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Luo Y, Xia Y, Liu D, Li X, Li H, Liu J, Zhou D, Dong Y, Li X, Qian Y, Xu C, Tao K, Li G, Pan W, Zhong Q, Liu X, Xu S, Wang Z, Liu R, Zhang W, Shan W, Fang T, Wang S, Peng Z, Jin P, Jin N, Shi S, Chen Y, Wang M, Jiao X, Luo M, Gong W, Wang Y, Yao Y, Zhao Y, Huang X, Ji X, He Z, Zhao G, Liu R, Wu M, Chen G, Hong L, Ma D, Fang Y, Liang H, Gao Q. Neoadjuvant PARPi or chemotherapy in ovarian cancer informs targeting effector Treg cells for homologous-recombination-deficient tumors. Cell 2024; 187:4905-4925.e24. [PMID: 38971151 DOI: 10.1016/j.cell.2024.06.013] [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: 01/18/2023] [Revised: 02/12/2024] [Accepted: 06/10/2024] [Indexed: 07/08/2024]
Abstract
Homologous recombination deficiency (HRD) is prevalent in cancer, sensitizing tumor cells to poly (ADP-ribose) polymerase (PARP) inhibition. However, the impact of HRD and related therapies on the tumor microenvironment (TME) remains elusive. Our study generates single-cell gene expression and T cell receptor profiles, along with validatory multimodal datasets from >100 high-grade serous ovarian cancer (HGSOC) samples, primarily from a phase II clinical trial (NCT04507841). Neoadjuvant monotherapy with the PARP inhibitor (PARPi) niraparib achieves impressive 62.5% and 73.6% response rates per RECIST v.1.1 and GCIG CA125, respectively. We identify effector regulatory T cells (eTregs) as key responders to HRD and neoadjuvant therapies, co-occurring with other tumor-reactive T cells, particularly terminally exhausted CD8+ T cells (Tex). TME-wide interferon signaling correlates with cancer cells upregulating MHC class II and co-inhibitory ligands, potentially driving Treg and Tex fates. Depleting eTregs in HRD mouse models, with or without PARP inhibition, significantly suppresses tumor growth without observable toxicities, underscoring the potential of eTreg-focused therapeutics for HGSOC and other HRD-related tumors.
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Affiliation(s)
- Yikai Luo
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Graduate Program in Quantitative and Computational Biosciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yu Xia
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dan Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiong Li
- Department of Gynecology & Obstetrics, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Huayi Li
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jiahao Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dongchen Zhou
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu Dong
- Precision Scientific (Beijing) Co., Ltd., Beijing 100085, China
| | - Xin Li
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yiyu Qian
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cheng Xu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Kangjia Tao
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guannan Li
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wen Pan
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Zhong
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xingzhe Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sen Xu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhi Wang
- Department of Gynecology & Obstetrics, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Ronghua Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Zhang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wanying Shan
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tian Fang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Siyuan Wang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zikun Peng
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Jin
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ning Jin
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shennan Shi
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuxin Chen
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mengjie Wang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaofei Jiao
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mengshi Luo
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenjian Gong
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ya Wang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Yao
- Precision Scientific (Beijing) Co., Ltd., Beijing 100085, China
| | - Yi Zhao
- Precision Scientific (Beijing) Co., Ltd., Beijing 100085, China
| | - Xinlin Huang
- Precision Scientific (Beijing) Co., Ltd., Beijing 100085, China
| | - Xuwo Ji
- Precision Scientific (Beijing) Co., Ltd., Beijing 100085, China
| | - Zhaoren He
- BioMap (Beijing) Intelligence Technology Limited, Beijing 100089, China
| | - Guangnian Zhao
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Rong Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mingfu Wu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Gang Chen
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ding Ma
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yong Fang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Han Liang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Graduate Program in Quantitative and Computational Biosciences, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Qinglei Gao
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Ghisoni E, Morotti M, Sarivalasis A, Grimm AJ, Kandalaft L, Laniti DD, Coukos G. Immunotherapy for ovarian cancer: towards a tailored immunophenotype-based approach. Nat Rev Clin Oncol 2024:10.1038/s41571-024-00937-4. [PMID: 39232212 DOI: 10.1038/s41571-024-00937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
Despite documented evidence that ovarian cancer cells express immune-checkpoint molecules, such as PD-1 and PD-L1, and of a positive correlation between the presence of tumour-infiltrating lymphocytes and favourable overall survival outcomes in patients with this tumour type, the results of trials testing immune-checkpoint inhibitors (ICIs) in these patients thus far have been disappointing. The lack of response to ICIs can be attributed to tumour heterogeneity as well as inherent or acquired resistance associated with the tumour microenvironment (TME). Understanding tumour immunobiology, discovering biomarkers for patient selection and establishing optimal treatment combinations remains the hope but also a key challenge for the future application of immunotherapy in ovarian cancer. In this Review, we summarize results from trials testing ICIs in patients with ovarian cancer. We propose the implementation of a systematic CD8+ T cell-based immunophenotypic classification of this malignancy, followed by discussions of the preclinical data providing the basis to treat such immunophenotypes with combination immunotherapies. We posit that the integration of an accurate TME immunophenotype characterization with genetic data can enable the design of tailored therapeutic approaches and improve patient recruitment in clinical trials. Lastly, we propose a roadmap incorporating tissue-based profiling to guide future trials testing adoptive cell therapy approaches and assess novel immunotherapy combinations while promoting collaborative research.
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Affiliation(s)
- Eleonora Ghisoni
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland
- Agora Cancer Research Center, Lausanne, Switzerland
| | - Matteo Morotti
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland
- Agora Cancer Research Center, Lausanne, Switzerland
| | - Apostolos Sarivalasis
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alizée J Grimm
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland
- Agora Cancer Research Center, Lausanne, Switzerland
| | - Lana Kandalaft
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland
- Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Denarda Dangaj Laniti
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland
- Agora Cancer Research Center, Lausanne, Switzerland
| | - George Coukos
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne (UNIL), Lausanne, Switzerland.
- Agora Cancer Research Center, Lausanne, Switzerland.
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Xu Y, Xiong F, Li H, Zheng H, Jiang J, Li Q, Li G, Zhao W, Li R, Li J, Xie R, An R, Zhang H, Gao Q. Biomarker-driven targeted therapy in patients with recurrent platinum-resistant epithelial ovarian cancer (BRIGHT): protocol for an open-label, multicenter, umbrella study. Int J Gynecol Cancer 2024; 34:1461-1465. [PMID: 38658024 DOI: 10.1136/ijgc-2024-005351] [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] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Platinum-resistant, recurrent ovarian cancer has an abysmal prognosis with limited treatment options. Poly-(ADP-ribose)-polymerase (PARP), angiogenesis, and immune checkpoint inhibitors might improve the outcomes of platinum-resistant, recurrent ovarian cancer, but accurate patient selections for those therapies remain a significant clinical challenge. PRIMARY OBJECTIVE To evaluate the efficacy and safety of biomarker-driven combinatorial therapies of pamiparib, tislelizumab, bevacizumab, and nab-paclitaxel in platinum-resistant, recurrent ovarian cancer. STUDY HYPOTHESIS A precision medicine combination of PARP inhibitors, anti-angiogenic therapy, immunotherapy, and chemotherapy will improve disease outcomes of platinum-resistant, recurrent ovarian cancer by accounting for genomic and immunologic features. TRIAL DESIGN The BRIGHT Trial is a prospective, open-label, multicenter, phase II, umbrella study planning to enroll 160 patients with serous, endometrioid, or clear cell platinum-resistant, recurrent ovarian cancer from 11 clinical centers in China. Patients are assigned to one of three experimental arms based on biomarkers. Patients with BRCA1/2 mutations will receive pamiparib plus bevacizumab (arm 1, n=40) regardless of CD8+ tumor-infiltrating lymphocytes count. Patients with wild-type BRCA1/2 (BRCAwt) and ≥3 CD8+ tumor-infiltrating lymphocytes count will receive the combination of tislelizumab, bevacizumab, and nab-paclitaxel (arm 2, n=50), while BRCAwt patients with <3 CD8+ tumor-infiltrating lymphocytes count will receive bevacizumab plus dose-dense nab-paclitaxel (arm 3, n=50). After completing patient enrollment in arm 2, another 20 BRCAwt patients with ≥3 CD8+ tumor-infiltrating lymphocytes count will be included as an arm 2 expansion. Treatment will continue until disease progression or intolerable toxicity, and all adverse events will be recorded. MAJOR INCLUSION/EXCLUSION CRITERIA Eligible patients include those aged ≥18 with serous, endometrioid, or clear cell ovarian cancer, platinum-resistant recurrence, and Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. PRIMARY ENDPOINT Objective response rate (ORR) assessed by the investigators by the RECIST 1.1 criteria. SAMPLE SIZE 160 patients. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Recruitment is estimated to be completed by 2024 and results may be published by 2027. TRIAL REGISTRATION ClinicalTrials.gov: NCT05044871.
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Affiliation(s)
- Yu Xu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Xiong
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huayi Li
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zheng
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital, Beijing, China
| | - Jie Jiang
- Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, China
| | - Qingshui Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Guiling Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weidong Zhao
- Department of Gynecological Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Rong Li
- Gynecological Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jundong Li
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong Xie
- Department of Gynecology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Ruifang An
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huifeng Zhang
- Department of Gynecologic Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Qinglei Gao
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education, Hubei Provincial Key Laboratory of Tumor Invasion and Metastasis), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Miras I, Estévez-García P, Muñoz-Galván S. Clinical and molecular features of platinum resistance in ovarian cancer. Crit Rev Oncol Hematol 2024; 201:104434. [PMID: 38960218 DOI: 10.1016/j.critrevonc.2024.104434] [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: 02/27/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
Ovarian cancer is the most lethal of all the gynecological tumors despite remarkable advances in our understanding of its molecular biology. The cornerstone treatment remains cytoreductive surgery followed by platinum-based chemotherapy. Recently, the addition of targeted therapies, such as PARP inhibitors, as first-line maintenance has led to outstanding improvements, mainly in BRCA mutated and homologous recombination deficient tumors. However, a significant proportion of patients will experience recurrence, primarily due to platinum resistance, which ultimately result in fatality. Among these patients, primary platinum-resistant have a particularly dismal prognosis due to their low response to current available therapies, historical exclusion from clinical trials, and the absence of validated biomarkers. In this review, we discuss the concept of platinum resistance in ovarian cancer, the clinical and molecular characteristics of this resistance, and the current and new treatment options for these patients.
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Affiliation(s)
- Isabel Miras
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas, Seville, Spain; Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Purificación Estévez-García
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas, Seville, Spain; Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain; CIBER de CANCER, Institute of Health Carlos III, Madrid, Spain
| | - Sandra Muñoz-Galván
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas, Seville, Spain; CIBER de CANCER, Institute of Health Carlos III, Madrid, Spain.
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5
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Kristeleit R, Leary A, Oaknin A, Redondo A, George A, Chui S, Seiller A, Liste-Hermoso M, Willis J, Shemesh CS, Xiao J, Lin KK, Molinero L, Guan Y, Ray-Coquard I, Mileshkin L. PARP inhibition with rucaparib alone followed by combination with atezolizumab: Phase Ib COUPLET clinical study in advanced gynaecological and triple-negative breast cancers. Br J Cancer 2024; 131:820-831. [PMID: 38971950 PMCID: PMC11369183 DOI: 10.1038/s41416-024-02776-7] [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: 01/30/2024] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Combining PARP inhibitors (PARPis) with immune checkpoint inhibitors may improve clinical outcomes in selected cancers. We evaluated rucaparib and atezolizumab in advanced gynaecological or triple-negative breast cancer (TNBC). METHODS After identifying the recommended dose, patients with PARPi-naive BRCA-mutated or homologous recombination-deficient/loss-of-heterozygosity-high platinum-sensitive ovarian cancer or TNBC received rucaparib plus atezolizumab. Tumour biopsies were collected pre-treatment, during single-agent rucaparib run-in, and after starting combination therapy. RESULTS The most common adverse events with rucaparib 600 mg twice daily and atezolizumab 1200 mg on Day 1 every 3 weeks were gastrointestinal effects, fatigue, liver enzyme elevations, and anaemia. Responding patients typically had BRCA-mutated tumours and higher pre-treatment tumour levels of PD-L1 and CD8 + T cells. Markers of DNA damage repair decreased during rucaparib run-in and combination treatment in responders, but typically increased in non-responders. Apoptosis signature expression showed the reverse. CD8 + T-cell activity and STING pathway activation increased during rucaparib run-in, increasing further with atezolizumab. CONCLUSIONS In this small study, rucaparib plus atezolizumab demonstrated acceptable safety and activity in BRCA-mutated tumours. Increasing anti-tumour immunity and inflammation might be a key mechanism of action for clinical benefit from the combination, potentially guiding more targeted development of such regimens. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03101280).
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Affiliation(s)
- Rebecca Kristeleit
- University College London Cancer Institute, London, UK.
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
| | | | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andres Redondo
- Medical Oncology Department, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Angela George
- The Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Stephen Chui
- Product Development Oncology, Genentech Inc., South San Francisco, CA, USA
| | | | | | - Jenna Willis
- Product Development Safety, Roche Products Ltd, Welwyn Garden City, UK
| | - Colby S Shemesh
- Clinical Pharmacology Oncology, Genentech Inc, South San Francisco, CA, USA
| | - Jim Xiao
- Clovis Oncology, San Francisco, CA, USA
| | | | - Luciana Molinero
- Translational Medicine, Genentech Inc., South San Francisco, CA, USA
| | - Yinghui Guan
- Translational Medicine, Genentech Inc., South San Francisco, CA, USA
| | - Isabelle Ray-Coquard
- Centre Leon Bérard, HESPER laboratory EA 7425, Université Claude Bernard Lyon Est, Lyon, France
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
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6
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Yuan Y, Zhang J, Zeng H, Gui A, Yan Y, Zou A, Yang L. Overcoming cisplatin resistance in ovarian cancer: A novel approach via mitochondrial targeting peptide Pal-pHK-pKV. Biochem Biophys Res Commun 2024; 734:150616. [PMID: 39232456 DOI: 10.1016/j.bbrc.2024.150616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
Cisplatin (DDP) resistance in advanced stages of ovarian cancer significantly reduces survival rates. Mitochondria may serve as a potential therapeutic target for ovarian cancer. Pal-pHK-pKV is a mitochondrial targeting peptide synthesized by supramolecular assembly. Our study aims to investigate whether Pal-pHK-pKV serves as a useful strategy to reverse DDP resistance in ovarian cancer. Subcutaneous tumor implantation of the DDP-resistant ovarian cancer cell line A2780CP was conducted in nude mice, and drugs were administered intraperitoneally to compare the inhibitory effects of Pal-pHK-pKV and DDP on A2780CP cells in vivo. Combination index values were calculated for various concentrations of DDP and Pal-pHK-pKV to determine the optimal combination concentration. Mitochondrial membrane potential, cytochrome C distribution and immunofluorescence were also measured. Our studies demonstrated that Pal-pHK-pKV treatment reduced the proliferation, invasion and metastasis of ovarian cancer cells and impaired mitochondrial function. Furthermore, the combination of Pal-pHK-pKV and DDP exhibited a synergistic effect. Mechanistically, Pal-pHK-pKV can impair mitochondrial function, reduce mitochondrial membrane potential and release ROS. On the other hand, Pal-pHK-pKV can affect ERK pathway activation and inhibit tumor development. In conclusion, the mitochondria-specific amphiphilic peptide Pal-pHK-pKV provides a novel approach for treating ovarian cancer and may potentially overcome DDP drug resistance.
