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Knight AD, Luke JJ. Beyond Immune Checkpoint Inhibitors: Emerging Targets in Melanoma Therapy. Curr Oncol Rep 2024; 26:826-839. [PMID: 38789670 DOI: 10.1007/s11912-024-01551-4] [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: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE OF REVIEW This review provides a comprehensive update on recent advancements in melanoma treatment by highlighting promising therapeutics with an aim to increase awareness of novel interventions currently in development. RECENT FINDINGS Over the last decade there has been considerable expansion of the previously available treatment options for patients with melanoma. In particular, novel immunotherapeutics have been developed to expand on the clinical advancements brought by BRAF targeting and immune checkpoint inhibitors. Despite the success of checkpoint inhibitors there remains an unmet need for patients that do not respond to treatment. This review delves into the latest advancements in novel checkpoint inhibitors, cytokines, oncolytic viruses, vaccines, bispecific antibodies, and adoptive cell therapy. Preclinical experiments and early-stage clinical trials studies have demonstrated promising results for these therapies, many of which have moved into pivotal, phase 3 studies.
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Affiliation(s)
- Andrew D Knight
- University of Pittsburgh Medical Center, 3459 Fifth Ave. Room W-927, Pittsburgh, PA, 15213, USA
| | - Jason J Luke
- UPMC Hillman Cancer Center and the University of Pittsburgh, 5150 Centre Ave. Room 1.27C, Pittsburgh, PA, 15232, USA.
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Geukes Foppen MH, Rohaan MW, Borgers JSW, Philips D, Vyth-Dreese F, Beijnen JH, Nuijen B, van den Berg JH, Haanen JBAG. Intradermal Naked DNA Vaccination by DNA Tattooing for Mounting Tumor-Specific Immunity in Stage IV Melanoma Patients: A Phase I Clinical Trial. Oncol Res Treat 2024; 47:351-359. [PMID: 38583422 PMCID: PMC11323828 DOI: 10.1159/000537896] [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: 12/14/2023] [Accepted: 02/15/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Naked DNA vaccination could be a powerful and safe strategy to mount antigen-specific cellular immunity. We designed a phase I clinical trial to investigate the toxicity of naked DNA vaccines encoding CD8+ T-cell epitope from tumor-associated antigen MART-1 in patients with advanced melanoma. METHODS This dose escalating phase Ia clinical trial investigates the toxicity and immunological response upon naked DNA vaccines encoding a CD8+ T-cell epitope from the tumor-associated antigen MART-1, genetically linked to the gene encoding domain 1 of subunit-tetanus toxin fragment C in patients with advanced melanoma (inoperable stage IIIC-IV, AJCC 7th edition). The vaccine was administrated via intradermal application using a permanent make-up or tattoo device. Safety was monitored according to CTCAE v.3.0 and skin biopsies and blood samples were obtained for immunologic monitoring. RESULTS Nine pretreated, HLA-A*0201-positive patients with advanced melanoma expressing MART-1 and MHC class I, with a good performance status, and adequate organ function, were included. With a median follow-up of 5.9 months, DNA vaccination was safe, without treatment-related deaths. Common treatment-emergent adverse events of any grade were dermatologic reactions at the vaccination site (100%) and pain (56%). One patient experienced grade 4 toxicity, most likely related to tumor progression. One patient (11%) achieved stable disease, lasting 353 days. Immune analysis showed no increase in vaccine-induced T cell response in peripheral blood of 5 patients, but did show a MART-1 specific CD8+ T cell response at the tattoo administration site. The maximum dose administered was 2 mg due to lack of clinical activity. CONCLUSION We showed that the developed DNA vaccine, applied using a novel intradermal application strategy, can be administered safely. Further research with improved vaccine formats is required to show possible clinical benefit of DNA vaccination.
