studied immunotherapeutic targets in these malignancies. In non-small cell lung cancer, anti-PD-1 antibodies have become part of the approved treatment arsenal. In small cell lung cancer and mesothelioma, the efficacy of checkpoint inhibition has not yet been proven. In this Concise Clinical Review, an overview of the landmark clinical trials investigating checkpoint blockade in lung cancer and mesothelioma is provided. Because response rates are around 20% in the majority of clinical trials, there is much room for improvement. Predictive biomarkers are therefore essential to fully develop the potential of CPIs. To increase efficacy, multiple clinical trials investigating the combination of cytotoxic T lymphocyte-associated protein 4 inhibitors and PD-1/PD ligand 1 blockade in lung cancer and mesothelioma are being conducted. Given the potential benefit of immunotherapy, implementation of current and new knowledge in trial designs and interpretation of results is essential for moving forward.
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Affiliation(s)
- Lysanne A Lievense
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.,2 Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands; and
| | - Daniel H Sterman
- 3 Division of Pulmonary, Critical Care, and Sleep Medicine, New York University (NYU) School of Medicine/NYU Langone Medical Center, New York, New York
| | - Robin Cornelissen
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Joachim G Aerts
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.,2 Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands; and
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32
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Hanna N, Johnson D, Temin S, Baker S, Brahmer J, Ellis PM, Giaccone G, Hesketh PJ, Jaiyesimi I, Leighl NB, Riely GJ, Schiller JH, Schneider BJ, Smith TJ, Tashbar J, Biermann WA, Masters G. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 35:3484-3515. [PMID: 28806116 DOI: 10.1200/jco.2017.74.6065] [Citation(s) in RCA: 442] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Provide evidence-based recommendations updating the 2015 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC). Methods The ASCO NSCLC Expert Panel made recommendations based on a systematic review of randomized controlled trials from February 2014 to December 2016 plus the Cancer Care Ontario Program in Evidence-Based Care's update of a previous ASCO search. Results This guideline update reflects changes in evidence since the previous guideline update. Fourteen randomized controlled trials provide the evidence base; earlier phase trials also informed recommendation development. Recommendations New or revised recommendations include the following. Regarding first-line treatment for patients with non-squamous cell carcinoma or squamous cell carcinoma (without positive markers, eg, EGFR/ALK /ROS1), if the patient has high programmed death ligand 1 (PD-L1) expression, pembrolizumab should be used alone; if the patient has low PD-L1 expression, clinicians should offer standard chemotherapy. All other clinical scenarios follow 2015 recommendations. Regarding second-line treatment in patients who received first-line chemotherapy, without prior immune checkpoint therapy, if NSCLC tumor is positive for PD-L1 expression, clinicians should use single-agent nivolumab, pembrolizumab, or atezolizumab; if tumor has negative or unknown PD-L1 expression, clinicians should use nivolumab or atezolizumab. All immune checkpoint therapy is recommended alone plus in the absence of contraindications. For patients who received a prior first-line immune checkpoint inhibitor, clinicians should offer standard chemotherapy. For patients who cannot receive immune checkpoint inhibitor after chemotherapy, docetaxel is recommended; in patients with nonsquamous NSCLC, pemetrexed is recommended. In patients with a sensitizing EGFR mutation, disease progression after first-line epidermal growth factor receptor tyrosine kinase inhibitor therapy, and T790M mutation, osimertinib is recommended; if NSCLC lacks the T790M mutation, then chemotherapy is recommended. Patients with ROS1 gene rearrangement without prior crizotinib may be offered crizotinib, or if they previously received crizotinib, they may be offered chemotherapy.