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Affiliation(s)
- Yiqing Yuan
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Junyi Zhang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Hongya Zeng
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Ailin Gui
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yichen Yan
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Aihua Zou
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, China.
| | - Ling Yang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China.
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7
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Kusuma F, Glenardi G, Mangkuliguna G, Winarto H, Purwoto G, Utami TW, Anggraeni TD. Efficacy, safety, and patient-reported outcome of immune checkpoint inhibitor in gynecologic cancers: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0307800. [PMID: 39133693 PMCID: PMC11318932 DOI: 10.1371/journal.pone.0307800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
Over the past decades, immune checkpoint inhibitors (ICIs) have shown dramatic efficacy in improving survival rates in multiple malignancies. Recently, gynecological cancer patients also showed to respond favorably to ICI treatment. This study aimed to evaluate the efficacy, safety, and patient-reported outcomes of ICI therapy in gynecological cancers. We conducted a systematic review and meta-analysis by retrieving literature from multiple electronic databases, such as MEDLINE, ScienceDirect, EBSCO, ProQuest, and Google Scholar. The protocol used in this study has been registered in PROSPERO (CRD42022369529). We included a total of 12 trials involving 8 therapies and 8,034 patients. ICI group demonstrated a longer OS (HR: 0.807; 95% CI: 0.719, 0.907; p = 0.000) and greater PFS improvement (HR: 0.809; 95% CI: 0.673, 0.973; p = 0.024) compared to the control group. There was no significant difference in the incidence of treatment-related adverse events [RR: 0.968; 95%CI: 0.936, 1.001; p = 0.061], but a higher incidence of immune-related adverse events (IRAEs) was observed in the ICI group (RR: 3.093; 95%CI: 1.933, 4.798; p = 0.000). Although the mean changes of QOL score from baseline was not significantly different between both groups (SMD: 0.048; 95% CI: -0.106, 0.202; p = 0.542), the time to definitive QOL deterioration was longer in the ICI group (HR: 0.508; 95% CI: 0.461, 0.560; p = 0.000). Despite having a higher incidence of IRAE, ICI was shown to improve survival rates and QOL of patients. Thus, it should be considered as a new standard of care for gynecologic cancers, especially in advanced stages.
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Affiliation(s)
- Fitriyadi Kusuma
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Glenardi Glenardi
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
- School of Medicine and Health Sciences, Department of Medicine, Atma Jaya Catholic University of Indonesia, North Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
- Lewoleba General Hospital, Lembata Island, East Nusa Tenggara, Indonesia
| | - Ghea Mangkuliguna
- School of Medicine and Health Sciences, Department of Medicine, Atma Jaya Catholic University of Indonesia, North Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Hariyono Winarto
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Gatot Purwoto
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Tofan Widya Utami
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Tricia Dewi Anggraeni
- Division of Oncology Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Greater Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
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8
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Coleman RL, Lorusso D, Oaknin A, Cecere SC, Denys H, Colombo N, van Gorp T, Konner JA, Romeo Marin M, Harter P, Murphy C, Wang Y, Esteves B, Method M, Matulonis U. Mirvetuximab soravtansine in folate receptor alpha (FRα)-high platinum-resistant ovarian cancer: final overall survival and post hoc sequence of therapy subgroup results from the SORAYA trial. Int J Gynecol Cancer 2024; 34:1119-1125. [PMID: 38858103 PMCID: PMC11347190 DOI: 10.1136/ijgc-2024-005401] [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: 02/16/2024] [Accepted: 04/25/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The single-arm, phase II SORAYA trial (NCT04296890) of mirvetuximab soravtansine-gynx in folate receptor alpha (FRα)-high platinum-resistant ovarian cancer (n=105 (efficacy-evaluable)) met its primary endpoint with an objective response rate of 32.4% (95% CI, 23.6 to 42.2). Here we report final SORAYA trial results for overall survival and post hoc objective response rates in subgroups by sequence and number of prior therapies. METHODS Eligible patients had high-grade serous platinum-resistant ovarian cancer with high FRα expression and one to three prior therapies (prior bevacizumab required). Enrolled participants received 6 mg/kg mirvetuximab soravtansine-gynx adjusted ideal body weight intravenously once every 3 weeks until progressive disease, unacceptable toxicity, withdrawal of consent, or death. Final overall survival and post hoc objective response rates were assessed in efficacy-evaluable participants. The safety population included all patients who received ≥1 dose of mirvetuximab soravtansine-gynx. RESULTS At data cut-off (December 22, 2022; n=105), final median overall survival was 15.0 months (95% CI, 11.5 to 18.7). Median overall survival in participants with one to two prior therapy lines was 18.7 months (95% CI, 13.8 to not estimable (NE)) and 11.6 months (95% CI, 7.1 to 16.7) with three prior therapy lines. Median overall survival was 15.0 months (95% CI, 11.5 to NE) in participants with prior poly (ADP-ribose) polymerase inhibitor (PARPi) treatment versus 14.0 months (95% CI, 7.1 to NE) in those without. Objective response rate (data cut-off: November 17, 2021) differed among participants who received mirvetuximab soravtansine-gynx as their first treatment in the platinum-resistant setting (34.8%; 95% CI, 23.5 to 47.6) versus a different first treatment (28.2%; 95% CI, 15.0 to 44.9) or had received prior bevacizumab in a platinum-sensitive (34.0%; 95% CI, 24.6 to 44.5) versus platinum-resistant setting (17.6%; 95% CI, 3.8 to 43.4). No new safety signals were observed. CONCLUSION These results support the clinically meaningful efficacy of mirvetuximab soravtansine-gynx in FRα-expressing platinum-resistant ovarian cancer, irrespective of prior treatment or sequence.
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Affiliation(s)
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Sabrina Chiara Cecere
- Department of Experimental Uro-Gynecological Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Nicoletta Colombo
- European Institute of Oncology IRCCS Library, Milan, Italy
- University of Milan-Bicocca, Milan, Italy
| | - Toon van Gorp
- Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jason A Konner
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margarita Romeo Marin
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Conleth Murphy
- Cancer Centre and Cancer Trials, Bon Secours Hospital Cork, Cork, Ireland
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9
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Murakami K, Ganguly S. The Nectin family ligands, PVRL2 and PVR, in cancer immunology and immunotherapy. Front Immunol 2024; 15:1441730. [PMID: 39156900 PMCID: PMC11327090 DOI: 10.3389/fimmu.2024.1441730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
In recent years, immunotherapy has emerged as a crucial component of cancer treatment. However, its efficacy remains limited across various cancer types, highlighting unmet needs. Poliovirus receptor-related 2 (PVRL2) and Poliovirus receptor (PVR) are members of the Nectin and Nectin-like Molecules family, known for their role as cell-cell adhesion molecules. With the development of immunotherapy, their involvement in tumor immune mechanisms as immune checkpoint factors has garnered significant attention. PVRL2 and PVR are predominantly expressed on tumor cells and antigen-presenting cells, binding to PVRIG and TIGIT, respectively, which are primarily found on T and NK cells, thereby suppressing antitumor immunity. Notably, gynecological cancers such as ovarian and endometrial cancers exhibit high expression levels of PVRL2 and PVR, with similar trends observed in various other solid and hematologic tumors. Targeting these immune checkpoint pathways offers a promising therapeutic avenue, potentially in combination with existing treatments. However, the immunomodulatory mechanism involving these bindings, known as the DNAM-1 axis, is complex, underscoring the importance of understanding it for developing novel therapies. This article comprehensively reviews the immunomodulatory mechanisms centered on PVRL2 and PVR, elucidating their implications for various cancer types.
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Affiliation(s)
| | - Sudipto Ganguly
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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10
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Dinkins K, Barton W, Wheeler L, Smith HJ, Mythreye K, Arend RC. Targeted therapy in high grade serous ovarian Cancer: A literature review. Gynecol Oncol Rep 2024; 54:101450. [PMID: 39092168 PMCID: PMC11292514 DOI: 10.1016/j.gore.2024.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
Ovarian cancer continues to have a high mortality rate despite therapeutic advances. Traditionally, treatment has focused on surgery followed by systemic platinum- based chemotherapy. Unfortunately, most patients develop resistance to platinum agents, highlighting the need for targeted therapies. PARP inhibitors and anti-angiogenic agents, such as bevacizumab, have more recently changed upfront therapy. Unfortunately, other targeted therapies including immunotherapy have not seen the same success. Emerging therapeutic targets and modalities such as small molecule tyrosine kinase inhibitors, lipid metabolism targeting agents, gene therapy, ribosome targeted drugs as well as several other therapeutic classes have been and are currently under investigation. In this review, we discuss targeted therapies in high grade serous ovarian cancer from preclinical studies to phase III clinical trials.
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Affiliation(s)
- Kaitlyn Dinkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Wade Barton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Lauren Wheeler
- Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL
| | - Haller J. Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Karthikeyan Mythreye
- Department of Pathology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Rebecca C. Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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11
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Sato S, Shoji T, Jo A, Otsuka H, Abe M, Tatsuki S, Chiba Y, Takatori E, Kaido Y, Nagasawa T, Kagabu M, Baba T. Antibody-Drug Conjugates: The New Treatment Approaches for Ovarian Cancer. Cancers (Basel) 2024; 16:2545. [PMID: 39061184 PMCID: PMC11275051 DOI: 10.3390/cancers16142545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Ovarian cancer (OC), accounting for approximately 200,000 deaths worldwide annually, is a heterogeneous disease showing major differences in terms of its incidence, tumor behavior, and outcomes across histological subtypes. In OC, primary chemotherapy, paclitaxel carboplatin, bevacizumab, and PARP inhibitors have shown prolonged progression-free survival and a favorable overall response rate compared to conventional treatments. However, treatment options for platinum-resistant recurrence cases are limited, with no effective therapies that significantly prolong the prognosis. Recently, mirvetuximab soravtansine, an alpha-folate receptor (FRα)-targeted antibody-drug conjugate (ADC), was approved by the US Food and Drug Administration for patients with FRα-positive recurrent epithelial OC (EOC). This approval was based on a Phase II study, which demonstrated its efficacy in such patients. ADCs comprise an antibody, a linker, and a payload, representing new concept agents without precedence. Advanced clinical studies are developing ADCs for patients with OC, targeting solid tumors such as gynecologic cancer. Ongoing clinical trials are evaluating ADCs targeting FRα and human epidermal growth factor receptor 2, trophoblast cell surface antigen-2, sodium-dependent phosphate transport protein 2B, and cadherin-6 in Phase II/III studies. In this review, we summarize the existing evidence supporting the use of ADCs in OC, discuss ongoing clinical trials and preclinical studies, and explore the potential of these innovative agents to address the challenges in OC treatment.
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Affiliation(s)
| | - Tadahiro Shoji
- Department of Obstetrics and Gynecology, Iwate Medical University, Yahaba 028-3694, Iwate, Japan; (S.S.); (A.J.); (H.O.); (M.A.); (S.T.); (Y.C.); (E.T.); (Y.K.); (T.N.); (M.K.); (T.B.)
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12
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Tarannum M, Dinh K, Vergara J, Birch G, Abdulhamid YZ, Kaplan IE, Ay O, Maia A, Beaver O, Sheffer M, Shapiro R, Ali AK, Dong H, Ham JD, Bobilev E, James S, Cameron AB, Nguyen QD, Ganapathy S, Chayawatto C, Koreth J, Paweletz CP, Gokhale PC, Barbie DA, Matulonis UA, Soiffer RJ, Ritz J, Porter RL, Chen J, Romee R. CAR memory-like NK cells targeting the membrane proximal domain of mesothelin demonstrate promising activity in ovarian cancer. SCIENCE ADVANCES 2024; 10:eadn0881. [PMID: 38996027 PMCID: PMC11244547 DOI: 10.1126/sciadv.adn0881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/10/2024] [Indexed: 07/14/2024]
Abstract
Epithelial ovarian cancer (EOC) remains one of the most lethal gynecological cancers. Cytokine-induced memory-like (CIML) natural killer (NK) cells have shown promising results in preclinical and early-phase clinical trials. In the current study, CIML NK cells demonstrated superior antitumor responses against a panel of EOC cell lines, increased expression of activation receptors, and up-regulation of genes involved in cell cycle/proliferation and down-regulation of inhibitory/suppressive genes. CIML NK cells transduced with a chimeric antigen receptor (CAR) targeting the membrane-proximal domain of mesothelin (MSLN) further improved the antitumor responses against MSLN-expressing EOC cells and patient-derived xenograft tumor cells. CAR arming of the CIML NK cells subtanstially reduced their dysfunction in patient-derived ascites fluid with transcriptomic changes related to altered metabolism and tonic signaling as potential mechanisms. Lastly, the adoptive transfer of MSLN-CAR CIML NK cells demonstrated remarkable inhibition of tumor growth and prevented metastatic spread in xenograft mice, supporting their potential as an effective therapeutic strategy in EOC.
