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Mullen S, Movia D. The role of extracellular vesicles in non-small-cell lung cancer, the unknowns, and how new approach methodologies can support new knowledge generation in the field. Eur J Pharm Sci 2023; 188:106516. [PMID: 37406971 DOI: 10.1016/j.ejps.2023.106516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
Extracellular vesicles (EVs) are nanosized particles released from most human cell types that contain a variety of cargos responsible for mediating cell-to-cell and organ-to-organ communications. Current knowledge demonstrates that EVs also play critical roles in many aspects of the progression of Non-Small-Cell Lung Cancer (NSCLC). Their roles range from increasing proliferative signalling to inhibiting apoptosis, promoting cancer metastasis, and modulating the tumour microenvironment to support cancer development. However, due to the limited availability of patient samples, intrinsic inter-species differences between human and animal EV biology, and the complex nature of EV interactions in vivo, where multiple cell types are present and several events occur simultaneously, the use of conventional preclinical and clinical models has significantly hindered reaching conclusive results. This review discusses the biological roles that EVs are currently known to play in NSCLC and identifies specific challenges in advancing today's knowledge. It also describes the NSCLC models that have been used to define currently-known EV functions, the limitations associated with their use in this field, and how New Approach Methodologies (NAMs), such as microfluidic platforms, organoids, and spheroids, can be used to overcome these limitations, effectively supporting future exciting discoveries in the NSCLC field and the potential clinical exploitation of EVs.
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Affiliation(s)
- Sive Mullen
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, James's Street, Dublin, Ireland; Laboratory for Biological Characterisation of Advanced Materials (LBCAM), Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Trinity Centre for Health Sciences, James's Street, Dublin, Ireland
| | - Dania Movia
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, James's Street, Dublin, Ireland; Laboratory for Biological Characterisation of Advanced Materials (LBCAM), Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Trinity Centre for Health Sciences, James's Street, Dublin, Ireland; Trinity St James's Cancer Institute, James's Street, Dublin, Ireland.
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Phase II Study of Immunotherapy With Tecemotide and Bevacizumab After Chemoradiation in Patients With Unresectable Stage III Non-Squamous Non-Small-Cell Lung Cancer (NS-NSCLC): A Trial of the ECOG-ACRIN Cancer Research Group (E6508). Clin Lung Cancer 2020; 21:520-526. [PMID: 32807654 DOI: 10.1016/j.cllc.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Although chemoradiotherapy (CRT) is the standard of care for patients with unresectable stage III non-small-cell lung cancer (LA-NSCLC), most patients relapse. Tecemotide is a MUC1 antigen-specific cancer immunotherapy vaccine. Bevacizumab improves survival in advanced nonsquamous (NS)-NSCLC and has a role in immune modulation. This phase II trial tested the combination of tecemotide and bevacizumab following CRT in patients with LA-NSCLC. PATIENTS AND METHODS Subjects with stage III NS-NSCLC suitable for CRT received carboplatin/paclitaxel weekly + 66 Gy followed by 2 cycles of consolidation carboplatin/paclitaxel ≤ 4 weeks of completion of CRT (Step 1). Patients with partial response/stable disease after consolidation therapy were registered onto step 2, which was 6 weekly tecemotide injections followed by every 6 weekly injections and bevacizumab every 3 weeks for up to 34 doses. The primary endpoint was to determine the safety of this regimen. RESULTS Seventy patients were enrolled; 68 patients (median age, 63 years; 56% male; 57% stage IIIA) initiated therapy, but only 39 patients completed CRT and consolidation therapy per protocol, primarily owing to disease progression or toxicity. Thirty-three patients (median age, 61 years; 58% male; 61% stage IIIA) were registered to step 2 (tecemotide + bevacizumab). The median number of step 2 cycles received was 11 (range, 2-25). Step 2 worst toxicity included grade 3, N = 9; grade 4, N = 1; and grade 5, N = 1. Grade 5 toxicity in step 2 was esophageal perforation attributed to bevacizumab. Among the treated and eligible patients (n = 32) who were treated on step 2, the median overall survival was 42.7 months (95% confidence interval, 21.7-63.3 months), and the median progression-free survival was 14.9 months (95% confidence interval, 11.0-20.9 months) from step 1 registration. CONCLUSIONS This cooperative group trial met its endpoint, demonstrating tolerability of bevacizumab + tecemotide after CRT and consolidation. In this selected group of patients, the median progression-free survival and overall survival are encouraging. Given that consolidation immunotherapy is now a standard of care following CRT in patients with LA-NSCLC, these results support a role for continued investigation of antiangiogenic and immunotherapy combinations in LA-NSCLC.
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Belluomini L, Fiorica F, Frassoldati A. Immune Checkpoint Inhibitors and Radiotherapy in NSCLC Patients: Not Just a Fluke. Oncol Ther 2019; 7:83-91. [PMID: 32700194 PMCID: PMC7360008 DOI: 10.1007/s40487-019-0092-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 12/30/2022] Open
Abstract
The discovery of immune checkpoint inhibitors (ICIs) such as programmed cell death protein 1 (PD-1) inhibitors, nivolumab and pembrolizumab, and programmed cell death ligand 1 (PD-L1) inhibitors, atezolizumab and durvalumab, has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). Concurrent radiotherapy (RT) is of particular interest with regard to the potential role for this combination in many settings. The purpose of this commentary is to evaluate the potential for the combination of immune checkpoint inhibitors and radiotherapy, including analysis of studies that have considered this combination in various settings.
