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Imataki O, Uemura M, Fujita H, Kadowaki N. Pathological landscape of tumor flare reaction to epcoritamab treatment. Int J Hematol 2024; 120:467-471. [PMID: 39134865 DOI: 10.1007/s12185-024-03833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 09/21/2024]
Abstract
Tumor flare reaction (TFR) is characterized by an increase in lesion size during immune-based therapy, often resembling disease progression. It signifies inflammation at the tumor site and is frequently seen in immunotherapy, where it is termed "tumor pseudoprogression." The exact mechanisms behind TFR remain unclear. We report the case of a 62-year-old Japanese man with relapsed and refractory diffuse large B cell lymphoma treated with epcoritamab. On day 10 of the first epcoritamab cycle, after two subcutaneous injections of epcoritamab, the cutaneous lymphoma lesions became swollen. This was identified as TFR, and was managed with a three-day course of intravenous dexamethasone at 12 mg/day. The third injection, scheduled for day 15, was delayed by 1 week. Four doses of epcoritamab were completed over the initial 35-day period. A skin biopsy was performed on day 30. Histopathological examination showed CD20+ large atypical lymphocytes forming residual nodules, encircled by CD4+ and CD8+ lymphocytes, with a predominance of CD8+ T cells over CD4+ T cells. Although infrequent, TFR may be a significant indicator of tumor response to epcoritamab therapy. The diagnosis of TFR could be underestimated, and proper identification and understanding of its clinicopathological features are crucial for its effective management.
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Affiliation(s)
- Osamu Imataki
- Faculty of Medicine, Division of Hematology, Department of Internal Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Town, Kita-County, Kagawa, 761-0793, Japan.
| | - Makiko Uemura
- Faculty of Medicine, Division of Hematology, Department of Internal Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Town, Kita-County, Kagawa, 761-0793, Japan
| | - Haruyuki Fujita
- Faculty of Medicine, Division of Hematology, Department of Internal Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Town, Kita-County, Kagawa, 761-0793, Japan
| | - Norimitsu Kadowaki
- Faculty of Medicine, Division of Hematology, Department of Internal Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Town, Kita-County, Kagawa, 761-0793, Japan
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2
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Chari A, Krishnan A, Rasche L, Ye JC, Garfall A, Popat R, Lipe B, Qin X, Campagna M, Masterson T, Tomlinson C, Hilder B, Tolbert J, Renaud T, Smit MD, Gray K, Kane C, Heuck C, van de Donk NWCJ. Clinical Management of Patients With Relapsed/Refractory Multiple Myeloma Treated With Talquetamab. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:665-693.e14. [PMID: 38871558 DOI: 10.1016/j.clml.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Talquetamab is a bispecific antibody targeting the multiple myeloma-associated antigen G protein-coupled receptor family C group 5 member D (GPRC5D). In the phase 1/2 MonumenTAL-1 trial (NCT03399799/NCT04634552), overall responses rates were > 71% in patients with triple-class exposed relapsed/refractory multiple myeloma (RRMM). Due to the distribution of the target antigen, a unique pattern of GPRC5D-associated adverse events (AEs) was observed, together with T-cell redirection-associated AEs. Management strategies for talquetamab-associated AEs are described. DISCUSSION GPRC5D-associated AEs included dermatologic (rash, nonrash, and nail toxicities) and oral AEs (dysgeusia, dysphagia, and dry mouth). The incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were consistent with other T-cell redirection therapies. The incidence of high-grade infections was lower than observed with B-cell maturation antigen-targeting bispecific antibodies, with less frequent use of intravenous immunoglobulin required. GPRC5D-associated AEs were mostly low grade and led to few discontinuations. Skin toxicities were managed with emollients, topical corticosteroids, and oral corticosteroids (for high-grade, persistent, or AEs that progress). Nail toxicities were commonly managed with emollients. Based on investigator experience, dose modification may be effective for controlling oral events. Observation for potential weight changes is required. Infections were managed per standard of care. CRS and ICANS were effectively managed, consistent with other trials of T-cell redirection therapies. CONCLUSION Although talquetamab had a distinct safety profile, AEs were considered clinically manageable and mostly low grade. With appropriate education and support, health care practitioners can ensure patients with RRMM maintain quality of life and treatment adherence. VIDEO ABSTRACT.