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Affiliation(s)
| | - Maartje W Rohaan
- Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands,
| | - Jessica S W Borgers
- Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands
| | - Daisy Philips
- Netherlands Cancer Institute, Division of Molecular Oncology and Immunology, Amsterdam, The Netherlands
| | - Florry Vyth-Dreese
- Netherlands Cancer Institute, Division of Molecular Oncology and Immunology, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Netherlands Cancer Institute, Division of Pharmacy and Pharmacology, Amsterdam, The Netherlands
| | - Bastiaan Nuijen
- Netherlands Cancer Institute, Division of Pharmacy and Pharmacology, Amsterdam, The Netherlands
| | - Joost H van den Berg
- Netherlands Cancer Institute, Division of Molecular Oncology and Immunology, Amsterdam, The Netherlands
| | - John B A G Haanen
- Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands
- Netherlands Cancer Institute, Division of Molecular Oncology and Immunology, Amsterdam, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Lin Z, Shen H, Liu X, Ma W, Wang M, Ruan J, Yu H, Ma S, Sun X. Recent advances of artificial intelligence in melanoma clinical practice. Melanoma Res 2023; 33:454-461. [PMID: 37696256 DOI: 10.1097/cmr.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Skin melanoma is a lethal cancer. The incidence of melanoma is increasing rapidly in all regions of the world. Despite significant breakthroughs in melanoma treatment in recent years, precise diagnosis of melanoma is still a challenge in some cases. Even specialized physicians may need time and effort to make accurate judgments. As artificial intelligence (AI) technology advances into medical practice, it may bring new solutions to this problem based on its efficiency, accuracy, and speed. This paper summarizes the recent progress of AI in melanoma-related applications, including melanoma diagnosis and classification, the discovery of new medication, guiding treatment, and prognostic assessment. The paper also compares the effectiveness of various algorithms in melanoma application and suggests future research directions for AI in melanoma clinical practice.
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Affiliation(s)
- Zijun Lin
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University
- Institute of Aging Research, School of Medical Technology, Guangdong Medical University
| | - Haoyan Shen
- School of Biomedical Engineering, Guangdong Medical University
| | - Xinguang Liu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University
- Institute of Aging Research, School of Medical Technology, Guangdong Medical University
| | - Wanrui Ma
- Department of General Medicine, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan
| | - Mingfa Wang
- Department of Pathology, The Second Affiliated Hospital of Hainan Medical University, Haikou
| | - Jie Ruan
- Institute of Aging Research, School of Medical Technology, Guangdong Medical University
| | - Hongbin Yu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Chinese American Tumor Institute, Guangdong Medical University, Dongguan, China
| | - Sha Ma
- School of Biomedical Engineering, Guangdong Medical University
| | - Xuerong Sun
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University
- Institute of Aging Research, School of Medical Technology, Guangdong Medical University
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Rizzetto G, De Simoni E, Molinelli E, Offidani A, Simonetti O. Efficacy of Pembrolizumab in Advanced Melanoma: A Narrative Review. Int J Mol Sci 2023; 24:12383. [PMID: 37569757 PMCID: PMC10419154 DOI: 10.3390/ijms241512383] [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: 06/22/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Pembrolizumab has been shown to increase survival in patients with metastatic melanoma. Considering the numerous oncoming studies, we decided to conduct a narrative review of the latest efficacy evidence regarding the use of pembrolizumab, alone or in combination, in patients with metastatic melanoma. A search was conducted in PubMed using "pembrolizumab," and "metastatic melanoma" as keywords, considering studies from 2022 onward. We reviewed pembrolizumab and associations, cost-effectiveness, virus, advanced acral melanoma, long-term outcomes, real-life data, biomarkers, obesity, and vaccines. In conclusion, pembrolizumab is a fundamental option in the therapy of metastatic melanoma. However, a certain group of patients do not respond and, therefore, new combination options need to be evaluated. In particular, the use of vaccines tailored to tumor epitopes could represent a breakthrough in the treatment of resistant forms. Further studies with larger sample numbers are needed to confirm the preliminary results.
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Affiliation(s)
| | | | | | | | - Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (G.R.); (E.D.S.); (E.M.); (A.O.)
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Biswas N, Chakrabarti S, Padul V, Jones LD, Ashili S. Designing neoantigen cancer vaccines, trials, and outcomes. Front Immunol 2023; 14:1105420. [PMID: 36845151 PMCID: PMC9947792 DOI: 10.3389/fimmu.2023.1105420] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Neoantigen vaccines are based on epitopes of antigenic parts of mutant proteins expressed in cancer cells. These highly immunogenic antigens may trigger the immune system to combat cancer cells. Improvements in sequencing technology and computational tools have resulted in several clinical trials of neoantigen vaccines on cancer patients. In this review, we have looked into the design of the vaccines which are undergoing several clinical trials. We have discussed the criteria, processes, and challenges associated with the design of neoantigens. We searched different databases to track the ongoing clinical trials and their reported outcomes. We observed, in several trials, the vaccines boost the immune system to combat the cancer cells while maintaining a reasonable margin of safety. Detection of neoantigens has led to the development of several databases. Adjuvants also play a catalytic role in improving the efficacy of the vaccine. Through this review, we can conclude that the efficacy of vaccines can make it a potential treatment across different types of cancers.
