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Ostmeyer J, Park JY, von Itzstein MS, Hsiehchen D, Fattah F, Gwin M, Catalan R, Khan S, Raj P, Wakeland EK, Xie Y, Gerber DE. T-cell tolerant fraction as a predictor of immune-related adverse events. J Immunother Cancer 2023; 11:e006437. [PMID: 37580069 PMCID: PMC10432621 DOI: 10.1136/jitc-2022-006437] [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] [Accepted: 06/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) therapies may cause unpredictable and potentially severe autoimmune toxicities termed immune-related adverse events (irAEs). Because T cells mediate ICI effects, T cell profiling may provide insight into the risk of irAEs. Here we evaluate a novel metric-the T-cell tolerant fraction-as a predictor of future irAEs. METHODS We examined T-cell receptor beta (TRB) locus sequencing from baseline pretreatment samples from an institutional registry and previously published studies. For each patient, we used TRB sequences to calculate the T-cell tolerant fraction, which was then assessed as a predictor of future irAEs (classified as Common Terminology Criteria for Adverse Event grade 0-1 vs grade ≥2). We then compared the tolerant fraction to TRB clonality and diversity. Finally, the tolerant fraction was assessed on (1) T cells enriched against napsin A, a potential autoantigen of irAEs; (2) thymic versus peripheral blood T cells; and (3) TRBs specific for various infections and autoimmune diseases. RESULTS A total of 77 patients with cancer (22 from an institutional registry and 55 from published studies) receiving ICI therapy (43 CTLA4, 19 PD1/PDL1, 15 combination CTLA4+PD1/PDL1) were included in the study. The tolerant fraction was significantly lower in cases with clinically significant irAEs (p<0.001) and had an area under the receiver operating curve (AUC) of 0.79. The tolerant fraction was lower for each ICI treatment category, reaching statistical significance for CTLA4 (p<0.001) and demonstrating non-significant trends for PD1/PDL1 (p=0.21) and combination ICI (p=0.18). The tolerant fraction for T cells enriched against napsin A was lower than other samples. The tolerant fraction was also lower in thymic versus peripheral blood samples, and lower in some (multiple sclerosis) but not other (type 1 diabetes) autoimmune diseases. In our study cohort, TRB clonality had an AUC of 0.62, and TRB diversity had an AUC of 0.60 for predicting irAEs. CONCLUSIONS Among patients receiving ICI, the baseline T-cell tolerant fraction may serve as a predictor of clinically significant irAEs.
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Affiliation(s)
- Jared Ostmeyer
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitchell S von Itzstein
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Hsiehchen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farjana Fattah
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary Gwin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rodrigo Catalan
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shaheen Khan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prithvi Raj
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward K Wakeland
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yang Xie
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David E Gerber
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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AlQuzi F, Bowers A, Alexander K, Bradford N. Assessment of Symptoms and Adverse Events Related to Immunotherapy in Patients With Cancer: An Integrative Review. J Pain Symptom Manage 2023; 66:e69-e84. [PMID: 36858244 DOI: 10.1016/j.jpainsymman.2023.02.316] [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: 12/21/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
CONTEXT Clinical practice guidelines advocate for routine assessment of symptoms and adverse events during immunotherapy treatment of cancer. Outside the clinical trial setting, there are few examples of such assessment in practice. OBJECTIVES To identify, appraise, and synthesize the available literature regarding the assessment of immune-related symptoms and adverse events in patients with cancer beyond the clinical trial setting. Specifically, we aimed to identify the measurement instruments used, who completes these and when. METHODS We completed an integrative review following established methods including a systematic literature search of electronic databases, a dual process for screening, quality appraisal, and data extraction. We included primary studies (retrospective or prospective) reporting the use of instruments or strategies to assess symptoms or adverse events in patients with cancer treated with immunotherapy. Outcomes of interest included: 1) how immune-related symptoms and adverse events were assessed; 2) types of assessment instruments; 3) frequency of instrument use and mode of administration; 4) the reported duration and intensity of symptoms and 5) adverse events and associated management strategies. Data were synthesized narratively. RESULTS We screened 2138 articles and included 16 articles representing 2553 patients with cancer undergoing immunotherapy. All articles were published between 2018 and 2022 and were of sound methodological quality. Seven studies were retrospective chart reviews, and the remaining studies prospectively collected data, with seven collecting patient reported outcomes. In studies where data were collected at more than one time point (n = 6), weekly assessment during immunotherapy was the most common frequency. The potential for implementation of assessment into routine clinical practice was described in just four studies. CONCLUSION Despite recommendations from clinical practice guidelines for routine assessment of symptoms and adverse events during immunotherapy treatment for cancer, there are few examples of how this is undertaken in clinical practice. The use of patient reported outcome measures to assess toxicity from immunotherapy is uncommon but offers the potential to identify symptoms early and facilitate timely intervention. Our review highlights the available instruments, how they have been used and the need for more applied research in this field to optimize patient outcomes.
