1
|
Mahadevia H, Ponvilawan B, Al-Obaidi A, Buckley J, Subramanian J, Bansal D. Exceptional synergistic response of PARP inhibitor and immune checkpoint inhibitor in esophageal adenocarcinoma with a germline BRCA2 mutation: a case report. Ther Adv Med Oncol 2024; 16:17588359241242406. [PMID: 38559611 PMCID: PMC10981852 DOI: 10.1177/17588359241242406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase (PARP) inhibitors have shown efficacy in various tumors. A significant therapeutic challenge with either ICIs or PARP inhibitors as monotherapy is treatment failure from intrinsic primary resistance or the development of secondarily acquired resistance after a period of responsiveness. The combination of PARP inhibitors and ICIs could mitigate this by potentiating treatment response. We describe an 83-year-old male patient who initially presented with abdominal pain, and weight loss along with alternating constipation and diarrhea. Imaging and biopsy revealed metastatic esophageal adenocarcinoma. Genomic testing revealed germline BRCA2 mutation. The patient initially underwent a few cycles of chemoimmunotherapy. However, due to intolerance to chemotherapy, the patient's case was discussed at a multidisciplinary molecular tumor board. He was switched to PARP inhibitor olaparib and ICI nivolumab. This combination led to a durable complete response. A combination of poly-ADP ribose polymerase inhibitor (PARPi) plus ICI may work in synergy through various mechanisms including enhanced neoantigen expression, release of immune-activating cytokines, and increased programmed death-ligand 1 expression. This may culminate in accentuated efficacy outcomes with a manageable safety profile. This exceptional response with ICI and PARPi in our case is consistent with the synergistic value of this combination, and prospective studies are warranted to definitively characterize clinical utility.
Collapse
Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ben Ponvilawan
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ammar Al-Obaidi
- Department of Hematology and Oncology, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Jennifer Buckley
- Department of Radiology, Saint Luke’s Hospital, Kansas City, MO, USA
| | | | - Dhruv Bansal
- Department of Hematology and Oncology, Saint Luke’s Cancer Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
| |
Collapse
|
2
|
Ponvilawan B, Mahadevia H, Qasim H, Sharma P, Bansal D, Subramanian J. Brief Report: Evaluating the Impact of Perioperative Immune Checkpoint Inhibitor in the Treatment of Patients with Resectable Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Clin Lung Cancer 2024:S1525-7304(24)00014-7. [PMID: 38433077 DOI: 10.1016/j.cllc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Ben Ponvilawan
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Himil Mahadevia
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Hana Qasim
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Parth Sharma
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Dhruv Bansal
- St. Luke's Cancer Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | | |
Collapse
|
3
|
Mahadevia H, Al-Obaidi A, Cossor F. The aggravating fury rituximab obliterated. Haematologica 2024. [PMID: 38268447 DOI: 10.3324/haematol.2023.284309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO - 64108; Department of Hematology/Oncology, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL - 32224
| | - Ammar Al-Obaidi
- Department of Hematology/Oncology, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO - 64108
| | - Furha Cossor
- Department of Hematology/Oncology, Saint Luke's Cancer Institute, Saint Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO - 64111.
| |
Collapse
|
4
|
Mahadevia H, Uson Junior PLS, Wang J, Borad M, Babiker H. An overview of up-and-coming immune checkpoint inhibitors for pancreatic cancer. Expert Opin Pharmacother 2024; 25:79-90. [PMID: 38193476 DOI: 10.1080/14656566.2024.2304125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein-1 (PD-1/PD-L1) pathway as well as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) have demonstrated substantial potential in several malignancies. Pancreatic adenocarcinoma (PC) still carries a high mortality despite tremendous advances in the anti-cancer arsenal. AREAS COVERED In this review, we discuss completed and ongoing studies on various ICIs in PC. ICIs have not yielded significant benefits as monotherapy. However, the combination with currently utilized therapies as well as with several other newer forms of therapy has delineated encouraging results. Larger trials are currently underway to definitively characterize the utility of ICIs in the treatment algorithm of PC. ICIs are approved for cancers with mismatch repair deficiency (dMMR) or microsatellite instability-high tumors (MSI-H) as a tumor-agnostic treatment strategy usually referred to as hot tumors. EXPERT OPINION Studies evaluating different drugs to transform the tumor microenvironment (TME) from 'cold' to 'hot' have not shown promise in PC. There still needs to be more prospective trials evaluating the efficacy of the combination of ICIs with different therapeutic modalities in PC that can augment the immunogenic potential of those 'cold' tumors. Exploratory biomarker analysis may help us identify those subsets of PC patients who may particularly benefit from ICIs.