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Affiliation(s)
- Nasser Hanna
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - David Johnson
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Sarah Temin
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Sherman Baker
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Julie Brahmer
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Peter M Ellis
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Giuseppe Giaccone
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Paul J Hesketh
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Ishmael Jaiyesimi
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Natasha B Leighl
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Gregory J Riely
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Joan H Schiller
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Bryan J Schneider
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Thomas J Smith
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Joan Tashbar
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - William A Biermann
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Gregory Masters
- Nasser Hanna, Indiana University Simon Cancer Center, Indianapolis, IN; David Johnson, University of Texas Southwestern Medical Center, Dallas, TX; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University Health System Massey Cancer Center, Richmond; Joan H. Schiller, Inova Schar Cancer Institute, Fairfax, VA; Julie Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton; Natasha B. Leighl, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Giuseppe Giaccone, Georgetown University, Washington, DC; Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Ishmael Jaiyesimi, William Beaumont Hospital, Royal Oak; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Gregory J. Riely, Memorial Sloan-Kettering Cancer Center, New York, NY; Joan Tashbar, Circle of Hope for Cancer Research, Orlando, FL; William A. Biermann, Einstein Medical Center Montgomery, East Norriton, PA; and Gregory Masters, Helen F. Graham Cancer Center and Research Institute, Newark, DE
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Tibaldi C, Lunghi A, Baldini E. Use of programmed cell death protein ligand 1 assay to predict the outcomes of non-small cell lung cancer patients treated with immune checkpoint inhibitors. World J Clin Oncol 2017; 8:320-328. [PMID: 28848698 PMCID: PMC5554875 DOI: 10.5306/wjco.v8.i4.320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/13/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
The recent discovery of immune checkpoints inhibitors, especially anti-programmed cell death protein 1 (PD-1) and anti-programmed cell death protein ligand 1 (PD-L1) monoclonal antibodies, has opened new scenarios in the management of non-small cell lung cancer (NSCLC) and this new class of drugs has achieved a rapid development in the treatment of this disease. However, considering the costs of these drugs and the fact that only a subset of patients experience long-term disease control, the identification of predictive biomarkers for the selection of candidates suitable for treatment has become a priority. The research focused mainly on the expression of the PD-L1 receptor on both tumor cells and/or immune infiltrates determined by immunohistochemistry (IHC). However, different checkpoint inhibitors were tested, different IHC assays were used, different targets were considered (tumor cells, immune infiltrates or both) and different expression thresholds were employed in clinical trials. In some trials the assay was used prospectively to select the patients, while in other trials it was evaluated retrospectively. Some confusion emerges, which makes it difficult to easily compare the literature data and to translate them in practice management. This mini-review shows the possibilities and pitfalls of the PD-L1 expression to predict the activity and efficacy of anti PD1/PD-L1 monoclonal antibodies in the treatment of NSCLC.
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Douillard JY. ESMO Copenhagen 2016: a lung cancer 'grand cru'. ESMO Open 2017; 2:e000196. [PMID: 28761753 PMCID: PMC5519794 DOI: 10.1136/esmoopen-2017-000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jean-Yves Douillard
- Chief Medical Officer, European Society for Medical Oncology, Viganello, TI, Switzerland
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Soo RA, Stone ECA, Cummings KM, Jett JR, Field JK, Groen HJM, Mulshine JL, Yatabe Y, Bubendorf L, Dacic S, Rami-Porta R, Detterbeck FC, Lim E, Asamura H, Donington J, Wakelee HA, Wu YL, Higgins K, Senan S, Solomon B, Kim DW, Johnson M, Yang JCH, Sequist LV, Shaw AT, Ahn MJ, Costa DB, Patel JD, Horn L, Gettinger S, Peters S, Wynes MW, Faivre-Finn C, Rudin CM, Tsao A, Baas P, Kelly RJ, Leighl NB, Scagliotti GV, Gandara DR, Hirsch FR, Spigel DR. Scientific Advances in Thoracic Oncology 2016. J Thorac Oncol 2017; 12:1183-1209. [PMID: 28579481 DOI: 10.1016/j.jtho.2017.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Abstract
Lung cancer care is rapidly changing with advances in genomic testing, the development of next-generation targeted kinase inhibitors, and the continued broad study of immunotherapy in new settings and potential combinations. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in thoracic cancer and care provide focused updates across multiple areas, including prevention and early detection, molecular diagnostics, pathology and staging, surgery, adjuvant therapy, radiotherapy, molecular targeted therapy, and immunotherapy for NSCLC, SCLC, and mesothelioma. Quality and value of care and perspectives on the future of lung cancer research and treatment have also been included in this concise review.
