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Coleman M, Mascialino SJ, Panjwani A, Edwards E, Sukhatme VV, Gavegnano C, Sukhatme VP. Readily available drugs and other interventions to potentially improve the efficacy of immune checkpoint blockade in cancer. Front Immunol 2024; 14:1281744. [PMID: 38299150 PMCID: PMC10827885 DOI: 10.3389/fimmu.2023.1281744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
To improve the efficacy of immune checkpoint inhibitors (ICIs) for cancer treatment, various strategies, including combination therapies with repurposed drugs, are being explored. Several readily available interventions with potential to enhance programmed death 1 (PD-1) blockade have been identified. However, these interventions often remain overlooked due to the lack of financial incentives for their development, making them financial orphans. This review summarizes current knowledge regarding off-label drugs, supplements, and other readily available interventions that could improve the efficacy of PD-1 blockade. The summary of each intervention includes the proposed mechanism of action for combination with checkpoint inhibitors and data from animal and human studies. Additionally, we include summaries of common interventions to be avoided by patients on PD-1 blockade. Finally, we present approaches for conducting further studies in patients, with the aim of expediting the clinical development of these interventions. We strive to increase awareness of readily available combination therapies that may advance cancer immunotherapy and help patients today.
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Affiliation(s)
- Merissa Coleman
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory University, Atlanta, GA, United States
| | - Sophia J. Mascialino
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory University, Atlanta, GA, United States
| | - Anusha Panjwani
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory University, Atlanta, GA, United States
| | - Emily Edwards
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory University, Atlanta, GA, United States
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Vidula V. Sukhatme
- Morningside Center for Innovative & Affordable Medicine, Emory University, Atlanta, GA, United States
- GlobalCures, Inc, Newton, MA, United States
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Christina Gavegnano
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory University, Atlanta, GA, United States
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, GA, United States
- Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Vikas P. Sukhatme
- Morningside Center for Innovative & Affordable Medicine, Emory University, Atlanta, GA, United States
- GlobalCures, Inc, Newton, MA, United States
- Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, United States
- Winship Cancer Institute, Emory University, Atlanta, GA, United States
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Stokes WA, Behera M, Jiang R, Gutman DA, Huang Z, Burns A, Sebastian NT, Sukhatme V, Lowe MC, Ramalingam SS, Sukhatme VP, Moghanaki D. Impact of concomitant fibrates on immunotherapy outcomes for advanced non-small cell lung cancer. Cancer Med 2022; 12:358-367. [PMID: 35607930 PMCID: PMC9844615 DOI: 10.1002/cam4.4847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peroxisome proliferator-activated receptor agonists such as fibrates restore oxidative metabolism in cytotoxic T-lymphocytes, thereby enhancing response to immune checkpoint inhibitors (ICI) in preclinical models. However, there is no evidence in humans on the clinical impact of fibrates as an adjunct to ICI. METHODS In this cohort study of Veterans with non-small cell lung cancer (NSCLC) receiving ICI, fibrate exposure was defined as a prescription filled within 90 days of an ICI infusion. Overall survival (OS), measured from the start of ICI, was compared between exposed and unexposed Veterans. Cox multivariable analysis (MVA) was used to identify factors associated with OS. A sensitivity analysis of Veterans with stage IV NSCLC who received docetaxel without ICI was similarly performed. RESULTS The ICI cohort included 3593 Veterans, of whom 301 (8.5%) coincidentally received a fibrate. Veterans receiving fibrates were more likely to be older, white, male, and married, and to have greater comorbidity burden, but less likely to receive chemotherapy. Coincidental fibrates were associated with improved OS both on MVA (HR 0.86, 95%CI 0.75-0.99) and in a matched subset (HR 0.75, 95%CI 0.63-0.90). In contrast, among the cohort of 968 Veterans treated with chemotherapy, fibrates did not have a significant impact on OS by MVA (HR 0.99, 95%CI 0.79-1.25) or in a matched subset (HR 1.02, 95%CI CI 0.75-1.39). CONCLUSIONS Concomitant fibrates are associated with improved OS among NSCLC patients receiving ICI but not among those receiving chemotherapy. This hypothesis-generating observation supports a potential role for fibrates as an adjunct to immunotherapy.