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Affiliation(s)
- Ajai Chari
- Department of Medicine, Hematology, and Medical Oncology and Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
| | - Amrita Krishnan
- Judy and Bernard Briskin Myeloma Center, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jing Christine Ye
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Alfred Garfall
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rakesh Popat
- Hematology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Brea Lipe
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Xiang Qin
- Janssen Research and Development, Spring House, PA
| | | | | | | | | | | | | | | | | | - Colleen Kane
- Janssen Research and Development, Spring House, PA
| | | | - Niels W C J van de Donk
- Department of Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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3
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Nagarajan C, Eu Jo MW, Martin TG. BCMA Directed Bispecific Antibody Induced Tumor Flare in Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:488-490. [PMID: 38643030 DOI: 10.1016/j.clml.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Chandramouli Nagarajan
- Department of Haematology, Singapore General Hospital and SingHealth DUKE NUS Blood Cancer Center, Singapore, Singapore.
| | | | - Thomas G Martin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, USA
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4
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Géraud A, Hueso T, Laparra A, Bige N, Ouali K, Cauquil C, Stoclin A, Danlos FX, Hollebecque A, Ribrag V, Gazzah A, Goldschmidt V, Baldini C, Suzzoni S, Bahleda R, Besse B, Barlesi F, Lambotte O, Massard C, Marabelle A, Castilla-Llorente C, Champiat S, Michot JM. Reactions and adverse events induced by T-cell engagers as anti-cancer immunotherapies, a comprehensive review. Eur J Cancer 2024; 205:114075. [PMID: 38733717 DOI: 10.1016/j.ejca.2024.114075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
T-cell engagers (TCE) are cancer immunotherapies that have recently demonstrated meaningful benefit for patients with hematological malignancies and solid tumors. The anticipated widespread use of T cell engagers poses implementation challenges and highlights the need for guidance to anticipate, mitigate, and manage adverse events. By mobilizing T-cells directly at the contact of tumor cells, TCE mount an obligatory and immediate anti-tumor immune response that could result in diverse reactions and adverse events. Cytokine release syndrome (CRS) is the most common reaction and is largely confined to the first drug administrations during step-up dosage. Cytokine release syndrome should be distinguished from infusion related reaction by clinical symptoms, timing to occurrence, pathophysiological aspects, and clinical management. Other common reactions and adverse events with TCE are immune effector Cell-Associated Neurotoxicity Syndrome (ICANS), infections, tumor flare reaction and cytopenias. The toxicity profiles of TCE and CAR-T cells have commonalities and distinctions that we sum-up in this review. As compared with CAR-T cells, TCE are responsible for less frequently severe CRS or ICANS. This review recapitulates terminology, pathophysiology, severity grading system and management of reactions and adverse events related to TCE.
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Affiliation(s)
- Arthur Géraud
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Thomas Hueso
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Ariane Laparra
- Gustave Roussy, Departement Interdisciplinaire d'Organisation des Parcours Patients, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Naike Bige
- Gustave Roussy, Service de réanimation et de soins intensifs, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Kaissa Ouali
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Cécile Cauquil
- Hôpital Universitaire du Kremlin Bicêtre, Service de Neurologie, 94270 Le Kremlin-Bicêtre, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Annabelle Stoclin
- Gustave Roussy, Service de réanimation et de soins intensifs, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Antoine Hollebecque
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Vincent Ribrag
- Gustave Roussy, Department Hématologie, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Anas Gazzah
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Vincent Goldschmidt
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Capucine Baldini
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Steve Suzzoni
- Gustave Roussy, Department of Pharmacy, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Rastislav Bahleda
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Benjamin Besse
- Gustave Roussy, Department de Médecine Oncologique, 94805 Villejuif, France; Université Paris-Saclay, Gustave Roussy, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Fabrice Barlesi
- Gustave Roussy, Department de Médecine Oncologique, 94805 Villejuif, France; Université Paris-Saclay, Gustave Roussy, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Olivier Lambotte
- Université Paris-Saclay, Gustave Roussy, 94805 Villejuif, France; Hôpital Universitaire du Kremlin Bicêtre, Service de Médecine Interne, 94270 Le Kremlin-Bicêtre, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Christophe Massard
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Université Paris-Saclay, Gustave Roussy, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Cristina Castilla-Llorente
- Gustave Roussy, Department Hématologie, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France
| | - Jean-Marie Michot
- Gustave Roussy, Département d'Innovation Thérapeutique et d'Essais Précoces, 94805 Villejuif, France; Gustave Roussy, Department d'Hématologie Clinique, 94805 Villejuif, France.