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Affiliation(s)
- Ross A Soo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; School of Surgery, University of Western Australia, Perth, Australia
| | - Emily C A Stone
- Department of Thoracic Medicine, St. Vincent's Hospital, Kinghorn Cancer Centre, Sydney, Australia
| | - K Michael Cummings
- Hollings Cancer Center Medical University of South Carolina, Charleston, South Carolina
| | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - James L Mulshine
- Internal Medicine, Graduate College, Rush University Medical Center, Chicago, Illinois
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Network of Biomedical Research Centers in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | | | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Jessica Donington
- Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kristin Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - James C H Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Republic of China
| | - Lecia V Sequist
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Myung-Ju Ahn
- Section of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Daniel B Costa
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jyoti D Patel
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Leora Horn
- Division of Hematology/Oncology, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Scott Gettinger
- Medical Oncology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Solange Peters
- Medical Oncology and Thoracic Malignancies, Oncology Department, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Aurora, Colorado
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Charles M Rudin
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Tsao
- Mesothelioma Program, Thoracic Chemo-Radiation Program, Department of Thoracic/Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Paul Baas
- Department of Chest Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ronan J Kelly
- Deptartment of Medical Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Natasha B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | - David R Gandara
- Thoracic Oncology Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
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Aguiar PN, De Mello RA, Barreto CMN, Perry LA, Penny-Dimri J, Tadokoro H, Lopes GDL. Immune checkpoint inhibitors for advanced non-small cell lung cancer: emerging sequencing for new treatment targets. ESMO Open 2017; 2:e000200. [PMID: 29209522 PMCID: PMC5703392 DOI: 10.1136/esmoopen-2017-000200] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 12/20/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in the world. Immune checkpoint inhibitors (ICI) stimulate cytotoxic lymphocyte activity against tumour cells. These agents are available for the treatment of non-small cell lung cancer (NSCLC) after failure of platinum-based therapy. One recent study has demonstrated that ICI monotherapy was superior to platinum-based chemotherapy for first-line treatment. Nevertheless, this benefit was only for a minority of the population (30%) whose tumour programmed death receptor ligand-1 (PD-L1) expression was above 50%. Therefore, several strategies are under investigation. One option for patients with PD-L1 expression lower than 50% may be the combination of ICI with platinum-based chemotherapy or with ICIs against different targets. However, all of these combinations are at an early stage of investigation and may be very expensive or toxic, producing several harmful adverse events.
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Affiliation(s)
| | - Ramon Andrade De Mello
- Department of Biomedical Sciences and Medicine, Division of Medical Oncology, University of Algarve, Faro, Portugal
| | | | | | | | - Hakaru Tadokoro
- Division of Medical Oncology, Federal University of São Paulo, São Paulo, Brazil
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Schallenberg S, Merkelbach-Bruse S, Buettner R. Lung cancer as a paradigm for precision oncology in solid tumours. Virchows Arch 2017; 471:221-233. [PMID: 28730537 DOI: 10.1007/s00428-017-2183-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/19/2017] [Accepted: 06/25/2017] [Indexed: 02/06/2023]
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in the western world. However, the combination of molecular genotyping and subsequent systematic treatment of decoded target structures is a prime example of precision oncology in solid tumours. In this review, current targets of approved therapeutics and potential targets in clinical and preclinical trials are outlined. Furthermore, immune checkpoint inhibitors, as promising new therapeutic options, which have already been applied successfully in cases of lung cancer, are introduced. A major issue of targeted treatment of lung tumours is the persistent development of resistance. The underlying mechanisms and established and potentially applicable alternative therapeutic approaches are described. In this process of precision oncology, immunohistochemistry, fluorescence in situ hybridization, and parallel sequencing are crucial diagnostic tools.