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Affiliation(s)
| | - Francesco Fiorica
- Radiation Oncology Unit, University Hospital St. Anna, Ferrara, Italy
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Shafique MR, Robinson LA, Antonia S. Durvalumab: a potential maintenance therapy in surgery-ineligible non-small-cell lung cancer. Cancer Manag Res 2018; 10:931-940. [PMID: 29760563 PMCID: PMC5937504 DOI: 10.2147/cmar.s148009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the most common cancer worldwide and the most common cause of cancer-related death. Non-small-cell lung cancer comprises ~87% of newly diagnosed cases of lung cancer, and nearly one-third of these patients have stage III disease. Despite improvements in the treatment of stage IV lung cancer, particularly with the introduction and dissemination of checkpoint inhibitors, very little progress has been made in the treatment of stage III lung cancer. In this article, we discuss the general staging criteria and treatment options for stage III lung cancer. We review how concurrent radiation and chemotherapy can have immunomodulatory effects, supporting the rationale for incorporating immunotherapy into existing treatment paradigms. Finally, we discuss the results of the PACIFIC trial and implications for the treatment of stage III lung cancer. In the PACIFIC trial, adding durvalumab as a maintenance therapy following the completion of chemoradiotherapy improved progression-free survival in patients with locally advanced unresectable stage III lung cancer. On the strength of these results, durvalumab has been approved by the US Food and Drug Administration for use in this setting, representing the first advance in the treatment of stage III lung cancer in nearly a decade.
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Affiliation(s)
- Michael R Shafique
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lary A Robinson
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott Antonia
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Abstract
OBJECTIVE Ospemifene, an estrogen receptor agonist/antagonist approved for the treatment of dyspareunia and vaginal dryness in postmenopausal women, has potential new indications as an immune modulator. The overall objective of the present series of preclinical studies was to evaluate the immunomodulatory activity of ospemifene in combination with a peptide cancer vaccine. METHODS Immune regulating effects, mechanism of action and structure activity relationships of ospemifene and related compounds were evaluated by examining expression of T-cell activating cytokines in vitro, and antigen-specific immune response and cytotoxic T-lymphocyte activity in vivo. The effects of ospemifene (OSP) on the immune response to a peptide cancer vaccine (PV) were evaluated after chronic [control (n = 22); OSP 50 mg/kg (n = 16); PV (n = 6); OSP+PV (n = 11)], intermittent [control (n = 10); OSP 10 and 50 mg/kg (n = 11); PV (n = 11); combination treatment (n = 11 each dose)] and pretreatment [control; OSP 100 mg/kg; PV 100 μg; combination treatment (n = 8 all groups)] ospemifene oral dosing schedules in a total of 317 mixed-sex tumor-bearing and nontumor-bearing mice. RESULTS The results showed that ospemifene induced expression of the key TH1 cytokines interferon gamma and interleukin-2 in vitro, which may be mediated by stimulating T-cells through phosphoinositide 3-kinase and calmodulin signaling pathways. In combination with an antigen-specific peptide cancer vaccine, ospemifene increased antigen-specific immune response and increased cytotoxic T-lymphocyte activity in tumor-bearing and nontumor-bearing mice. The pretreatment, intermittent, and chronic dosing schedules of ospemifene activate naive T-cells, modulate antigen-induced tolerance and reduce tumor-associated, pro-inflammatory cytokines, respectively. CONCLUSIONS Taken together, ospemifene's dose response and schedule-dependent immune modulating activity offers a method of tailoring and augmenting the efficacy of previously failed antigen-specific cancer vaccines for a wide range of malignancies.
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Xu X, Chen W, Leng S, Padilla MT, Saxton B, Hutt J, Tessema M, Kato K, Kim KC, Belinsky SA, Lin Y. Muc1 knockout potentiates murine lung carcinogenesis involving an epiregulin-mediated EGFR activation feedback loop. Carcinogenesis 2017; 38:604-614. [PMID: 28472347 DOI: 10.1093/carcin/bgx039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/22/2017] [Indexed: 12/14/2022] Open
Abstract
Mucin 1 (MUC1) is a tumor antigen that is aberrantly overexpressed in various cancers, including lung cancer. Our previous in vitro studies showed that MUC1 facilitates carcinogen-induced EGFR activation and transformation in human lung bronchial epithelial cells (HBECs), which along with other reports suggests an oncogenic property for MUC1 in lung cancer. However, direct evidence for the role of MUC1 in lung carcinogenesis is lacking. In this study, we used the 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced A/J mouse lung tumor model to investigate the effect of whole-body Muc1 knockout (KO) on carcinogen-induced lung carcinogenesis. Surprisingly, lung tumor multiplicity was significantly increased in Muc1 KO compared to wild-type (WT) mice. The EGFR/AKT pathway was unexpectedly activated, and expression of the EGFR ligand epiregulin (EREG) was increased in the lung tissues of the Muc1 KO compared to the WT mice. EREG stimulated proliferation and protected against cigarette smoke extract (CSE)-induced cytotoxicity in in vitro cultured human bronchial epithelial cells. Additionally, we determined that MUC1 was expressed in human fibroblast cell lines where it suppressed CSE-induced EREG production. Further, suppression of MUC1 cellular activity with GO-201 enhanced EREG production in lung cancer cells, which in turn protected cancer cells from GO-201-induced cell death. Moreover, an inverse association between MUC1 and EREG was detected in human lung cancer, and EREG expression was inversely associated with patient survival. Together, these results support a promiscuous role of MUC1 in lung cancer development that may be related to cell-type specific functions of MUC1 in the tumor microenvironment, and MUC1 deficiency in fibroblasts and malignant cells results in increased EREG production that activates the EGFR pathway for lung carcinogenesis.