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5
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Dar N, Roberts N, Gru A, Obiorah I, Zheng J, Shields LK, Cropley T, Marchi E. Tumor flare reaction in a patient with mycosis fungoides treated with a novel immune-epigenetic doublet. JAAD Case Rep 2024; 48:18-22. [PMID: 38741658 PMCID: PMC11090057 DOI: 10.1016/j.jdcr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Affiliation(s)
- Nakul Dar
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Nathan Roberts
- Department of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia
| | - Alejandro Gru
- Department of Dermatology, Columbia University Irvine Medical Center, New York, New York
| | - Ifeyinwa Obiorah
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Jiefu Zheng
- Department of Radiology and Medical Imaging, University of Virginia Medical Center, Charlottesville, Virginia
| | - Lale Kostakoglu Shields
- Department of Radiology and Medical Imaging, University of Virginia Medical Center, Charlottesville, Virginia
| | - Thomas Cropley
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Enrica Marchi
- Department of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia
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6
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Hoffmann E, Masthoff M, Kunz WG, Seidensticker M, Bobe S, Gerwing M, Berdel WE, Schliemann C, Faber C, Wildgruber M. Multiparametric MRI for characterization of the tumour microenvironment. Nat Rev Clin Oncol 2024; 21:428-448. [PMID: 38641651 DOI: 10.1038/s41571-024-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.
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Affiliation(s)
- Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Bobe
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
| | | | | | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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7
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Borcinova M, Bartolini R, Foley LK, Novak V, Taborska P, Stakheev D, Rataj M, Smrz D, Fialova M, Hacek J, Komarc M, Vesely S, Babjuk M, Striz I, Bartunkova J, Buchler T, Ozaniak Strizova Z. Distinct leukocyte populations and cytokine secretion profiles define tumoral and peritumoral areas in renal cell carcinoma. Transl Oncol 2024; 42:101891. [PMID: 38310685 PMCID: PMC10862072 DOI: 10.1016/j.tranon.2024.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/17/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common malignancy frequently diagnosed at the metastatic stage. We performed a comprehensive analysis of the tumor immune microenvironment (TIME) in RCC patients, including the peritumoral tissue microenvironment, to characterize the phenotypic patterns and functional characteristics of infiltrating immune cells. T cells from various compartments (peripheral blood, tumor, peritumoral area, and adjacent healthy renal tissue) were assessed using flow cytometry and Luminex analyses, both before and after T cell-specific stimulation, to evaluate activation status and migratory potential. Our findings demonstrated that tumor-infiltrating lymphocytes (TILs) exhibited heightened cytokine production compared to peritumoral T cells (pTILs), acting as the primary source of cytotoxic markers (IFN-γ, granzyme B, and FasL). CD8+ T cells primarily employed Fas Ligand for cytotoxicity, while CD4+ T cells relied on CD107a. In addition, a statistically significant negative correlation between patient mortality and the presence of CD4+CD107+ pTILs was demonstrated. The engagement with the PD-1/PD-L1 pathway was also more evident in CD4+ and CD8+ pTILs as opposed to TILs. PD-L1 expression in the non-leukocyte fraction of the tumor tissue was relatively lower than in their leukocytic counterparts and upon stimulation, peripheral blood T cells displayed much stronger responses to stimulation than TILs and pTILs. Our results suggest that tumor and peritumoral T cells exhibit limited responsiveness to additional activation signals, while peripheral T cells retain their capacity to respond to stimulatory signals.
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Affiliation(s)
- Martina Borcinova
- Gynecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Robin Bartolini
- Lausanne Center for Immuno-oncology Toxicities (LCIT), Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lily Koumbas Foley
- Chemokine Research Group, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TT, UK
| | - Vojtech Novak
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavla Taborska
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Dmitry Stakheev
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michal Rataj
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Daniel Smrz
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martina Fialova
- Department of Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jaromir Hacek
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Stepan Vesely
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marek Babjuk
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ilja Striz
- Department of Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jirina Bartunkova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Tomas Buchler
- Department of Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Zuzana Ozaniak Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
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8
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Numakura K, Sekine Y, Hatakeyama S, Muto Y, Sobu R, Kobayashi M, Sasagawa H, Kashima S, Yamamto R, Nara T, Akashi H, Tabata R, Sato S, Saito M, Narita S, Ohyama C, Habuchi T. Primary resistance to nivolumab plus ipilimumab therapy in patients with metastatic renal cell carcinoma. Cancer Med 2023; 12:16837-16845. [PMID: 37403728 PMCID: PMC10501267 DOI: 10.1002/cam4.6306] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Nivolumab plus ipilimumab (NIVO+IPI) is the first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Approximately 40% of patients achieve a durable response; however, 20% develop primary resistant disease (PRD) to NIVO+IPI, about which little is known in patients with mRCC. Therefore, this investigation aimed to evaluate the clinical implication of PRD in patients with mRCC to select better candidates in whom NIVO+IPI can be initiated as first-line therapy. METHODS This multi-institutional retrospective cohort study used data collected between August 2015 and January 2023. In total, 120 patients with mRCC treated with NIVO+IPI were eligible. Associations between immune-related adverse events and progression-free survival, overall survival (OS), and objective response rate were analyzed. The relationship between other clinical factors and outcomes was also evaluated. RESULTS The median observation period was 16 months (interquartile range, 5-27). The median age at NIVO+IPI initiation was 68 years in the male-dominant population (n = 86, 71.7%), and most patients had clear cell histology (n = 104, 86.7%). PRD was recorded in 26 (23.4%) of 111 investigated patients during NIVO+IPI therapy. Patients who experienced PRD showed worse OS (hazard ratio: 4.525, 95% confidence interval [CI]: 2.315-8.850, p < 0.001). Multivariable analysis showed that lymph node metastasis (LNM) (odds ratio: 4.274, 95% CI: 1.075-16.949, p = 0.039) was an independent risk factor for PRD. CONCLUSIONS PRD was strongly correlated with worse survival rates. LNM was independently associated with PRD in patients with mRCC receiving NIVO+IPI as first-line therapy and might indicate that a candidate will not benefit from NIVO+IPI.