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MESH Headings
- Mesothelin
- Humans
- Animals
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Female
- Mice
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/immunology
- Ovarian Neoplasms/therapy
- Cell Line, Tumor
- Receptors, Chimeric Antigen/metabolism
- Receptors, Chimeric Antigen/immunology
- Receptors, Chimeric Antigen/genetics
- Xenograft Model Antitumor Assays
- GPI-Linked Proteins/metabolism
- GPI-Linked Proteins/genetics
- Immunotherapy, Adoptive/methods
- Carcinoma, Ovarian Epithelial/metabolism
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/immunology
- Carcinoma, Ovarian Epithelial/therapy
- Immunologic Memory
- Protein Domains
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Affiliation(s)
- Mubin Tarannum
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Khanhlinh Dinh
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Juliana Vergara
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Grace Birch
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yasmin Z Abdulhamid
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Isabel E Kaplan
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Oyku Ay
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andreia Maia
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Owen Beaver
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Michal Sheffer
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Roman Shapiro
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alaa Kassim Ali
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Han Dong
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - James Dongjoo Ham
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Eden Bobilev
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sydney James
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Amy B Cameron
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Quang-De Nguyen
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Suthakar Ganapathy
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Chayapatou Chayawatto
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - John Koreth
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Cloud P Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Prafulla C Gokhale
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - David A Barbie
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Division of Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ursula A Matulonis
- Division of Gynecologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Robert J Soiffer
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jerome Ritz
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Rebecca L Porter
- Division of Gynecologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jianzhu Chen
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rizwan Romee
- Division of Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Pires IS, Covarrubias G, Gomerdinger VF, Backlund C, Shanker A, Gordon E, Wu S, Pickering AJ, Melo MB, Suh H, Irvine DJ, Hammond PT. "Target-and-release" nanoparticles for effective immunotherapy of metastatic ovarian cancer. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.05.602135. [PMID: 39005274 PMCID: PMC11245112 DOI: 10.1101/2024.07.05.602135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Immunotherapies such as checkpoint inhibitors (CPI) are effective in treating several advanced cancers, but these treatments have had limited success in metastatic ovarian cancer (OC). Here, we engineered liposomal nanoparticles (NPs) carrying a layer-by-layer (LbL) polymer coating that promotes their binding to the surface of OC cells. Covalent anchoring of the potent immunostimulatory cytokine interleukin-12 (IL-12) to phospholipid headgroups of the liposome core enabled the LbL particles to concentrate IL-12 in disseminated OC tumors following intraperitoneal administration. Shedding of the LbL coating and serum protein-mediated extraction of IL-12-conjugated lipids from the liposomal core over time enabled IL-12 to disseminate in the tumor bed following rapid NP localization in tumor nodules. Optimized IL-12 LbL-NPs promoted robust T cell accumulation in ascites and tumors in mouse models, extending survival compared to free IL-12 and remarkedly sensitizing tumors to CPI, leading to curative treatments and immune memory.
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Affiliation(s)
- Ivan S Pires
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Gil Covarrubias
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Victoria F Gomerdinger
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Coralie Backlund
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Apoorv Shanker
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Ezra Gordon
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Shengwei Wu
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Andrew J Pickering
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Mariane B Melo
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Heikyung Suh
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Darrell J Irvine
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA
- Department of Materials Science and Engineering, MIT, Cambridge, MA 02139, USA
- Ragon Institute of MGH, MIT and Harvard University, Cambridge, MA 02139, USA
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Paula T Hammond
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, 02139 USA
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Hamada K, Murakami R, Ueda A, Kashima Y, Miyagawa C, Taki M, Yamanoi K, Yamaguchi K, Hamanishi J, Minamiguchi S, Matsumura N, Mandai M. A Deep Learning-Based Assessment Pipeline for Intraepithelial and Stromal Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Carcinoma. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:1272-1284. [PMID: 38537936 DOI: 10.1016/j.ajpath.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 04/07/2024]
Abstract
Tumor-infiltrating lymphocytes (TILs) are associated with improved survival in patients with epithelial ovarian cancer. However, TIL evaluation has not been used in routine clinical practice because of reproducibility issues. The current study developed two convolutional neural network models to detect TILs and to determine their spatial location in whole slide images, and established a spatial assessment pipeline to objectively quantify intraepithelial and stromal TILs in patients with high-grade serous ovarian carcinoma. The predictions of the established models showed a significant positive correlation with the number of CD8+ T cells and immune gene expressions. Patients with a higher density of intraepithelial TILs had a significantly prolonged overall survival and progression-free survival in multiple cohorts. On the basis of the density of intraepithelial and stromal TILs, patients were classified into three immunophenotypes: immune inflamed, excluded, and desert. The immune-desert subgroup showed the worst prognosis. Gene expression analysis showed that the immune-desert subgroup had lower immune cytolytic activity and T-cell-inflamed gene-expression profile scores, whereas the immune-excluded subgroup had higher expression of interferon-γ and programmed death 1 receptor signaling pathway. The established evaluation method provided detailed and comprehensive quantification of intraepithelial and stromal TILs throughout hematoxylin and eosin-stained slides. It has potential for clinical application for personalized treatment of patients with ovarian cancer.
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Affiliation(s)
- Kohei Hamada
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryusuke Murakami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoko Kashima
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Chiho Miyagawa
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Yamanoi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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15
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Lu S, Wang J, Huang J, Sun F, Zhu J, Que Y, Li H, Guo Y, Cai R, Zhen Z, Sun X, Zhang Y. Pegylated liposomal doxorubicin combined with cyclophosphamide and vincristine in pediatric patients with relapsed/refractory solid tumor: a single-arm, open-label, phase I study. EClinicalMedicine 2024; 73:102701. [PMID: 39007065 PMCID: PMC11246015 DOI: 10.1016/j.eclinm.2024.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/16/2024] Open
Abstract
Background The combined vincristine, pegylated liposomal doxorubicin (PLD), and cyclophosphamide (VPC) regimen has never been studied in pediatric patients. Methods This open-label, single-center, single-arm phase I study utilizing a "3 + 3" design enrolled children with relapsed/refractory (R/R) solid tumors. Three dose levels of PLD (Duomeisu®) were studied (30, 40, or 50 mg/m2) in combination with cyclophosphamide (1500 mg/m2), mesna (1500 mg/m2), and vincristine (1.5 mg/m2, maximum 2 mg) once every 3 weeks. The primary endpoints included safety, the maximum tolerated dose (MTD) of PLD (Duomeisu®), and the recommended phase 2 dose (RP2D) of PLD (Duomeisu®) for further phase 2 investigation. The secondary endpoints were objective response rate (ORR) and disease control rate (DCR). This study is registered with ClinicalTrials.gov, NCT04213612. Findings Between January 7, 2020, and November 18, 2021, 34 patients were eligible and evaluable for toxicity, while 26 patients were evaluable for response. The MTD of PLD (Duomeisu®) was 30 mg/m2. The most common adverse event (AE) was grade 3 or 4 neutropenia (61.8%). The most common grade 1 or 2 non-hematologic AE and cardiotoxicity effects were vomiting (35.3%) and abnormal electrocardiogram T waves (20.6%), respectively. ORR and DCR to VPC regimen after two cycles were 50.0% and 92.3%, respectively. Targeted gene panel sequencing revealed the activation of TP53 mutation may be an adverse prognostic factor. Interpretation The VPC regimen showed a promising safety profile and had preliminary efficacy in children with R/R solid tumors. The RP2D for PLD (Duomeisu®) combined with cyclophosphamide and vincristine is 30 mg/m2 once every 3 weeks. Funding CSPC Ouyi Pharmaceutical Co., Ltd., Shijiazhuang, the National Key Research and Development Program of China [No. 2022YFC2705005], the National Natural Science Foundation of China [No. 82203303], and the Basic and Applied Basic Research Foundation of Guangdong Province [No. 2021A1515110234].
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Affiliation(s)
- Suying Lu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Juan Wang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Junting Huang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Feifei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Jia Zhu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yi Que
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Hui Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ying Guo
- Department of Clinical Research, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ruiqing Cai
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Zijun Zhen
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Xiaofei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yizhuo Zhang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
- Young Talents Program of Sun Yat-sen University Cancer Center, PR China
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16
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Lin H, Wu CH, Fu HC, Ou YC. Evolving treatment paradigms for platinum-resistant ovarian cancer: An update narrative review. Taiwan J Obstet Gynecol 2024; 63:471-478. [PMID: 39004472 DOI: 10.1016/j.tjog.2024.05.006] [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] [Accepted: 11/22/2023] [Indexed: 07/16/2024] Open
Abstract
Platinum-resistant ovarian cancer (PROC) refers to disease progression within 6 months after the completion of platinum-based chemotherapy. Historically, treatment options for PROC were limited with a poor prognosis and non-platinum single agent plus bevacizumab has been the mainstay of treatment. Fortunately, there have been notable advancements in recent years, leading to an advance in treatment paradigms for this challenging disease. Various combinations of chemotherapy, targeted agents such as poly (ADP-ribose) polymerase (PARP) inhibitors, and immunotherapy are being explored for an improved treatment outcome. Antibody-drug conjugates targeting folate receptor alpha, which deliver a cytotoxic payload directly to cancer cells, have emerged as a promising therapeutic approach for PROC. WEE1 inhibitors, such as adavosertib, function by inhibiting the WEE1 kinase activity, leading to premature entry of a cell into mitosis phase and thus increased DNA damage. It has been observed that cancer cells with TP53 mutations may be more sensitive to WEE1 inhibitors. Biomarker testing such as analysis of the expression level of folate receptor alpha or mutation in TP53 may be applicable for identifying patients who are more likely to respond to the specific therapy, enabling a more personalized treatment approach. This overview summarizes key clinical findings on the efficacy and safety of theses novel biomarker-driven therapeutic approaches.
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Affiliation(s)
- Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
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17
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Qian X, Yang H, Ye Z, Gao B, Qian Z, Ding Y, Mao Z, Du Y, Wang W. Celecoxib Augments Paclitaxel-Induced Immunogenic Cell Death in Triple-Negative Breast Cancer. ACS NANO 2024; 18:15864-15877. [PMID: 38829727 DOI: 10.1021/acsnano.4c02947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Triple-negative breast cancer (TNBC) is a highly aggressive malignancy that lacks effective targeted therapies. Inducing immunogenic cell death (ICD) in tumor cells represents a promising strategy to enhance therapeutic efficacy by promoting antitumor immunity. Paclitaxel (PTX), a commonly used chemotherapy drug for TNBC, can induce ICD; however, the resulting immunogenicity is limited. Thus, there is an urgent need to explore strategies that improve the effectiveness of ICD in TNBC by incorporating immunoregulatory agents. This study investigated the potential of celecoxib (CXB) to enhance PTX-induced ICD by blocking the biosynthesis of PGE2 in the tumor cells. We observed that the combination of CXB and PTX promoted the maturation of dendritic cells and primed a T cell-dependent immune response, leading to enhanced tumor rejection in a vaccination assay. To further optimize drug delivery in vivo, we developed cRGD-modified liposomes for the targeted codelivery of CXB and PTX. This delivery system significantly improved drug accumulation and triggered robust antitumor immunity in an orthotopic mouse model of TNBC. Moreover, it served as an in situ vaccine to inhibit tumor recurrence and lung metastasis. Overall, our findings provide in-depth insights into the therapeutic mechanism underlying the combination of CXB and PTX, highlighting their potential as effective immune-based therapies for TNBC.
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Affiliation(s)
- Xiaohui Qian
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
| | - Huang Yang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Ziqiang Ye
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Bingqiang Gao
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
| | - Zhefeng Qian
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
| | - Yuan Ding
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
| | - Zhengwei Mao
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Yang Du
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang, China
- National Innovation Center for Fundamental Research on Cancer Medicine, Hangzhou 310009, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
- ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou 310058, Zhejiang, China
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Madariaga A, Cole H, Pittman T, Grant RC, Dhani NC, Liu A, Bowering V, Sellman S, Oza AM, Lheureux S. High grade adverse event reporting and enrolment in gynecologic oncology clinical trials. Gynecol Oncol 2024; 185:1-7. [PMID: 38342004 DOI: 10.1016/j.ygyno.2024.02.003] [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: 11/02/2023] [Revised: 01/09/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE The primary objective is to assess factors associated with treatment related high grade (CTCAE grade ≥ 3) adverse event (AE) reporting among participants in gynecologic oncology clinical trials. METHODS All AEs recorded in the Princess Margaret Clinical Trial adverse event database between 01/2016 and 12/2018 were evaluated. Gynecologic oncology clinical trials assessing systemic therapy were included. Inferential statistics on risk factors of related grade ≥ 3 adverse event reporting and GEE logistic models with Odds Ratios (OR) were performed. Multivariable analysis adjusting for age, clinical trial phase, sponsor, and therapy type. RESULTS The gynecology cancer clinical trials accrued 317 unique patients (359 nested on trials) in 42 systemic therapy trials. In the period, 17,175 related AEs were reported in the gynecological cancer trials, 7.4% were grade ≥ 3. On multivariable analysis, no odds differences of grade ≥ 3 related AEs were detected according to study phase. Patients in immunotherapy clinical trials had lower odds of related grade ≥ 3 AEs than patients on targeted or other therapy (adjusted OR [aOR] 0.43; 95% CI 0.24-0.75). There was greater odds of related grade ≥ 3 AEs in clinical trials assessing combination vs single therapeutics (aOR 2.26, 95% CI 1.34-3.80). Patients aged ≥65 (aOR 1.77; 95% CI 1.08-2.89) had greater odds of related grade ≥ 3 AEs than patients aged 50 to 65 years. When compared to other disease sites, the odds of having a grade ≥ 3 related AE reported in gynecology clinical trials was no different. CONCLUSIONS In this cohort, factors influencing the odds of related grade ≥ 3 AE reporting in gynecologic trials included type of therapy and age. The study phase did not correlate with odds of high-grade AE reporting.
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Affiliation(s)
- Ainhoa Madariaga
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Heather Cole
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tyler Pittman
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert C Grant
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Neesha C Dhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Valerie Bowering
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanna Sellman
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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19
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Kuang X, Xu R, Li J. Association of PD-L1 expression with survival benefit from PD-1/PD-L1 inhibitors in advanced cancer: Systematic review and meta-analysis of phase III randomized clinical trials. Crit Rev Oncol Hematol 2024; 198:104357. [PMID: 38614270 DOI: 10.1016/j.critrevonc.2024.104357] [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: 10/16/2023] [Revised: 02/02/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Whether PD-L1 testing is needed to identify patients receiving PD-1/PD-L1 inhibitors is an area of debate. METHODS PubMed and Embase were searched for phase III randomized clinical trials. We assessed the heterogeneity of overall survival (OS) between patients with high and low PD-L1 expression using an interaction test. RESULTS Seventy studies representing 44791 patients were included. Both the CPS and TPS can predict better survival from anti-PD-1/PD-L1 therapy in patients with high PD-L1 expression. However, only CPS 1 has the ability to select patients who are unlikely to respond to anti-PD-1/PD-L1 therapy, while an OS advantage can be obtained from PD-1/PD-L1 inhibitors both in patients with high and low PD-L1 expression defined by CPS 5, CPS 10 and TPS. CONCLUSION CPS 1 is recommended to select patients with the likelihood of benefiting from PD-1/PD-L1 inhibitors while excluding patients who may not respond.