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Affiliation(s)
- Xiuling Xu
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Wenshu Chen
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Shuguang Leng
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Mabel T Padilla
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Bryanna Saxton
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Julie Hutt
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Mathewos Tessema
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Kosuke Kato
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ 86715, USA
| | - Kwang Chul Kim
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ 86715, USA
| | - Steven A Belinsky
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
| | - Yong Lin
- Molecular Biology and Lung Cancer Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest DR. SE, Albuquerque, NM 87108, USA and
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Khaniabadi PM, Majid AMS, Asif M, Khaniabadi BM, Shahbazi-Gahrouei D, Jaafar MS. Breast cancer cell targeted MR molecular imaging probe: Anti-MUC1 antibody-based magnetic nanoparticles. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/851/1/012014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Phase I/II study of tecemotide as immunotherapy in Japanese patients with unresectable stage III non-small cell lung cancer. Lung Cancer 2017; 105:23-30. [PMID: 28236981 DOI: 10.1016/j.lungcan.2017.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Unresectable stage III NSCLC (non-small cell lung cancer) confers a poor prognosis and interest is growing in the use of immunotherapy to improve outcomes for patients with this disease. We investigated the safety and efficacy of maintenance tecemotide, a mucin 1 (MUC1)-specific agent that induces T-cell responses to MUC1, versus placebo in Japanese patients with stage III unresectable NSCLC and no disease progression after primary chemoradiotherapy. MATERIALS AND METHODS Patients aged ≥20 years with unresectable stage III NSCLC, stable disease or clinical response after primary chemoradiotherapy and performance status ≤1, were recruited across 25 centers in Japan. Patients were randomized 2:1 to tecemotide (930μg as lipopeptide) or placebo subcutaneously once weekly for 8 weeks, then every 6 weeks until disease progression or treatment withdrawal. Cyclophosphamide 300mg/m2 (maximum dose 600mg) was given intravenously 3days before the first dose of tecemotide. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival, time to progression, time to treatment failure and safety. RESULTS The intent-to-treat population comprised 172 patients; 114 received tecemotide and 58 placebo. Baseline characteristics were comparable between treatment arms. Most patients (94%) received primary concurrent chemoradiotherapy. There was no apparent trend toward increased OS time with tecemotide over placebo (median 32.4 versus 32.2 months, hazard ratio 0.95, 95% confidence interval 0.61-1.48; P=0.83). No improvements in secondary efficacy endpoints were observed. The frequency of treatment-related adverse events was similar, and serious adverse event rates were the same in both arms. There were no new safety signals. CONCLUSIONS These results do not support those from a randomized phase III study (START) of improved OS with tecemotide in the subgroup of patients treated with primary concurrent chemoradiotherapy.
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Wang S, Li J. [Progress in Immunotherapy for Squamous Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:682-686. [PMID: 27760599 PMCID: PMC5973414 DOI: 10.3779/j.issn.1009-3419.2016.10.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
近几年来,肺鳞癌在化疗及靶向治疗上的进展不够显著,但免疫治疗却在肺鳞癌的治疗上取得了突破性的进展。免疫治疗通过免疫系统来清除肿瘤细胞,主要分为免疫检查点抑制剂及治疗性疫苗。免疫检查点抑制剂,包括抗细胞毒性T淋巴细胞抗原4(cytotoxic T-lymphocyte associated antigen 4, CTLA-4)抗体与抗程序性死亡受体-1(programmed death receptor 1, PD-1)抗体等多种药物已进行了肺鳞癌的Ⅱ期、Ⅲ期临床试验,并取得了一定成果。免疫治疗将成为肺鳞癌治疗的一种重要手段。
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Affiliation(s)
- Shouzheng Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100021, China
| | - Junling Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100021, China
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Olesch C, Sha W, Angioni C, Sha LK, Açaf E, Patrignani P, Jakobsson PJ, Radeke HH, Grösch S, Geisslinger G, von Knethen A, Weigert A, Brüne B. MPGES-1-derived PGE2 suppresses CD80 expression on tumor-associated phagocytes to inhibit anti-tumor immune responses in breast cancer. Oncotarget 2016; 6:10284-96. [PMID: 25871398 PMCID: PMC4496355 DOI: 10.18632/oncotarget.3581] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/13/2015] [Indexed: 01/04/2023] Open
Abstract
Prostaglandin E2 (PGE2) favors multiple aspects of tumor development and immune evasion. Therefore, microsomal prostaglandin E synthase (mPGES-1/-2), is a potential target for cancer therapy. We explored whether inhibiting mPGES-1 in human and mouse models of breast cancer affects tumor-associated immunity. A new model of breast tumor spheroid killing by human PBMCs was developed. In this model, tumor killing required CD80 expression by tumor-associated phagocytes to trigger cytotoxic T cell activation. Pharmacological mPGES-1 inhibition increased CD80 expression, whereas addition of PGE2, a prostaglandin E2 receptor 2 (EP2) agonist, or activation of signaling downstream of EP2 reduced CD80 expression. Genetic ablation of mPGES-1 resulted in markedly reduced tumor growth in PyMT mice. Macrophages of mPGES-1−/− PyMT mice indeed expressed elevated levels of CD80 compared to their wildtype counterparts. CD80 expression in tumor-spheroid infiltrating mPGES-1−/− macrophages translated into antigen-specific cytotoxic T cell activation. In conclusion, mPGES-1 inhibition elevates CD80 expression by tumor-associated phagocytes to restrict tumor growth. We propose that mPGES-1 inhibition in combination with immune cell activation might be part of a therapeutic strategy to overcome the immunosuppressive tumor microenvironment.