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Affiliation(s)
- Fatimah AlQuzi
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; School of Nursing (F.A.), Umm AL-Qura University, Mecca, Kingdom of Saudi Arabia
| | - Alison Bowers
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Kimberley Alexander
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Natalie Bradford
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia.
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Lagos-Villaseca A, Koshkin VS, Kinet MJ, Rosen CA. Laryngeal Mucous Membrane Pemphigoid as an Immune-related Adverse Effect of Pembrolizumab Treatment. J Voice 2023:S0892-1997(22)00429-5. [PMID: 36658034 DOI: 10.1016/j.jvoice.2022.12.028] [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: 10/19/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
Pembrolizumab is an immune checkpoint inhibitor (ICI) approved for multiple indications in a variety of malignancies. Although generally well tolerated, the potential for significant adverse effects, specifically immune related adverse effects (irAEs) needs to be taken into consideration. Several cases of bullous pemphigoid have been reported as a cutaneous adverse effect of ICIs since 2015, and there are recent reports of mucous membrane pemphigoid (MMP). We present the case of an 84-year-old male with metastatic urothelial carcinoma on treatment with pembrolizumab, who developed laryngeal mucous membrane pemphigoid as an irAE. The diagnosis was based on patient's clinical history and serologic testing, and supported by symptomatic improvement after ICI discontinuation and immunosuppression. Pembrolizumab-induced MMP is a newly described and infrequent irAE, requiring early suspicion and close monitoring for its diagnosis and management.
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Affiliation(s)
- Antonia Lagos-Villaseca
- UCSF Voice & Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California; Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Maxime J Kinet
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Clark A Rosen
- UCSF Voice & Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California.
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Zhou J, Du Z, Fu J, Yi X. Blood cell counts can predict adverse events of immune checkpoint inhibitors: A systematic review and meta-analysis. Front Immunol 2023; 14:1117447. [PMID: 36960068 PMCID: PMC10029759 DOI: 10.3389/fimmu.2023.1117447] [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: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Background Cancer is concerning owing to its high mortality rate. Consequently, methods of prolonging the life of patients with cancer have become the primary focus of attention research. In recent years, immune checkpoint inhibitors (ICIs) have achieved good clinical efficacy as antitumor drugs; however, their severe adverse effects have made their use challenging. In order to clarify the predictors of adverse effects, scientists have conducted a series of studies. Blood counts can potentially monitor risk factors associated with the occurrence of immune-related adverse events (irAEs). Herein, a meta-analysis was performed to clarify further the guiding significance of blood counts in the clinical setting. Methods Studies that satisfied the inclusion criteria were obtained by searching the database. Included studies were those in which irAEs had been observed, and evidence of an association between blood counts and irAEs was reported. The included ones were evaluated for quality. In addition to sensitivity analysis and subgroup analysis, a meta-analysis was performed using the odds ratio (OR) and 95% confidence interval (CI) for each study. Results A total of 18 articles were included in our study. The analyses were performed separately according to different blood cell count indicators. The blood cell count metrics associated with irAEs were: absolute eosinophil count, neutrophil: lymphocyte ratio, and platelet: lymphocyte ratio. Conclusion Our review and meta-analysis of studies suggest that absolute eosinophil count, neutrophil: lymphocyte ratio, and platelet: lymphocyte ratio may serve as predictors of the emergence of irAEs. Given the small number of studies focusing on the relationship between patient blood cell counts and the risk of irAEs, future studies need to further explore the mechanisms of occurrence and potential associations.