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Affiliation(s)
- Kazuyuki Numakura
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Yuya Sekine
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yumina Muto
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Ryuta Sobu
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Mizuki Kobayashi
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Hajime Sasagawa
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Soki Kashima
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Ryohei Yamamto
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Taketoshi Nara
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Hideo Akashi
- Department of AnatomyAkita University Graduate School of MedicineAkitaJapan
| | - Ryuji Tabata
- Department of UrologyAgeo Central General HospitalAgeoJapan
| | - Satoshi Sato
- Department of UrologyAgeo Central General HospitalAgeoJapan
| | - Mitsuru Saito
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Shintaro Narita
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Tomonori Habuchi
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
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9
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Sortais C, Cordeil S, Bourbon E, Idlhaj M, Ferrant E, Safar V, Golfier C, Lazareth A, Bouafia-Sauvy F, Tordo J, Ghesquières H, Sesques P, Bachy E. Flare-up phenomenon or pseudoprogression after CAR T-cell infusion in non-Hodgkin aggressive lymphomas. Leuk Lymphoma 2023; 64:707-711. [PMID: 36573418 DOI: 10.1080/10428194.2022.2161304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Clara Sortais
- Department of Hematology, CHU de Nantes, Nantes, France
| | - Stéphanie Cordeil
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Estelle Bourbon
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Maryam Idlhaj
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Emmanuelle Ferrant
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Violaine Safar
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Camille Golfier
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Anne Lazareth
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Fadhela Bouafia-Sauvy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Jérémie Tordo
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Hervé Ghesquières
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
- Lymphoma Immuno-biology (LIB) Research Unit, Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
- Lymphoma Immuno-biology (LIB) Research Unit, Claude Bernard Lyon 1 University, Lyon, France
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10
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Razzak AN, Syed A, Procknow ER, Bequest A, Jha P. Modern Malignant Mesothelioma Manifestation. Cureus 2023; 15:e36479. [PMID: 37090283 PMCID: PMC10117962 DOI: 10.7759/cureus.36479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) involves the uncontrolled growth of mesothelial cells that form the lining of pleural serous layers. MPM has been linked with asbestos exposure in mining and manufacturing occupations with an unforgiving prognosis of 4-18 months. In this case report, we present a 56-year-old male with a significant past medical history of hypertension, hyperlipidemia, hepatic steatosis, and ulcerative colitis who presented to the emergency department for worsening cough, eight-pound weight loss over the previous year, night sweats, and fatigue. The patient was admitted due to right pleural effusion with lower lobe collapse seen on imaging; upon diagnostic workup including pleural biopsy, results were consistent with malignant mesothelioma of the epithelioid type. Over the course of six months post-diagnosis, the patient underwent multiple hospital admissions due to acute hypoxic respiratory failure from the segmental left upper lobe and subsegmental right upper lobe pulmonary emboli, recurrent pleural effusion, and anemia. Given the aggressive nature of MPM, the patient was determined not to be a surgical candidate and underwent palliative chemotherapy sessions until his passing. As the patient worked in heating/ventilation/air conditioning with asbestos exposure, taking a full occupational history was crucial. MPM is relatively rare; however, the incidence has increased over the last decade due to tumor development lag time post-asbestos exposure and an increase in do-it-yourself projects. There is no cure for MPM. Multimodal treatment approaches with surgery, chemotherapy, radiotherapy, and immunotherapy have been noted in the literature.