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Affiliation(s)
- Xiaohong Kuang
- Department of Hematology, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Run Xu
- Department of General Surgery, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Jian Li
- Department of General Surgery, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.
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20
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Leung JH, Leung HWC, Wang SY, Yip Fion HT, Chan ALF. Comparison of target agent treatment strategies for platinum-resistant recurrent ovarian cancer: A Bayesian network meta-analysis. Medicine (Baltimore) 2024; 103:e38183. [PMID: 38788019 PMCID: PMC11124750 DOI: 10.1097/md.0000000000038183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND We aimed to compare 7 newer immunotherapies and targeted therapies for platinum-resistant relapsed ovarian cancer. METHODS We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library electronic databases for phase III trials involving platinum-resistant recurrent ovarian cancer (PRrOC) patients treated with immunotherapy or targeted therapy in combination with chemotherapy. The quality of the included trials was assessed using the GRADE method. The primary outcome of comparison was progression-free survival, and secondary outcomes included overall survival and safety. RESULTS This analysis included 7 randomized phase III controlled trials, encompassing 2485 PRrOC patients. Combining bevacizumab plus chemotherapy and lurbinectedin demonstrated statistically significant differences in progression-free survival compared to all other regimens of interest. However, no statistically significant differences were observed in the overall survival. Nivolumab and mirvetuximab exhibited fewer serious adverse events than the other regimens of interest. CONCLUSIONS Our findings indicate that bevacizumab combined with chemotherapy and lurbinectedin monotherapy has significant efficacy in patients with PRrOC. For patients with PRrOC who have exhausted treatment options, nivolumab and mirvetuximab may be considered as alternatives because of their better safety profiles.
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Affiliation(s)
- John Hang Leung
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Henry W. C. Leung
- Department of Radiation Oncology, An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Shyh-Yau Wang
- Department of Radiation, An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hei-Tung Yip Fion
- Department Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Agnes L. F. Chan
- Department of Pharmacy, An-Nan Hospital, China Medical University, Tainan, Taiwan
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21
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Knisely A, Hinchcliff EM, Gardiner E, Rangwala R, Lito K, Fellman B, Yuan Y, Sood AK, Westin SN, Lu KH, Jazaeri AA. Phase 1b study of batiraxcept in combination with durvalumab in patients with platinum-resistant ovarian cancer. iScience 2024; 27:109801. [PMID: 38726365 PMCID: PMC11079458 DOI: 10.1016/j.isci.2024.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
Combining an immune checkpoint inhibitor with batiraxcept (AVB-S6-500), an AXL inhibitor that acts via selective binding to growth arrest-specific protein 6 (GAS6), may improve anti-tumor immunity in platinum-resistant ovarian cancer (PROC). This phase 1b trial of durvalumab in combination with escalating doses of batiraxcept enrolled patients with recurrent PROC (NCT04019288). The primary objective was to determine the toxicity profile of the combination. Eleven patients were enrolled on the trial. No dose-limiting toxicities were observed, and no objective responses were noted. Median progression free survival (PFS) was 1.81 months (95% confidence interval (CI) 1.71-2.40), and median overall survival (OS) was 4.53 months (95% CI 2.10-24.74). Batiraxcept effectively reduced serum GAS6 levels at 1-h post-treatment, resulting in trough levels below the limit of detection in all cases but one. In conclusion, the combination of batiraxcept and durvalumab was safe and tolerable but did not demonstrate anti-tumor activity in a heterogenous population of patients with recurrent PROC.
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Affiliation(s)
- Anne Knisely
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily M. Hinchcliff
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kathryn Lito
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N. Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amir A. Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Zhao P, Zhao T, Yu L, Ma W, Liu W, Zhang C. The risk of endocrine immune-related adverse events induced by PD-1 inhibitors in cancer patients: a systematic review and meta-analysis. Front Oncol 2024; 14:1381250. [PMID: 38756658 PMCID: PMC11096456 DOI: 10.3389/fonc.2024.1381250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Objective Endocrinopathies are the most common immune-related adverse events (irAEs) observed during therapy with PD-1 inhibitors. In this study, we conducted a comprehensive systematic review and meta-analysis to evaluate the risk of immune-related endocrinopathies in patients treated with PD-1 inhibitors. Methods We performed a systematic search in the PubMed, Embase, and Cochrane Library databases to retrieve all randomized controlled trials (RCTs) involving PD-1 inhibitors, spanning from their inception to November 24, 2023. The comparative analysis encompassed patients undergoing chemotherapy, targeted therapy, or receiving placebo as control treatments. This study protocol has been registered with PROSPERO (CRD42023488303). Results A total of 48 clinical trials comprising 24,514 patients were included. Compared with control groups, patients treated with PD-1 inhibitors showed an increased risk of immune-related adverse events, including hypothyroidism, hyperthyroidism, hypophysitis, thyroiditis, diabetes mellitus, and adrenal insufficiency. Pembrolizumab was associated with an increased risk of all aforementioned endocrinopathies (hypothyroidism: RR=4.76, 95%CI: 3.55-6.39; hyperthyroidism: RR=9.69, 95%CI: 6.95-13.52; hypophysitis: RR=5.47, 95%CI: 2.73-10.97; thyroiditis: RR=5.95, 95%CI: 3.02-11.72; diabetes mellitus: RR=3.60, 95%CI: 1.65-7.88; adrenal insufficiency: RR=4.80, 95%CI: 2.60-8.88). Nivolumab was associated with an increased risk of hypothyroidism (RR=7.67, 95%CI: 5.00-11.75) and hyperthyroidism (RR=9.22, 95%CI: 4.71-18.04). Tislelizumab and sintilimab were associated with an increased risk of hypothyroidism (RR=19.07, 95%CI: 5.46-66.69 for tislelizumab and RR=18.36, 95%CI: 3.58-94.21 for sintilimab). For different tumor types, both hypothyroidism and hyperthyroidism were at high risks. Besides, patients with non-small cell lung cancer were at a higher risk of thyroiditis and adrenal insufficiency. Patients with melanoma were at a higher risk of hypophysitis and diabetes mellitus. Both low- and high-dose group increased risks of hypothyroidism and hyperthyroidism. Conclusion Risk of endocrine irAEs may vary in different PD-1 inhibitors and different tumor types. Increased awareness and understanding of the risk features of endocrine irAEs associated with PD-1 inhibitors is critical for clinicians. Systematic review registration crd.york.ac.uk/prospero, identifier PROSPERO (CRD42023488303).
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Affiliation(s)
- Pengfei Zhao
- Department of Clinical Pharmacy, Weifang People's Hospital, Weifang, China
| | - Ting Zhao
- Department of Clinical Pharmacy, Weifang People's Hospital, Weifang, China
| | - Lihong Yu
- Department of Clinical Pharmacy, Weifang People's Hospital, Weifang, China
| | - Wenming Ma
- Department of Clinical Pharmacy, Weifang People's Hospital, Weifang, China
| | - Wenyu Liu
- Department of Pharmacy, Weifang People's Hospital, Weifang, China
| | - Chenning Zhang
- Department of Rehabilitation Medicine & Department of Pharmacy, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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23
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Hinchcliff EM, Knisely A, Adjei N, Fellman B, Yuan Y, Patel A, Xu C, Westin SN, Sood AK, Soliman PT, Shafer A, Fleming ND, Gershenson DM, Vikram R, Bathala T, Vining D, Ganeshan DM, Lu KH, Sun CC, Meyer LA, Jazaeri AA. Randomized phase 2 trial of tremelimumab and durvalumab in combination versus sequentially in recurrent platinum-resistant ovarian cancer. Cancer 2024; 130:1061-1071. [PMID: 38009662 PMCID: PMC11267492 DOI: 10.1002/cncr.35126] [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: 08/03/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Single-agent immune checkpoint inhibitors (ICIs) have demonstrated limited responses in recurrent ovarian cancer; however, 30%-40% of patients achieve stable disease. The primary objective was to estimate progression-free survival (PFS) after sequential versus combination cytotoxic T-lymphocyte antigen 4 and programmed death ligand 1 ICIs in patients with platinum-resistant high-grade serous ovarian cancer (HGSOC). METHODS Patients were randomized to a sequential arm (tremelimumab followed by durvalumab on progression) or a combination arm (tremelimumab plus durvalumab, followed by durvalumab) via a Bayesian adaptive design that made it more likely for patients to be randomized to the more effective arm. The primary end point was immune-related PFS (irPFS). RESULTS Sixty-one subjects were randomized to sequential (n = 38) or combination therapy (n = 23). Thirteen patients (34.2%) in the sequential arm received durvalumab. There was no difference in PFS in the sequential arm (1.84 months; 95% CI, 1.77-2.17 months) compared with the combination arm (1.87 months; 95% CI, 1.77-2.43 months) (p = .402). In the sequential arm, no responses were observed, although 12 patients (31.6%) demonstrated stable disease. In the combination arm, two patients (8.7%) had partial response, whereas one patient (4.4%) had stable disease. Adverse events were consistent with those previously reported for ICIs. Patient-reported outcomes were similar in both arms. CONCLUSIONS There was no difference in irPFS for combination tremelimumab plus durvalumab compared to tremelimumab alone (administered as part of a sequential treatment strategy) in a heavily pretreated population of patients with platinum-resistant HGSOC. Response rates were comparable to prior reports, although the combination regimen did not add significant benefit, as has been previously described.
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Affiliation(s)
- Emily M Hinchcliff
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Anne Knisely
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Naomi Adjei
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Bryan Fellman
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Ami Patel
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Cai Xu
- Department of Symptom Research, MD Anderson Cancer Center, Houston, TX
| | - Shannon N. Westin
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Pamela T. Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Aaron Shafer
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Nicole D. Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - David M. Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | | | | | - David Vining
- Department of Radiology, MD Anderson Cancer Center, Houston, TX
| | | | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Charlotte C. Sun
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Larissa A. Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
| | - Amir A. Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX
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Vardarli I, Tan S, Brandenburg T, Weidemann F, Görges R, Herrmann K, Führer D. Risk and Incidence of Endocrine Immune-Related Adverse Effects Under Checkpoint Inhibitor Mono- or Combination Therapy in Solid Tumors: A Meta-Analysis of Randomized Controlled Trials. J Clin Endocrinol Metab 2024; 109:1132-1144. [PMID: 37967245 DOI: 10.1210/clinem/dgad670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT Few meta-analyses on incidence of endocrine immune-related adverse effects (eirAEs) have been published and many trials have been published since. OBJECTIVE We performed a comprehensive meta-analysis with updated literature to assess risk and incidence of eirAEs of any grade and grade 3 to 5 by immune checkpoint inhibitor (ICI) monotherapy or combination therapy in solid tumors. METHODS An electronic search using PubMed/Medline, Embase, and the Cochrane Library was performed. Randomized controlled studies (RCTs) assessing eirAEs under ICI monotherapy or ICI combination therapy were selected. Stata software (v17) was used for statistical analyses and risk of bias was evaluated using Review Manager version 5.3. RESULTS A total of 69 RCTs with 80 independent reports, involving 42 886 patients, were included in the study. Meta-analysis revealed the following pooled estimates for risk ratio and incidence, respectively: for any grade hypothyroidism 7.81 (95% CI, 5.68-10.74, P < .0001) and 7.64% (95% CI, 6.23-9.17, P < .0001); significantly increased also for hyperthyroidism, hypophysitis/hypopituitarism, and adrenal insufficiency; and for insulin-dependent diabetes mellitus 1.52 (95% CI, 1.07-2.18, P = .02), and 0.087% (95% CI, 0.019-0.189, P = .0006), respectively. Meta-regression showed that combination of ICIs (nivolumab plus ipilimumab; durvalumab plus tremelimumab) is an independent risk factor for any grade hypophysitis/hypopituitarism, and that ICI agent is an independent factor of risk for adrenal insufficiency, but that cancer type is not an independent risk factor for eirAEs. CONCLUSION We showed that risk, independent from cancer type, and incidence of eirAEs are substantially increased with ICI therapy. Combination of ICIs increases risk for eirAEs, especially for hypophysitis/hypopituitarism.
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Affiliation(s)
- Irfan Vardarli
- 5th Medical Department, Division of Endocrinology and Diabetes, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen 45657, Germany
| | - Susanne Tan
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry-Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Tim Brandenburg
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry-Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Frank Weidemann
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen 45657, Germany
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry-Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
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25
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Cui Y, Zhang W, Lu W, Feng Y, Wu X, Zhuo Z, Zhang D, Zhang Y. An exosome-derived lncRNA signature identified by machine learning associated with prognosis and biomarkers for immunotherapy in ovarian cancer. Front Immunol 2024; 15:1228235. [PMID: 38404588 PMCID: PMC10884316 DOI: 10.3389/fimmu.2024.1228235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Ovarian cancer (OC) has the highest mortality rate among gynecological malignancies. Current treatment options are limited and ineffective, prompting the discovery of reliable biomarkers. Exosome lncRNAs, carrying genetic information, are promising new markers. Previous studies only focused on exosome-related genes and employed the Lasso algorithm to construct prediction models, which are not robust. Methods 420 OC patients from the TCGA datasets were divided into training and validation datasets. The GSE102037 dataset was used for external validation. LncRNAs associated with exosome-related genes were selected using Pearson analysis. Univariate COX regression analysis was used to filter prognosis-related lncRNAs. The overlapping lncRNAs were identified as candidate lncRNAs for machine learning. Based on 10 machine learning algorithms and 117 algorithm combinations, the optimal predictor combinations were selected according to the C index. The exosome-related LncRNA Signature (ERLS) model was constructed using multivariate COX regression. Based on the median risk score of the training datasets, the patients were divided into high- and low-risk groups. Kaplan-Meier survival analysis, the time-dependent ROC, immune cell infiltration, immunotherapy response, and immune checkpoints were analyzed. Results 64 lncRNAs were subjected to a machine-learning process. Based on the stepCox (forward) combined Ridge algorithm, 20 lncRNA were selected to construct the ERLS model. Kaplan-Meier survival analysis showed that the high-risk group had a lower survival rate. The area under the curve (AUC) in predicting OS at 1, 3, and 5 years were 0.758, 0.816, and 0.827 in the entire TCGA cohort. xCell and ssGSEA analysis showed that the low-risk group had higher immune cell infiltration, which may contribute to the activation of cytolytic activity, inflammation promotion, and T-cell co-stimulation pathways. The low-risk group had higher expression levels of PDL1, CTLA4, and higher TMB. The ERLS model can predict response to anti-PD1 and anti-CTLA4 therapy. Patients with low expression of PDL1 or high expression of CTLA4 and low ERLS exhibited significantly better survival prospects, whereas patients with high ERLS and low levels of PDL1 or CTLA4 exhibited the poorest outcomes. Conclusion Our study constructed an ERLS model that can predict prognostic risk and immunotherapy response, optimizing clinical management for OC patients.