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Affiliation(s)
- Juyue Zhou
- Graduate Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zhonghai Du
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
- *Correspondence: Zhonghai Du,
| | - Jie Fu
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Xiuxiu Yi
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
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Gan L, Chen H, Liu X, Zhang L. Ophthalmic immune-related adverse events associated with immune checkpoint inhibitors. Front Immunol 2023; 14:1130238. [PMID: 37033964 PMCID: PMC10076523 DOI: 10.3389/fimmu.2023.1130238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose To investigate the incidence of immune-related adverse events (irAEs) of immune checkpoint inhibitor (ICI) therapy and to report the clinical features, management, and outcomes of ophthalmic irAEs. Methods We retrospectively reviewed the medical records of patients who received ICI therapy from January 2016 to September 2022 at Peking Union Medical College Hospital and analyzed the incidence of systemic and ophthalmic adverse effects of this therapy. Results Of 962 patients, 248 (25.8%) experienced irAEs. The first-year incidences of total irAEs and ophthalmic irAEs were 23.5% and 1.1%. The most common ICI received by the patients was pembrolizumab (373; 38.8%). Nearly half of the patients (477; 49.6%) had lung cancer. Combination therapy was associated with an increased incidence of irAEs without statistical significance. Patients with lung cancer presented with an increased incidence of total irAEs (p = 0.003) and ophthalmic irAEs (p = 0.032). Eleven patients had ophthalmic manifestations, including ophthalmoplegia (6/11), conjunctivitis (3/11), reactive cutaneous capillary endothelial proliferation (RCCEP) (1/11), and orbital inflammation (1/11). Eight patients had concomitant extra-ophthalmic irAEs. Furthermore, ICIs were discontinued in nine patients, and most ophthalmic manifestations were well controlled with topical and systemic steroids. Ten patients were treated with intravenous or oral steroids. However, cancer progression occurred in five out of eleven patients after the interruption of ICIs. Conclusion IrAEs are correlated with ICI regimens and underlying neoplasia. In our Chinese cohort, patients have a higher risk of ophthalmoplegia than uveitis. Early recognition and multidisciplinary consultation are crucial for optimal treatment of ophthalmic irAEs.
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Affiliation(s)
- Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaowei Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xiaowei Liu, ; Li Zhang,
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xiaowei Liu, ; Li Zhang,
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Leucht K, Ali N, Foller S, Grimm MO. Management of Immune-Related Adverse Events from Immune-Checkpoint Inhibitors in Advanced or Metastatic Renal Cell Carcinoma. Cancers (Basel) 2022; 14:4369. [PMID: 36139530 PMCID: PMC9497384 DOI: 10.3390/cancers14184369] [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: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) are now, among other cancers, routinely used for the treatment of advanced or metastatic renal cell carcinoma (mRCC). In mRCC various combinations of ICIs and inhibitors of the vascular epidermal growth factor receptor tyrosine kinase (VEGFR-TKIs) as well as dual checkpoint inhibition (nivolumab + ipilimumab), the latter for patients with intermediate and poor risk according to IMDC only (international metastatic renal cell carcinoma database consortium), are now standard of care in the first line setting. Therefore, a profound understanding of immune-related adverse events (irAE) and the differential diagnosis of adverse reactions caused by other therapeutic agents in combination therapies is of paramount importance. Here we describe prevention, early diagnosis and clinical management of the most relevant irAE derived from ICI treatment focusing on the new VEGFR-TKI/ICI combinations.