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Affiliation(s)
- William A. Stokes
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA,Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | | | - Renjian Jiang
- Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - David A. Gutman
- Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA,Atlanta Veterans Affairs Health Care SystemDecaturGeorgiaUSA
| | - Zhonglu Huang
- Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Abigail Burns
- Atlanta Veterans Affairs Health Care SystemDecaturGeorgiaUSA
| | - Nikhil T. Sebastian
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA,Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Vidula Sukhatme
- Morningside Center for Innovative and Affordable MedicineEmory UniversityAtlantaGeorgiaUSA,GlobalCures, IncNewtonMassachusettsUSA
| | - Michael C. Lowe
- Morningside Center for Innovative and Affordable MedicineEmory UniversityAtlantaGeorgiaUSA,Division of Surgical OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Suresh S. Ramalingam
- Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA,Department of Hematology and Medical OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Vikas P. Sukhatme
- Morningside Center for Innovative and Affordable MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Drew Moghanaki
- Department of Radiation OncologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
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Vandeborne L, Pantziarka P, Van Nuffel AMT, Bouche G. Repurposing Infectious Diseases Vaccines Against Cancer. Front Oncol 2021; 11:688755. [PMID: 34055652 PMCID: PMC8155725 DOI: 10.3389/fonc.2021.688755] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
Vaccines used to prevent infections have long been known to stimulate immune responses to cancer as illustrated by the approval of the Bacillus Calmette-Guérin (BCG) vaccine to treat bladder cancer since the 1970s. The recent approval of immunotherapies has rejuvenated this research area with reports of anti-tumor responses with existing infectious diseases vaccines used as such, either alone or in combination with immune checkpoint inhibitors. Here, we have reviewed and summarized research activities using approved vaccines to treat cancer. Data supporting a cancer therapeutic use was found for 16 vaccines. For 10 (BCG, diphtheria, tetanus, human papillomavirus, influenza, measles, pneumococcus, smallpox, typhoid and varicella-zoster), clinical trials have been conducted or are ongoing. Within the remaining 6, preclinical evidence supports further evaluation of the rotavirus, yellow fever and pertussis vaccine in carefully designed clinical trials. The mechanistic evidence for the cholera vaccine, combined with the observational data in colorectal cancer, is also supportive of clinical translation. There is limited data for the hepatitis B and mumps vaccine (without measles vaccine). Four findings are worth highlighting: the superiority of intravesical typhoid vaccine instillations over BCG in a preclinical bladder cancer model, which is now the subject of a phase I trial; the perioperative use of the influenza vaccine to limit and prevent the natural killer cell dysfunction induced by cancer surgery; objective responses following intratumoral injections of measles vaccine in cutaneous T-cell lymphoma; objective responses induced by human papillomavirus vaccine in cutaneous squamous cell carcinoma. All vaccines are intended to induce or improve an anti-tumor (immune) response. In addition to the biological and immunological mechanisms that vary between vaccines, the mode of administration and sequence with other (immuno-)therapies warrant more attention in future research.
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Jung JH, Hwang J, Kim JH, Sim DY, Im E, Park JE, Park WY, Shim BS, Kim B, Kim SH. Phyotochemical candidates repurposing for cancer therapy and their molecular mechanisms. Semin Cancer Biol 2019; 68:164-174. [PMID: 31883914 DOI: 10.1016/j.semcancer.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/18/2019] [Accepted: 12/15/2019] [Indexed: 12/24/2022]
Abstract
Though limited success through chemotherapy, radiotherapy and surgery has been obtained for efficient cancer therapy for modern decades, cancers are still considered high burden to human health worldwide to date. Recently repurposing drugs are attractive with lower cost and shorter time compared to classical drug discovery, just as Metformin from Galega officinalis, originally approved for treating Type 2 diabetes by FDA, is globally valued at millions of US dollars for cancer therapy. As most previous reviews focused on FDA approved drugs and synthetic agents, current review discussed the anticancer potential of phytochemicals originally approved for treatment of cardiovascular diseases, diabetes, infectious diarrhea, depression and malaria with their molecular mechanisms and efficacies and suggested future research perspectives.
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Affiliation(s)
- Ji Hoon Jung
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Jisung Hwang
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Ju-Ha Kim
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Deok Yong Sim
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Eunji Im
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Ji Eon Park
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Woon Yi Park
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Bum-Sang Shim
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Bonglee Kim
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea
| | - Sung-Hoon Kim
- Cancer Molecular Target Herbal Research Laboratory, College of Korean Medicine, Seoul 02447, Republic of Korea.
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Satish Kumar K, Velayutham R, Roy KK. A systematic computational analysis of human matrix metalloproteinase 13 (MMP-13) crystal structures and structure-based identification of prospective drug candidates as MMP-13 inhibitors repurposable for osteoarthritis. J Biomol Struct Dyn 2019; 38:3074-3086. [PMID: 31378153 DOI: 10.1080/07391102.2019.1651221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Ravichandiran Velayutham
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
| | - Kuldeep K. Roy
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
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