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Affiliation(s)
- Catherine Olesch
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Weixiao Sha
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Carlo Angioni
- Institute of Clinical Pharmacology/ZAFES, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Lisa Katharina Sha
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Elias Açaf
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Paola Patrignani
- Department of Neuroscience, Imaging and Clinical Sciences and Center of Excellence on Aging (CeSI), "G. d'Annunzio" University, Chieti, Italy
| | - Per-Johan Jakobsson
- Department of Medicine, Rheumatology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Heinfried H Radeke
- Pharmazentrum Frankfurt/ZAFES, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Sabine Grösch
- Institute of Clinical Pharmacology/ZAFES, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology/ZAFES, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas von Knethen
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Bernhard Brüne
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
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Wurz GT, Kao CJ, Wolf M, DeGregorio MW. Tecemotide: an antigen-specific cancer immunotherapy. Hum Vaccin Immunother 2015; 10:3383-93. [PMID: 25483673 DOI: 10.4161/hv.29836] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The identification of tumor-associated antigens (TAA) has made possible the development of antigen-specific cancer immunotherapies such as tecemotide. One of those is mucin 1 (MUC1), a cell membrane glycoprotein expressed on some epithelial tissues such as breast and lung. In cancer, MUC1 becomes overexpressed and aberrantly glycosylated, exposing the immunogenic tandem repeat units in the extracellular domain of MUC1. Designed to target tumor associated MUC1, tecemotide is being evaluated in Phase III clinical trials for treatment of unresectable stage IIIA/IIIB non-small cell lung cancer (NSCLC) as maintenance therapy following chemoradiotherapy. Additional Phase II studies in other indications are ongoing. This review discusses the preclinical and clinical development of tecemotide, ongoing preclinical studies of tecemotide in human MUC1 transgenic mouse models of breast and lung cancer, and the potential application of these models for optimizing the timing of chemoradiotherapy and tecemotide immunotherapy to achieve the best treatment outcome for patients.
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Key Words
- ADT, androgen deprivation therapy
- APC, antigen presenting cell
- ASI, active specific immunotherapy
- BSC, best supportive care
- CEA, carcinoembryonic antigen
- CI, confidence interval
- CONSORT, consolidated standards of reporting trials
- CPA, cyclophosphamide
- CRT, chemoradiotherapy
- CTL, Cytotoxic T-lymphocyte
- Chemoradiotherapy
- DMPG, Dimyristoyl phosphatidylglycerol
- DPPC, Dipalmitoyl phosphatidylcholine
- DTH, delayed-type hypersensitivity
- ECOG, Eastern cooperative oncology group
- ELISpot, enzyme-linked immunosorbent spot
- FACT-L, functional assessment of cancer therapy-lung
- Gy, gray
- HLA, human lymphocyte antigen
- HR, hazard ratio
- IFN-γ, interferon gamma
- IL-2, Interleukin 2
- INSPIRE, stimuvax trial in Asian NSCLC patients: stimulating immune response
- ITT, intent to treat
- IgG, immunoglobulin G
- KLH, keyhole limpet hemocyanin
- LICC, L-BLP25 in colorectal cancer
- LR, locoregional
- MAP, multiple antigenic peptide
- MHC, major histocompatibility complex
- MMT, muc1-expressing mammary tumor
- MPLA, monophosphoryl lipid A
- MUC1
- MUC1, Mucin 1
- MUC1.Tg, MUC1 transgenic
- NSCLC, non-small cell lung cancer
- OH-BBN, N-butyl-N-(4-hydroxybutyl)nitrosamine
- OS, overall survival
- PBL, peripheral blood lymphocytes
- PCR, pathological complete remission
- PSA, prostate specific antigen
- PyV-mT, polyomavirus middle-T
- QOL, quality of life
- RCB, residual cancer burden
- RECIST, response evaluation criteria in solid tumors
- RTX, radiotherapy
- START, stimulating targeted antigenic responses to NSCLC
- TAA, tumor associated antigen
- TGF-β, transforming growth factor β
- TH1, T-helper type I
- TH2, T-helper type II
- TNF-α, tumor necrosis factor α
- TOI, trial outcome index
- VNTR, variable number of tandem repeats
- i.v., intravenous
- immunotherapy
- non-small cell lung cancer
- tecemotide
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Affiliation(s)
- Gregory T Wurz
- a University of California , Davis; Department of Internal Medicine; Division of Hematology and Oncology ; Sacramento , CA USA
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Mitchell P, Thatcher N, Socinski MA, Wasilewska-Tesluk E, Horwood K, Szczesna A, Martín C, Ragulin Y, Zukin M, Helwig C, Falk M, Butts C, Shepherd FA. Tecemotide in unresectable stage III non-small-cell lung cancer in the phase III START study: updated overall survival and biomarker analyses. Ann Oncol 2015; 26:1134-1142. [PMID: 25722382 DOI: 10.1093/annonc/mdv104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tecemotide is a MUC1-antigen-specific cancer immunotherapy. The phase III START study did not meet its primary end point but reported notable survival benefit with tecemotide versus placebo in an exploratory analysis of the predefined patient subgroup treated with concurrent chemoradiotherapy. Here, we attempted to gain further insight into the effects of tecemotide in START. PATIENTS AND METHODS START recruited patients who did not progress following frontline chemoradiotherapy for unresectable stage III non-small-cell lung cancer. We present updated overall survival (OS) data and exploratory analyses of OS for baseline biomarkers: soluble MUC1 (sMUC1), antinuclear antibodies (ANA), neutrophil/lymphocyte ratio (NLR), lymphocyte count, and HLA type. RESULTS Updated OS data are consistent with the primary analysis: median 25.8 months (tecemotide) versus 22.4 months (placebo) (HR 0.89, 95% CI 0.77-1.03, P = 0.111), with ∼20 months additional median follow-up time compared with the primary analysis. Exploratory analysis of the predefined subgroup treated with concurrent chemoradiotherapy revealed clinically relevant prolonged OS with tecemotide versus placebo (29.4 versus 20.8 months; HR 0.81, 95% CI 0.68-0.98, P = 0.026). No improvement was seen with sequential chemoradiotherapy. High sMUC1 and ANA correlated with a possible survival benefit with tecemotide (interaction P = 0.0085 and 0.0022) and might have future value as biomarkers. Interactions between lymphocyte count, NLR, or prespecified HLA alleles and treatment effect were not observed. CONCLUSION Updated OS data support potential treatment benefit with tecemotide in patients treated with concurrent chemoradiotherapy. Exploratory biomarker analyses suggest that elevated sMUC1 or ANA levels correlate with tecemotide benefit. CLINICALTRIALSGOV NUMBER NCT00409188.