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Affiliation(s)
- Simon Schallenberg
- Institute of Pathology, University Hospital and Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Institute of Pathology, University Hospital and Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Reinhard Buettner
- Institute of Pathology, University Hospital and Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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O’reilly A, Larkin J. Checkpoint inhibitors in advanced melanoma: effect on the field of immunotherapy. Expert Rev Anticancer Ther 2017; 17:647-655. [DOI: 10.1080/14737140.2017.1341315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Aine O’reilly
- Department of Renal & Melanoma, Royal Marsden Hospital, London, UK
| | - James Larkin
- Department of Renal & Melanoma, Royal Marsden Hospital, London, UK
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Somasundaram A, Burns TF. The next generation of immunotherapy: keeping lung cancer in check. J Hematol Oncol 2017; 10:87. [PMID: 28434399 PMCID: PMC5402056 DOI: 10.1186/s13045-017-0456-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/29/2017] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the deadliest malignancy with more cancer deaths per year than the next three cancers combined. Despite remarkable advances in targeted therapy, advanced lung cancer patients have not experienced a significant improvement in mortality. Lung cancer has been shown to be immunogenic and responsive to checkpoint blockade therapy. Checkpoint signals such as CTLA-4 and PD-1/PD-L1 dampen T cell activation and allow tumors to escape the adaptive immune response. Response rates in patients with pretreated, advanced NSCLC were much higher and more durable with PD-1 blockade therapy compared to standard-of-care, cytotoxic chemotherapy. Therefore, PD-1 inhibitors such as nivolumab and pembrolizumab were rapidly approved for both squamous and nonsquamous lung cancer in the pretreated population. The advent of these new therapies have revolutionized the treatment of lung cancer; however, the majority of NSCLC patients still do not respond to PD-1/PD-L1 inhibition leaving an unmet need for a large and growing population. Immunotherapy combinations with chemotherapy, radiation therapy, or novel immunomodulatory agents are currently being examined with the hope of achieving higher response rates and improving overall survival rate. Chemotherapy and radiation therapy has been theorized to increase the release of tumor antigen leading to increased responses with immunotherapy. However, cytotoxic chemotherapy and radiation therapy may also destroy actively proliferating T cells. The correct combination and order of therapy is under investigation. The majority of patients who do respond to immunotherapy have a durable response attributed to the effect of adaptive immune system’s memory. Unfortunately, some patients’ tumors do progress afterward and investigation of checkpoint blockade resistance is still nascent. This review will summarize the latest efficacy and safety data for early and advanced NSCLC in both the treatment-naïve and pretreated settings. The emerging role of immunotherapy for the treatment of small cell lung cancer and malignant mesothelioma will also be discussed.
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Affiliation(s)
| | - Timothy F Burns
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Hillman Cancer Center Research Pavilion, 5117 Centre Avenue, Pittsburgh, PA, 15213-1863, USA.
