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Musaelyan AA, Moiseyenko FV, Emileva TE, Oganesyan AP, Oganyan KA, Urtenova MA, Odintsova SV, Chistyakov IV, Degtyarev AM, Akopov AL, Imyanitov EN, Orlov SV. Clinical predictors of response to single‑agent immune checkpoint inhibitors in chemotherapy‑pretreated non‑small cell lung cancer. Mol Clin Oncol 2024; 20:32. [PMID: 38476335 PMCID: PMC10928663 DOI: 10.3892/mco.2024.2730] [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: 08/24/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Single-agent immune checkpoint inhibitors (ICIs) are the standard option for chemotherapy-pretreated metastatic non-small cell lung cancer (NSCLC), however only a subset of patients responds to this treatment. The present study aimed at the development of a tool for personalized prediction of the efficacy of ICIs. The study included 181 epidermal growth factor receptor/anaplastic lymphoma kinase-negative patients with metastatic NSCLC receiving single-agent ICI in the second or later line of therapy. For the comparison, a total of 63 metastatic patients with NSCLC treated by chemotherapy were also analyzed. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2, never-smoking status and the baseline neutrophil-to-lymphocyte ratio (NLR) ≥4.3 were associated with reduced progression-free survival (PFS) and overall survival (OS) [ECOG PS: Hazard ratio (HR)=2.09; P=0.028 and HR=2.02; P=0.035, respectively; never-smoking: HR=3.53; P=0.007 and HR=1.80; P=0.004, respectively; NLR ≥4.3: HR=4.34; P<0.0001 and HR=4.89; P<0.0001 respectively]. Patients with an NLR <4.3, who had a favorable ECOG PS (0-1) and smoking history in the past, derived the utmost benefit from ICI [n=77; objective response rate (ORR)=35%; PFS and OS: 17.1 and 33.7 months, respectively]. The worst efficacy of ICI was observed in patients who had an NLR ≥4.3 coupled with poor ECOG PS and/or never-smoking status (n=38; ORR=8%; PFS=3.2 months and OS=7.2 months). The remaining patients belonged to the group with intermediate outcomes (n=66; ORR=17%; PFS and OS: 4.3 and 12.2 months, respectively). While combination of these factors was highly predictive for ICIs, it was not associated with outcomes of chemotherapy treatment. Easily available characteristics of the patients allow for highly accurate predictions of outcomes of single-agent ICI therapy in chemotherapy-pretreated NSCLC.
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Affiliation(s)
- Aram A. Musaelyan
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
- Research Institute of Medical Primatology, Sochi 354376, Russia
| | - Fedor V. Moiseyenko
- N.P. Napalkov City Cancer Center, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
- N.N. Petrov National Medical Research Center of Oncology, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
- Department of Oncology, I.I. Mechnikov North-Western Medical University, Saint Petersburg 191015, Russia
| | - Tancholpon E. Emileva
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | - Ani P. Oganesyan
- N.P. Napalkov City Cancer Center, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
- N.N. Petrov National Medical Research Center of Oncology, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
| | - Karina A. Oganyan
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | - Magaripa A. Urtenova
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | - Svetlana V. Odintsova
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | - Ivan V. Chistyakov
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | | | - Andrey L. Akopov
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
| | - Evgeny N. Imyanitov
- Research Institute of Medical Primatology, Sochi 354376, Russia
- N.P. Napalkov City Cancer Center, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
- N.N. Petrov National Medical Research Center of Oncology, Ministry of Public Health of The Russian Federation, Saint Petersburg 197758, Russia
- Department of General and Molecular Medical Genetics, Saint Petersburg Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Sergey V. Orlov
- Department of Clinical Oncology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg 197022, Russia
- Research Institute of Medical Primatology, Sochi 354376, Russia
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Poletto S, Paruzzo L, Nepote A, Caravelli D, Sangiolo D, Carnevale-Schianca F. Predictive Factors in Metastatic Melanoma Treated with Immune Checkpoint Inhibitors: From Clinical Practice to Future Perspective. Cancers (Basel) 2023; 16:101. [PMID: 38201531 PMCID: PMC10778365 DOI: 10.3390/cancers16010101] [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: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The introduction of immunotherapy revolutionized the treatment landscape in metastatic melanoma. Despite the impressive results associated with immune checkpoint inhibitors (ICIs), only a portion of patients obtain a response to this treatment. In this scenario, the research of predictive factors is fundamental to identify patients who may have a response and to exclude patients with a low possibility to respond. These factors can be host-associated, immune system activation-related, and tumor-related. Patient-related factors can vary from data obtained by medical history (performance status, age, sex, body mass index, concomitant medications, and comorbidities) to analysis of the gut microbiome from fecal samples. Tumor-related factors can reflect tumor burden (metastatic sites, lactate dehydrogenase, C-reactive protein, and circulating tumor DNA) or can derive from the analysis of tumor samples (driver mutations, tumor-infiltrating lymphocytes, and myeloid cells). Biomarkers evaluating the immune system activation, such as IFN-gamma gene expression profile and analysis of circulating immune cell subsets, have emerged in recent years as significantly correlated with response to ICIs. In this manuscript, we critically reviewed the most updated literature data on the landscape of predictive factors in metastatic melanoma treated with ICIs. We focus on the principal limits and potentiality of different methods, shedding light on the more promising biomarkers.
