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Grote C, Bohne AS, Blome C, Kähler KC. Quality of life under treatment with the immune checkpoint inhibitors ipilimumab and nivolumab in melanoma patients. Real-world data from a prospective observational study at the Skin Cancer Center Kiel. J Cancer Res Clin Oncol 2024; 150:454. [PMID: 39387946 DOI: 10.1007/s00432-024-05981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 09/30/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE Combined immunotherapy (ipilimumab + nivolumab) has improved survival in stage IV melanoma patients, making Health-related Quality of Life (HrQoL) crucial due to potential immune-related adverse events (irAEs). Previous studies treated HrQoL as secondary/explorative endpoint, and no specific HrQoL questionnaire for melanoma patients on immune checkpoint inhibitor (ICI) therapy exists. This study aimed to gather specific HrQoL data during combined ICI therapy, tracking changes during and after treatment, and examining associations with gender, irAEs, and treatment response. METHODS 35 melanoma patients (22 males, 13 females) undergoing combined ICI were surveyed using the Short-form 36 questionnaire (SF-36), the Inflammatory Bowel Disease Questionnaire - Deutsch (IBDQ-D), and the distress thermometer (DT). HrQoL was evaluated during treatment, after six months, and at the onset of autoimmune colitis. RESULTS irAEs occurred in 51.4% of patients, with colitis being the most common (26.1%). 45.7% had progressive disease. SF-36 showed stable HrQoL during treatment and follow-up. Women had worse HrQoL on the physical component scale than men (p = 0.019). Patients with progression showed worse HrQoL over time in physical (p = 0.015) and mental health scales (p = 0.04). IBDQ-D showed constant HrQoL throughout treatment and follow-up. Distress on DT remained constant, with women reporting higher levels of distress. CONCLUSION HrQoL remained stable during and after therapy. Female gender and disease progression negatively impacted HrQoL. The development of irAEs was not associated with HrQoL, though this may not apply to severe irAEs like colitis, which were not assessed.
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Affiliation(s)
- Carolin Grote
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Hospital Schleswig- Holstein (UKSH), Kiel, Germany
| | | | - Christine Blome
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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2
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Strudel M, Festino L, Vanella V, Beretta M, Marincola FM, Ascierto PA. Melanoma: Prognostic Factors and Factors Predictive of Response to Therapy. Curr Med Chem 2020; 27:2792-2813. [PMID: 31804158 DOI: 10.2174/0929867326666191205160007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A better understanding of prognostic factors and biomarkers that predict response to treatment is required in order to further improve survival rates in patients with melanoma. Prognostic Factors: The most important histopathological factors prognostic of worse outcomes in melanoma are sentinel lymph node involvement, increased tumor thickness, ulceration and higher mitotic rate. Poorer survival may also be related to several clinical factors, including male gender, older age, axial location of the melanoma, elevated serum levels of lactate dehydrogenase and S100B. Predictive Biomarkers: Several biomarkers have been investigated as being predictive of response to melanoma therapies. For anti-Programmed Death-1(PD-1)/Programmed Death-Ligand 1 (PD-L1) checkpoint inhibitors, PD-L1 tumor expression was initially proposed to have a predictive role in response to anti-PD-1/PD-L1 treatment. However, patients without PD-L1 expression also have a survival benefit with anti-PD-1/PD-L1 therapy, meaning it cannot be used alone to select patients for treatment, in order to affirm that it could be considered a correlative, but not a predictive marker. A range of other factors have shown an association with treatment outcomes and offer potential as predictive biomarkers for immunotherapy, including immune infiltration, chemokine signatures, and tumor mutational load. However, none of these have been clinically validated as a factor for patient selection. For combined targeted therapy (BRAF and MEK inhibition), lactate dehydrogenase level and tumor burden seem to have a role in patient outcomes. CONCLUSION With increasing knowledge, the understanding of melanoma stage-specific prognostic features should further improve. Moreover, ongoing trials should provide increasing evidence on the best use of biomarkers to help select the most appropriate patients for tailored treatment with immunotherapies and targeted therapies.