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40
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Iafolla MAJ, Juergens RA. Update on Programmed Death-1 and Programmed Death-Ligand 1 Inhibition in the Treatment of Advanced or Metastatic Non-Small Cell Lung Cancer. Front Oncol 2017; 7:67. [PMID: 28428947 PMCID: PMC5382272 DOI: 10.3389/fonc.2017.00067] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/23/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Non-small-cell lung cancer (NSCLC) has a large worldwide prevalence with a high mortality rate. Chemotherapy has offered modest improvements in survival over the past two decades. Immune checkpoint modulation with programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibition has shown the promise of changing the future landscape of cancer therapy. This update reviews recent advances in the treatment of NSCLC with immune checkpoint modulation. METHODS Publications and proceedings were identified from searching PubMed and proceedings from the annual meetings of the American Society of Clinical Oncology, European Society for Medical Oncology, and European Lung Cancer Conference. RESULTS Atezolizumab, nivolumab, and pembrolizumab increase overall survival in second-line treatment of Stage III/IV squamous and non-squamous NSCLC when compared to docetaxel. Pembrolizumab increases progression-free survival in the first-line treatment of Stage IV NSCLC with 50% PD-L1 expression when compared to platinum-based chemotherapy. Combination therapy with chemotherapy and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors has shown promise in early trials. CONCLUSION Immune checkpoint modulation produces durable responses and overall survival benefits with less toxicity compared to conventional chemotherapy. Future investigations are combining PD-1/L1 inhibition with chemotherapy, targeted therapy, or other immuno-oncology agents in an effort to further improve efficacy.
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Affiliation(s)
- Marco A J Iafolla
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Rosalyn A Juergens
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
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Fessas P, Lee H, Ikemizu S, Janowitz T. A molecular and preclinical comparison of the PD-1-targeted T-cell checkpoint inhibitors nivolumab and pembrolizumab. Semin Oncol 2017; 44:136-140. [PMID: 28923212 PMCID: PMC5612055 DOI: 10.1053/j.seminoncol.2017.06.002] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/27/2017] [Indexed: 01/05/2023]
Abstract
T-cell checkpoint inhibition has a profound impact on cancer care and the programmed cell death protein 1 (PD-1)-targeted antibodies nivolumab and pembrolizumab have been two of the lead molecules of this therapeutic revolution. Their clinical comparability is a highly relevant topic of discussion, but to a significant degree is a consequence of their molecular properties. Here we provide a molecular, preclinical, and early clinical comparison of the two antibodies, based on the available data and recent literature. We acknowledge the limitations of such comparisons, but suggest that based on the available data, differences in clinical trial outcomes between nivolumab and pembrolizumab are more likely drug-independent than drug-dependent.
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Affiliation(s)
- Petros Fessas
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Hassal Lee
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Shinji Ikemizu
- Division of Structural Biology, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tobias Janowitz
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, United Kingdom; Department of Oncology, University of Cambridge, Cambridge Biomedical Research Centre and Addenbrooke's Hospital, Cambridge, United Kingdom.
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Sun JM. PD-1/PD-L1 inhibitor therapy: transitioning from a second-line to a first-line therapy for non-small cell lung cancer. PRECISION AND FUTURE MEDICINE 2017. [DOI: 10.23838/pfm.2017.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Melosky B. Current Treatment Algorithms for Patients with Metastatic Non-Small Cell, Non-Squamous Lung Cancer. Front Oncol 2017; 7:38. [PMID: 28373963 PMCID: PMC5357779 DOI: 10.3389/fonc.2017.00038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/28/2017] [Indexed: 12/26/2022] Open
Abstract
The treatment paradigm for metastatic non-small cell, non-squamous lung cancer is continuously evolving due to new treatment options and our increasing knowledge of molecular signal pathways. As a result of treatments becoming more efficacious and more personalized, survival for selected groups of non-small cell lung cancer (NSCLC) patients is increasing. In this paper, three algorithms will be presented for treating patients with metastatic non-squamous, NSCLC. These include treatment algorithms for NSCLC patients whose tumors have EGFR mutations, ALK rearrangements, or wild-type/wild-type tumors. As the world of immunotherapy continues to evolve quickly, a future algorithm will also be presented.