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Affiliation(s)
- Yongjia Cui
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weixuan Zhang
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenping Lu
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaogong Feng
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Xiaoqing Wu
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhili Zhuo
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongni Zhang
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yichi Zhang
- Guang Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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26
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Deng M, Tang F, Chang X, Liu P, Ji X, Hao M, Wang Y, Yang R, Ma Q, Zhang Y, Miao J. Immunotherapy for Ovarian Cancer: Disappointing or Promising? Mol Pharm 2024; 21:454-466. [PMID: 38232985 DOI: 10.1021/acs.molpharmaceut.3c00986] [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] [Indexed: 01/19/2024]
Abstract
Ovarian cancer, one of the deadliest malignancies, lacks effective treatment, despite advancements in surgical techniques and chemotherapy. Thus, new therapeutic approaches are imperative to improving treatment outcomes. Immunotherapy, which has demonstrated considerable success in managing various cancers, has already found its place in clinical practice. This review aims to provide an overview of ovarian tumor immunotherapy, including its basics, key strategies, and clinical research data supporting its potential. In particular, this discussion highlights promising strategies such as checkpoint inhibitors, vaccines, and pericyte transfer, both individually and in combination. However, the advancement of new immunotherapies necessitates large controlled randomized trials, which will undoubtedly shape the future of ovarian cancer treatment.
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Affiliation(s)
- Mengqi Deng
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Fan Tang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Xiangyu Chang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Penglin Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Xuechao Ji
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Menglin Hao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Yixiao Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Ruiye Yang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Qingqing Ma
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
- Nanyuan Hospital of Fengtai District, Beijing 100006, China
| | - Yubo Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
- Qingdao Hospital, University of Health and Rehabilitation Sciences, Shandong 266011, China
| | - Jinwei Miao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
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27
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Elyashiv O, Aleohin N, Migdan Z, Leytes S, Peled O, Tal O, Levy T. The Poor Prognosis of Acquired Secondary Platinum Resistance in Ovarian Cancer Patients. Cancers (Basel) 2024; 16:641. [PMID: 38339392 PMCID: PMC10854926 DOI: 10.3390/cancers16030641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE The goal of this study was to evaluate response to treatment and survival in epithelial ovarian cancer patients with acquired secondary platinum resistance (SPR) compared to patients with primary platinum resistance (PPR). METHODS Patients were categorized as PPR (patients with disease recurrence occurring during or <6 months after completing first-line platinum-based chemotherapy) and SPR (patients with previously platinum-sensitive disease that developed platinum resistance on subsequent treatments). Clinico-pathological variables and treatment outcomes were compared. RESULTS Of the 118 patients included in this study, 60 had PPR and 58 developed SPR. The SPR women had a significantly higher rate of optimal debulking during their upfront and interval operations, significantly lower CA-125 levels during their primary treatment, and a significantly higher complete and partial response rate to primary chemotherapy. Once platinum resistance appeared, no significant difference in survival was observed between the two groups. The median PFS was 2 months in the PPR group and 0.83 months in the SPR group (p = 0.085). Also, no significant difference was found in post-platinum-resistant relapse survival, with a median of 17.63 months in the PPR and 20.26 months in the SPR group (p = 0.515). CONCLUSIONS Platinum resistance is an important prognostic factor in women with EOC. Patients with SPR acquire the same poor treatment outcome as with PPR. There is a great need for future research efforts to discover novel strategies and biological treatments to reverse resistance and improve survival.
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Affiliation(s)
- Osnat Elyashiv
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Natalie Aleohin
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Zohar Migdan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Sophia Leytes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ofri Peled
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ori Tal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel; (O.E.); (Z.M.); (O.P.); (O.T.)
- Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Verma N, Renauer PA, Dong C, Xin S, Lin Q, Zhang F, Glazer PM, Chen S. Genome scale CRISPR screens identify actin capping proteins as key modulators of therapeutic responses to radiation and immunotherapy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.14.575614. [PMID: 38293095 PMCID: PMC10827061 DOI: 10.1101/2024.01.14.575614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Radiotherapy (RT), is a fundamental treatment for malignant tumors and is used in over half of cancer patients. As radiation can promote anti-tumor immune effects, a promising therapeutic strategy is to combine radiation with immune checkpoint inhibitors (ICIs). However, the genetic determinants that impact therapeutic response in the context of combination therapy with radiation and ICI have not been systematically investigated. To unbiasedly identify the tumor intrinsic genetic factors governing such responses, we perform a set of genome-scale CRISPR screens in melanoma cells for cancer survival in response to low-dose genotoxic radiation treatment, in the context of CD8 T cell co-culture and with anti-PD1 checkpoint blockade antibody. Two actin capping proteins, Capza3 and Capg, emerge as top hits that upon inactivation promote the survival of melanoma cells in such settings. Capza3 and Capg knockouts (KOs) in mouse and human cancer cells display persistent DNA damage due to impaired homology directed repair (HDR); along with increased radiation, chemotherapy, and DNA repair inhibitor sensitivity. However, when cancer cells with these genes inactivated were exposed to sublethal radiation, inactivation of such actin capping protein promotes activation of the STING pathway, induction of inhibitory CEACAM1 ligand expression and resistance to CD8 T cell killing. Patient cancer genomics analysis reveals an increased mutational burden in patients with inactivating mutations in CAPG and/or CAPZA3, at levels comparable to other HDR associated genes. There is also a positive correlation between CAPG expression and activation of immune related pathways and CD8 T cell tumor infiltration. Our results unveil the critical roles of actin binding proteins for efficient HDR within cancer cells and demonstrate a previously unrecognized regulatory mechanism of therapeutic response to radiation and immunotherapy.
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Affiliation(s)
- Nipun Verma
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut, USA
| | - Paul A. Renauer
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
| | - Chuanpeng Dong
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
| | - Shan Xin
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
| | - Qianqian Lin
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
| | - Feifei Zhang
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
| | - Peter M. Glazer
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut, USA
- Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sidi Chen
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- System Biology Institute, Yale University, West Haven, Connecticut, USA
- Immunobiology Program, Yale University, New Haven, Connecticut, USA
- Molecular Cell Biology, Genetics, and Development Program, Yale University, New Haven, Connecticut, USA
- Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Stem Cell Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Center for Biomedical Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
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29
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St Laurent J, Liu JF. Treatment Approaches for Platinum-Resistant Ovarian Cancer. J Clin Oncol 2024; 42:127-133. [PMID: 37910841 DOI: 10.1200/jco.23.01771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Jessica St Laurent
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA
| | - Joyce F Liu
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
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30
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Blanc-Durand F, Clemence Wei Xian L, Tan DSP. Targeting the immune microenvironment for ovarian cancer therapy. Front Immunol 2023; 14:1328651. [PMID: 38164130 PMCID: PMC10757966 DOI: 10.3389/fimmu.2023.1328651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
Ovarian cancer (OC) is an aggressive malignancy characterized by a complex immunosuppressive tumor microenvironment (TME). Immune checkpoint inhibitors have emerged as a breakthrough in cancer therapy by reactivating the antitumor immune response suppressed by tumor cells. However, in the case of OC, these inhibitors have failed to demonstrate significant improvements in patient outcomes, and existing biomarkers have not yet identified promising subgroups. Consequently, there remains a pressing need to understand the interplay between OC tumor cells and their surrounding microenvironment to develop effective immunotherapeutic approaches. This review aims to provide an overview of the OC TME and explore its potential as a therapeutic strategy. Tumor-infiltrating lymphocytes (TILs) are major actors in OC TME. Evidence has been accumulating regarding the spontaneous TILS response against OC antigens. Activated T-helpers secrete a wide range of inflammatory cytokines with a supportive action on cytotoxic T-cells. Simultaneously, mature B-cells are recruited and play a significant antitumor role through opsonization of target antigens and T-cell recruitment. Macrophages also form an important subset of innate immunity (M1-macrophages) while participating in the immune-stimulation context. Finally, OC has shown to engage a significant natural-killer-cells immune response, exerting direct cytotoxicity without prior sensitization. Despite this initial cytotoxicity, OC cells develop various strategies to induce an immune-tolerant state. To this end, multiple immunosuppressive molecules are secreted to impair cytotoxic cells, recruit regulatory cells, alter antigen presentation, and effectively evade immune response. Consequently, OC TME is predominantly infiltrated by immunosuppressive cells such as FOXP3+ regulatory T-cells, M2-polarized macrophages and myeloid-derived suppressor cells. Despite this strong immunosuppressive state, PD-1/PD-L1 inhibitors have failed to improve outcomes. Beyond PD-1/PD-L1, OC expresses multiple other immune checkpoints that contribute to immune evasion, and each representing potential immune targets. Novel immunotherapies are attempting to overcome the immunosuppressive state and induce specific immune responses using antibodies adoptive cell therapy or vaccines. Overall, the OC TME presents both opportunities and obstacles. Immunotherapeutic approaches continue to show promise, and next-generation inhibitors offer exciting opportunities. However, tailoring therapies to individual immune characteristics will be critical for the success of these treatments.
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Affiliation(s)
- Felix Blanc-Durand
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine and Cancer Science Institute (CSI), National University of Singapore (NUS), Singapore, Singapore
| | - Lai Clemence Wei Xian
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine and Cancer Science Institute (CSI), National University of Singapore (NUS), Singapore, Singapore
| | - David S. P. Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Centre for Cancer Research (N2CR) and Cancer Science Institute (CSI), National University of Singapore, Singapore, Singapore
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31
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Moore KN, Angelergues A, Konecny GE, García Y, Banerjee S, Lorusso D, Lee JY, Moroney JW, Colombo N, Roszak A, Tromp J, Myers T, Lee JW, Beiner M, Cosgrove CM, Cibula D, Martin LP, Sabatier R, Buscema J, Estévez-García P, Coffman L, Nicum S, Duska LR, Pignata S, Gálvez F, Wang Y, Method M, Berkenblit A, Bello Roufai D, Van Gorp T. Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer. N Engl J Med 2023; 389:2162-2174. [PMID: 38055253 DOI: 10.1056/nejmoa2309169] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Mirvetuximab soravtansine-gynx (MIRV), a first-in-class antibody-drug conjugate targeting folate receptor α (FRα), is approved for the treatment of platinum-resistant ovarian cancer in the United States. METHODS We conducted a phase 3, global, confirmatory, open-label, randomized, controlled trial to compare the efficacy and safety of MIRV with the investigator's choice of chemotherapy in the treatment of platinum-resistant, high-grade serous ovarian cancer. Participants who had previously received one to three lines of therapy and had high FRα tumor expression (≥75% of cells with ≥2+ staining intensity) were randomly assigned in a 1:1 ratio to receive MIRV (6 mg per kilogram of adjusted ideal body weight every 3 weeks) or chemotherapy (paclitaxel, pegylated liposomal doxorubicin, or topotecan). The primary end point was investigator-assessed progression-free survival; key secondary analytic end points included objective response, overall survival, and participant-reported outcomes. RESULTS A total of 453 participants underwent randomization; 227 were assigned to the MIRV group and 226 to the chemotherapy group. The median progression-free survival was 5.62 months (95% confidence interval [CI], 4.34 to 5.95) with MIRV and 3.98 months (95% CI, 2.86 to 4.47) with chemotherapy (P<0.001). An objective response occurred in 42.3% of the participants in the MIRV group and in 15.9% of those in the chemotherapy group (odds ratio, 3.81; 95% CI, 2.44 to 5.94; P<0.001). Overall survival was significantly longer with MIRV than with chemotherapy (median, 16.46 months vs. 12.75 months; hazard ratio for death, 0.67; 95% CI, 0.50 to 0.89; P = 0.005). During the treatment period, fewer adverse events of grade 3 or higher occurred with MIRV than with chemotherapy (41.7% vs. 54.1%), as did serious adverse events of any grade (23.9% vs. 32.9%) and events leading to discontinuation (9.2% vs. 15.9%). CONCLUSIONS Among participants with platinum-resistant, FRα-positive ovarian cancer, treatment with MIRV showed a significant benefit over chemotherapy with respect to progression-free and overall survival and objective response. (Funded by ImmunoGen; MIRASOL ClinicalTrials.gov number, NCT04209855.).
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Affiliation(s)
- Kathleen N Moore
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Antoine Angelergues
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Gottfried E Konecny
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Yolanda García
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Susana Banerjee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Domenica Lorusso
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jung-Yun Lee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - John W Moroney
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Nicoletta Colombo
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Andrzej Roszak
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jacqueline Tromp
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Tashanna Myers
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jeong-Won Lee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Mario Beiner
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Casey M Cosgrove
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - David Cibula
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Lainie P Martin
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Renaud Sabatier
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Joseph Buscema
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Purificación Estévez-García
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Lan Coffman
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Shibani Nicum
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Linda R Duska
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Sandro Pignata
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Fernando Gálvez
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Yuemei Wang
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Michael Method
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Anna Berkenblit
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Diana Bello Roufai
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Toon Van Gorp
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
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Xu L, Ma S, Fan B, Yuan Z, Yin P. Bufalin-loaded vitamin E succinate-grafted chitosan oligosaccharide/RGD-conjugated TPGS mixed micelles inhibit intraperitoneal metastasis of ovarian cancer. Cancer Nanotechnol 2023. [DOI: 10.1186/s12645-023-00178-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Intraperitoneal metastasis is one of the major causes of the high mortality rate of ovarian cancer. Bufalin (BU) is an effective component of the traditional Chinese medicine Chansu that exerts antitumor effects, including metastasis inhibition. In our previous studies, we found that BU inhibited the migration and invasion of ovarian cancer cells. However, the application of BU is limited due to its insolubility, toxicity and imprecise targeting. The aim of this study was to use vitamin E succinate (VES)-grafted chitosan oligosaccharide (CSO)/arginine-glycine-aspartic acid peptide (RGD)-conjugated d-alpha-tocopheryl polyethylene glycol 1000 succinate (TPGS) mixed micelles (VeC/T-RGD MMs) to deliver BU to ovarian cancer cells to inhibit intraperitoneal metastasis. Moreover, the toxicity of BU was reduced by coating it with the mixed micelles to increase its biocompatibility for practical applications.
