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Ou L, Liu S, Wang H, Guo Y, Guan L, Shen L, Luo R, Elder DE, Huang AC, Karakousis G, Miura J, Mitchell T, Schuchter L, Amaravadi R, Flowers A, Mou H, Yi F, Guo W, Ko J, Chen Q, Tian B, Herlyn M, Xu X. Patient-derived melanoma organoid models facilitate the assessment of immunotherapies. EBioMedicine 2023; 92:104614. [PMID: 37229906 PMCID: PMC10277922 DOI: 10.1016/j.ebiom.2023.104614] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Only a minority of melanoma patients experience durable responses to immunotherapies due to inter- and intra-tumoral heterogeneity in melanoma. As a result, there is a pressing need for suitable preclinical models to investigate resistance mechanisms and enhance treatment efficacy. METHODS Here, we report two different methods for generating melanoma patient-derived organoids (MPDOs), one is embedded in collagen gel, and the other is inlaid in Matrigel. MPDOs in Matrigel are used for assessing the therapeutic effects of anti-PD-1 antibodies (αPD-1), autochthonous tumor infiltrating lymphocytes (TILs), and small molecule compounds. MPDOs in collagen gel are used for evaluating the chemotaxis and migratory capacity of TILs. FINDING The MPDOs in collagen gel and Matrigel have similar morphology and immune cell composition to their parental melanoma tissues. MPDOs show inter- and intra-tumoral heterogeneity and contain diverse immune cells such as CD4+, CD8+ T, Treg, CD14+ monocytic, CD15+, and CD11b+ myeloid cells. The tumor microenvironment (TME) in MPDOs is highly immunosuppressive, and the lymphoid and myeloid lineages express similar levels of PD-1, PD-L1, and CTLA-4 as their parental melanoma tissues. Anti-PD-1 antibodies (αPD-1) reinvigorate CD8+ T cells and induce melanoma cell death in the MPDOs. TILs expanded by IL-2 and αPD-1 show significantly lower expression of TIM-3, better migratory capacity and infiltration of autochthonous MPDOs, and more effective killing of melanoma cells than TILs expanded by IL-2 alone or IL-2 with αCD3. A small molecule screen discovers that Navitoclax increases the cytotoxicity of TIL therapy. INTERPRETATION MPDOs may be used to test immune checkpoint inhibitors and cellular and targeted therapies. FUNDING This work was supported by the NIH grants CA114046, CA261608, CA258113, and the Tara Miller Melanoma Foundation.
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Affiliation(s)
- Lingling Ou
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Shujing Liu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Huaishan Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yeye Guo
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lei Guan
- Department of Biology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Longbin Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Ruhui Luo
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - David E Elder
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Alexander C Huang
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Miura
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tara Mitchell
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lynn Schuchter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ravi Amaravadi
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ahron Flowers
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Haiwei Mou
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Fan Yi
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Wei Guo
- Department of Biology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jina Ko
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qing Chen
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Bin Tian
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Ou L, Wang H, Huang H, Zhou Z, Lin Q, Guo Y, Mitchell T, Huang AC, Karakousis G, Schuchter L, Amaravadi R, Guo W, Salvino J, Herlyn M, Xu X. Preclinical platforms to study therapeutic efficacy of human γδ T cells. Clin Transl Med 2022; 12:e814. [PMID: 35731974 PMCID: PMC9217106 DOI: 10.1002/ctm2.814] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gamma delta (γδ) T lymphocytes are promising candidate for adoptive T cell therapy, however, their treatment efficacy is not satisfactory. Vδ2 T cells are unique to primates and few suitable models are available to assay their anti-tumour function. METHODS We tested human γδ T cell activation, tumour infiltration, and tumour-killing in four three-dimensional (3D) models, including