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Affiliation(s)
- Martina Strudel
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Lucia Festino
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
| | - Massimiliano Beretta
- Centro di Riferimento Oncologico, Department of Medical Oncology, Aviano (PN), Italy
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Cancer Immunotherapy and Innovative Therapy Unit, Naples, Italy
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3
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Krieger T, Pearson I, Bell J, Doherty J, Robbins P. Targeted literature review on use of tumor mutational burden status and programmed cell death ligand 1 expression to predict outcomes of checkpoint inhibitor treatment. Diagn Pathol 2020; 15:6. [PMID: 32000815 PMCID: PMC6990470 DOI: 10.1186/s13000-020-0927-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
Background To achieve optimal outcomes, an individual approach is needed in the treatment and care of patients. The potential value of tumor mutational burden (TMB) status and/or programmed cell death ligand 1 (PD-L1) expression as biomarkers to predict which patients are most likely to respond to checkpoint inhibitors has been explored in many studies. The goal of this targeted literature review is to identify data available for TMB status and/or PD-L1 expression that predict response to checkpoint inhibitors and/or anti–cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) antibodies. Methods Targeted literature searches were performed using electronic medical databases (MEDLINE, Embase, and BIOSIS) and internet searches of specified sites. Bibliographies of key systematic literature reviews and meta-analyses also were reviewed for studies of interest. Results The review identified 27 studies of non-small cell lung cancer (NSCLC), 40 studies of melanoma, 10 studies of urothelial cancer, and 5 studies of renal cell cancer indications. Studies also were identified in other cancer types, e.g., colorectal, breast, gastric, and Merkel cell cancer and squamous-cell carcinoma of the head and neck. Twelve trials, including six in NSCLC and four in melanoma, evaluated TMB as a predictor of outcomes. A TMB of ≥10 mutations per megabase was shown to be an effective biomarker in the CheckMate 227 study. PD-L1 expression was included in the majority of identified studies and was found to predict response in in melanoma and in all types of NSCLC. Prediction of response was not a prespecified analysis in some studies; others had small sample sizes and wide confidence intervals. A clear predictive trend for PD-L1 expression was not identified in renal, breast, gastric, or Merkel cell cancer. Conclusion Based on data contained in this review, assessment of TMB status and PD-L1 expression may help enhance the prediction of response to checkpoint inhibition in some tumors, such as NSCLC and melanoma. In this rapidly growing area of research, further exploratory biomarkers are being investigated including tumor-infiltrating lymphocytes, immune profiling (e.g., effector T cells or regulatory T cells), epigenetic signatures, T-cell receptor repertoire, proteomics, microbiome, and metabolomics.
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Affiliation(s)
- Tina Krieger
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK.
| | - Isobel Pearson
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
| | - Judith Bell
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
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4
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O'Reilly A, Hughes P, Mann J, Lai Z, Teh JJ, Mclean E, Edmonds K, Lingard K, Chauhan D, Lynch J, Au L, Ludlow A, Pattison N, Wiseman T, Turajlic S, Gore M, Larkin J, Husson O. An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors. Support Care Cancer 2019; 28:561-570. [PMID: 31089820 PMCID: PMC6954131 DOI: 10.1007/s00520-019-04818-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023]
Abstract
Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achieving high-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aim of this study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-related adverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK. Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durable response to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression. HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEs and survival. HRQoL data was compared with two norm-based datasets. Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity of any grade occurred in 92% of patients and 43% had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients required steroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyond steroids. Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical role functioning and general health compared with the normative population. There was a trend towards inferior scores in patients with previous exposure to ipilimumab compared with those never exposed to ipilimumab. Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicity and experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population’s unique survivorship needs. Electronic supplementary material The online version of this article (10.1007/s00520-019-04818-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aine O'Reilly
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Peta Hughes
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Jasmine Mann
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | | | | | | | - Kim Edmonds
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Karla Lingard
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Dharmisha Chauhan
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Joanna Lynch
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Lewis Au
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Aileen Ludlow
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Natalie Pattison
- University of Hertfordshire/East & North Herts NHS Trust, London, UK
| | - Theresa Wiseman
- Health Service Research, Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Samra Turajlic
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK.,Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Martin Gore
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - James Larkin
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK.
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Pol JG, Acuna SA, Yadollahi B, Tang N, Stephenson KB, Atherton MJ, Hanwell D, El-Warrak A, Goldstein A, Moloo B, Turner PV, Lopez R, LaFrance S, Evelegh C, Denisova G, Parsons R, Millar J, Stoll G, Martin CG, Pomoransky J, Breitbach CJ, Bramson JL, Bell JC, Wan Y, Stojdl DF, Lichty BD, McCart JA. Preclinical evaluation of a MAGE-A3 vaccination utilizing the oncolytic Maraba virus currently in first-in-human trials. Oncoimmunology 2018; 8:e1512329. [PMID: 30546947 PMCID: PMC6287790 DOI: 10.1080/2162402x.2018.1512329] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022] Open
Abstract
Multiple immunotherapeutics have been approved for cancer patients, however advanced solid tumors are frequently refractory to treatment. We evaluated the safety and immunogenicity of a vaccination approach with multimodal oncolytic potential in non-human primates (NHP) (Macaca fascicularis). Primates received a replication-deficient adenoviral prime, boosted by the oncolytic Maraba MG1 rhabdovirus. Both vectors expressed the human MAGE-A3. No severe adverse events were observed. Boosting with MG1-MAGEA3 induced an expansion of hMAGE-A3-specific CD4+ and CD8+ T-cells with the latter peaking at remarkable levels and persisting for several months. T-cells reacting against epitopes fully conserved between simian and human MAGE-A3 were identified. Humoral immunity was demonstrated by the detection of circulating MAGE-A3 antibodies. These preclinical data establish the capacity for the Ad:MG1 vaccination to engage multiple effector immune cell populations without causing significant toxicity in outbred NHPs. Clinical investigations utilizing this program for the treatment of MAGE-A3-positive solid malignancies are underway (NCT02285816, NCT02879760).