Collapse
Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Internal Medicine, Division of Hematology-Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Pedro Luiz Serrano Uson Junior
- Department of Internal Medicine, Division of Hematology-Oncology, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Department of Internal Medicine, Division of Hematology-Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jing Wang
- Department of Internal Medicine, Division of Hematology-Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mitesh Borad
- Department of Internal Medicine, Division of Hematology-Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Hani Babiker
- Department of Internal Medicine, Division of Hematology-Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| |
Collapse
|
5
|
Ponvilawan B, Sharma P, Mahadevia H, Subramanian J, Bansal D. Outcomes of Immunotherapy Versus Chemotherapy as First-Line Treatment in Advanced NSCLC: A Meta-Analysis of Randomized Clinical Trials. J Thorac Oncol 2023; 18:e90-e93. [PMID: 37599052 DOI: 10.1016/j.jtho.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Ben Ponvilawan
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Parth Sharma
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Himil Mahadevia
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Janakiraman Subramanian
- Division of Oncology, Depatment of Medicine, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Dhruv Bansal
- St. Luke's Cancer Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| |
Collapse
|
6
|
Al-Obaidi A, Mahadevia H, Syed Z, Raza S. A Challenging Case of Kaposi Sarcoma Inflammatory Cytokine Syndrome. Cureus 2023; 15:e42218. [PMID: 37605703 PMCID: PMC10439840 DOI: 10.7759/cureus.42218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS) is a serious, uncommon disease that occurs in patients who are positive for HIV and human herpesvirus-8 (HHV-8). It is characterized by a constellation of clinical findings, including fever, weight loss, and fluid retention, as well as a lack of multicentric Castleman disease (MCD) features on histopathology and an elevated serum HHV-8 viral load. Diagnosis is often delayed, and treatment options are limited, culminating in high mortality rates. We hereby present a 32-year-old male patient with HIV who was untreated for a few years and came with fever, night sweats, pancytopenia, and widespread adenopathy. A thorough evaluation of opportunistic infections was unremarkable. Clinically MCD was suspected, but lymph node biopsy only showed Kaposi sarcoma (KS) with no characteristic features of MCD. However, with clinical deterioration, KICS was strongly suspected. Kaposi sarcoma immune reconstitution syndrome (KS-IRIS) was also a possibility as the patient was restarted on antiretroviral therapy. Rituximab was commenced, but the patient suffered a cardiac arrest and could not be revived. Alternative diagnosis must be explored in patients with HIV presenting with constitutional symptoms, cytopenia, and adenopathy after opportunistic infections and malignancies are ruled out. If they have KS with HHV-8 positivity and there is a lack of characteristic features of MCD in lymph node biopsy, prompt suspicion of KICS should be made, and treatment with rituximab and/or chemotherapy should be instituted rapidly. KS-IRIS is also possible if patients have recently received antiretroviral therapy and have a rapid decline in viral load and increase in CD4 counts (immunological recovery). HHV8 viral load levels may help to distinguish between these two inflammatory conditions.
Collapse
Affiliation(s)
- Ammar Al-Obaidi
- Hematology/Oncology, University of Missouri Kansas City, Kansas City, USA
| | - Himil Mahadevia
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| | - Zain Syed
- Biomedical Engineering, Case Western Reserve University, Cleveland, USA
| | - Shahzad Raza
- Hematology and Medical Oncology, The Cleveland Clinic, Cleveland, USA
| |
Collapse
|
7
|
Mahadevia H, Al-Obaidi A, Madan U, Cossor F. CLO23-049: An Unusual Case Presentation of Severe Idiopathic Multicentric Castleman Disease (iMCD). J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
8
|
Mahadevia H, Ponvilawan B, Sharma P, Al-Obaidi A, Qasim H, Koyi J, Anwer F, Raza S. Advancements and future trends of immunotherapy in light-chain amyloidosis. Crit Rev Oncol Hematol 2023; 183:103917. [PMID: 36696931 DOI: 10.1016/j.critrevonc.2023.103917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Light-chain (AL) amyloidosis is a type of plasma cell neoplasm with abnormal monoclonal immunoglobulin light-chain production and their subsequent deposition in tissues causing end-organ damage. In addition to existing treatments including autologous stem cell transplantation, there is a need for other approaches for eradicating abnormal plasma cells and amyloid tissue deposits. Treatment strategies of AL amyloidosis are mostly based on medications that are effective in multiple myeloma due to similar cell of origin. Daratumumab along with proteasome inhibitors and corticosteroids has become standard of care for AL amyloidosis. Another appealing approach is disassembling amyloid deposits with hope to potentially reverse the damage done by the disease. This was met with promising results for CAEL-101 and birtamimab. Although still in early stages, novel treatment options in pipeline, including antibody-drug conjugates, bispecific T-cell engagers, and chimeric antigen receptor T cell therapy may diversify the treatment armamentarium of AL amyloidosis in the future.