unicellular, bicellular and multicellular melanoma spheroids, and patient-derived melanoma organoids. We studied the effects of checkpoint inhibitors on γδ T cells and performed a small molecule screen using these platforms. RESULTS γδ T cells rapidly responded to melanoma cells and infiltrated melanoma spheroids better than αβ T cells in PBMCs. Cancer-associated fibroblasts (CAFs) in bicellular spheroids, stroma cells in multicellular melanoma spheroids and inhibitory immune cells in organoids significantly inhibited immune cell infiltrates including γδ T cells and lessened their cytotoxicity to tumour cells. Tumour-infiltrating γδ T cells showed exhausted immunophenotypes with high checkpoints expression (CTLA-4, PD-1 and PD-L1). Immune checkpoint inhibitors increased γδ T cell infiltration of 3D models and killing of melanoma cells in all four 3D models. Our small molecule screen assay and subsequent mechanistic studies demonstrated that epigenetic modifiers enhanced the chemotaxis and cytotoxicity of γδ T cells through upregulating MICA/B, inhibiting HDAC6/7 pathway and downregulating the levels of PD-L1 and PD-L2 in CAFs and tumour cells. These compounds increased CXCR4 and CD107a expression, IFN-γ production and decreased PD-1 expression of γδ T cells. CONCLUSIONS Tumour-infiltrating γδ T cells show exhausted immunophenotypes and limited anti-tumour capacity in melanoma 3D models. Checkpoint inhibitors and epigenetic modifiers enhance anti-tumour functions of γδ T cells. These four 3D models provided valuable preclinical platforms to test γδ T cell functions for immunotherapy.
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Affiliation(s)
- Lingling Ou
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Stomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Huaishan Wang
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hui Huang
- The First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Zhiyan Zhou
- The First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Qiang Lin
- The First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yeye Guo
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tara Mitchell
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alexander C. Huang
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Giorgos Karakousis
- Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lynn Schuchter
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ravi Amaravadi
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Wei Guo
- Department of BiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joseph Salvino
- Molecular and Cellular Oncogenesis ProgramThe Wistar InstitutePhiladelphiaPennsylvaniaUSA
| | - Meenhard Herlyn
- Molecular and Cellular Oncogenesis ProgramThe Wistar InstitutePhiladelphiaPennsylvaniaUSA
| | - Xiaowei Xu
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Coutifaris P, Wang K, Apostolidis S, Painter M, Flowers A, Goel R, Mathew D, Pattekar A, Amaravadi R, Mitchell T, Bates P, Hensley S, Karakousis G, Schuchter L, Greenplate A, Wherry EJ, Huang AC. Abstract IA07: Impact of immunotherapy on COVID-19 immunity: Insights from checkpoint blockade in cancer. Cancer Immunol Res 2022. [DOI: 10.1158/2326-6074.tumimm21-ia07] [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: 11/16/2022]
Abstract
Abstract
Over the last few years, we have gained insights into how immunotherapy, including checkpoint blockade, modulates key CD4 and CD8 T cell subsets in anti-tumor immunity. This information can now give us insights into how immunotherapy can impact immunity in the setting of COVID-19. Indeed, we recently demonstrated that cancer patients with T cell depletion have high COVID-19 mortality despite adequate B cell and antibody production, highlighting the importance of cellular immunity. Conversely, in the setting of B cell depletion by anti-CD20 therapy, CD8 T cells can compensate for impaired humoral immunity. PD-1 blockade increases the activation and proliferation of CD4 T follicular-helper cells, which plays a key role in promoting B cell responses and quality antibody production. Thus, it is possible that PD-1 blockade enhances the efficacy of SARS-CoV-2 vaccination. However, PD-1 blockade in melanoma patients was actually associated with at 2-fold decrease in SARS-CoV-2 specific antibodies and neutralizing antibodies, compared to a healthy donor cohort. PD-1 blockade was also associated with depletion of memory CD4 T cells, suggesting there may be consequences to prolonged PD-1 blockade.