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Affiliation(s)
- Abrahim N Razzak
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Ali Syed
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | | | - Andrea Bequest
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
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11
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Colucci M, D’Alonzo V, Santangelo F, Miracco C, Valente M, Maio M, Di Giacomo AM. Successful Targeting of CTLA-4 in a Melanoma Clinical Case: A Long-Term "One Stop Therapeutic Shop". Onco Targets Ther 2022; 15:1409-1415. [PMID: 36457762 PMCID: PMC9707535 DOI: 10.2147/ott.s367389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/12/2022] [Indexed: 02/04/2024] Open
Abstract
The anti-Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) monoclonal antibody ipilimumab was the first in-class immune-checkpoint inhibitor (ICI) approved for the treatment of melanoma patients. Initially approved for metastatic cutaneous melanoma, treatment with ipilimumab subsequently demonstrated to significantly improve recurrence free survival (RFS) in fully resected, high-risk, stage III melanoma patients. Therapeutic use of ipilimumab has also allowed the initial identification and characterization of unconventional clinical and radiological patterns of response (ie, tumor flare, pseudo-progression) that may occur during ICI therapy, unlike chemotherapy or targeted therapy. As a result, the standard Response Evaluation Criteria In Solid Tumors (RECIST) and the World Health Organization (WHO) criteria conventionally utilized to assess responses to chemo/targeted therapy have been initially replaced by the immune-related (ir) Response Criteria (irRC) and then by the irRECIST, that encompass all patterns of response typical of ICI therapy, being key for the optimal comprehensive management of treated patients. Here, we report a paradigmatic clinical case of a long-term survival in a stage III melanoma patient, experiencing tumor flares during adjuvant treatment with ipilimumab, and an untreated disease relapse several years after ending therapy.
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Affiliation(s)
| | | | | | - Clelia Miracco
- Department of Pathology, University of Siena, Siena, Italy
| | - Monica Valente
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital, Siena, Italy
| | - Michele Maio
- University of Siena, Siena, Italy
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital, Siena, Italy
- NIBIT Foundation Onlus, Genoa, Italy
| | - Anna Maria Di Giacomo
- University of Siena, Siena, Italy
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital, Siena, Italy
- NIBIT Foundation Onlus, Genoa, Italy
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12
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Poteska R, Rahbar K, Semjonow A, Schrader AJ, Boegemann M, Schlack K. The prognostic potential of alkaline phosphatase and lactic acid dehydrogenase in bmCRPC patients without significant PSA response under enzalutamide. BMC Cancer 2022; 22:375. [PMID: 35395766 PMCID: PMC8994227 DOI: 10.1186/s12885-022-09483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background In patients with bone metastatic castration-resistant prostate cancer (bmCRPC) on systemic treatment, it is difficult to differentiate between continuous rise of prostate specific antigen (PSA) representing progression, and PSA-surge, which is followed by clinical response or stable disease. The purpose of this study was to evaluate the prognostic value of dynamic changes of alkaline phosphatase (ALP) and lactic acid dehydrogenase (LDH) levels as a predictor of clinical efficacy or therapeutic resistance of patients who do not show a sufficient initial PSA decline of ≥50% from baseline during early therapy with Enzalutamide. Methods Forty-eight men with bmCRPC on Enzalutamide 07/2010-09/2019 with initially rising PSA were analyzed. We monitored PSA, LDH and ALP at week 0, 2, 4, and every 4 weeks thereafter and analyzed the correlation between ALP rising at 12 weeks with or without LDH-normalization and the association with survival. For this we used Kaplan Meier analysis and uni- and multivariate cox-regression models. Results In Kaplan-Meier analysis, ALP rising at 12 weeks with or without LDH-normalization was associated with significantly worse median progression-free survival (PFS) of 3 months vs. 5 months (Log rank P = 0.02) and 3 months vs. 5 months (P = 0.01), respectively and overall survival (OS) with 8 months vs. 15 months (P = 0.02) and 8 months vs. 17 months (P < 0.01). In univariate analysis of PFS, ALP rising at 12 weeks alone, ALP rising at 12 weeks without LDH-normalization and application of Enzalutamide after chemotherapy showed a statistically significant association towards shorter PFS (hazard ratio (HR): 0.51, P = 0.04; HR: 0.48, P = 0.03; HR: 0.48, P = 0.03). Worse OS was significantly associated with ALP rising at 12 weeks alone, ALP rising at 12 weeks without LDH-normalization, and application of Enzalutamide after chemotherapy (HR: 0.47, P = 0.02; HR: 0.36, P < 0.01; HR: 0.31, P < 0.01). In multivariate analysis only the application of Enzalutamide after chemotherapy remained an independent prognostic factor for worse OS (HR: 0.36, P = 0.01). Conclusions Dynamic changes of ALP (non-rise) and LDH (normalization) under therapy with Enzalutamide may be associated with clinical benefit, better PFS, and OS in patients with bmCRPC who do not show a PSA decline.