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Affiliation(s)
- P Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.
| | - N Thatcher
- Christie Hospital NHS Trust, Manchester, UK
| | | | | | - K Horwood
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - A Szczesna
- Mazowieckie Centrum Leczenia Chorób Pluc i Gruzlicy, Otwock, Poland
| | - C Martín
- Division of Clinical Oncology, Instituto Especializado Alexander Fleming, Buenos Aires, Argentina
| | - Y Ragulin
- Medical Radiological Research Center, Obninsk, Russia
| | - M Zukin
- Clinical Oncology, Instituto Nacional do Câncer-INCA, Rio de Janeiro, Brazil
| | | | - M Falk
- Merck KGaA, Darmstadt, Germany
| | - C Butts
- Cancer Care, Cross Cancer Institute, Edmonton
| | - F A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
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Kao CJ, Wurz GT, Lin YC, Vang DP, Griffey SM, Wolf M, DeGregorio MW. Assessing the Effects of Concurrent versus Sequential Cisplatin/Radiotherapy on Immune Status in Lung Tumor-Bearing C57BL/6 Mice. Cancer Immunol Res 2015; 3:741-50. [PMID: 25672395 DOI: 10.1158/2326-6066.cir-14-0234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022]
Abstract
Concurrent and sequential cisplatin-based chemoradiotherapy regimens are standard therapeutic approaches in cancer treatment. Recent clinical data suggest that these different dosing schedules may adversely affect antigen-specific immunotherapy. The goal of the present preclinical study was to explore the effects of concurrent and sequential cisplatin/radiotherapy on immune status in a lung cancer mouse model. A total of 150 C57BL/6 mice were randomized into six treatment groups: control; 8 Gy thoracic radiotherapy (dose schedules 1 and 2); cisplatin 2.5 mg/kg i.p.; cisplatin + radiotherapy (concurrent); and cisplatin + radiotherapy (sequential; n = 25, all groups). At the end of the study (week 41), serum cytokines were assessed by multiplex immunoassay, surface markers of spleen-derived lymphocytes were assessed by immunostaining and flow cytometry, lung tumor expression of programmed death ligands 1 and 2 (PD-L1/2) was evaluated by immunohistochemistry, and miRNA profiling was performed in serum and lymphocytes by quantitative real-time PCR. Lung whole mounts were prepared to assess treatment effects on lung tumor foci formation. The results showed that sequential chemoradiotherapy (two cycles of cisplatin followed by 8 Gy radiotherapy) had equivalent antitumor activity as concurrent therapy. However, sequential cisplatin/radiotherapy resulted in significant differences in several immune response biomarkers, including regulatory T cells, miR-29c, expression of costimulatory molecule CD28, and serum IFNγ. PD-L1 and PD-L2 were strongly expressed in tumor foci, but no trend was seen between groups. These results suggest that monitoring immune status may be necessary when designing treatment regimens combining immunotherapy with chemoradiotherapy.
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Affiliation(s)
- Chiao-Jung Kao
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Gregory T Wurz
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Yi-Chen Lin
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Daniel P Vang
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Stephen M Griffey
- Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Michael Wolf
- ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Michael W DeGregorio
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California.
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Xia W, Wang J, Xu Y, Jiang F, Xu L. L-BLP25 as a peptide vaccine therapy in non-small cell lung cancer: a review. J Thorac Dis 2014; 6:1513-20. [PMID: 25364531 DOI: 10.3978/j.issn.2072-1439.2014.08.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/03/2014] [Indexed: 12/30/2022]
Abstract
Lung cancer is one of the most prevalent malignancies worldwide and the leading cause of cancer-related death. Most cases are non-small cell lung cancer (NSCLC). The median overall survival of patients with advanced stage undergoing current standard chemotherapy is approximately 10 months. The addition of new compounds, including targeted agents, to standard first-line cytotoxic doublets, which are administered concurrently and/or as maintenance therapy in patients who have not experienced disease progression after first-line treatment, has shown potential in improving the efficacy in patients with advanced disease. L-BLP25 is a mucin 1 (MUC1) antigen-specific immunotherapy induces a T-cell response to MUC1 in both a preclinical MUC1-transgenic lung cancer mouse model and patients. This review is aimed at introducing the mechanism by which L-BLP25 targets MUC1, summarizing the achievements gained in the completed clinical trials with L-BLP25 administered as maintenance therapy in the treatment of unresectable stage III/IV NSCLC, and discussing the research trends.