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Affiliation(s)
- Barbara Melosky
- Medical Oncology, British Columbia Cancer Agency, Vancouver Centre , Vancouver, BC , Canada
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Remon J, Besse B, Soria JC. Successes and failures: what did we learn from recent first-line treatment immunotherapy trials in non-small cell lung cancer? BMC Med 2017; 15:55. [PMID: 28285592 PMCID: PMC5346853 DOI: 10.1186/s12916-017-0819-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/16/2017] [Indexed: 12/13/2022] Open
Abstract
The immune checkpoint inhibitors have significantly modified the therapeutic landscape of advanced non-small cell lung cancer in second-line and, more recently, first-line settings. Because of the superior outcome with pembrolizumab as an upfront strategy, PD-L1 status should now be considered a new reflex biomarker for guiding first-line treatment in patients with advanced non-small cell lung cancer. Improved responses have also been reported with the combination of immune checkpoint inhibitors and chemotherapy as the first-line treatment; however, this strategy has not yet been validated by phase III trial data and its interplay with PD-L1 status still requires clarification.In this manuscript we review the contradictory results of recent phase III trials with immune checkpoint inhibitors in the first-line setting, the potential reasons for discrepancies, and some of the remaining open questions related to the positioning of immune checkpoint inhibitors in the first-line setting of non-small cell lung cancer.
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Affiliation(s)
- Jordi Remon
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,Medical Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,University Paris-Sud, Orsay, France
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Shum E, Wang F, Kim S, Perez-Soler R, Cheng H. Investigational therapies for squamous cell lung cancer: from animal studies to phase II trials. Expert Opin Investig Drugs 2017; 26:415-426. [PMID: 28277882 DOI: 10.1080/13543784.2017.1302425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION It remains challenging to treat squamous cell lung cancer (SCC) with limited therapeutic options. However, recent breakthroughs in targeted therapies and immunotherapies have shed some light on the management of this deadly disease. Areas covered: The article first reviews the current treatment options for advanced SCC, especially recent FDA approved molecular agents (afatinib, ramucirumab and necitumumab) and immunotherapies (nivolumab, pembrolizumab and atezolimumab). We then provide an overview on investigational therapies with data ranging from preclinical to phase II studies, focusing on new cytotoxic agents, emerging molecularly targeted agents (including a PARP inhibitor for Homologous Recombinant Deficiency positive SCC) and novel immunotherapeutic strategies. Expert opinion summary: Identification of potential therapeutic targets, development of novel clinical trials and the rapid approvals of immune checkpoint inhibitors have shifted the management paradigm for squamous cell lung cancer. On the other hand, continued efforts are needed to identify the predictive biomarkers and to investigate novel mechanistically-driven mono- and combination therapies. We need to learn more about the biology behind immune checkpoint blockade and tumor genomics in SCC for better patient selection and future trial design.
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Affiliation(s)
- Elaine Shum
- a Department of Oncology , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA
| | - Feng Wang
- a Department of Oncology , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA
| | - Salem Kim
- a Department of Oncology , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA
| | - Roman Perez-Soler
- a Department of Oncology , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA
| | - Haiying Cheng
- a Department of Oncology , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA
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Zugazagoitia J, Molina-Pinelo S, Lopez-Rios F, Paz-Ares L. Biological therapies in nonsmall cell lung cancer. Eur Respir J 2017; 49:49/3/1601520. [PMID: 28254765 DOI: 10.1183/13993003.01520-2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/28/2016] [Indexed: 11/05/2022]
Abstract
Biological therapies have improved survival outcomes of advanced-stage nonsmall cell lung cancer (NSCLC). Genotype-directed therapies have changed treatment paradigms of patients with EGFR-mutant and ALK/ROS1-rearranged lung adenocarcinomas, and the list of druggable targets with demonstrated clinical actionability (BRAF, MET, RET, NTRK1 and HER2) continues to expand. Furthermore, we have incrementally understood the mechanisms of cancer immune evasion and foresee ways to effectively circumvent them, particularly at the immune checkpoint level. Drugs targeting the tumour immune-evasive PD-1 pathway have demonstrated remarkable treatment benefits in this disease, with a non-negligible fraction of patients potentially receiving long-term survival benefits. Herein, we briefly discuss the role of various medical disciplines in the management of advanced-stage NSCLC and review the most relevant biological therapies for this disease, with particular emphasis in genotype-directed therapies and immune checkpoint inhibitors.