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Affiliation(s)
- Renata Poteska
- Department of Urology, University Hospital Muenster, Münster, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Münster, Germany.,University Hospital Muenster, Westdeutsches Tumorzentrum, Münster, Germany
| | - Axel Semjonow
- Department of Urology, University Hospital Muenster, Münster, Germany.,University Hospital Muenster, Westdeutsches Tumorzentrum, Münster, Germany
| | - Andres Jan Schrader
- Department of Urology, University Hospital Muenster, Münster, Germany.,University Hospital Muenster, Westdeutsches Tumorzentrum, Münster, Germany
| | - Martin Boegemann
- Department of Urology, University Hospital Muenster, Münster, Germany.,University Hospital Muenster, Westdeutsches Tumorzentrum, Münster, Germany
| | - Katrin Schlack
- Department of Urology, University Hospital Muenster, Münster, Germany. .,University Hospital Muenster, Westdeutsches Tumorzentrum, Münster, Germany. .,Department of Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany.
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13
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Kyriazoglou A, Beuselinck B. Equivocal evaluation of progressive disease in patients treated with immune checkpoint inhibitors: a challenge for clinical trials and biomarker research. Acta Clin Belg 2022; 77:406-409. [PMID: 33308043 DOI: 10.1080/17843286.2020.1853886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We present two patient cases (one with bladder carcinoma and one with renal cell carcinoma) who consulted our department of General Medical Oncology, after having been treated in other hospitals in two clinical trials with immune checkpoint inhibitors and having been dismissed from the trials after 5 months of therapy for progressive disease. They consulted to discuss consecutive treatment opportunities. However, longer follow-up has shown that both patients were dismissed equivocally from both trials. We are worried that equivocal response evaluation in the context of clinical trials with immune checkpoint inhibitors, due to pseudo-progression or delayed responses, can negatively impact trial outcomes as well as biomarker research.
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Affiliation(s)
- Anastasios Kyriazoglou
- Department of Clinical Therapeutics, General Hospital Alexandra, Athens, Greece
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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14
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Patel P. Cancer Treatment Related Pain. Cancer Treat Res 2021; 182:27-37. [PMID: 34542874 DOI: 10.1007/978-3-030-81526-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
When discussing cancer treatment, it is important to be aware of the potential toxicities and side effects associated with these treatments.
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Affiliation(s)
- Purvi Patel
- Kaiser Permanente, 11284 Slover Ave, Suite 106, Fontana, CA, 92337, USA.
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15
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Pan H, Yu Y, Li L, Liu B, Liu Y. Fabrication and Characterization of Taurine Functionalized Graphene Oxide with 5-Fluorouracil as Anticancer Drug Delivery Systems. NANOSCALE RESEARCH LETTERS 2021; 16:84. [PMID: 33983544 PMCID: PMC8119561 DOI: 10.1186/s11671-021-03541-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/03/2021] [Indexed: 06/01/2023]
Abstract
Recently, nanocarrier systems for cancer drugs, especially GO-based drug delivery systems, have become a boon for cancer patients. In this study, we choose Tau to functionalize the GO surface to improve its biocompatibility. Firstly, nano-scale GO was synthesized by the modified Hummer's method and ultrasonic stripping method. The taurine-modified graphene oxide carrier (Tau-GO) was synthesized by chemical method to obtain Tau-GO that has a good dispersibility and stability in water, with a zeta potential of - 38.8 mV and a particle size of 242 nm. Based on the encapsulation efficiency evaluation criteria, the optimal formulation was determined to combine Tau-GO and 5-FU by non-covalent bonding. The 5-FU-Tau-GO was more stable in neutral environment than in acidic environment, and with a certain PH response and sustained release effect. In vivo, we compared oral and intravenous administrations of 5-FU and 5-FU-Tau-GO, respectively, using pharmacokinetic tests and related parameters and showed that 5-FU-Tau-GO oral or intravenous administration prolongs the action time of 5-FU in the body and improves its bioavailability. In addition, the inhibition of HepG2 cells that was measured by the MTT assay, showed that the IC50 value of 5-FU was 196 ± 8.73 μg/mL, and the IC50 value of 5-FU-Tau-GO was 65.2 ± 0.7 μg/mL, indicating that 5- FU-Tau-GO is more potent against HepG2 cells and has a stronger inhibitory effect on cancer cells. The effect on cell morphology that was measured using the AO/EB staining also showed that 5-FU-Tau-GO not only disrupted cells, but also significantly induced apoptosis compared to 5-FU. We also verified by computer aided design that Tau-GO can bind better to 5-FU than to the unmodified GO, and that the formed 5-FU-Tau-GO system is more stable, and conducive to the transfer and release of 5-FU in vivo.