Results
The BU-loaded VeC/T-RGD MMs (BU@MMs) had an average diameter of 161 ± 1.4 nm, a zeta potential of 4.49 ± 1.54 mV and a loading efficiency of 2.54%. The results showed that these micelles inhibited cell proliferation, induced apoptosis, and reduced the migration and invasion of A2780 and SKOV3 cells. Further studies indicated that BU@MMs enhanced the levels of e-cadherin and decreased the expression levels of N-cadherin, vimentin and Snail in vitro. In addition, the mixed micelles effectively enhanced the anticancer effect and inhibited intraperitoneal metastasis in intraperitoneal metastatic models. The BU@MMs exhibited fewer toxic side effects than BU, indicating better biocompatibility and biosafety for in vivo applications.
Conclusions
Our studies show that BU@MMs are a potential multifunctional nano-drug delivery system that can effectively inhibit the intraperitoneal metastasis of ovarian cancer.
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Mollica V, Rizzo A, Marchetti A, Tateo V, Tassinari E, Rosellini M, Massafra R, Santoni M, Massari F. The impact of ECOG performance status on efficacy of immunotherapy and immune-based combinations in cancer patients: the MOUSEION-06 study. Clin Exp Med 2023; 23:5039-5049. [PMID: 37535194 DOI: 10.1007/s10238-023-01159-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
ECOG performance status (PS) is a pivotal prognostic factor in a wide number of solid tumors. We performed a meta-analysis to assess the role of ECOG PS in terms of survival in patients with ECOG PS 0 or ECOG PS 1 treated with immunotherapy alone or combined with other anticancer treatments. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, all phase II and III randomized clinical trials that compared immunotherapy or immune-based combinations in patients with solid tumors were retrieved. The outcomes of interest were overall survival (OS) and progression-free survival (PFS). We also performed subgroup analyses focused on type of therapy (ICI monotherapy or combinations), primary tumor type, setting (first line of treatment, subsequent lines). Overall, 60 studies were included in the analysis for a total of 35.020 patients. The pooled results showed that immunotherapy, either alone or in combination, reduces the risk of death or progression in both ECOG PS 0 and 1 populations. The survival benefit was consistent in all subgroups. Immune checkpoint inhibitors monotherapy or immune-based combinations are associated with improved survival irrespective of ECOG PS 0 or 1. Clinical trials should include more frail patients to assess the value of immunotherapy in these patients.
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Affiliation(s)
- Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Andrea Marchetti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Tateo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Ledermann JA, Shapira-Frommer R, Santin AD, Lisyanskaya AS, Pignata S, Vergote I, Raspagliesi F, Sonke GS, Birrer M, Provencher DM, Sehouli J, Colombo N, González-Martín A, Oaknin A, Ottevanger PB, Rudaitis V, Kobie J, Nebozhyn M, Edmondson M, Sun Y, Cristescu R, Jelinic P, Keefe SM, Matulonis UA. Molecular determinants of clinical outcomes of pembrolizumab in recurrent ovarian cancer: Exploratory analysis of KEYNOTE-100. Gynecol Oncol 2023; 178:119-129. [PMID: 37862791 DOI: 10.1016/j.ygyno.2023.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE This prespecified exploratory analysis evaluated the association of gene expression signatures, tumor mutational burden (TMB), and multiplex immunohistochemistry (mIHC) tumor microenvironment-associated cell phenotypes with clinical outcomes of pembrolizumab in advanced recurrent ovarian cancer (ROC) from the phase II KEYNOTE-100 study. METHODS Pembrolizumab-treated patients with evaluable RNA-sequencing (n = 317), whole exome sequencing (n = 293), or select mIHC (n = 125) data were evaluated. The association between outcomes (objective response rate [ORR], progression-free survival [PFS], and overall survival [OS]) and gene expression signatures (T-cell-inflamed gene expression profile [TcellinfGEP] and 10 non-TcellinfGEP signatures), TMB, and prespecified mIHC cell phenotype densities as continuous variables was evaluated using logistic (ORR) and Cox proportional hazards regression (PFS; OS). One-sided p-values were calculated at prespecified α = 0.05 for TcellinfGEP, TMB, and mIHC cell phenotypes and at α = 0.10 for non-TcellinfGEP signatures; all but TcellinfGEP and TMB were adjusted for multiplicity. RESULTS No evidence of associations between ORR and key axes of gene expression was observed. Negative associations were observed between outcomes and TcellinfGEP-adjusted glycolysis (PFS, adjusted-p = 0.019; OS, adjusted-p = 0.085) and hypoxia (PFS, adjusted-p = 0.064) signatures. TMB as a continuous variable was not associated with outcomes (p > 0.05). Positive associations were observed between densities of myeloid cell phenotypes CD11c+ and CD11c+/MHCII-/CD163-/CD68- in the tumor compartment and ORR (adjusted-p = 0.025 and 0.013, respectively). CONCLUSIONS This exploratory analysis in advanced ROC did not find evidence for associations between gene expression signatures and outcomes of pembrolizumab. mIHC analysis suggests CD11c+ and CD11c+/MHCII-/CD163-/CD68- phenotypes representing myeloid cell populations may be associated with improved outcomes with pembrolizumab in advanced ROC. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02674061.
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Affiliation(s)
- Jonathan A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, United Kingdom.
| | - Ronnie Shapira-Frommer
- The Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, United States
| | - Alla S Lisyanskaya
- Department of Oncogynecology, St. Petersburg City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Ignace Vergote
- Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University Hospital Leuven, Leuven, Belgium
| | | | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Birrer
- UAMS Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, United States
| | - Diane M Provencher
- Centre Hospitalier de l'Université de Montréal (CHUM), Institut du Cancer de Montréal, Montreal, Canada
| | - Jalid Sehouli
- Gynecology with Center of Oncological Surgery, Charité-Medical University of Berlin, Berlin, Germany
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio González-Martín
- Department of Medical Oncology and Program in Solid Tumors-Cima, Cancer Center Clínica Universidad de Navarra, Madrid, Spain
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P B Ottevanger
- Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vilius Rudaitis
- Clinic of Obstetrics and Gynecology, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania
| | - Julie Kobie
- Merck & Co., Inc., Rahway, NJ, United States
| | | | | | - Yuan Sun
- Merck & Co., Inc., Rahway, NJ, United States
| | | | | | | | - Ursula A Matulonis
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Kurtz JE, Pujade-Lauraine E, Oaknin A, Belin L, Leitner K, Cibula D, Denys H, Rosengarten O, Rodrigues M, de Gregorio N, Martinez García J, Petru E, Kocián R, Vergote I, Pautier P, Schmalfeldt B, Gaba L, Polterauer S, Mouret Reynier MA, Sehouli J, Churruca C, Selle F, Joly F, D'Hondt V, Bultot-Boissier É, Lebreton C, Lotz JP, Largillier R, Heudel PE, Heitz F. Atezolizumab Combined With Bevacizumab and Platinum-Based Therapy for Platinum-Sensitive Ovarian Cancer: Placebo-Controlled Randomized Phase III ATALANTE/ENGOT-ov29 Trial. J Clin Oncol 2023; 41:4768-4778. [PMID: 37643382 PMCID: PMC10602539 DOI: 10.1200/jco.23.00529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/23/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE Platinum-based doublets with concurrent and maintenance bevacizumab are standard therapy for ovarian cancer (OC) relapsing after a platinum-free interval (PFI) >6 months. Immunotherapy may be synergistic with bevacizumab and chemotherapy. PATIENTS AND METHODS ATALANTE/ENGOT-ov29 (ClinicalTrials.gov identifier: NCT02891824), a placebo-controlled double-blinded randomized phase III trial, enrolled patients with recurrent epithelial OC, one to two previous chemotherapy lines, and PFI >6 months. Eligible patients were randomly assigned 2:1 to atezolizumab (1,200 mg once every 3 weeks or equivalent) or placebo for up to 24 months, combined with bevacizumab and six cycles of chemotherapy doublet, stratified by PFI, PD-L1 status, and chemotherapy regimen. Coprimary end points were investigator-assessed progression-free survival (PFS) in the intention-to-treat (ITT) and PD-L1-positive populations (alpha .025 for each population). RESULTS Between September 2016 and October 2019, 614 patients were randomly assigned: 410 to atezolizumab and 204 to placebo. Only 38% had PD-L1-positive tumors. After 3 years' median follow-up, the PFS difference between atezolizumab and placebo did not reach statistical significance in the ITT (hazard ratio [HR], 0.83; 95% CI, 0.69 to 0.99; P = .041; median 13.5 v 11.3 months, respectively) or PD-L1-positive (HR, 0.86; 95% CI, 0.63 to 1.16; P = .30; median 15.2 v 13.1 months, respectively) populations. The immature overall survival (OS) HR was 0.81 (95% CI, 0.65 to 1.01; median 35.5 v 30.6 months with atezolizumab v placebo, respectively). Global health-related quality of life did not differ between treatment arms. Grade ≥3 adverse events (AEs) occurred in 88% of atezolizumab-treated and 87% of placebo-treated patients; grade ≥3 AEs typical of immunotherapy were more common with atezolizumab (13% v 8%, respectively). CONCLUSION ATALANTE/ENGOT-ov29 did not meet its coprimary PFS objectives in the ITT or PD-L1-positive populations. OS follow-up continues. Further research on biopsy samples is warranted to decipher the immunologic landscape of late-relapsing OC.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- Department of Medical and Surgical Oncology & Hematology, ICANS, Strasbourg, France
| | - Eric Pujade-Lauraine
- Association de Recherche sur les CAncers dont GYnécologiques (ARCAGY)-GINECO, Paris, France
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lisa Belin
- Biostatistics and Public Health Department, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpětriére – Charles Foix, Paris, France
| | - Katharina Leitner
- Gynecology and Obstetrics Department, Medical University of Innsbruck, Innsbruck, Austria
| | - David Cibula
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - Ora Rosengarten
- Oncology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Manuel Rodrigues
- Department of Medical Oncology and INSERM U830, Institut Curie, PSL Research University, Paris, France
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynaecology, University Hospital Ulm, Ulm, Germany
- SLK Klinikum Heilbronn, Heilbronn, Germany
| | - Jeronimo Martinez García
- Medical Oncology Department, Hospital Universitario Virgen Arrixaca (El Palmar) and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Roman Kocián
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ignace Vergote
- Department of Gynecology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Barbara Schmalfeldt
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Gaba
- Department of Medical Oncology, Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clínic de Barcelona, Institut D'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Cristina Churruca
- Department of Medical Oncology, Hospital Universitario Donostia, Donostia, Spain
| | - Frédéric Selle
- Oncology Department, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Florence Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Véronique D'Hondt
- Medical Oncology Department, Institut Régional du Cancer Montpellier (ICM), Montpellier, France
| | - Émilie Bultot-Boissier
- Oncology Department, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Jean-Pierre Lotz
- Medical Oncology Service, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rémy Largillier
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France
| | | | - Florian Heitz
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
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Eskander RN, Moore KN, Monk BJ, Herzog TJ, Annunziata CM, O’Malley DM, Coleman RL. Overcoming the challenges of drug development in platinum-resistant ovarian cancer. Front Oncol 2023; 13:1258228. [PMID: 37916177 PMCID: PMC10616588 DOI: 10.3389/fonc.2023.1258228] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/11/2023] [Indexed: 11/03/2023] Open
Abstract
The definition of "platinum-resistant ovarian cancer" has evolved; it now also reflects cancers for which platinum treatment is no longer an option. Standard of care for platinum-resistant ovarian cancer is single-agent, non-platinum chemotherapy with or without bevacizumab, which produces modest response rates, with the greatest benefits achieved using weekly paclitaxel. Several recent phase 3 trials of pretreated patients with prior bevacizumab exposure failed to meet their primary efficacy endpoints, highlighting the challenge in improving clinical outcomes among these patients. Combination treatment with antiangiogenics has improved outcomes, whereas combination strategies with immune checkpoint inhibitors have yielded modest results. Despite extensive translational research, there has been a lack of reliable and established biomarkers that predict treatment response in platinum-resistant ovarian cancer. Additionally, in the platinum-resistant setting, implications for the time between the penultimate dose of platinum therapy and platinum retreatment remain an area of debate. Addressing the unmet need for an effective treatment in the platinum-resistant setting requires thoughtful clinical trial design based on a growing understanding of the disease. Recent cancer drug approvals highlight the value of incorporating molecular phenotypes to better define patients who are more likely to respond to novel therapies. Clinical trials designed per the Gynecologic Cancer InterGroup recommendations-which advocate against relying solely upon the platinum-free interval-will help advance our understanding of recurrent ovarian cancer response where platinum rechallenge in the platinum-resistant setting may be considered. The inclusion of biomarkers in clinical trials will improve patient stratification and potentially demonstrate correlations with biomarker expression and duration of response. With the efficacy of antibody-drug conjugates shown for the treatment of some solid and hematologic cancers, current trials are evaluating the use of various novel conjugates in the setting of platinum-resistant ovarian cancer. Emerging novel treatments coupled with combination trials and biomarker explorations offer encouraging results for potential strategies to improve response rates and prolong progression-free survival in this population with high unmet need. This review outlines existing data from contemporary clinical trials of patients with platinum-resistant ovarian cancer and suggests historical synthetic benchmarks for non-randomized trials.
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Affiliation(s)
- Ramez N. Eskander
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rebecca and John Moores Cancer Center, University of California San Diego Health, San Diego, CA, United States
| | - Kathleen N. Moore
- Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma College of Medicine, Oklahoma, OK, United States
| | - Bradley J. Monk
- Gynecologic Oncology, HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ, United States
| | - Thomas J. Herzog
- Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | | | - David M. O’Malley
- Division of Gynecologic Oncology, The Ohio State University and The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Robert L. Coleman
- Gynecologic Oncology, US Oncology Research, Texas Oncology, The Woodlands, TX, United States
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Li A, Luo L, Du W, Yu Z, He L, Fu S, Wang Y, Zhou Y, Yang C, Yang Y, Fang W, Zhang L, Hong S. Deciphering transcriptomic determinants of the divergent link between PD-L1 and immunotherapy efficacy. NPJ Precis Oncol 2023; 7:87. [PMID: 37696887 PMCID: PMC10495439 DOI: 10.1038/s41698-023-00443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
Programmed cell death ligand 1 (PD-L1) expression remains the most widely used biomarker for predicting response to immune checkpoint inhibitors (ICI), but its predictiveness varies considerably. Identification of factors accounting for the varying PD-L1 performance is urgently needed. Here, using data from three independent trials comprising 1239 patients, we have identified subsets of cancer with distinct PD-L1 predictiveness based on tumor transcriptome. In the Predictiveness-High (PH) group, PD-L1+ tumors show better overall survival, progression-free survival, and objective response rate with ICI than PD-L1- tumors across three trials. However, the Predictiveness-Low (PL) group demonstrates an opposite trend towards better outcomes for PD-L1- tumors. PD-L1+ tumors from the PH group demonstrate the superiority of ICI over chemotherapy, whereas PD-L1+ tumors from the PL group show comparable efficacy between two treatments or exhibit an opposite trend favoring chemotherapy. This observation of context-dependent predictiveness remains strong regardless of immune subtype (Immune-Enriched or Non-Immune), PD-L1 regulation mechanism (adaptative or constitutive), tumor mutation burden, or neoantigen load. This work illuminates avenues for optimizing the use of PD-L1 expression in clinical decision-making and trial design, although this exploratory concept should be further confirmed in large trials.