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Affiliation(s)
- Jon Zugazagoitia
- Medical Oncology Dept, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain.,Lung Cancer Group, Clinical Research Program, CNIO (Centro Nacional de Investigaciones Oncológicas), Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain.,These authors contributed equally to this work
| | - Sonia Molina-Pinelo
- Medical Oncology Dept, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain.,Lung Cancer Group, Clinical Research Program, CNIO (Centro Nacional de Investigaciones Oncológicas), Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain.,These authors contributed equally to this work
| | - Fernando Lopez-Rios
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain.,Laboratorio de Dianas Terapéuticas, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Luis Paz-Ares
- Medical Oncology Dept, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain .,Lung Cancer Group, Clinical Research Program, CNIO (Centro Nacional de Investigaciones Oncológicas), Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain.,Complutense University, Madrid, Spain
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Santarpia M, Karachaliou N, Rosell R. Beyond platinum treatment for NSCLC: what does the future hold? Expert Rev Anticancer Ther 2017; 17:293-295. [PMID: 28129003 DOI: 10.1080/14737140.2017.1288103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mariacarmela Santarpia
- a Medical Oncology Unit, Department of Human Pathology 'G. Barresi' , University of Messina , Messina , Italy
| | - Niki Karachaliou
- b Institute of Oncology Rosell (IOR) , University Hospital Sagrat Cor , Barcelona , Spain
| | - Rafael Rosell
- c Institute of Oncology Rosell (IOR), Quirón-Dexeus University Institute , Barcelona , Spain.,d Cancer Biology & Precision Medicine Program , Catalan Institute of Oncology, Hospital Germans Trias i Pujol , Badalona , Barcelona , Spain.,e Cellular and Molecular Biology Laboratory, Germans Trias i Pujol Health Sciences Institute and Hospital , Badalona , Barcelona , Spain
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48
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Pirker R. Milestones in the systemic treatment of lung cancer. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2017; 10:22-26. [PMID: 28367252 PMCID: PMC5357246 DOI: 10.1007/s12254-017-0313-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/18/2017] [Indexed: 12/26/2022]
Abstract
Several milestones in the systemic treatment of lung cancer have been reached. Combination chemotherapy of small cell lung cancer was the first of these milestones. The establishment of palliative chemotherapy in patients with advanced non-small cell lung cancer and of adjuvant chemotherapy in patients with completely resected non-small cell lung cancer was another important milestone. Targeted therapies with angiogenesis inhibitors, EGFR inhibitors, and ALK inhibitors also advanced treatment. The clinical introduction of immune checkpoint inhibitors was the latest milestone.
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Affiliation(s)
- Robert Pirker
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Immune-checkpoint inhibition in first-line treatment of advanced non-small cell lung cancer patients: Current status and future approaches. Lung Cancer 2017; 106:70-75. [PMID: 28285697 DOI: 10.1016/j.lungcan.2017.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/04/2017] [Indexed: 01/06/2023]
Abstract
Immune checkpoint inhibitors are considered standard second-line treatment in advanced non-small cell lung cancer patients. This strategy has also become standard in first-line setting for a subgroup of patients with strongly positive PD-L1 tumors; therefore, PD-L1 status might be considered a new biomarker that deserves upfront testing. New combinations of immune checkpoint inhibitors and with chemotherapy have been tested in first-line treatment. However, some questions remain unanswered such as the best treatment strategy or the real upfront efficacy of these therapeutic strategies in the whole lung cancer population. In this review we summarize the main results in the first-line setting of recent phase III trials with immune checkpoint inhibitors in advanced non-small cell lung cancer patients.
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Evolution and Increasing Complexity of the Therapeutic Landscape in Advanced Non–Small-cell Lung Cancer. Clin Lung Cancer 2017; 18:1-4. [DOI: 10.1016/j.cllc.2016.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 11/22/2022]
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