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Affiliation(s)
- Hao Pan
- School of Pharmacy, Liaoning University, Shenyang, 110036 China
| | - Yanjie Yu
- School of Pharmacy, Liaoning University, Shenyang, 110036 China
| | - Li Li
- School of Pharmacy, Liaoning University, Shenyang, 110036 China
- Liaoning Key Laboratory of New Drug Research & Development, Shenyang, 110036 China
| | - Bingmi Liu
- School of Pharmacy, Liaoning University, Shenyang, 110036 China
- Liaoning Pharmaceutical Engineering Research Center for Natural Medicine, Shenyang, 110036 China
| | - Yu Liu
- School of Pharmacy, Liaoning University, Shenyang, 110036 China
- Liaoning Key Laboratory of New Drug Research & Development, Shenyang, 110036 China
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16
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Salvaris R, Ong J, Gregory GP. Bispecific Antibodies: A Review of Development, Clinical Efficacy and Toxicity in B-Cell Lymphomas. J Pers Med 2021; 11:jpm11050355. [PMID: 33946635 PMCID: PMC8147062 DOI: 10.3390/jpm11050355] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022] Open
Abstract
The treatment landscape of B-cell lymphomas is evolving with the advent of novel agents including immune and cellular therapies. Bispecific antibodies (bsAbs) are molecules that recognise two different antigens and are used to engage effector cells, such as T-cells, to kill malignant B-cells. Several bispecific antibodies have entered early phase clinical development since the approval of the CD19/CD3 bispecific antibody, blinatumomab, for relapsed/refractory acute lymphoblastic leukaemia. Novel bsAbs include CD20/CD3 antibodies that are being investigated in both aggressive and indolent non-Hodgkin lymphoma with encouraging overall response rates including complete remissions. These results are seen even in heavily pre-treated patient populations such as those who have relapsed after chimeric antigen receptor T-cell therapy. Potential toxicities include cytokine release syndrome, neurotoxicity and tumour flare, with a number of strategies existing to mitigate these risks. Here, we review the development of bsAbs, their mechanism of action and the different types of bsAbs and how they differ in structure. We will present the currently available data from clinical trials regarding response rates, progression free survival and outcomes across a range of non-Hodgkin lymphoma subtypes. Finally, we will discuss the key toxicities of bsAbs, their rates and management of these adverse events.
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Affiliation(s)
- Ross Salvaris
- Monash Haematology, Monash Health, Clayton, VIC 3168, Australia; (J.O.); (G.P.G.)
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
- Correspondence:
| | - Jeremy Ong
- Monash Haematology, Monash Health, Clayton, VIC 3168, Australia; (J.O.); (G.P.G.)
| | - Gareth P. Gregory
- Monash Haematology, Monash Health, Clayton, VIC 3168, Australia; (J.O.); (G.P.G.)
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
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17
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Abstract
Purpose Lutetium Lu-177 dotatate is the first peptide receptor radionuclide therapy approved by the US Food and Drug Administration. Well-designed studies in Europe have shown dramatic effectiveness in improving progression-free survival in patients with gastroenteropancreatic neuroendocrine tumors, which are progressive and generally metastatic. This therapy is a molecular targeted therapy linking a beta-emitting radioisotope to dotatate, which binds tightly to somatostatin receptors on neuroendocrine tumors cells. Various adverse effects of this therapy have been reported in the literature, including potential toxicity to renal, hepatic, and hematologic tissues and risk of second malignancy. Our study sought to explore acute adverse effects in this patient population. Methods and Materials We tracked adverse effects and patient experience in our first year of therapy experience with this new agent. Results In our first 12 patients who received Lutetium Lu-177 dotatate, tumor flare reactions occurred in 5 patients due to worsening symptoms of bone or soft tissue metastasis. This flare reaction can be mitigated with short course of corticosteroid therapy or other strategies. Conclusions Flare reaction is common in patients with progressive metastatic gastroenteropancreatic neuroendocrine tumors and can be managed successfully with several strategies.
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18
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Suyama T, Yui T, Horiuchi A, Irie R, Osamura Y, Miyao N. Transient atelectasis due to hilar lymph node swelling affected by lenalidomide-induced tumor flare reaction. J Clin Exp Hematop 2021; 61:48-52. [PMID: 33431741 PMCID: PMC8053573 DOI: 10.3960/jslrt.20045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Tumor flare reaction (TFR) is a unique immune-mediated tumor recognition phenomenon
presenting as rapid enlargement of the tumor, which mimics disease progression, developing
in the early stage of treatment using immunomodulatory drugs or immune checkpoint
inhibitors. A 59-year-old man with follicular lymphoma had residual tumor burden in the
left hilar lymph nodes after R-CHOP therapy, and received lenalidomide and rituximab
(R2) therapy. He developed respiratory distress on day 11 of R2
therapy. Chest X-ray and CT demonstrated left lung atelectasis due to left hilar lymph
node swelling. We performed transbronchial lung biopsy on day 20 of R2 therapy.