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Affiliation(s)
- Stefano Poletto
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Luca Paruzzo
- Department of Oncology, University of Turin, 10124 Turin, Italy; (L.P.); (D.S.)
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alessandro Nepote
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Daniela Caravelli
- Medical Oncology Division, Candiolo Cancer Institute, FPO-IRCCs, 10060 Candiolo, Italy; (D.C.); (F.C.-S.)
| | - Dario Sangiolo
- Department of Oncology, University of Turin, 10124 Turin, Italy; (L.P.); (D.S.)
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Pala L, De Pas T, Stucchi E, Catania C, Cocorocchio E, Zampino MG, Rossi G, Zattarin E, Di Muzio A, Laszlo D, Stucchi S, Conforti F. Immune-checkpoint inhibitors in anal squamous cell carcinoma: a systematic review and meta-analysis. Semin Oncol 2023; 50:140-143. [PMID: 38065801 DOI: 10.1053/j.seminoncol.2023.11.002] [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: 06/11/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Squamous cell carcinoma of the anus (SCCA) is a rare tumor. While most patients with locally advanced disease are cured with chemo-radiotherapy, about a quarter eventually experience metastatic recurrence. Standard treatment for advanced disease is chemotherapy, but recently evidence on the activity of immunotherapy has been reported. We performed a systematic review and meta-analysis of prospective trials testing immune-checkpoint inhibitors (ICIs) in patients with SCCA. OBJECTIVE We aimed to evaluate the overall response rate (ORR) and the disease control rate (DCR) of ICIs in patients with advanced SCCA. METHODS We systematically searched PubMed, Embase, and Scopus, through December 31, 2022, for prospective trials assessing ICIs in patients with advanced SCCA. The primary and secondary endpoints were respectively ORR and DCR. RESULTS Six prospective trials were included in the analysis, one of which was randomized. Overall, seven treatment arms and 347 patients have been analyzed. Five treatment arms tested ICIs as monotherapy and two arms examined ICIs in combination with cetuximab and bevacizumab, respectively. The pooled ORR was 13% (95%CI, 10%-17%), with a DCR of 57% (95%CI, 40%-74%). Results did not change in a sensitivity analysis, which excluded the two treatment arms testing the combination of ICIs with other drugs. CONCLUSIONS The efficacy of ICIs in SCCAs is low. Combination strategies with targeted drugs or chemotherapy might represent a better therapeutic strategy for these patients. Further studies are awaited to identify resistance mechanisms to ICIs and optimize their efficacy.
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Affiliation(s)
- Laura Pala
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy.