Collapse
Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Ben Ponvilawan
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Parth Sharma
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Ammar Al-Obaidi
- Department of Hematology/Oncology, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Hana Qasim
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Jagadish Koyi
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic, 10201 Carnegie Ave, Cleveland, OH 44106, USA.
| | - Shahzad Raza
- Taussig Cancer Center, Cleveland Clinic, 10201 Carnegie Ave, Cleveland, OH 44106, USA.
| |
Collapse
|
9
|
Coston T, Mahadevia H, Plante MM, Accurso JM, Sharma A, Johnson G, Ashman JB, Kendi AT, Sonbol MB, Hobday TJ, Halfdanarson TR, Starr JS. Characterizing bone metastases and skeletal-related events in patients with well-differentiated neuroendocrine neoplasms utilizing Ga68-DOTATE PET. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
641 Background: Tumors of neuroendocrine origin are a rare, heterogenous group of neoplasms. Neuroendocrine neoplasms (NENs) are categorized by site of origin, differentiation status, and by grade (Ki-67 expression and/or mitotic rate), with prognostic variability accordingly. These tumors frequently metastasize to bone, with reported incidence between 6-12% by older SSTR imaging. Our study evaluates patients with well-differentiated tumors of neuroendocrine origin to determine the incidence of osseous metastases when evaluated with higher-sensitivity Ga68 DOTATATE PET scans. The study characterizes the clinical features. Methods: This study was performed at a single, 3-site, US tertiary-care institution. IRB approval was obtained. An automated data extraction tool was used to mine the electronic medical record by searching all positron emission tomography (PET) studies for keywords. Identified scans had to include a combination of the following keywords: “Dotatate” AND “met*” or “lesion” AND “bone” or “osse*” or “skel*”. The individual medical records from the generated report were reviewed to include only patients with 1) well-differentiated NETs of GI and pancreatic origin, lung carcinoid, paraganglioma/pheochromocytoma, or other/unknown primary site, and 2) patients with confirmed osseous metastatic disease. Patient data was entered into a database and evaluated in aggregate. Results: 1,948 PET scans of 1,473 patients were extracted from the EMR, from which 424 patients were identified for inclusion; scans were performed between 5/2018 and 5/2021. Calculated incidence of bone metastasis by Ga68 DOTATATE PET was 28.8%. Median age of included population was 61 years (range 14-92), 49.5% being male. Site of origin was 47.2% bowel NET, 18.9% pancreatic NET, 10.8% lung carcinoid, 10.6% paraganglioma/pheochromocytoma, 2.1% other site, and 10.4% unknown primary. Majority of patients were asymptomatic (64.0%), had sclerotic appearance (76.7%), Krenning 4 (71.4%), and >3 sites (68.3%) of osseous disease. 94.6% of the population had disease of the axial skeleton; 65.6% appendicular. Only 57 patients (13.4%) with osseous disease suffered a fracture, despite metastases at high-risk sites. Fracture occurred at disproportionately low rates in NETs originating in bowel (22.8% of fractures), with proportionately higher rates among pancreatic NETS and paragangliomas/pheochromocytomas (31.6% and 22.8%, respectively). Fractures occurred at proportionately higher rates in higher-grade disease compared to low-grade. Conclusions: Osseous metastatic disease in well-differentiated NENs is evident at much higher rates when imaging with Ga68 DOTATATE PET compared with previously reported data. Nevertheless, fracture occurred at a low rate, suggesting that these patients are at a relatively low risk for skeletal-related events.
Collapse
|
10
|
Mahadevia H, Kujtan L, Roth M, Sharma P, Buckley JR, Ewing E, Bansal D. Utility of RNA Expression to Determine the Tissue of Origin of Malignancies with an Inconclusive Histopathology. Case Rep Oncol 2023; 16:784-790. [PMID: 37900851 PMCID: PMC10603602 DOI: 10.1159/000533376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/26/2023] [Indexed: 10/31/2023] Open
Abstract
We present 2 cases of cancer of unknown origin in which RNA-based cancer classification testing provided vital insight and directed treatment management. The tissue of origin could not be determined in both of these patients utilizing morphology and immunohistochemical analysis of the tissue samples. Next-generation sequencing and tumor-of-origin testing using an RNA-based molecular cancer classifier were performed to elucidate the possible tissue of origin. A 61-year-old male with a history of localized basal cell carcinoma presented with a 4.4-cm axillary lymph node in addition to upper extremity edema and supraclavicular lymphadenopathy. RNA-based tumor origin testing revealed skin basal or squamous cell carcinoma as the likely tissue of origin, with a probability of 97%. He received vismodegib, a hedgehog inhibitor, after progression on cemiplimab and experienced a partial response by RECIST criteria, which is currently ongoing for over a year. A 74-year-old female patient with a remote history of ovarian cancer for which she underwent resection and adjuvant chemotherapy presented 15 years later with abdominal pain. The diagnostic workup revealed a 2-cm pancreatic mass and enlarged peritoneal lymph nodes. RNA sequencing revealed a 99% likelihood of the tissue of origin being serous ovarian carcinoma. Subsequently, she underwent surgery and adjuvant chemotherapy and is currently in remission with letrozole maintenance. Genomic data already plays a crucial role in therapeutic decision-making for individuals with cancer. These cases highlight the complementary role of genomic data in the diagnostic workup of cancer, leading to favorable patient outcomes.