The biopsied left bronchus tissue exhibited extensive necrosis, which had a B-cell
phenotype consistent with that of follicular lymphoma. Neither NK cells nor cytotoxic T
cells were detected. It was unclear whether the immune effector cells disappeared at the
time of transbronchial lung biopsy. Atelectasis in our patient improved by continuing
R2 therapy beyond TFR.
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Affiliation(s)
- Takahiro Suyama
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Terue Yui
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Atsuo Horiuchi
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Rie Irie
- Pathology, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | | | - Naoki Miyao
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
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19
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Worlikar T, Mendiratta-Lala M, Vlaisavljevich E, Hubbard R, Shi J, Hall TL, Cho CS, Lee FT, Greve J, Xu Z. Effects of Histotripsy on Local Tumor Progression in an in vivo Orthotopic Rodent Liver Tumor Model. BME FRONTIERS 2020; 2020. [PMID: 34327513 PMCID: PMC8318009 DOI: 10.34133/2020/9830304] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective and Impact Statement This is the first longitudinal study investigating the effects of histotripsy on local tumor progression in an in vivo orthotopic, immunocompetent rat hepatocellular carcinoma (HCC) model. Introduction Histotripsy is the first noninvasive, nonionizing, nonthermal, mechanical ablation technique using ultrasound to generate acoustic cavitation to liquefy the target tissue into acellular debris with millimeter accuracy. Previously, histotripsy has demonstrated in vivo ablation of noncancerous liver tissue. Methods N1-S1 HCC tumors were generated in the livers of immunocompetent rats (n = 6, control; n = 15, treatment). Real-time ultrasound-guided histotripsy was applied to ablate either 100% tumor volume + up to 2mm margin (n = 9, complete treatment) or 50-75% tumor volume (n = 6, partial treatment) by delivering 1-2 cycle histotripsy pulses at 100 Hz PRF (pulse repetition frequency) with p - ≥30MPa using a custom 1MHz transducer. Rats were monitored weekly using MRI (magnetic resonance imaging) for 3 months or until tumors reached ~25mm. Results MRI revealed effective post-histotripsy reduction of tumor burden with near-complete resorption of the ablated tumor in 14/15 (93.3%) treated rats. Histopathology showed <5mm shrunken, non-tumoral, fibrous tissue at the treatment site at 3 months. Rats with increased tumor burden (3/6 control and 1 partial treatment) were euthanized early by 2-4 weeks. In 3 other controls, histology revealed fibrous tissue at original tumor site at 3 months. There was no evidence of histotripsy-induced off-target tissue injury. Conclusion Complete and partial histotripsy ablation resulted in effective tumor removal for 14/15 rats, with no evidence of local tumor progression or recurrence.
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Affiliation(s)
- Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Ryan Hubbard
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Clifford S Cho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.,Department of Surgery, VA Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin 53705, USA
| | - Joan Greve
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
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20
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Cheson BD, Morschhauser F, Martin P. Management of Adverse Events From the Combination of Rituximab and Lenalidomide in the Treatment of Patients With Follicular and Low-Grade Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:563-571. [PMID: 32303486 DOI: 10.1016/j.clml.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Frontline treatment for patients with indolent non-Hodgkin lymphoma often includes immunochemotherapy. Although the disease of most patients responds to initial treatment, relapse is common. Recent results from the phase 3 Augment trial showed that combining rituximab with the immunomodulatory drug lenalidomide (R2) significantly improved efficacy over rituximab monotherapy in patients with recurrent non-Hodgkin lymphoma. As a result of these data, R2 was approved in the US (Food and Drug Administration) and Japan (Pharmaceuticals and Medical Devices Agency) for previously treated adult patients with follicular and marginal zone lymphoma; and by the European Medicine Agency and the Swiss Agency for Therapeutic Products (Swissmedic) for previously treated adult patients with follicular lymphoma. R2 has also been studied as initial treatment, where results have been comparable, but not superior, to chemoimmunotherapy. The resulting expanded use of R2 reinforces the need for a detailed review of its safety profile and management, as presented here. Tolerability of R2 has been consistent among trials, with most adverse events (AEs) being predictable and manageable. Hematologic AEs, particularly grade 3/4 neutropenia; low-grade cutaneous reactions, such as rash; and gastrointestinal AEs represent the most common AEs associated with R2. The general R2 safety profile and optimal strategies for AE management are discussed.
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Affiliation(s)
| | | | - Peter Martin
- Department of Medicine, Weill Medical College of Cornell University, New York, NY
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21
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Pseudoprogression of Metastatic Melanoma to the Orbit With Pembrolizumab. Ophthalmic Plast Reconstr Surg 2020; 36:e36-e40. [DOI: 10.1097/iop.0000000000001543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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