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Parvathareddy V, Selamet U, Sen AA, Mamlouk O, Song J, Page VD, Abdelrahim M, Diab A, Abdel-Wahab N, Abudayyeh A. Infliximab for Treatment of Immune Adverse Events and Its Impact on Tumor Response. Cancers (Basel) 2023; 15:5181. [PMID: 37958355 PMCID: PMC10649345 DOI: 10.3390/cancers15215181] [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: 09/17/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Background: Immune-related adverse events (irAEs) challenge the use of immune checkpoint inhibitors (ICIs). We performed a retrospective study to evaluate response to infliximab for immune-related adverse event management, and infliximab's effect on progression-free survival (PFS) and overall survival (OS) with a focus on melanoma and genitourinary cancers. Methods: We retrospectively reviewed records of all cancer patients exposed to infliximab after immune checkpoint inhibitor (ICI) treatment from 2004 to 2021 at the MD Anderson Cancer Center. Survival was assessed utilizing the Kaplan-Meier method. Univariate and multivariate logistic regression was utilized to evaluate predictors of infliximab response, OS, and PFS. Results: We identified 185 cancer patients (93 melanoma and 37 genitourinary cancers) treated with ICI and who received infliximab to treat irAEs. Within 3 months of treatment initiation, 71% of the patients responded to infliximab, 27% had no response, and 2% had unknown response. Among different irAEs, colitis was associated with increased response to infliximab at 3 months, irrespective of the type of malignancy. We evaluated best tumor response before and after infliximab in the entire cohort and again in the melanoma and genitourinary (GU); the findings were similar in the melanoma cohort and the entire cohort, where best tumor response before and after infliximab was not significantly different. In the melanoma cohort, acute kidney injury (AKI) was associated with increased risk of death, p = 0.0109, and having response to infliximab was associated with decreased risk of death, p = 0.0383. Interestingly in GU cancer patients, myositis was associated with increased risk of death, p = 0.0041, and having a response to infliximab was marginally associated with decreased risk of death, p = 0.0992. As regards PFS, in a multivariate Cox regression model, having a history of cardiovascular disease remained significantly associated with shorter PFS in the melanoma cohort. For patients with GU cancers, response to infliximab was associated with longer PFS. Conclusions: Our study is among the largest retrospective analyses of infliximab use for irAE management. Patients with colitis were the best responders to infliximab. AKI before initiation of infliximab in the melanoma subcohort and myositis in GU subcohort are associated with higher risk of death. Our results indicate no association between infliximab and cancer progression with the exception of genitourinary cancers.
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Affiliation(s)
| | - Umut Selamet
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA;
| | - Aditi A. Sen
- Department of Nephrology, Baylor College of Medicine, Houston, TX 77030, USA; (V.P.); (A.A.S.)
| | - Omar Mamlouk
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Unit 1468, 1400 Pressler Street, Houston, TX 77030, USA; (O.M.); (V.D.P.)
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Valda D. Page
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Unit 1468, 1400 Pressler Street, Houston, TX 77030, USA; (O.M.); (V.D.P.)
| | - Maen Abdelrahim
- Institute of Academic Medicine and Weill Cornell Medical College, Houston Methodist Cancer Center, Houston, TX 77479, USA;
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.D.); (N.A.-W.)
| | - Noha Abdel-Wahab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.D.); (N.A.-W.)
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Faculty of Medicine, Assiut 71515, Egypt
| | - Ala Abudayyeh
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Unit 1468, 1400 Pressler Street, Houston, TX 77030, USA; (O.M.); (V.D.P.)
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Benoot T, Piccioni E, De Ridder K, Goyvaerts C. TNFα and Immune Checkpoint Inhibition: Friend or Foe for Lung Cancer? Int J Mol Sci 2021; 22:ijms22168691. [PMID: 34445397 PMCID: PMC8395431 DOI: 10.3390/ijms22168691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Tumor necrosis factor-alpha (TNFα) can bind two distinct receptors (TNFR1/2). The transmembrane form (tmTNFα) preferentially binds to TNFR2. Upon tmTNFα cleavage by the TNF-alpha-converting enzyme (TACE), its soluble (sTNFα) form is released with higher affinity for TNFR1. This assortment empowers TNFα with a plethora of opposing roles in the processes of tumor cell survival (and apoptosis) and anti-tumor immune stimulation (and suppression), in addition to angiogenesis and metastases. Its functions and biomarker potential to predict cancer progression and response to immunotherapy are reviewed here, with a focus on lung cancer. By mining existing sequencing data, we further demonstrate that the expression levels of TNF and TACE are significantly decreased in lung adenocarcinoma patients, while the TNFR1/TNFR2 balance are increased. We conclude that the biomarker potential of TNFα alone will most likely not provide conclusive findings, but that TACE could have a key role along with the delicate balance of sTNFα/tmTNFα as well as TNFR1/TNFR2, hence stressing the importance of more research into the potential of rationalized treatments that combine TNFα pathway modulators with immunotherapy for lung cancer patients.
