1
|
Shih BB, Ma C, Cortes JR, Reglero C, Miller H, Quinn SA, Albero R, Laurent AP, Mackey A, Ferrando AA, Geskin L, Palomero T. Romidepsin and Afatinib Abrogate Jak-Signal Transducer and Activator of Transcription Signaling and Elicit Synergistic Antitumor Effects in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2024; 144:1579-1589.e8. [PMID: 38219917 PMCID: PMC11193653 DOI: 10.1016/j.jid.2023.12.010] [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: 08/27/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
Cutaneous T-cell lymphomas are mature lymphoid neoplasias resulting from the malignant transformation of skin-resident T-cells. A distinctive clinical feature of cutaneous T-cell lymphomas is their sensitivity to treatment with histone deacetylase inhibitors. However, responses to histone deacetylase inhibitor therapy are universally transient and noncurative, highlighting the need for effective and durable drug combinations. In this study, we demonstrate that the combination of romidepsin, a selective class I histone deacetylase inhibitor, with afatinib, an EGFR family inhibitor, induces strongly synergistic antitumor effects in cutaneous T-cell lymphoma models in vitro and in vivo through abrogation of Jak-signal transducer and activator of transcription signaling. These results support a previously unrecognized potential role for histone deacetylase inhibitor plus afatinib combination in the treatment of cutaneous T-cell lymphomas.
Collapse
Affiliation(s)
- Bobby B Shih
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Cindy Ma
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Jose R Cortes
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Clara Reglero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Hannah Miller
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - S Aidan Quinn
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Robert Albero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Biomedical Research Institute August Pi y Sunyer (IDIBAPS), Barcelona, Spain
| | - Anouchka P Laurent
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Adam Mackey
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Adolfo A Ferrando
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Regeneron Pharmaceuticals, Tarrytown, New York, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA; Department of Pediatrics, Columbia University Medical Center, New York, New York, USA; Department of Systems Biology, Columbia University Medical Center, New York, New York, USA
| | - Larisa Geskin
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Teresa Palomero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA.
| |
Collapse
|
2
|
Hague C, Farquharson N, Menasce L, Parry E, Cowan R. Cutaneous T-cell lymphoma: diagnosing subtypes and the challenges. Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2021.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cutaneous T-cell lymphoma is a rare type of extranodal non-Hodgkin's lymphoma that primarily affects the skin. The uncertain pathogenesis and variable clinical presentation make the diagnosis and management of cutaneous T-cell lymphoma a challenge. Cutaneous T-cell lymphoma is a chronic, relapsing illness with treatment aimed at symptomatic relief and improving patient related quality of life. Early-stage cutaneous T-cell lymphoma typically follows an indolent course, often being mistaken for benign dermatological conditions which can lead to a diagnostic delay. Advanced stage cutaneous T-cell lymphoma has a poor prognosis with significant morbidity. Accurate diagnosis and early involvement of a specialist team is paramount to ensure correct management and improved patient outcomes. Promising advances are being made to develop novel agents which could improve prognosis and quality of life. This article provides an overview of the two main subtypes of cutaneous T-cell lymphoma: mycosis fungoides and Sézary syndrome. Clinical presentation, histopathological correlation and diagnostic challenges are reviewed alongside example case studies.
Collapse
Affiliation(s)
- Christina Hague
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nina Farquharson
- Department of Dermatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lia Menasce
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Eileen Parry
- Department of Dermatology, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, UK
| | - Richard Cowan
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Roccuzzo G, Giordano S, Avallone G, Rubatto M, Canonico S, Funaro A, Ortolan E, Senetta R, Fava P, Fierro MT, Ribero S, Quaglino P. Sézary Syndrome: Different Erythroderma Morphological Features with Proposal for a Clinical Score System. Cells 2022; 11:cells11030333. [PMID: 35159143 PMCID: PMC8834570 DOI: 10.3390/cells11030333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Sézary syndrome is a rare subtype of cutaneous T-cell lymphoma characterized by erythroderma, peripheral lymphadenopathies, and circulating atypical cerebriform T-cells. To date, no definite staging system has been developed for these patients. In this retrospective analysis of the archive of the Dermatological Clinic of the University of Turin, Italy, erythrodermic SS patients were classified according to clinical records and photographs into three main presentations: erythematous, infiltrated, or melanodermic. The pattern of erythroderma was found to be associated with disease outcome, as better survivals were recorded in patients with erythematous and infiltrative erythroderma. Patients in the melanodermic group, though less represented in our investigation, seemed to show a worse trend in survival. According to this preliminary evidence, a new prognostic classification, with a revised score specific for Sézary syndrome patients, can be proposed to usefully integrate the current staging system. The correlation displayed in our research will be hopefully confirmed by prospective studies with larger cohorts, with the aim of identifying significant prognostic features in this subset of cutaneous T-cell lymphoma patients.