Citation Format: Paulina Coutifaris, Kevin Wang, Sokratis Apostolidis, Mark Painter, Ahron Flowers, Rishi Goel, Divij Mathew, Ajinkya Pattekar, Ravi Amaravadi, Tara Mitchell, Paul Bates, Scott Hensley, Giorgos Karakousis, Lynn Schuchter, Allie Greenplate, E. John Wherry, Alexander C. Huang. Impact of immunotherapy on COVID-19 immunity: Insights from checkpoint blockade in cancer [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr IA07.
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Affiliation(s)
| | - Kevin Wang
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Rishi Goel
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Paul Bates
- 1University of Pennsylvania, Philadelphia, PA
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Weiss S, Sznol M, Shaheen M, Berciano-Guerrero MÁ, Felip E, Rodríguez-Abreu D, Arance AM, Boni V, Linette G, Schuchter L, Gonzalez-Cao M, Iannotti N, Ganti AK, Hauke R, Berrocal A, Filbert E, Kluger H. 389 Phase II of CD40 agonistic antibody sotigalimab (APX005M) in combination with nivolumab in subjects with metastatic melanoma with confirmed disease progression on anti-PD-1 therapy. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundA significant number of melanoma patients treated with anti-PD-1 alone or in combination with anti-CTLA-4 have transient or no response to treatment. Sotigalimab is a CD40 agonist antibody with unique epitope specificity and Fc receptor binding profile for optimal therapeutic application. Preclinical studies suggest that sotigalimab can be combined with PD-1 blockade to trigger effective anti-tumor immunity. We conducted a multi-center, open label, Phase Ib-parallel arm phase II trial (NCT03123783) to evaluate the combination of sotigalimab with nivolumab in subjects with anti-PD-1/PD-L1 refractory metastatic melanoma.MethodsThe study objective was to evaluate the efficacy and safety of sotigalimab in combination with nivolumab in anti-PD-1/PD-L1 refractory advanced melanoma patients. Subjects received sotigalimab (0.3mg/kg) combined with nivolumab (360mg) every 3 weeks. Thirty-eight subjects with unresectable or metastatic melanoma who had confirmed progressive disease during treatment with anti-PD-1 therapy (documented by 2 consecutive tumor assessments) were enrolled (evaluable for safety) and 33 subjects were evaluable for efficacy.ResultsSix subjects had PR (including one unconfirmed PR) for an ORR of 18%. The mDOR was 18.7 months. Two subjects with PR received treatment for >2 years. Three of the six responding subjects remain off all therapy for ≥26 months, and one patient required stereotactic radiosurgery to a single brain lesion ten months after stopping therapy and has not required additional local or systemic therapy since. Three additional subjects had prolonged SD (12.6, 7.6, 6.2 months). The DCR was 48% and 33% of subjects experienced reduction in target lesions. Efficacy was observed in patients regardless of their tumor PD-L1 expression. The overall safety profile of the combination is consistent with the profiles of individual agents. The majority of AEs observed were of mild to moderate intensity (CTCAE Grade ≤2). The most commonly observed AEs were: pyrexia, chills, nausea, fatigue, pruritus, transaminitis, headache, asthenia, myalgia, rash, vomiting and arthralgia. There were no Grade 4 or 5 AEs related to study drugs. There were no treatment discontinuations due to AEs.ConclusionsThe combination of sotigalimab and nivolumab demonstrated treatment benefit (tumor response or prolonged disease control) in anti-PD-1/PD-L1 refractory melanoma patients with an overall favorable safety and tolerability profile. Notably, a subset of patients remain in response off treatment for ≥26 months. These results warrant further study of this combination in advanced, refractory melanoma.AcknowledgementsWe extend our gratitude to the patients and their families who made this trial possible and the clinical study teams involved in this trial. We thank BMS for providing the nivolumab for this study.Trial RegistrationNCT03123783Ethics ApprovalThis study was approved by the Institutional Review Boards at Yale University (#20170300), University of Nebraska Medical Center (#543-18-CB) and The Hospital Regional de Málaga (#19.03.1341E1-GHM).