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Affiliation(s)
- Wenjie Xia
- 1 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China ; 2 The Fourth Clinical College of Nanjing Medical University, Nanjing 210000, China ; 3 The First Clinical College of Nanjing Medical University, Nanjing 210000, China
| | - Jie Wang
- 1 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China ; 2 The Fourth Clinical College of Nanjing Medical University, Nanjing 210000, China ; 3 The First Clinical College of Nanjing Medical University, Nanjing 210000, China
| | - Youtao Xu
- 1 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China ; 2 The Fourth Clinical College of Nanjing Medical University, Nanjing 210000, China ; 3 The First Clinical College of Nanjing Medical University, Nanjing 210000, China
| | - Feng Jiang
- 1 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China ; 2 The Fourth Clinical College of Nanjing Medical University, Nanjing 210000, China ; 3 The First Clinical College of Nanjing Medical University, Nanjing 210000, China
| | - Lin Xu
- 1 Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Baiziting 42, Nanjing 210009, China ; 2 The Fourth Clinical College of Nanjing Medical University, Nanjing 210000, China ; 3 The First Clinical College of Nanjing Medical University, Nanjing 210000, China
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15
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Mostafa AA, Morris DG. Immunotherapy for Lung Cancer: Has it Finally Arrived? Front Oncol 2014; 4:288. [PMID: 25374843 PMCID: PMC4206190 DOI: 10.3389/fonc.2014.00288] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/06/2014] [Indexed: 01/08/2023] Open
Abstract
The possible link between infection/inflammation/immune activation and a cancer patient’s outcome from both a causative and outcome point of view has long been postulated. Substantial progress in the understanding of tumor-associated antigens/epitopes, immune cellular subpopulations, cytokine pathways/expression, the tumor microenvironment, and the balance between tumor-immune suppression and stimulation have been made over the past decade. This knowledge has heralded a new era of tumor immunotherapy utilizing vaccines, immune checkpoint inhibition, and oncolytic viruses. Despite significant progress in the molecular era now with targeted therapeutics such as EGFR tyrosine kinase inhibitors and ALK fusion protein inhibitors that have significantly improved the outcome of these specific lung cancer subpopulations, the overall 5 year survival for all non-small cell lung cancer (NSCLC) is still <20%. Unlike malignancies such as malignant melanoma, renal cell carcinoma, and neuroblastoma given their documented spontaneous remission rates lung cancer historically has been felt to be resistant to immune approaches likely related to an immunosuppressive tumor microenvironment and/or lack of immune recognition. Defining responding populations, understanding the mechanism(s) underlying durable immune responses, and the role of chemotherapy, radiation, oncolytic viruses, and other tumor disrupting agents in augmenting immune responses have led to improved optimization of immune therapeutic strategies. The purpose of this review is to focus on the recent advances in lung immunotherapy with an emphasis on recent clinical trials in the last 5 years in NSCLC.
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Affiliation(s)
- Ahmed A Mostafa
- Department of Oncology, University of Calgary , Calgary, AB , Canada
| | - Don G Morris
- Department of Oncology, University of Calgary , Calgary, AB , Canada
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16
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Wu R, Ru Q, Chen L, Ma B, Li C. Stereospecificity of Ginsenoside Rg3 in the Promotion of Cellular Immunity in Hepatoma H22-Bearing Mice. J Food Sci 2014; 79:H1430-5. [DOI: 10.1111/1750-3841.12518] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/14/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Rihui Wu
- Wuhan Inst. of Biomedical Sciences; Jianghan Univ; Wuhan 430056 China
| | - Qin Ru
- Wuhan Inst. of Biomedical Sciences; Jianghan Univ; Wuhan 430056 China
| | - Lin Chen
- Wuhan Inst. of Biomedical Sciences; Jianghan Univ; Wuhan 430056 China
| | - Baomiao Ma
- Wuhan Inst. of Biomedical Sciences; Jianghan Univ; Wuhan 430056 China
| | - Chaoying Li
- Wuhan Inst. of Biomedical Sciences; Jianghan Univ; Wuhan 430056 China
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DeGregorio M, Soe L, Wolf M. Tecemotide (L-BLP25) versus placebo after chemoradiotherapy for stage III non-small cell lung cancer (START): a randomized, double-blind, phase III trial. J Thorac Dis 2014; 6:571-3. [PMID: 24976972 DOI: 10.3978/j.issn.2072-1439.2014.05.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 04/25/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Michael DeGregorio
- 1 University of California, Davis, Department of Internal Medicine, Division of Hematology and Oncology, Sacramento, CA, USA ; 2 El Dorado Hematology and Oncology, Marshall Hospital, Cameron Park, CA, USA ; 3 Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Lin Soe
- 1 University of California, Davis, Department of Internal Medicine, Division of Hematology and Oncology, Sacramento, CA, USA ; 2 El Dorado Hematology and Oncology, Marshall Hospital, Cameron Park, CA, USA ; 3 Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Michael Wolf
- 1 University of California, Davis, Department of Internal Medicine, Division of Hematology and Oncology, Sacramento, CA, USA ; 2 El Dorado Hematology and Oncology, Marshall Hospital, Cameron Park, CA, USA ; 3 Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
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18