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Affiliation(s)
- Nupur Biswas
- Rhenix Lifesciences, Hyderabad, India,*Correspondence: Nupur Biswas, ;
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Malaina I, Martínez L, Montoya JM, Alonso S, Boyano MD, Asumendi A, Izu R, Sanchez-Diez A, Cancho-Galan G, M. de la Fuente I. A Universal Antigen-Ranking Method to Design Personalized Vaccines Targeting Neoantigens against Melanoma. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010155. [PMID: 36676104 PMCID: PMC9867041 DOI: 10.3390/life13010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
Background: The main purpose of this article is to introduce a universal mathematics-aided vaccine design method against malignant melanoma based on neoantigens. The universal method can be adapted to the mutanome of each patient so that a specific candidate vaccine can be tailored for the corresponding patient. Methods: We extracted the 1134 most frequent mutations in melanoma, and we associated each of them to a vector with 10 components estimated with different bioinformatics tools, for which we found an aggregated value according to a set of weights, and then we ordered them in decreasing order of the scores. Results: We prepared a universal table of the most frequent mutations in melanoma ordered in decreasing order of viability to be used as candidate vaccines, so that the selection of a set of appropriate peptides for each particular patient can be easily and quickly implemented according to their specific mutanome and transcription profile. Conclusions: We have shown that the techniques that are commonly used for the design of personalized anti-tumor vaccines against malignant melanoma can be adapted for the design of universal rankings of neoantigens that originate personalized vaccines when the mutanome and transcription profile of specific patients is considered, with the consequent savings in time and money, shortening the design and production time.
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Affiliation(s)
- Iker Malaina
- Department of Mathematics, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
- Correspondence:
| | - Luis Martínez
- Department of Mathematics, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
| | - Juan Manuel Montoya
- Department of Mathematics, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
- Faculty of Basic Sciences, University of Pamplona, Pamplona 6800, Colombia
| | - Santos Alonso
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
| | - María Dolores Boyano
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
- Biocruces Bizkaia Health Research Institute, 48903 Bizkaia, Spain
| | - Aintzane Asumendi
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
- Biocruces Bizkaia Health Research Institute, 48903 Bizkaia, Spain
| | - Rosa Izu
- Biocruces Bizkaia Health Research Institute, 48903 Bizkaia, Spain
- Department of Dermatology, Basurto University Hospital, 48013 Bizkaia, Spain
| | - Ana Sanchez-Diez
- Biocruces Bizkaia Health Research Institute, 48903 Bizkaia, Spain
- Department of Dermatology, Basurto University Hospital, 48013 Bizkaia, Spain
| | - Goikoane Cancho-Galan
- Biocruces Bizkaia Health Research Institute, 48903 Bizkaia, Spain
- Department of Pathology, Basurto University Hospital, 48013 Bizkaia, Spain
| | - Ildefonso M. de la Fuente
- Department of Mathematics, University of the Basque Country UPV/EHU, 48940 Bizkaia, Spain
- CEBAS-CSIC Institute, Department of Nutrition, 30100 Murcia, Spain
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Switzer B, Piperno-Neumann S, Lyon J, Buchbinder E, Puzanov I. Evolving Management of Stage IV Melanoma. Am Soc Clin Oncol Educ Book 2023; 43:e397478. [PMID: 37141553 DOI: 10.1200/edbk_397478] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Significant advancements have been made in the treatment of advanced melanoma with the use of immune checkpoint inhibitors, novel immunotherapies, and BRAF/MEK-targeted therapies with numerous frontline treatment options. However, there remains suboptimal evidence to guide treatment decisions in many patients. These include patients with newly diagnosed disease, immune checkpoint inhibitor (ICI)-resistant/ICI-refractory disease, CNS metastases, history of autoimmune disease, and/or immune-related adverse events (irAEs). Uveal melanoma (UM) is a rare melanoma associated with a poor prognosis in the metastatic setting. Systemic treatments, including checkpoint inhibitors, failed to demonstrate any survival benefit. Tebentafusp, a bispecific molecule, is the first treatment to improve overall survival (OS) in patients with HLA A*02:01-positive metastatic UM.
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Affiliation(s)
- Benjamin Switzer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - James Lyon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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