Collapse
Affiliation(s)
- Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
- Correspondence: ; Tel.: +39-011-6335-843
| | - Silvia Giordano
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Gianluca Avallone
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Marco Rubatto
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Silvia Canonico
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Ada Funaro
- Laboratory of Immunogenetics, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.F.); (E.O.)
| | - Erika Ortolan
- Laboratory of Immunogenetics, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.F.); (E.O.)
| | - Rebecca Senetta
- Pathology Unit, Department of Oncology, University of Turin, 10126 Torino, Italy;
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Maria Teresa Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.G.); (G.A.); (M.R.); (S.C.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| |
Collapse
|
4
|
Roccuzzo G, Giordano S, Fava P, Pileri A, Guglielmo A, Tonella L, Sanlorenzo M, Ribero S, Fierro MT, Quaglino P. Immune Check Point Inhibitors in Primary Cutaneous T-Cell Lymphomas: Biologic Rationale, Clinical Results and Future Perspectives. Front Oncol 2021; 11:733770. [PMID: 34485162 PMCID: PMC8415544 DOI: 10.3389/fonc.2021.733770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022] Open
Abstract
Primary cutaneous T-cell lymphomas (PCTCL) are the most common types of cutaneous lymphomas, with Mycosis fungoides as the most frequent subtype. Besides early stages which usually have a good prognosis, advanced stages remain a great therapeutic challenge with low survival rates. To date, none of the currently available therapeutic options have significantly improved the outcomes of advanced cutaneous lymphomas. Recent studies have demonstrated that immune-checkpoint molecules, such as PD-1 and CTLA-4, play part in the proliferation pathways of neoplastic T-cells, as well as in other tumors. Hence, the potential role of immune-checkpoint-inhibitors in treating cutaneous lymphomas has been investigated in the last years. Herein, we outline the current knowledge regarding the role of immune-checkpoint molecules in PCTCL, their signaling pathways, microenvironment and therapeutic inhibition rationale. Moreover, we review the published data on immunotherapies in PCTCL and summarize the currently ongoing clinical trials in this field.
Collapse
Affiliation(s)
- Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Silvia Giordano
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Alessandro Pileri
- Dermatology-IRCCS Policlinico di Sant'Orsola Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alba Guglielmo
- Dermatology-IRCCS Policlinico di Sant'Orsola Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luca Tonella
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Martina Sanlorenzo
- Department of Medicine, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Maria Teresa Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| |
Collapse
|
5
|
Abstract
Primary cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. CTCL subtypes demonstrate a variety of clinical, histological, and molecular features, and can follow an indolent or a very aggressive course. The underlying pathogenetic mechanisms are not yet entirely understood. The pathophysiology of CTCL is complex and a single initiating factor has not yet been identified. Diagnosis is based on clinicopathological correlation and requires an interdisciplinary team. Treatment decision is made based on short-term and long-term goals. Therapy options comprise skin-directed therapies, such as topical steroids or phototherapy, and systemic therapies, such as monoclonal antibodies or chemotherapy. So far, the only curative treatment approach is allogeneic haematopoietic stem cell transplantation. Novel therapies, such as chimeric antigen receptor T cells, monoclonal antibodies or small molecules, are being investigated in clinical trials. Patients with CTCL have reduced quality of life and a lack of effective treatment options. Further research is needed to better identify the underlying mechanisms of CTCL development and course as well as to better tailor treatment strategies to individual patients.