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Kao CJ, Wurz GT, Monjazeb AM, Vang DP, Cadman TB, Griffey SM, Wolf M, DeGregorio MW. Antitumor effects of cisplatin combined with tecemotide immunotherapy in a human MUC1 transgenic lung cancer mouse model. Cancer Immunol Res 2014; 2:581-9. [PMID: 24894093 DOI: 10.1158/2326-6066.cir-13-0205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goals of the present study were to define the effects of simultaneous cisplatin/tecemotide therapy on tumor development in a human mucin 1 (MUC1) transgenic lung cancer mouse model and to examine the effects of radiotherapy (RTX) on splenocytes, serum cytokines, and immune response to tecemotide. Two hundred twenty-six human MUC1 transgenic C57BL/6 mice were used in five studies designed to assess (i) serum cytokine and immune responses following four weekly 10-μg doses of tecemotide; (ii) the effects of simultaneous administration of cisplatin (2.5 mg/kg × 2 doses/cycle × 4 cycles) and tecemotide (2 cycles × 8 weekly 10-μg doses/cycle) therapy on tumor development, serum cytokines, and immune response; (iii) the dose-response effects of RTX on lymphocyte counts 16 hours following doses of 2 to 8 Gy; (iv) the time course of lymphocyte recovery from 16 hours to 20 days following 8-Gy RTX; and (v) the effects of simultaneous administration of RTX (8 Gy) and tecemotide on the immune response to tecemotide (four weekly 10-μg doses). Serum cytokines were analyzed by multiplex immunoassay, IFNγ immune responses by enzyme-linked immunosorbent spot (ELISpot), and lung tumor foci by lung whole mounts. Simultaneous cisplatin/tecemotide therapy resulted in significant and additive reduction in lung tumor foci compared with control mice, with significantly elevated serum IFNγ levels and specific IFNγ immune responses observed in both tecemotide and tecemotide + cisplatin-treated mice. Finally, neither cisplatin nor radiation interfered with the immune response to tecemotide.
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Affiliation(s)
- Chiao-Jung Kao
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Gregory T Wurz
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Arta M Monjazeb
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Daniel P Vang
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Timothy B Cadman
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Stephen M Griffey
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Michael Wolf
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Michael W DeGregorio
- Authors' Affiliations: Division of Hematology and Oncology, Department of Internal Medicine, Department of Radiation Oncology, University of California, Davis, Sacramento; Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California; and Department of ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
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19
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Butts C, Socinski MA, Mitchell PL, Thatcher N, Havel L, Krzakowski M, Nawrocki S, Ciuleanu TE, Bosquée L, Trigo JM, Spira A, Tremblay L, Nyman J, Ramlau R, Wickart-Johansson G, Ellis P, Gladkov O, Pereira JR, Eberhardt WEE, Helwig C, Schröder A, Shepherd FA. Tecemotide (L-BLP25) versus placebo after chemoradiotherapy for stage III non-small-cell lung cancer (START): a randomised, double-blind, phase 3 trial. Lancet Oncol 2013; 15:59-68. [PMID: 24331154 DOI: 10.1016/s1470-2045(13)70510-2] [Citation(s) in RCA: 365] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Effective maintenance therapies after chemoradiotherapy for lung cancer are lacking. Our aim was to investigate whether the MUC1 antigen-specific cancer immunotherapy tecemotide improves survival in patients with stage III unresectable non-small-cell lung cancer when given as maintenance therapy after chemoradiation. METHODS The phase 3 START trial was an international, randomised, double-blind trial that recruited patients with unresectable stage III non-small-cell lung cancer who had completed chemoradiotherapy within the 4-12 week window before randomisation and received confirmation of stable disease or objective response. Patients were stratified by stage (IIIA vs IIIB), response to chemoradiotherapy (stable disease vs objective response), delivery of chemoradiotherapy (concurrent vs sequential), and region using block randomisation, and were randomly assigned (2:1, double-blind) by a central interactive voice randomisation system to either tecemotide or placebo. Injections of tecemotide (806 μg lipopeptide) or placebo were given every week for 8 weeks, and then every 6 weeks until disease progression or withdrawal. Cyclophosphamide 300 mg/m(2) (before tecemotide) or saline (before placebo) was given once before the first study drug administration. The primary endpoint was overall survival in a modified intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00409188. FINDINGS From Feb 22, 2007, to Nov 15, 2011, 1513 patients were randomly assigned (1006 to tecemotide and 507 to placebo). 274 patients were excluded from the primary analysis population as a result of a clinical hold, resulting in analysis of 829 patients in the tecemotide group and 410 in the placebo group in the modified intention-to-treat population. Median overall survival was 25.6 months (95% CI 22.5-29.2) with tecemotide versus 22.3 months (19.6-25.5) with placebo (adjusted HR 0.88, 0.75-1.03; p=0.123). In the patients who received previous concurrent chemoradiotherapy, median overall survival for the 538 (65%) of 829 patients assigned to tecemotide was 30.8 months (95% CI 25.6-36.8) compared with 20.6 months (17.4-23.9) for the 268 (65%) of 410 patients assigned to placebo (adjusted HR 0.78, 0.64-0.95; p=0.016). In patients who received previous sequential chemoradiotherapy, overall survival did not differ between the 291 (35%) patients in the tecemotide group and the 142 (35%) patients in the placebo group (19.4 months [95% CI 17.6-23.1] vs 24.6 months [18.8-33.0], respectively; adjusted HR 1.12, 0.87-1.44; p=0.38). Grade 3-4 adverse events seen with a greater than 2% frequency with tecemotide were dyspnoea (49 [5%] of 1024 patients in the tecemotide group vs 21 [4%] of 477 patients in the placebo group), metastases to central nervous system (29 [3%] vs 6 [1%]), and pneumonia (23 [2%] vs 12 [3%]). Serious adverse events with a greater than 2% frequency with tecemotide were pneumonia (30 [3%] in the tecemotide group vs 14 [3%] in the placebo group), dyspnoea (29 [3%] vs 13 [3%]), and metastases to central nervous system (32 [3%] vs 9 [2%]). Serious immune-related adverse events did not differ between groups. INTERPRETATION We found no significant difference in overall survival with the administration of tecemotide after chemoradiotherapy compared with placebo for all patients with unresectable stage III non-small-cell lung cancer. However, tecemotide might have a role for patients who initially receive concurrent chemoradiotherapy, and further study in this population is warranted. FUNDING Merck KGaA (Darmstadt, Germany).