| | - Tommaso De Pas
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Erika Stucchi
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy; Humanitas University, Rozzano, Italy
| | - Chiara Catania
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Maria Giulia Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanna Rossi
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Emma Zattarin
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Daniele Laszlo
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Sara Stucchi
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Fabio Conforti
- Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
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Nardin C, Hennemann A, Diallo K, Funck-Brentano E, Puzenat E, Heidelberger V, Jeudy G, Samimi M, Lesage C, Boussemart L, Peuvrel L, Rouanet J, Brunet-Possenti F, Gerard E, Seris A, Jouary T, Saint-Jean M, Puyraveau M, Saiag P, Aubin F. Efficacy of Immune Checkpoint Inhibitor (ICI) Rechallenge in Advanced Melanoma Patients' Responders to a First Course of ICI: A Multicenter National Retrospective Study of the French Group of Skin Cancers (Groupe de Cancérologie Cutanée, GCC). Cancers (Basel) 2023; 15:3564. [PMID: 37509227 PMCID: PMC10377277 DOI: 10.3390/cancers15143564] [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: 04/24/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The long-term effectiveness of immune checkpoint inhibitor (ICI) rechallenge for progressive or recurrent advanced melanoma following previous disease control induced by ICI has not been thoroughly described in the literature. PATIENTS AND METHODS In this retrospective multicenter national real-life study, we enrolled patients who had been rechallenged with an ICI after achieving disease control with a first course of ICI, which was subsequently interrupted. The primary objective was to evaluate tumor response, while the secondary objectives included assessing the safety profile, identifying factors associated with tumor response, and evaluating survival outcomes. RESULTS A total of 85 patients from 12 centers were included in the study. These patients had advanced (unresectable stage III or stage IV) melanoma that had been previously treated and controlled with a first course of ICI before undergoing rechallenge with ICI. The rechallenge treatments consisted of pembrolizumab (n = 44, 52%), nivolumab (n = 35, 41%), ipilimumab (n = 2, 2%), or ipilimumab plus nivolumab (n = 4, 5%). The best overall response rate was 54%. The best response was a complete response in 30 patients (35%), a partial response in 16 patients (19%), stable disease in 18 patients (21%) and progressive disease in 21 patients (25%). Twenty-eight adverse events (AEs) were reported in 23 patients (27%), including 18 grade 1-2 AEs in 14 patients (16%) and 10 grade 3-4 AEs in nine patients (11%). The median progression-free survival (PFS) was 21 months, and the median overall survival (OS) was not reached at the time of analysis. Patients who received another systemic treatment (chemotherapy, targeted therapy or clinical trial) between the two courses of ICI had a lower response to rechallenge (p = 0.035) and shorter PFS (p = 0.016). CONCLUSION Rechallenging advanced melanoma patients with ICI after previous disease control induced by these inhibitors resulted in high response rates (54%) and disease control (75%). Therefore, ICI rechallenge should be considered as a relevant therapeutic option.
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Affiliation(s)
- Charlée Nardin
- Service de Dermatologie, Centre Hospitalier Universitaire, 25000 Besancon, France
- Université Franche Comté, Inserm 1098 RIGHT, 25020 Besancon, France
| | - Aymeric Hennemann
- Service de Dermatologie, Centre Hospitalier Universitaire, 25000 Besancon, France
| | - Kadiatou Diallo
- Centre de Méthodologie Clinique, Centre Hospitalier Universitaire, 25030 Besancon, France
| | - Elisa Funck-Brentano
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Ambroise-Paré, Service de Dermatologie Générale et Oncologique, 92104 Boulogne-Billancourt, France
| | - Eve Puzenat
- Service de Dermatologie, Centre Hospitalier Universitaire, 25000 Besancon, France
| | | | - Géraldine Jeudy
- Service de Dermatologie, Centre Hospitalier Universitaire, Hôpital Le Bocage, 21079 Dijon, France
| | - Mahtab Samimi
- Service de Dermatologie, Centre Hospitalier Universitaire, BIP 1282, INRA-Université de Tours, 37020 Tours, France
| | - Candice Lesage
- Service de Dermatologie, Centre Hospitalier Universitaire, 34295 Montpellier, France
| | - Lise Boussemart
- Service de Dermatologie, Centre Hospitalier Universitaire, Université de Nantes, INSERM, Immunology and New Concepts in Immunotherapy, INCIT, UMR 1302, 44000 Nantes, France
| | - Lucie Peuvrel
- Institut de Cancérologie de l'Ouest, 44800 Saint-Herblain, France
| | - Jacques Rouanet
- Service de Dermatologie, Centre Hospitalier Universitaire, 63003 Clermont-Ferrand, France
| | | | - Emilie Gerard
- Service de Dermatologie, Centre Hospitalier Universitaire, 33075 Bordeaux, France
| | - Alice Seris
- Oncologie Médicale, Centre Hospitalier, 64046 Pau, France
| | - Thomas Jouary
- Oncologie Médicale, Centre Hospitalier, 64046 Pau, France
| | | | - Marc Puyraveau
- Centre de Méthodologie Clinique, Centre Hospitalier Universitaire, 25030 Besancon, France
| | - Philippe Saiag
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Ambroise-Paré, Service de Dermatologie Générale et Oncologique, 92104 Boulogne-Billancourt, France
| | - François Aubin
- Service de Dermatologie, Centre Hospitalier Universitaire, 25000 Besancon, France
- Université Franche Comté, Inserm 1098 RIGHT, 25020 Besancon, France
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