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Affiliation(s)
| | | | | | - Marc-Oliver Grimm
- Department of Urology, University Hospital Jena, 07747 Jena, Germany
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Osawa T, Abe T, Kikuchi H, Matsumoto R, Murai S, Nakao T, Tanaka S, Watanabe A, Shinohara N. Validation of an online application to identify potential immune-related adverse events associated with immune checkpoint inhibitors based on the patient’s symptoms. PLoS One 2022; 17:e0265230. [PMID: 35290407 PMCID: PMC8923505 DOI: 10.1371/journal.pone.0265230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are increasingly being used to treat malignancies. Some patients experience immune-related adverse events (irAEs), which may affect any organ/tissue. IrAEs are occasionally fatal and usually have nonspecific symptoms. We developed a three-step application (https://irae-search.com/) to provide healthcare professionals with information on the diagnosis, treatment options, and published reports for 38 categories of irAEs encountered in clinical practice. Methods IrAEs reported in ≥5 cases were identified from articles published between October 2018 and August 2020 by searching Japanese (SELIMIC, JAPIC-Q Service, and JMED Plus) and international (MEDLINE, EMBASE, Derwent Drug File) databases. The cases’ symptoms were entered into the application to identify irAEs, which were verified using the reported diagnosis, to evaluate the application’s sensitivity and specificity. Results Overall, 1209 cases (1067 reports) were analyzed. The three most common categories of irAEs were pituitary or adrenal disorders (14% of cases), skin disorders (13%), and diabetes mellitus (10%). The top three primary diseases were lung cancer (364 cases), melanoma (286 cases), and renal cell carcinoma (218 cases). The average sensitivity was 90.8% (range 44.4%–100.0%) initially, and improved to 94.8% (range 83.3%–100.0%) after incorporating the symptoms reported in published cases into the application’s logic for two irAE categories. The average specificity was 79.3% (range 59.1% [thyroid disorders]–98.2% [arthritis]). Conclusion irAE Search is an easy-to-use application designed to help healthcare professionals identify potential irAEs in ICI-treated patients in a timely manner to facilitate prompt management/treatment. The application showed high sensitivity and moderate-to-high specificity for detecting irAEs.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takafumi Nakao
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Shinji Tanaka
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Ayu Watanabe
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Kreze A, Homer M, Barešová T, Klemperová K. Hypoparathyroidism: an uncommon adverse effect of treatment with durvalumab. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:K21-K24. [PMID: 37435467 PMCID: PMC10259288 DOI: 10.1530/eo-22-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 07/13/2023]
Abstract
Summary Immune checkpoint inhibitors (ICIs) are monoclonal antibodies approved for the treatment of numerous cancer types. Toxicities induced by ICIs may affect any organ system and manifest as endocrinopathy. The main side effects related to treatment are immune-related adverse events (irAEs), especially thyroid dysfunction and hypophysitis. Rare endocrine irAEs are diabetes insipidus, hypoparathyroidism, thyrotoxic crisis and hypogonadism. We report a case of hypoparathyroidism induced by ICI treatment with durvalumab, which has not previously been described. Learning points Treatment with immune checkpoint inhibitors (ICIs) is associated with many endocrine side effects.It is recommended that patients treated with ICIs are observed by an endocrinologist.If side effects are treated accordingly, ICI therapy can continue.
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Affiliation(s)
- Alexander Kreze
- Endocrine Clinic of Internal Medicine Department, The Bulovka University Hospital, Praha, Czech Republic
- Department of Internal Medicine, The Bulovka University Hospital, Praha, Czech Republic
| | - Matěj Homer
- Department of Internal Medicine, The Bulovka University Hospital, Praha, Czech Republic
| | - Tereza Barešová
- Department of Internal Medicine, The Bulovka University Hospital, Praha, Czech Republic
| | - Kristina Klemperová
- Department of Biochemistry, The Bulovka University Hospital, Praha, Czech Republic
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Risk Stratification and Treatment Algorithm of Metastatic Renal Cell Carcinoma. J Clin Med 2021; 10:jcm10225339. [PMID: 34830621 PMCID: PMC8618488 DOI: 10.3390/jcm10225339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022] Open
Abstract
Systemic therapy for metastatic renal cell carcinoma has continuously evolved over the last two decades. Significant improvements in overall survival and quality of life of patients with advanced disease have been observed. With the approval of combination therapies with PD(L)-1 immune checkpoint inhibitors (ICI) as first-line therapy in 2019, the previous standard VEGFR-TKI monotherapy has been replaced as the primary treatment option. In addition to immunotherapy with nivolumab and ipilimumab, three VEGFR-TKI/ICI combinations are now approved. Therapy selection should be preceded by risk stratification using defined criteria from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Clinical parameters, as well as detailed patient counseling on differences in the efficacy profile (response rate, long-term progression-free survival), potential side effects, and impact on quality of life, are of key importance in the individual treatment decision.