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Affiliation(s)
| | | | - Paul L Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, VIC, Australia
| | | | - Libor Havel
- Klinika Pneumologie a Hrudní Chirurgie, Univerzity Karlovy, Prague, Czech Republic
| | | | - Sergiusz Nawrocki
- University of Warmia and Mazury, Olsztyn, Poland; Silesian Medical University, Katowice, Poland
| | - Tudor-Eliade Ciuleanu
- Ion Chiricuta Cancer Institute and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Lionel Bosquée
- Centre Hospitalier du Bois de l'Abbaye et de Hesbaye, Seraing, Belgium
| | | | | | - Lise Tremblay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada
| | - Jan Nyman
- Sahlgrenska University Hospital, Göteborg, Sweden
| | - Rodryg Ramlau
- Wielkopolskie Centrum Pulmonologii i Torakochirurgii, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Peter Ellis
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Oleg Gladkov
- Chelyabinsk Regional Clinical Oncology Dispensary, Chelyabinsk, Russia
| | | | - Wilfried Ernst Erich Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | - Frances A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
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20
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Vang DP, Wurz GT, Griffey SM, Kao CJ, Gutierrez AM, Hanson GK, Wolf M, DeGregorio MW. Induction of invasive transitional cell bladder carcinoma in immune intact human MUC1 transgenic mice: a model for immunotherapy development. J Vis Exp 2013:e50868. [PMID: 24300078 DOI: 10.3791/50868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A preclinical model of invasive bladder cancer was developed in human mucin 1 (MUC1) transgenic (MUC1.Tg) mice for the purpose of evaluating immunotherapy and/or cytotoxic chemotherapy. To induce bladder cancer, C57BL/6 mice (MUC1.Tg and wild type) were treated orally with the carcinogen N-butyl-N-(4-hydroxybutyl)nitrosamine (OH-BBN) at 3.0 mg/day, 5 days/week for 12 weeks. To assess the effects of OH-BBN on serum cytokine profile during tumor development, whole blood was collected via submandibular bleeds prior to treatment and every four weeks. In addition, a MUC1-targeted peptide vaccine and placebo were administered to groups of mice weekly for eight weeks. Multiplex fluorometric microbead immunoanalyses of serum cytokines during tumor development and following vaccination were performed. At termination, interferon gamma (IFN-γ)/interleukin-4 (IL-4) ELISpot analysis for MUC1 specific T-cell immune response and histopathological evaluations of tumor type and grade were performed. The results showed that: (1) the incidence of bladder cancer in both MUC1.Tg and wild type mice was 67%; (2) transitional cell carcinomas (TCC) developed at a 2:1 ratio compared to squamous cell carcinomas (SCC); (3) inflammatory cytokines increased with time during tumor development; and (4) administration of the peptide vaccine induces a Th1-polarized serum cytokine profile and a MUC1 specific T-cell response. All tumors in MUC1.Tg mice were positive for MUC1 expression, and half of all tumors in MUC1.Tg and wild type mice were invasive. In conclusion, using a team approach through the coordination of the efforts of pharmacologists, immunologists, pathologists and molecular biologists, we have developed an immune intact transgenic mouse model of bladder cancer that expresses hMUC1.
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Affiliation(s)
- Daniel P Vang
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis
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21
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Kao CJ, Wurz GT, Schröder A, Wolf M, Degregorio MW. Clarifying the pharmacodynamics of tecemotide (L-BLP25)-based combination therapy. Oncoimmunology 2013; 2:e26285. [PMID: 24498545 PMCID: PMC3896473 DOI: 10.4161/onci.26285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022] Open
Abstract
The results of a recently completed Phase III clinical trial suggest that concurrent chemoradiotherapy followed by tecemotide provides superior benefits to Stage IIIa and IIIb non-small cell lung carcinoma patients as compared with sequential chemoradiotherapy followed by tecemotide. These clinical observations will be dissected in a transgenic model of lung cancer that we have recently established (hMUC1.Tg C57BL/6 mice).
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Affiliation(s)
- Chiao-Jung Kao
- University of California, Davis; Department of Internal Medicine; Division of Hematology and Oncology; Sacramento, CA USA
| | - Gregory T Wurz
- University of California, Davis; Department of Internal Medicine; Division of Hematology and Oncology; Sacramento, CA USA
| | | | - Michael Wolf
- ImmunoOncology; Merck Serono Research; Merck KGaA, Germany
| | - Michael W Degregorio
- University of California, Davis; Department of Internal Medicine; Division of Hematology and Oncology; Sacramento, CA USA
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