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Vellanki PJ, DeBoy EA, Bawadkji MM, Schuchter L, Rooper L, Mehra R, Kang H, Armanios M. Ovarian Failure Preceding Head and Neck Squamous Cell Carcinoma Identifies an Adult-Onset Cancer-Prone Syndrome Caused by FANCM Mutations. JCO Precis Oncol 2021; 5:PO.21.00110. [PMID: 34568721 DOI: 10.1200/po.21.00110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/30/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paz J Vellanki
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Current affiliation: Food and Drug Administration, Silver Spring, MD
| | - Emily A DeBoy
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Malek Bawadkji
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Current affiliation: Union Memorial Hospital, Baltimore, MD
| | - Lynn Schuchter
- Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lisa Rooper
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ranee Mehra
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.,Current affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Hyunseok Kang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.,Current affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Mary Armanios
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Ou L, Wang H, Liu Q, Zhang J, Lu H, Luo L, Shi C, Lin S, Dong L, Guo Y, Huang L, Zhu J, Yin X, Huang AC, Karakousis G, Schuchter L, Amaravadi R, Zheng C, Fan Y, Guo W, Xu X. Dichotomous and stable gamma delta T-cell number and function in healthy individuals. J Immunother Cancer 2021; 9:jitc-2020-002274. [PMID: 34011536 PMCID: PMC8137237 DOI: 10.1136/jitc-2020-002274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Gamma-delta (γδ) T lymphocytes are primed to potently respond to pathogens and transformed cells by recognizing a broad range of antigens. However, adoptive immunotherapy with γδT cells has exhibited mixed treatment responses. Better understanding of γδT cell biology and stratifying healthy donors for allogeneic adoptive therapy is clinically needed to fully realize the therapeutic potential of γδT cells. METHODS We examine 98 blood samples from healthy donors and measure their expansion capacity after zoledronate stimulation, and test the migration and cytotoxic effector function of expanded γδT cells in 2D culture, 3D tumor spheroid and patient-derived melanoma organoid assays. RESULTS We find that γδT cell expansion capacity is independent of expansion methods, gender, age and HLA type. Basal γδT cell levels in Peripheral blood mononuclear cell (PBMC) correlate well with their expansion, migration and cytotoxic effector capacity in vitro. Circulating γδT cells with lower expression of PD-1, CTLA-4, Eomes, T-bet and CD69, or higher IFN-γ production expand better. γδT cells with central memory and effector memory phenotypes are significantly more abundant in good expanders. A cut-off level of 0.82% γδT cells in PBMC stratifies good versus poor γδT cell expansion with a sensitivity of 97.78%, specificity of 90.48% and area under the curve of 0.968 in a healthy individual. Donors with higher Vδ2 Index Score in PBMC have greater anti-tumor functions including migratory function and cytotoxicity. CONCLUSIONS Our results demonstrate that the interindividual γδT cell functions correlate with their circulating levels in healthy donors. Examination of circulating γδT cell level may be used to select healthy donors to participate in γδT-based immunotherapies.