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Patel A, Bisno DI, Patel HV, Ghodoussipour S, Saraiya B, Mayer T, Singer EA. Immune Checkpoint Inhibitors in the Management of Urothelial Carcinoma. JOURNAL OF CANCER IMMUNOLOGY 2021; 3:115-136. [PMID: 34263255 PMCID: PMC8276975 DOI: 10.33696/cancerimmunol.3.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Urothelial carcinoma is one of the most common cancers in the United States, yet outcomes are historically suboptimal. Since 2016, the approval of five programmed cell death 1 and programmed death-ligand 1 immune checkpoint inhibitors for locally advanced and metastatic urothelial carcinoma has led to improved oncologic outcomes for many patients in the second-line setting. Two checkpoint inhibitors, pembrolizumab and atezolizumab subsequently earned approval for first-fine therapy with restricted indications. More recently, pembrolizumab was approved for bacillus Calmette-Guérin-unresponsive high-risk non-muscle invasive bladder cancer, opening the door for other immune checkpoint inhibitors to be integrated into treatment in earlier disease stages. Recent bacillus Calmette-Guérin shortages have highlighted the need for alternative treatment options for patients with non-muscle invasive bladder cancer. Currently, there are no FDA-approved checkpoint inhibitors for non-metastatic muscle-invasive bladder cancer. Furthermore, many patients are ineligible for standard cisplatin-based chemotherapy regimens. Numerous ongoing clinical trials are employing immune checkpoint inhibitors for muscle-invasive bladder cancer patients in the neoadjuvant, adjuvant, perioperative, and bladder-sparing setting. Although up to 10% of urothelial carcinoma tumors arise in the upper urinary tract, few studies are designed for this population. We highlight the need for more trials designed for patients with upper tract disease. Overall, there are numerous clinical trials investigating the safety and efficacy of immune checkpoint inhibitors in all stages of disease as single-agents and combined with dual-immune checkpoint inhibition, chemotherapy, radiotherapy, and other pharmacologic agents. As the field continues to evolve rapidly, we aim to provide an overview of recent and ongoing immunotherapy clinical trials in urothelial carcinoma.
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Affiliation(s)
- Aakash Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Daniel I Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Hiren V Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Saum Ghodoussipour
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Biren Saraiya
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Tina Mayer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Eric A Singer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
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11
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Grimm MO, Gottschlich T, Ali N, Foller S, Leucht K. [Side effects of immune checkpoint inhibitor treatment of urological tumors]. Urologe A 2021; 60:803-815. [PMID: 34100956 DOI: 10.1007/s00120-021-01550-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 01/02/2023]
Abstract
Immune checkpoint inhibitors (ICI) are currently routinely used for the treatment of advanced or metastatic urothelial and renal cell carcinomas. Furthermore, several clinical trials are currently investigating their role in adjuvant and neoadjuvant settings as well as in high-risk non-muscle-invasive bladder cancer. As a result, urologists are increasingly confronted with patients who are currently receiving, have recently received or will receive ICI treatment. Care is often interdisciplinary, with urologists playing a central role. Therefore, a profound understanding of immune-mediated adverse events and their differential diagnoses with respect to side effects of other medications in combination treatment are therefore extremely important. This article focusses on the prevention, early diagnosis and clinical management of the most relevant immune-related side effects derived from the new VEGFR-TKI/ICI combinations.
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Affiliation(s)
- Marc-Oliver Grimm
- Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Tobias Gottschlich
- Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Nalyan Ali
- Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Susan Foller
- Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Katharina Leucht
- Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
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