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Affiliation(s)
- Anlin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Linfeng Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Du
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhixin Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lina He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Sha Fu
- Department of Cellular & Molecular Diagnostics Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation of Sun Yat-Sen University, Guangzhou, China
| | - Yuanyuan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yixin Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chunlong Yang
- Department of Oncology, The People's Hospital of Fengqing, Lincang, China
| | - Yunpeng Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenfeng Fang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Shaodong Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
- Department of Oncology, The People's Hospital of Fengqing, Lincang, China.
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Holloway RW, Thaker P, Mendivil AA, Ahmad S, Al-Niaimi AN, Barter J, Beck T, Chambers SK, Coleman RL, Crafton SM, Crane E, Ramez E, Ghamande S, Graybill W, Herzog T, Indermaur MD, John VS, Landrum L, Lim PC, Lucci JA, McHale M, Monk BJ, Moore KN, Morris R, O'Malley DM, Reid TJ, Richardson D, Rose PG, Scalici JM, Silasi DA, Tewari K, Wang EW. A phase III, multicenter, randomized study of olvimulogene nanivacirepvec followed by platinum-doublet chemotherapy and bevacizumab compared with platinum-doublet chemotherapy and bevacizumab in women with platinum-resistant/refractory ovarian cancer. Int J Gynecol Cancer 2023; 33:1458-1463. [PMID: 37666539 DOI: 10.1136/ijgc-2023-004812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Treatment options for patients with platinum-resistant/refractory ovarian cancers are limited and only marginally effective. The development of novel, more effective therapies addresses a critical unmet medical need. Olvimulogene nanivacirepvec (Olvi-Vec), with its strong immune modulating effect on the tumor microenvironment, may provide re-sensitization to platinum and clinically reverse platinum resistance or refractoriness in platinum-resistant/refractory ovarian cancer. PRIMARY OBJECTIVE The primary objective is to evaluate the efficacy of intra-peritoneal Olvi-Vec followed by platinum-based chemotherapy and bevacizumab in patients with platinum-resistant/refractory ovarian cancer. STUDY HYPOTHESIS This phase III study investigates Olvi-Vec oncolytic immunotherapy followed by platinum-based chemotherapy and bevacizumab as an immunochemotherapy evaluating the hypothesis that such sequential combination therapy will prolong progression-free survival (PFS) and bring other clinical benefits compared with treatment with platinum-based chemotherapy and bevacizumab. TRIAL DESIGN This is a multicenter, prospective, randomized, and active-controlled phase III trial. Patients will be randomized 2:1 into the experimental arm treated with Olvi-Vec followed by platinum-doublet chemotherapy and bevacizumab or the control arm treated with platinum-doublet chemotherapy and bevacizumab. MAJOR INCLUSION/EXCLUSION CRITERIA Eligible patients must have recurrent, platinum-resistant/refractory, non-resectable high-grade serous, endometrioid, or clear-cell ovarian, fallopian tube, or primary peritoneal cancer. Patients must have had ≥3 lines of prior chemotherapy. PRIMARY ENDPOINT The primary endpoint is PFS in the intention-to-treat population. SAMPLE SIZE Approximately 186 patients (approximately 124 patients randomized to the experimental arm and 62 to the control arm) will be enrolled to capture 127 PFS events. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Expected complete accrual in 2024 with presentation of primary endpoint results in 2025. TRIAL REGISTRATION NCT05281471.
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Affiliation(s)
| | - Premal Thaker
- Obstetrics and Gynecology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | | | - Sarfraz Ahmad
- AdventHealth Cancer Institute, Orlando, Florida, USA
| | | | - James Barter
- Holy Cross Hospital, Silver Spring, Maryland, USA
| | - Tiffany Beck
- Hoag Cancer Center, Newport Beach, California, USA
| | | | | | - Sarah M Crafton
- West Penn Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Erin Crane
- Levine Cancer Institution, Atrium Health, Charlotte, North Carolina, USA
| | - Eskander Ramez
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Sharad Ghamande
- Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Whitney Graybill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Herzog
- Cancer Center, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Veena S John
- Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Lisa Landrum
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | | | - Joseph A Lucci
- McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Michael McHale
- Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Bradley J Monk
- University of Arizona and Creighton University School of Medicine, HonorHealth Research Institute, Phoenix, Arizona, USA
| | | | | | - David M O'Malley
- James Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | | | - Debra Richardson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Peter G Rose
- Gynecology Oncology Desk A-81, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer M Scalici
- Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama, USA
| | - Dan-Arin Silasi
- Mercy St Louis/Diavid C Pratt Cancer Center, St Louis, Missouri, USA
| | - Krishnansu Tewari
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA
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Zhang Z, Pan Q, Lu M, Zhao B. Intermediate endpoints as surrogates for outcomes in cancer immunotherapy: a systematic review and meta-analysis of phase 3 trials. EClinicalMedicine 2023; 63:102156. [PMID: 37600482 PMCID: PMC10432823 DOI: 10.1016/j.eclinm.2023.102156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023] Open
Abstract
Background Cancer immunotherapy shows unique efficacy kinetics that differs from conventional treatment. These characteristics may lead to the prolongation of trial duration, hence reliable surrogate endpoints are urgently needed. We aimed to systematically evaluate the study-level performance of commonly reported intermediate clinical endpoints for surrogacy in cancer immunotherapy. Methods We searched the Embase, PubMed, and Cochrane databases, between database inception and October 18, 2022, for phase 3 randomised trials investigating the efficacy of immunotherapy in patients with advanced solid tumours. An updated search was done on July, 15, 2023. No language restrictions were used. Eligible trials had to set overall survival (OS) as the primary or co-primary endpoint and report at least one intermediate clinical endpoint including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and 1-year overall survival. Other key inclusion and exclusion criteria included: (1) adult patients (>18 years old) with advanced solid tumour; (2) no immunotherapy conducted in the control arms; (3) follow-up is long enough to achieve OS; (4) data should be public available. A two-stage meta-analytic approach was conducted to evaluate the magnitude of the association between these intermediate endpoints and OS. A surrogate was identified if the coefficient of determination (R2) was 0.7 or greater. Leave-one-out cross-validation and pre-defined subgroup analysis were conducted to examine the heterogeneity. Potential publication bias was evaluated using the Egger's and Begg's tests. This trial was registered with PROSPERO, number CRD42022381648. Findings 52,342 patients with 15 types of tumours from 77 phase 3 studies were included. ORR (R2 = 0.11; 95% CI, 0.00-0.24), DCR (R2 = 0.01; 95% CI, 0.00-0.01), and PFS (R2 = 0.40; 95% CI, 0.23-0.56) showed weak associations with OS. However, a strong correlation was observed between 1-year survival and clinical outcome (R2 = 0.74; 95% CI, 0.64-0.83). These associations remained relatively consistent across pre-defined subgroups stratified based on tumour types, masking methods, line of treatments, drug targets, treatment strategies, and follow-up durations. No significant heterogeneities or publication bias were identified. Interpretation 1-year milestone survival was the only identified surrogacy endpoint for outcomes in cancer immunotherapy. Ongoing investigations and development of new endpoints and incorporation of biomarkers are needed to identify potential surrogate markers that can be more robust than 1-year survival. This work may provide important references in assisting the design and interpretation of future clinical trials, and constitute complementary information in drafting clinical practice guidelines. Funding None.
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Affiliation(s)
- Zhishan Zhang
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Qunxiong Pan
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Mingdong Lu
- The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bin Zhao
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
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40
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Konstantinopoulos PA, Matulonis UA. Clinical and translational advances in ovarian cancer therapy. NATURE CANCER 2023; 4:1239-1257. [PMID: 37653142 DOI: 10.1038/s43018-023-00617-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
Ovarian cancer is an aggressive disease that is frequently detected at advanced stages and is initially very responsive to platinum-based chemotherapy. However, the majority of patients relapse following initial surgery and chemotherapy, highlighting the urgent need to develop new therapeutic strategies. In this Review, we outline the main therapeutic principles behind the management of newly diagnosed and recurrent epithelial ovarian cancer and discuss the current landscape of targeted and immune-based approaches.
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41
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Taki M. Mini-review: Immunology in ovarian cancer. J Obstet Gynaecol Res 2023; 49:2245-2251. [PMID: 37415252 DOI: 10.1111/jog.15730] [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: 05/14/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
Immunotherapy for ovarian cancer has been studied for many years and programmed cell death protein 1 ligand/programmed cell death protein 1 (PD-L1/PD-1) blockade has been attempted in several clinical trials; however, the expected therapeutic effect has not been achieved. In contrast, the PD-L1/PD-1 blockade has been clinically applied to endometrial and cervical cancers, and a certain therapeutic effect has been observed. In endometrial cancer, promising outcomes have been achieved with a combination of an anti-PD-1 antibody and lenvatinib, regardless of the number of regimens, even in cases of recurrence after platinum administration. Therefore, immunotherapy is expected to have a therapeutic effect on ovarian cancer regardless of platinum resistance. In this review, considering immunotherapy for ovarian cancer, we discuss the immune mechanisms that exist in ovarian cancer and the immunotherapeutic strategies that should be developed.
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Affiliation(s)
- Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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42
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Herzog TJ, Hays JL, Barlin JN, Buscema J, Cloven NG, Kong LR, Tyagi NK, Lanneau GS, Long BJ, Marsh RL, Seward SM, Starks DC, Welch S, Moore KN, Konstantinopoulos PA, Gilbert L, Monk BJ, O'Malley DM, Chen X, Dalal R, Coleman RL, Sehouli J. ARTISTRY-7: phase III trial of nemvaleukin alfa plus pembrolizumab vs chemotherapy for platinum-resistant ovarian cancer. Future Oncol 2023; 19:1577-1591. [PMID: 37334673 DOI: 10.2217/fon-2023-0246] [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] [Indexed: 06/20/2023] Open
Abstract
Standard single-agent nonplatinum chemotherapy provides only modest benefit in a small proportion of patients with platinum-resistant/-refractory ovarian cancer, with objective response rates of 6-20% and progression-free survival of ≈3-4 months. Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel cytokine designed to capture and expand the therapeutic potential of high-dose interleukin-2 (IL-2) while mitigating its associated toxicity issues. Nemvaleukin preferentially activates cytotoxic CD8+ T cells and natural killer cells with minimal, non-dose-dependent effects on CD4+ regulatory T cells. The global, randomized, open-label, phase III ARTISTRY-7 trial will compare efficacy and safety of nemvaleukin plus pembrolizumab with chemotherapy in patients with platinum-resistant ovarian cancer. The primary end point is investigator-assessed progression-free survival. Clinical Trial Registration: GOG-3063; ENGOT-OV68; NCT05092360 (ClinicalTrials.gov).
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Center, UC College of Medicine, Cincinnati, OH 45267, USA
| | - John L Hays
- Wexner Medical Center & James Cancer Hospital, Ohio State University, Columbus, OH 43210, USA
| | | | | | - Noelle G Cloven
- Texas Oncology - Fort Worth Cancer Center, Fort Worth, TX 76104, USA
| | - Lynn R Kong
- Ventura County Hematology Oncology Specialists, Oxnard, CA 93930, USA
| | | | | | - Beverly J Long
- Sarasota Memorial Healthcare System, Sarasota, FL 34239, USA
| | | | | | | | - Stephen Welch
- London Health Sciences Centre, London, ON, N6A 5A5, Canada
| | - Kathleen N Moore
- College of Medicine, University of Oklahoma, Oklahoma City, OK 73117, USA
| | | | - Lucy Gilbert
- McGill University Health Centre, Women's Health Research Unit, Montréal, QC, H3H 2R9, Canada
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ 85012, USA
| | - David M O'Malley
- Wexner Medical Center & James Cancer Hospital, Ohio State University, Columbus, OH 43210, USA
| | | | | | | | - Jalid Sehouli
- Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Berlin, 11017, Germany
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Porter RL, Matulonis UA. Mirvetuximab soravtansine for platinum-resistant epithelial ovarian cancer. Expert Rev Anticancer Ther 2023; 23:783-796. [PMID: 37458180 DOI: 10.1080/14737140.2023.2236793] [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: 04/13/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Mirvetuximab soravtansine (mirvetuximab) is an antibody drug conjugate (ADC) comprised of a humanized folate receptor alpha (FRα)-binding monoclonal antibody attached via a cleavable linker to the cytotoxic maytansinoid molecule, DM4. FRα is expressed in several epithelial cancers, including high grade serous ovarian cancer (HGSOC). Mirvetuximab received accelerated approval by the United States Food and Drug Administration (FDA) in November 2022 based on the results of the SORAYA trial, which tested mirvetuximab for the treatment of patients with recurrent platinum resistant HGSOC with high FRα expression and showed an overall response rate (ORR) of 32.4% and a median duration of response of 6.9 months. Mirvetuximab toxicities included low grade ocular and gastrointestinal toxicities. The National Comprehensive Cancer Network (NCCN) ovarian cancer 2023 guidelines adopted mirvetuximab as 2A, and mirvetuximab combined with bevacizumab as 2B, recommendations. AREAS COVERED This manuscript will review the preclinical and clinical development of mirvetuximab, the toxicities associated with mirvetuximab and mitigation strategies, and future applications of mirvetuximab. EXPERT OPINION Mirvetuximab represents the first biomarker-directed therapy with an indication specifically for the treatment of PROC. The efficacy and favorable safety profile support further development of mirvetuximab and mirvetuximab combinations in platinum sensitive and newly diagnosed ovarian cancer.