Collapse
|
6
|
Quaglino P, Prince H, Cowan R, Vermeer M, Papadavid L, Bagot M, Servitjie O, Berti E, Guenova E, Stadler R, Querfeld C, Busschots A, Hodak E, Patsatsi A, Sanches J, Maule M, Yoo J, Kevin M, Fava P, Ribero S, Zocchi L, Rubatto M, Fierro M, Wehkamp U, Marshalko M, Mitteldorf C, Akilov O, Ortiz-Romero P, Estrach T, Vakeva L, Enz P, Wobser M, Bayne M, Jonak C, Rubeta M, Forbes A, Bates A, Battistella M, Amel-Kashipaz R, Vydianath B, Combalia A, Georgiou E, Hauben E, Hong E, Jost M, Knobler R, Amitay-Laish I, Miyashiro D, Cury-Martins J, Martinez X, Muniesa C, Prag-Naveh H, Nikolaou V, Quint K, Ram-Wolff C, Rieger K, Stranzenbach R, Szepesi Á, Alberti-Violetti S, Felicity E, Cerroni L, Kempf W, Whittaker S, Willemze R, Kim Y, Scarisbrick J. Treatment of early-stage mycosis fungoides: results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study. Br J Dermatol 2021; 184:722-730. [PMID: 32479678 PMCID: PMC7704558 DOI: 10.1111/bjd.19252] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is a prospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) in patients with newly diagnosed mycosis fungoides (MF). OBJECTIVES To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB) staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures. METHODS In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centres in 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review. RESULTS The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smaller percentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariate analysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA, 20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs. T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%, while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improved significantly both in patients with responsive disease and in those with stable disease. CONCLUSIONS Disease characteristics such as presence of plaques and FMF influence physician treatment choices, and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, future treatment guidelines for early-stage MF need to address these issues.
Collapse
Affiliation(s)
- P. Quaglino
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - H.M. Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R. Cowan
- Christie Hospital, Manchester UK
| | - M. Vermeer
- Leiden University Medical Centre, The Netherlands
| | | | - M. Bagot
- Hospital St Louis, Paris, France
| | - O. Servitjie
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - R. Stadler
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - C. Querfeld
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | | | - E. Hodak
- Rabin Medical Center, Tel Aviv University, Israel
| | - A. Patsatsi
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - J. Sanches
- University of Sao Paulo Medical School, Brazil, South America
| | - M. Maule
- Cancer Epidemiology Unit, Department Medical Sciences, University of Turin, Italy
| | - J. Yoo
- University Hospitals Birmingham, UK
| | - M. Kevin
- University Hospitals Birmingham, UK
| | - P. Fava
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - S. Ribero
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - L. Zocchi
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M. Rubatto
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M.T. Fierro
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - U. Wehkamp
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - C. Mitteldorf
- HELIOS Klinikum Hildesheim GmbH, University Medical Center Göttingen, Germany
| | - O. Akilov
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | | | - T. Estrach
- Hospital Clinico, University of Barcelona, Spain
| | - L. Vakeva
- Helsinki University Central Hospital, Finland
| | - P.A. Enz
- Hospital Italiano De Buenos Aires, Argentina, South America
| | - M. Wobser
- University Hospital Wuerzburg, Germany
| | | | - C. Jonak
- Dept of Dermatology, Medical University of Vienna, Austria
| | - M. Rubeta
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford UK
| | | | - A. Bates
- University Hospital Southampton, Southampton, UK
| | | | | | | | - A. Combalia
- Hospital Clinico, University of Barcelona, Spain
| | - E. Georgiou
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - E. Hauben
- Belgium University Hospitals Leuven, Leuven, Belgium
| | | | - M. Jost
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R. Knobler
- Dept of Dermatology, Medical University of Vienna, Austria
| | | | - D. Miyashiro
- University of Sao Paulo Medical School, Brazil, South America
| | - J. Cury-Martins
- University of Sao Paulo Medical School, Brazil, South America
| | - X. Martinez
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | - C. Muniesa
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - K. Quint
- Leiden University Medical Centre, The Netherlands
| | | | | | - R. Stranzenbach
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - Á. Szepesi
- Semmelweis University, Budapest, Hungary
| | | | | | - L. Cerroni
- Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria
| | - W. Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zurich, Switzerland
| | - S. Whittaker
- Kings College London, Guys and St Thomas NHS Foundation Trust, London
| | - R. Willemze
- Leiden University Medical Centre, The Netherlands
| | | | | |
Collapse
|