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Affiliation(s)
- Lingling Ou
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Stomatology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Huaishan Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qin Liu
- Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Jie Zhang
- Department of Computer Science, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Hezhe Lu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Liangping Luo
- Department of Stomatology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Changzheng Shi
- Department of Stomatology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Shaoqiang Lin
- Integrated Traditional and Western Medicine Research Center of The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Liyun Dong
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yeye Guo
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lili Huang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinjin Zhu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiangfan Yin
- Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Alexander C Huang
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynn Schuchter
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Amaravadi
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cathy Zheng
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi Fan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Guo
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang LL, Patel G, Chiesa-Fuxench ZC, McGettigan S, Schuchter L, Mitchell TC, Ming ME, Chu EY. Timing of Onset of Adverse Cutaneous Reactions Associated With Programmed Cell Death Protein 1 Inhibitor Therapy. JAMA Dermatol 2019; 154:1057-1061. [PMID: 30027278 DOI: 10.1001/jamadermatol.2018.1912] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance An increasing number of cutaneous adverse reactions resulting from use of programmed cell death protein 1 (PD-1) inhibitors have been described, but with relatively little focus to date on the timing of these reactions. Objective To determine the timing of cutaneous drug reactions after initiation of PD-1 inhibitor therapy. Design, Setting, and Participants This retrospective observational study included patients referred to an academic dermatology clinic by an oncologist from January 1, 2014, through February 28, 2018, with at least 1 skin biopsy specimen of a skin reaction associated with PD-1 inhibitor use. Participants were included if they had a biopsy-proven cutaneous reaction in response to a PD-1 inhibitor used alone or in combination with ipilimumab. Exposures All patients included in this study received pembrolizumab, nivolumab, or nivolumab with ipilimumab as immunotherapy for cancer. Main Outcomes and Measures The main outcome measure was time to onset of biopsy-proven cutaneous reactions that occurred during or after use of pembrolizumab or nivolumab. Results A total of 17 patients (12 men, 5 women; mean [SD] age, 68.6 [11.1] years) were identified who presented with cutaneous adverse reactions associated with PD-1 inhibitor therapy; these reactions included lichenoid dermatitis, bullous pemphigoid, erythema multiforme, eczema, lupus, and sarcoidosis. Twelve patients presented with reactions at least 3 months after beginning pembrolizumab or nivolumab therapy. The skin reactions presented a median (range) of 4.2 months (0.5-38.0 months) after drug initiation. In 5 cases, the cutaneous adverse reactions attributed to the PD-1 inhibitor therapy developed after the drug therapy was terminated. Conclusions and Relevance Diverse cutaneous adverse reactions secondary to PD-1 inhibitor use may present with delayed onsets and even after discontinuation of therapy. Dermatologists should be aware of the potential for delayed presentations of cutaneous adverse reactions.
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Affiliation(s)
- Leo L Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Zelma C Chiesa-Fuxench
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Suzanne McGettigan
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lynn Schuchter
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Tara C Mitchell
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Kluger H, Weiss SA, Olszanski AJ, Schuchter L, Linette GP, Garland L, Iannotti NO, Johnson M, Avsar E, Srivastava MK, Trifan OC, Edelman MJ. Abstract CT089: Phase Ib/II of CD40 agonistic antibody APX005M in combination with nivolumab (nivo) in subjects with metastatic melanoma (M) or non-small cell lung cancer (NSCLC). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite recent success with checkpoint inhibitors, the majority of patients with M or NSCLC have a transient response or no response to checkpoint blockade. Preclinical data suggest that activation of CD40 can be combined with PD-1 blockade to trigger effective T cell immunity. We are conducting a multi-center, open label Phase Ib/II clinical trial to evaluate the combination of APX005M with nivo in subjects with M or NSCLC. We report safety and efficacy from the completed Phase Ib portion of the study and the 1st stage of the Phase II M cohort.
Methods: Phase Ib followed a 3+3 design and enrolled adult subjects with M and disease progression (PD) while receiving anti-PD-1 therapy (anti-CTLA-4 more than 3 months prior to study entry was allowed) and subjects with immunotherapy naïve NSCLC, in 3 dose levels of APX005M (0.03, 0.1 and 0.3 mg/kg) combined with a fixed dose of nivo (360mg) every 3 weeks. Primary objectives in Phase Ib were to evaluate safety and determine the Phase II dose (P2D) of APX005M. Phase II is enrolling subjects with M or NSCLC in two parallel Phase II cohorts, each following a Simon 2-stage design. Primary objective in Phase II is to evaluate the tumor response in each cohort. Phase Ib analyses were performed on dose limiting toxicity (DLT)-evaluable subjects. Phase II analyses were performed on all treated subjects.