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Affiliation(s)
- Rebecca L Porter
- Division of Gynecologic Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, United States of America
| | - Ursula A Matulonis
- Division of Gynecologic Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, United States of America
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Song Q, Xu SX, Wu JZ, Ling L, Wang S, Shu XH, Ying DN, Pei WW, Wu YC, Sun SF, Zhang YN, Zhou SH, Shao ZY. The preoperative platelet to neutrophil ratio and lymphocyte to monocyte ratio are superior prognostic indicators compared with other inflammatory biomarkers in ovarian cancer. Front Immunol 2023; 14:1177403. [PMID: 37457691 PMCID: PMC10347525 DOI: 10.3389/fimmu.2023.1177403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background Previous studies have suggested that the ratios of immune-inflammatory cells could serve as prognostic indicators in ovarian cancer. However, which of these is the superior prognostic indicator in ovarian cancer remains unknown. In addition, studies on the prognostic value of the platelet to neutrophil ratio (PNR) in ovarian cancer are still limited. Methods A cohort of 991 ovarian cancer patients was analyzed in the present study. Receiver operator characteristic (ROC) curves were utilized to choose the optimal cut-off values of inflammatory biomarkers such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and PNR. The correlation of inflammatory biomarkers with overall survival (OS) and relapse-free survival (RFS) was investigated by Kaplan-Meier methods and log-rank test, followed by Cox regression analyses. Results Kaplan-Meier curves suggested that LMR<3.39, PLR≥181.46, and PNR≥49.20 had obvious associations with worse RFS (P<0.001, P=0.018, P<0.001). Multivariate analysis suggested that LMR (≥3.39 vs. <3.39) (P=0.042, HR=0.810, 95% CI=0.661-0.992) and PNR (≥49.20 vs. <49.20) (P=0.004, HR=1.351, 95% CI=1.103-1.656) were independent prognostic indicators of poor RFS. In addition, Kaplan-Meier curves indicated that PLR≥182.23 was significantly correlated with worse OS (P=0.039). Conclusion Taken together, PNR and LMR are superior prognostic indicators compared with NLR, PLR, and SII in patients with ovarian cancer.
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Affiliation(s)
- Qian Song
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Song-Xiao Xu
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jun-Zhou Wu
- Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Lin Ling
- Department of Gynaecology, Haining People’s Hospital, Haining, Zhejiang, China
| | - Sheng Wang
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xin-Hua Shu
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Dan-Ni Ying
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Wang-Wei Pei
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yu-Chen Wu
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Su-Fang Sun
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yi-Ning Zhang
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Si-Hang Zhou
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Zhu-Yan Shao
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, The Key Laboratory of Zhejiang Province for Aptamers and Theranostics, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Wilczyński JR, Wilczyński M, Paradowska E. "DEPHENCE" system-a novel regimen of therapy that is urgently needed in the high-grade serous ovarian cancer-a focus on anti-cancer stem cell and anti-tumor microenvironment targeted therapies. Front Oncol 2023; 13:1201497. [PMID: 37448521 PMCID: PMC10338102 DOI: 10.3389/fonc.2023.1201497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Ovarian cancer, especially high-grade serous type, is the most lethal gynecological malignancy. The lack of screening programs and the scarcity of symptomatology result in the late diagnosis in about 75% of affected women. Despite very demanding and aggressive surgical treatment, multiple-line chemotherapy regimens and both approved and clinically tested targeted therapies, the overall survival of patients is still unsatisfactory and disappointing. Research studies have recently brought some more understanding of the molecular diversity of the ovarian cancer, its unique intraperitoneal biology, the role of cancer stem cells, and the complexity of tumor microenvironment. There is a growing body of evidence that individualization of the treatment adjusted to the molecular and biochemical signature of the tumor as well as to the medical status of the patient should replace or supplement the foregoing therapy. In this review, we have proposed the principles of the novel regimen of the therapy that we called the "DEPHENCE" system, and we have extensively discussed the results of the studies focused on the ovarian cancer stem cells, other components of cancer metastatic niche, and, finally, clinical trials targeting these two environments. Through this, we have tried to present the evolving landscape of treatment options and put flesh on the experimental approach to attack the high-grade serous ovarian cancer multidirectionally, corresponding to the "DEPHENCE" system postulates.
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Affiliation(s)
- Jacek R Wilczyński
- Department of Gynecological Surgery and Gynecological Oncology, Medical University of Lodz, Lodz, Poland
| | - Miłosz Wilczyński
- Department of Gynecological, Endoscopic and Oncological Surgery, Polish Mother's Health Center-Research Institute, Lodz, Poland
- Department of Surgical and Endoscopic Gynecology, Medical University of Lodz, Lodz, Poland
| | - Edyta Paradowska
- Laboratory of Virology, Institute of Medical Biology of the Polish Academy of Sciences, Lodz, Poland
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Tu M, Xu J. Advances in immunotherapy for gynecological malignancies. Crit Rev Oncol Hematol 2023:104063. [PMID: 37385307 DOI: 10.1016/j.critrevonc.2023.104063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/21/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
To date, surgery, chemotherapy and radiotherapy are mainly used to treat or remove gynecological malignancies. However, these approaches have their limitations when facing complicated female diseases such as advanced cervical and endometrial cancer (EC), chemotherapy-resistant gestational trophoblastic neoplasia and platinum-resistant ovarian cancer. Instead, immunotherapy, as an alternative, could significantly improve prognosis of those patients receiving traditional treatments, with better antitumor activities and possibly less cellular toxicities. Its' development is still not fast enough to meet the current clinical needs. More preclinical studies and larger-scale clinical trials are required. This review aims to introduce the landscape and up-to-date status of immunotherapy against gynecological malignancies, with a discussion of the challenges and future direction.
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Affiliation(s)
- Mengyan Tu
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Junfen Xu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China.
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Yoon WH, DeFazio A, Kasherman L. Immune checkpoint inhibitors in ovarian cancer: where do we go from here? CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:358-377. [PMID: 37457131 PMCID: PMC10344730 DOI: 10.20517/cdr.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy, and despite advancements in therapeutics, most women unfortunately still succumb to their disease. Immunotherapies, in particular immune checkpoint inhibitors (ICI), have been therapeutically transformative in many tumour types, including gynaecological malignancies such as cervical and endometrial cancer. Unfortunately, these therapeutic successes have not been mirrored in ovarian cancer clinical studies. This review provides an overview of the ovarian tumour microenvironment (TME), particularly factors associated with survival, and explores current research into immunotherapeutic strategies in EOC, with an exploratory focus on novel therapeutics in navigating drug resistance.
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Affiliation(s)
- Won-Hee Yoon
- Department of Medical Oncology, Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown 2148, Australia
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead 2145, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia
| | - Anna DeFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia
- Department of Gynecological Oncology, Westmead Hospital, Westmead 2145, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney 2011, Australia
| | - Lawrence Kasherman
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia
- Department of Medical Oncology, Illawarra Cancer Care Centre, Wollongong 2500, Australia
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Richardson DL, Eskander RN, O'Malley DM. Advances in Ovarian Cancer Care and Unmet Treatment Needs for Patients With Platinum Resistance: A Narrative Review. JAMA Oncol 2023; 9:851-859. [PMID: 37079311 DOI: 10.1001/jamaoncol.2023.0197] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Importance Platinum-based chemotherapy has been the standard of care for ovarian cancer for the past 3 decades. Although most patients respond to platinum-based treatment, emergence of platinum resistance in recurrent ovarian cancer is inevitable during the disease course. Outcomes for patients with platinum-resistant ovarian cancer are poor, and options remain limited, highlighting a substantial unmet need for new treatment options. Observations This review summarizes the current and evolving treatment landscape for platinum-resistant ovarian cancer with a focus on the development of novel compounds. Biologic and targeted therapies such as bevacizumab and poly (ADP-ribose) polymerase (PARP) inhibitors-originally approved in the platinum-resistant setting but since withdrawn-are now used in the up-front or platinum-sensitive setting, prolonging the duration of platinum sensitivity and delaying the use of nonplatinum options. The greater use of maintenance therapy and the emphasis on using platinum beyond first-line treatment has most likely been associated with a greater number of lines of platinum therapy before a patient is designated as having platinum-resistant ovarian cancer. In this contemporary setting, recent trials in platinum-resistant ovarian cancer have mostly had negative outcomes, with none having a clinically significant effect on progression-free or overall survival since the approval of bevacizumab in combination with chemotherapy. Nonetheless, a multitude of new therapies are under evaluation; preliminary results are encouraging. A focus on biomarker-directed treatment and patient selection may provide greater success in identifying novel therapies for treating platinum-resistant ovarian cancer. Conclusions and Relevance Although many clinical trials in platinum-resistant ovarian cancer have had negative outcomes, these failures provide insights into how clinical trial design, biomarker-directed therapy, and patient selection could facilitate future successes in platinum-resistant ovarian cancer treatment.
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Affiliation(s)
- Debra L Richardson
- Division of Gynecologic Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Ramez N Eskander
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego Moores Cancer Center, UC San Diego Health, La Jolla
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus
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Fitzsimmons TS, Singh N, Walker TDJ, Newton C, Evans DGR, Crosbie EJ, Ryan NAJ. Immune checkpoint inhibitors efficacy across solid cancers and the utility of PD-L1 as a biomarker of response: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1192762. [PMID: 37250628 PMCID: PMC10219231 DOI: 10.3389/fmed.2023.1192762] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICPI) are a tumor agnostic treatment. However, trials of their use have been site specific. Here we summarize the trial data and explore the utility of programmed death-ligand 1 (PD-L1) expression as a biomarker to direct their pan-cancer use. Method A systematic review of literature, following PRISMA guidelines, was performed. Medline, Embase, Cochrane CENTRAL, NHS Health and Technology, and Web of Science were searched from their conception to June 2022 limited to the English language. The search terms and method were devised by a specialist medical librarian. Studies were limited to adults with solid cancers (excluding melanomas) treated with ICPIs. Only phase III randomized control trials (RCT) were included. The primary outcome was overall survival and secondary outcomes were progression free survival, PD-L1 expression, quality of life outcomes and adverse event data. Where present in eligible clinical trials, hazard ratios (HR), risk ratios (RR), standard error (SE) and 95% confidence intervals (CI) were extracted or calculated. Heterogeneity across studies was described with the use of an I2 score (Low: 25, 50%: moderate, 75% low heterogeneity). HR pools inverse variance methods were adopted by Random Effects (RE). Means were standardized across any heterogenous scale limits. Results In total 46,510 participants were included in the meta-analysis. Overall, meta-analysis favored the use of ICPIs with an overall survival (OS) HR of 0.74 (95% CI 0.71 to 0.78). Lung cancers showed the most benefit in OS [HR 0.72 (95% 0.66-0.78)] followed by head and neck cancers [HR 0.75 (95% CI 0.66-0.84)] and gastroesophageal junction cancers [HR 0.75 (95% CI 0.61-0.92)]. ICPIs seem to be efficacious at both primary presentation and recurrence [OS HR 0.73 (95% CI 0.68-0.77)] vs. [OS HR 0.79 (95% CI 0.72 to 0.87)] respectively. Interestingly, subgroup analysis comparing studies in which most cancers demonstrated PD-L1 expression vs. those studies in which a minority of cancer demonstrated PD-L1 expression reported similar effect of ICPI use on OS; oddly the data favored ICPI use in studies with a minority of PD-L1 expression. Specifically, studies with minority PD-L1 expression had an HR 0.73 (95% CI 0.68-0.78) vs. studies with majority PD-L1 expression HR 0.76 (95% CI 0.70-0.84). This was maintained even when studies exploring the same cancer site were directly compared. Subgroup analysis was performed comparing the impact on OS subdivided by the specific ICPI used. Where meta-analysis was performed, Nivolumab led to the greatest impact [HR 0.70 (95% CI 0.64-0.77)] with Avelumab failing to reach significance [HR 0.93 (95% CI 0.80-1.06)]. However, overall heterogenicity was high (I2 = 95%). Finally, the use of ICPIs led to an improved side effect profile when compared with standard chemotherapy [RR 0.85 (95% CI 0.73-0.98)]. Conclusion ICPIs improve survival outcomes in all cancer types. These effects are seen in the primary, recurrent, chemotherapy sensitive, chemotherapy resistant disease. These data support their use as a tumor agnostic therapy. Furthermore, they are well tolerated. However, PD-L1 as a biomarker for the targeting of ICPI use seems problematic. Other biomarkers such as mismatch repair or tumor mutational burden should be explored in randomized trials. In addition, there are still limited trials looking at ICPI use outside of lung cancer.
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Affiliation(s)
| | - Niharika Singh
- Clinical Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas D. J. Walker
- Division of Cancer Sciences, St Mary’s Hospital, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Claire Newton
- Department of Obstetrics and Gynaecology, St Michaels Hospital, Bristol, United Kingdom
| | - Dafydd G. R. Evans
- Division of Evolution and Genomic Medicine, St Mary’s Hospital, University of Manchester, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, St Mary’s Hospital, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Neil A. J. Ryan
- The College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
- Department of Gynaecology Oncology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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50
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Tolcher A, Hamilton E, Coleman RL. The evolving landscape of antibody-drug conjugates in gynecologic cancers. Cancer Treat Rev 2023; 116:102546. [PMID: 37023499 DOI: 10.1016/j.ctrv.2023.102546] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
Despite significant advances in the treatment of cervical, ovarian, and uterine cancers with the approvals of checkpoint and PARP inhibitors into standard treatment, patients with recurrent metastatic gynecologic malignancies still experience poor outcomes, and most of these patients will experience disease relapse. Once standard preferred treatments are exhausted, options have historically been limited to treatments associated with poor outcomes and notable toxicities. Consequently, novel therapies that are effective and well-tolerated are needed for patients with recurrent and metastatic gynecologic malignancies. Antibody-drug conjugates (ADCs) are a class of targeted therapies that are well established in several cancers including hematologic malignancies and some solid tumors. Significant strides in ADC technology and design have led to improvements in efficacy and safety with newer-generation ADCs. Consequently, ADCs are gaining traction in gynecologic cancers with the recent US Food and Drug Administration approvals of tisotumab vedotin in cervical cancer and mirvetuximab soravtansine in ovarian cancer. Many additional ADCs against various targets are being explored in patients with metastatic or recurrent gynecologic malignancies. The purpose of this review is to summarize the nuanced structural and functional properties of ADCs, while outlining opportunities for innovation. Further, we highlight the ADCs in clinical development for gynecologic malignancies, exploring how ADCs may be able to address the clinical care gap for patients with gynecologic cancers.
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Affiliation(s)
- Anthony Tolcher
- NEXT Oncology, 2829 Babcock Road Suite 300, San Antonio, TX 78229 United States.
| | - Erika Hamilton
- Sarah Cannon Research Institute at Tennessee Oncology, 335 24 Avenue North, Suite 200, Nashville, TN 37203, United States
| | - Robert L Coleman
- US Oncology Research, Texas Oncology, 9180 Pinecraft Drive Suite 600, The Woodlands, TX 77380, United States
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