Collapse
Affiliation(s)
- Himil Mahadevia
- Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Lara Kujtan
- Hematology/Oncology, University of Missouri, Kansas City, MO, USA
| | - Marc Roth
- Hematology/Oncology, Saint Luke’s Hospital, Kansas City, MO, USA
| | - Parth Sharma
- Internal Medicine, University of Missouri, Kansas City, MO, USA
| | | | | | - Dhruv Bansal
- Hematology/Oncology, Saint Luke’s Hospital, Kansas City, MO, USA
| |
Collapse
|
11
|
Sh Ahmed O, Mahadevia H, Manochakian R, Zhao Y, Salinas M, Khoor A, LeGout J, Lou Y. A Case of Full Recovery from Prolonged Cardiac Arrest after Infusion with Paclitaxel and Pembrolizumab. Case Rep Oncol 2022; 15:1063-1073. [PMID: 36605223 PMCID: PMC9808305 DOI: 10.1159/000527205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Lung cancer is one of the most common cancers and has the highest risk of mortality in both genders. This devastating cancer is also a significant financial and emotional burden to patients and the healthcare system. Chemotherapy and immunotherapy have become the cornerstone for the treatment of lung cancer. However, treatment may come with severe and sometimes fatal side effects. In this report, we present the case of a 52-year-old Caucasian male who suffered two episodes of prolonged cardiac arrest after the infusion of paclitaxel and pembrolizumab.
Collapse
Affiliation(s)
- Omar Sh Ahmed
- Clinical Research Unit, Mayo Clinic, Jacksonville, FL, USA
| | - Himil Mahadevia
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Rami Manochakian
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Yujie Zhao
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Manisha Salinas
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Andras Khoor
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Jordan LeGout
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
12
|
Mahadevia H, Imperial RJL, Toskich B, Mody K. B-catenin mutations and the response of advanced hepatocellular carcinoma to immune checkpoint inhibitors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16124 Background: Immune checkpoint inhibitors (ICI) have emerged as a standard treatment option for advanced hepatocellular carcinoma (HCC). Unfortunately, many patients with advanced HCC develop progressive disease on ICI therapy. Furthermore, clinical predictors of response to ICI therapy in HCC are poorly understood. B-catenin mutations are among the most frequent genetic abnormalities in HCC and may provide a mechanism for immune evasion and poor response to ICI (Ruiz de Galarreta, Marina et al. “β-Catenin Activation Promotes Immune Escape and Resistance to Anti-PD-1 Therapy in Hepatocellular Carcinoma.” Cancer discovery 9,8 (2019): 1124-1141. doi:10.1158/2159-8290.CD-19-0074). Methods: We conducted a retrospective cohort study of patients with advanced HCC who were treated with ICI therapy. All patients had ctDNA tumor profiling and were assessed for B-catenin mutation status. Disease status was determined by RECISTv1.1. Median progression-free survival (PFS), 3-month PFS, 6-month PFS, and the disease control rate (DCR) on ICI therapy were compared between B-catenin mutation (BCM) and B-catenin wild-type (BCWT) groups. Results: 15 stage III/IV HCC patients were included in the study. 9 patients harbored BCMs and 6 patients were BCWT. The median PFS in patients with BCM HCC was 4.0 months versus 4.9 months in patients with BCWT HCC. At 3 months, PFS was 56% for BCM HCC compared to 67% for BCWT HCC. Furthermore, the 6-month PFS was 11% for BCM HCC and 50% for BCWT HCC. For best response, 33% of patients with BCM HCC achieved stable disease compared to 67% of patients with BCWT HCC. No patients in our cohort achieved partial or complete response. The DCR for BCM HCC was 33% and the DCR for BCWT HCC was 67%. Conclusions: In patients with advanced HCC, B-catenin mutation status may serve as a potential biomarker of response to ICI therapy. Our data suggests that patients who do not harbor these mutations, have a more durable response to ICI therapy. Further studies are needed to validate these findings.
Collapse
|