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Montfort A, Filleron T, Virazels M, Dufau C, Milhès J, Pagès C, Olivier P, Ayyoub M, Mounier M, Lusque A, Brayer S, Delord JP, Andrieu-Abadie N, Levade T, Colacios C, Ségui B, Meyer N. Combining Nivolumab and Ipilimumab with Infliximab or Certolizumab in Patients with Advanced Melanoma: First Results of a Phase Ib Clinical Trial. Clin Cancer Res 2020; 27:1037-1047. [PMID: 33272982 DOI: 10.1158/1078-0432.ccr-20-3449] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE TNF blockers can be used to manage gastrointestinal inflammatory side effects following nivolumab and/or ipilimumab treatment in patients with advanced melanoma. Our preclinical data showed that anti-TNF could promote the efficacy of immune checkpoint inhibitors. PATIENTS AND METHODS TICIMEL (NTC03293784) is an open-label, two-arm phase Ib clinical trial. Fourteen patients with advanced and/or metastatic melanoma (stage IIIc/IV) were enrolled. Patients were treated with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) combined to infliximab (5 mg/kg, N = 6) or certolizumab (400/200 mg, N = 8). The primary endpoint was safety and the secondary endpoint was antitumor activity. Adverse events (AEs) were graded according to the NCI Common Terminology Criteria for Adverse Events and response was assessed following RECIST 1.1. RESULTS Only one dose-limiting toxicity was observed in the infliximab cohort. The two different combinations were found to be safe. We observed lower treatment-related AEs with infliximab as compared with certolizumab. In the certolizumab cohort, one patient was not evaluable for response. In this cohort, four of eight patients exhibited hepatobiliary disorders and seven of seven evaluable patients achieved objective response including four complete responses (CRs) and three partial responses (PRs). In the infliximab cohort, we observed one CR, two PRs, and three progressive diseases. Signs of activation and maturation of systemic T-cell responses were seen in patients from both cohorts. CONCLUSIONS Our results show that both combinations are safe in human and provide clinical and biological activities. The high response rate in the certolizumab-treated patient cohort deserves further investigations.
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Affiliation(s)
- Anne Montfort
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thomas Filleron
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Mathieu Virazels
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Carine Dufau
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean Milhès
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Cécile Pagès
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Pascale Olivier
- Service de Pharmacologie médicale et clinique, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur le médicament du CHU de Toulouse, Toulouse, France
| | - Maha Ayyoub
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Muriel Mounier
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Amélie Lusque
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Stéphanie Brayer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nathalie Andrieu-Abadie
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thierry Levade
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Laboratoire de Biochimie, Institut Fédératif de Biologie, CHU Purpan, Toulouse, France
| | - Céline Colacios
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Bruno Ségui
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nicolas Meyer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
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Bertrand F, Montfort A, Marcheteau E, Imbert C, Gilhodes J, Filleron T, Rochaix P, Andrieu-Abadie N, Levade T, Meyer N, Colacios C, Ségui B. TNFα blockade overcomes resistance to anti-PD-1 in experimental melanoma. Nat Commun 2017; 8:2256. [PMID: 29273790 PMCID: PMC5741628 DOI: 10.1038/s41467-017-02358-7] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/23/2017] [Indexed: 12/12/2022] Open
Abstract
Antibodies against programmed cell death-1 (PD-1) have considerably changed the treatment for melanoma. However, many patients do not display therapeutic response or eventually relapse. Moreover, patients treated with anti-PD-1 develop immune-related adverse events that can be cured with anti-tumor necrosis factor α (TNF) antibodies. Whether anti-TNF antibodies affect the anti-cancer immune response remains unknown. Our recent work has highlighted that TNFR1-dependent TNF signalling impairs the accumulation of CD8+ tumor-infiltrating T lymphocytes (CD8+ TILs) in mouse melanoma. Herein, our results indicate that TNF or TNFR1 blockade synergizes with anti-PD-1 on anti-cancer immune responses towards solid cancers. Mechanistically, TNF blockade prevents anti-PD-1-induced TIL cell death as well as PD-L1 and TIM-3 expression. TNF expression positively correlates with expression of PD-L1 and TIM-3 in human melanoma specimens. This study provides a strong rationale to develop a combination therapy based on the use of anti-PD-1 and anti-TNF in cancer patients. Most melanoma patients do not respond to anti-PD1 therapy. Here, the authors show that TNFα blockade synergizes with anti-PD-1 by preventing anti-PD-1-induced CD8+ T cell death and TIM-3 expression on such cells.
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Affiliation(s)
- Florie Bertrand
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France
| | - Anne Montfort
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France
| | - Elie Marcheteau
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France.,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France.,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France
| | - Caroline Imbert
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France.,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France.,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France
| | - Julia Gilhodes
- Institut Universitaire du Cancer, 31059, Toulouse, France
| | | | | | - Nathalie Andrieu-Abadie
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France
| | - Thierry Levade
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France.,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France.,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France.,Laboratoire de Biochimie, Institut Fédératif de Biologie, CHU Purpan, 31059, Toulouse, France
| | - Nicolas Meyer
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France.,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France.,Institut Universitaire du Cancer, Toulouse, Hôpital Larrey et Oncopôle, 31059, Toulouse, France
| | - Céline Colacios
- INSERM UMR 1037, CRCT, 31037, Toulouse, France.,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France.,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France.,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France
| | - Bruno Ségui
- INSERM UMR 1037, CRCT, 31037, Toulouse, France. .,Equipe Labellisée Ligue Contre Le Cancer, 31037, Toulouse, France. .,Université Toulouse III - Paul Sabatier, 31062, Toulouse, France. .,Université Fédérale de Toulouse Midi-Pyrénées, 41 Allée Jules Guesde, 31000, Toulouse, France.
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