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Affiliation(s)
- Jonathan G Pol
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Sergio A Acuna
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Beta Yadollahi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nan Tang
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Matthew J Atherton
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - David Hanwell
- Animal Resources Centre, University Health Network, Toronto, ON, Canada
| | | | - Alyssa Goldstein
- Animal Resources Centre, University Health Network, Toronto, ON, Canada
| | - Badru Moloo
- Animal Resources Centre, University Health Network, Toronto, ON, Canada
| | - Patricia V Turner
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
| | - Roberto Lopez
- Animal Resources Centre, University Health Network, Toronto, ON, Canada
| | - Sandra LaFrance
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Carole Evelegh
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Galina Denisova
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Robin Parsons
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Jamie Millar
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Gautier Stoll
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Equipe 11 labellisée Ligue Nationale contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Sorbonne Universités/Université Pierre et Marie Curie, Paris, France
| | | | | | | | - Jonathan L Bramson
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - John C Bell
- Turnstone Biologics, Ottawa, ON, Canada.,Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Yonghong Wan
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - David F Stojdl
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Turnstone Biologics, Ottawa, ON, Canada
| | - Brian D Lichty
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.,Turnstone Biologics, Ottawa, ON, Canada
| | - J Andrea McCart
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Canada
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6
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Hansen A, Massard C, Ott P, Haas N, Lopez J, Ejadi S, Wallmark J, Keam B, Delord JP, Aggarwal R, Gould M, Yang P, Keefe S, Piha-Paul S. Pembrolizumab for advanced prostate adenocarcinoma: findings of the KEYNOTE-028 study. Ann Oncol 2018; 29:1807-1813. [DOI: 10.1093/annonc/mdy232] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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7
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Hepner A, Salgues A, Anjos CAD, Sahade M, Camargo VP, Garicochea B, Shoushtari AN, Postow MA, Fernandes GS, Munhoz RR. Treatment of advanced melanoma - A changing landscape. ACTA ACUST UNITED AC 2018; 63:814-823. [PMID: 29239458 DOI: 10.1590/1806-9282.63.09.814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 05/02/2017] [Indexed: 11/21/2022]
Abstract
Following decades of relative ostracism, advances in the treatment of melanoma have brought a new reality for patients, physicians and researchers. While antibodies targeting molecules involved in the modulation of the interaction between melanoma and immune cells changed the meaning of the term "cancer immunotherapy," a better characterization of the molecular aberrations involved in melanoma carcinogenesis prompted the development of inhibitors of the mitogen-activated protein kinase pathway (MAPK) that also led to significant improvements both in response rates and survival. As a result, new drugs have been approved for clinical use in the United States and Europe, including the immune-checkpoint blockers ipilmumab, pembrolizumab and nivolumab, the oncolytic herpesvirus talimogene laherparepvec, and the targeted-agents vemurafenib, dabrafenib, cobimetinib and trametinib. In this article, we review the results of studies that brought new approaches to the bedside and discuss how these developments are being incorporated into the care of patients in Brazil.
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Affiliation(s)
- Adriana Hepner
- Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | | | - Marina Sahade
- Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Arasanz H, Lacalle A, Lecumberri MJ, de Lascoiti ÁF, Blanco-Luquin I, GatoCañas M, Pérez-Ricarte L, Zuazo M, Kochan G, Escors D. Immunotherapy in malignant melanoma: recent approaches and new perspectives. Melanoma Manag 2017; 4:39-48. [PMID: 30190903 PMCID: PMC6094586 DOI: 10.2217/mmt-2016-0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
Immunotherapy has radically transformed the management of metastatic malignant melanoma. Ipilimumab, a CTLA-4-targeted monoclonal antibody, was the first immunotherapeutic drug to reach a survival benefit compared with traditional chemotherapy. PD-1 targeted therapies, pembrolizumab and nivolumab, have demonstrated, in recent clinical trials, to be even more effective and safer. PD-1 and CTLA-4 blockade combination appears to improve the outcomes achieved so far, although increasing toxicity. However, many questions concerning the optimal timing of administration or the most adequate sequence of treatment are yet to be answered.
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Affiliation(s)
- Hugo Arasanz
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
| | - Alejandra Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - Maria José Lecumberri
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | | | - Idoia Blanco-Luquin
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
| | - María GatoCañas
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
| | - Leyre Pérez-Ricarte
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - Miren Zuazo
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
| | - Grazyna Kochan
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
| | - David Escors
- Immunomodulation Group, Navarrabiomed-Biomedical Research Centre, IdisNA. Irunlarrea 3, 31008, Pamplona, Spain
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