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van der Westhuizen A, Lyle M, Graves MC, Zhu X, Wong JWH, Cornall K, Ren S, Pugliese L, Levy R, Majid A, Vilain RE, Bowden NA. Repurposing Azacitidine and Carboplatin to Prime Immune Checkpoint Blockade-resistant Melanoma for Anti-PD-L1 Rechallenge. Cancer Res Commun 2022; 2:814-826. [PMID: 36923309 PMCID: PMC10010343 DOI: 10.1158/2767-9764.crc-22-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
Purpose Drug repurposing offers the opportunity for chemotherapy to be used to reestablish sensitivity to immune checkpoint blockade (ICB) therapy. Here we investigated the clinical and translational aspects of an early phase II study of azacitidine and carboplatin priming for anti-PDL1 immunotherapy (avelumab) in patients with advanced ICB-resistant melanoma. Experimental Design A total of 20 participants with ICB-resistant metastatic melanoma received 2 × 4-week cycles of azacitidine and carboplatin followed by ICB rechallenge with anti-PD-L1 avelumab. The primary objective was overall response rate after priming and ICB rechallenge. Secondary objectives were clinical benefit rate (CBR), progression-free survival (PFS), and overall survival (OS). Translational correlation analysis of HLA-A and PD-L1 expression, RNA sequencing, and reduced representation bisulfite sequencing of biopsies at baseline, after priming and after six cycles of avelmuab was performed. Results The overall response rate (ORR) determined after azacitidine and carboplatin priming was 10% (2/20) with two partial responses (PR). The ORR determined after priming followed by six cycles of avelumab (week 22) was 10%, with 2 of 20 participants achieving immune partial response (iPR). The CBR for azacitidine and carboplatin priming was 65% (13/20) and after priming followed by six cycles of avelumab CBR was 35% (n = 7/20). The median PFS was 18.0 weeks [95% confidence interval (CI): 14.87-21.13 weeks] and the median OS was 47.86 weeks (95% CI: 9.67-86.06 weeks). Translational correlation analysis confirmed HLA-A generally increased after priming with azacitidine and carboplatin, particularly if it was absent at the start of treatment. Average methylation of CpGs across the HLA-A locus was decreased after priming and T cells, in particular CD8+, showed the greatest increase in infiltration. Conclusions Priming with azacitidine and carboplatin can induce disease stabilization and resensitization to ICB for metastatic melanoma. Significance There are limited treatments for melanoma once resistance to ICB occurs. Chemotherapy induces immune-related responses and may be repurposed to reinstate the response to ICB. This study provides the first evidence that chemotherapy can provide clinical benefit and increase OS for ICB-resistant melanoma.
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Affiliation(s)
- Andre van der Westhuizen
- Hunter Medical Research Institute and School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
- Corresponding Authors: Nikola A. Bowden, Hunter Medical Research Institute, University of Newcastle, c/o – University Dr, Callaghan NSW 2308, Australia. Phone: 612-4042-0277; E-mail: ; and Andre van der Westhuizen,
| | - Megan Lyle
- Liz Plummer Cancer Centre, Cairns Hospital, Cairns, Queensland, Australia
| | - Moira C. Graves
- Hunter Medical Research Institute and School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Xiaoqiang Zhu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, P.R. China
| | - Jason W. H. Wong
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, P.R. China
| | - Kerrie Cornall
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Shu Ren
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Leanna Pugliese
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Richard Levy
- Department of Surgery, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Adeeb Majid
- Department of Surgery, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Ricardo E. Vilain
- Hunter Medical Research Institute and School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Department of Anatomical Pathology, Pathology North, NSW Health Pathology, Newcastle, NSW, Australia
| | - Nikola A. Bowden
- Hunter Medical Research Institute and School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Corresponding Authors: Nikola A. Bowden, Hunter Medical Research Institute, University of Newcastle, c/o – University Dr, Callaghan NSW 2308, Australia. Phone: 612-4042-0277; E-mail: ; and Andre van der Westhuizen,
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