Results: Phase Ib: No DLTs were observed in the 9 subjects enrolled in Phase Ib and the P2D for APX005M is 0.3 mg/kg. Four subjects experienced Grade 3 AEs considered related to study drugs (non-DLTs, including transaminitis, hyperbilirubinemia, anemia, pneumonitis, 1 subject each) with no grade 4 AEs reported. Of the 5 subjects with M, 1 had a confirmed PR, 2 had prolonged SD (>8 months) and 2 had PD as best overall response. Of the 4 subjects with NSCLC, 1 had a robust confirmed PR, 2 had SD (on study lesion biopsies histology negative) and 1 had PD as best overall response. Phase II: The 1st stage of the M cohort enrolled 10 additional subjects. One subject experienced a Grade 3 AE considered related to study drugs with no grade 4 AEs reported. Of these 10 subjects, 2 had confirmed PR, 2 had SD, and 6 had PD as best overall response. The overall toxicity profile of the combination is consistent with the profiles of individual agents. NanoString analysis of paired tumor biopsies revealed high tumor-infiltrating lymphocytes, and increased expression of IFNγ inducible cytokines (CXCL9 and CXCL10) while on treatment. Increased tumor T cell infiltration was further confirmed by immunohistochemistry.
Conclusions: APX005M + nivo demonstrated a good safety profile and promising antitumor activity in M subjects with PD while receiving anti-PD-1 therapy and potential activity in NSCLC. The study is currently enrolling subjects in the 2nd stage of the Phase II M cohort and the 1st stage of the Phase II NSCLC cohort. Clinical trial information: NCT03123783.
Citation Format: Harriet Kluger, Sarah A. Weiss, Anthony J. Olszanski, Lynn Schuchter, Gerald P. Linette, Linda Garland, Nicholas O. Iannotti, Melissa Johnson, Emin Avsar, Minu K. Srivastava, Ovid C. Trifan, Martin J. Edelman. Phase Ib/II of CD40 agonistic antibody APX005M in combination with nivolumab (nivo) in subjects with metastatic melanoma (M) or non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT089.
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Affiliation(s)
| | | | | | | | | | - Linda Garland
- 4The University of Arizona Cancer Center, Tucson, AZ
| | | | | | - Emin Avsar
- 7Bristol Meyers Squibb, Princeton Pike, NJ
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Garman B, Anastopoulos IN, Krepler C, Brafford P, Sproesser K, Jiang Y, Wubbenhorst B, Amaravadi R, Bennett J, Beqiri M, Elder D, Flaherty KT, Frederick DT, Gangadhar TC, Guarino M, Hoon D, Karakousis G, Liu Q, Mitra N, Petrelli NJ, Schuchter L, Shannan B, Shields CL, Wargo J, Wenz B, Wilson MA, Xiao M, Xu W, Xu X, Yin X, Zhang NR, Davies MA, Herlyn M, Nathanson KL. Genetic and Genomic Characterization of 462 Melanoma Patient-Derived Xenografts, Tumor Biopsies, and Cell Lines. Cell Rep 2018; 21:1936-1952. [PMID: 29141224 DOI: 10.1016/j.celrep.2017.10.052] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/17/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022] Open
Abstract
Tumor-sequencing studies have revealed the widespread genetic diversity of melanoma. Sequencing of 108 genes previously implicated in melanomagenesis was performed on 462 patient-derived xenografts (PDXs), cell lines, and tumors to identify mutational and copy number aberrations. Samples came from 371 unique individuals: 263 were naive to treatment, and 108 were previously treated with targeted therapy (34), immunotherapy (54), or both (20). Models of all previously reported major melanoma subtypes (BRAF, NRAS, NF1, KIT, and WT/WT/WT) were identified. Multiple minor melanoma subtypes were also recapitulated, including melanomas with multiple activating mutations in the MAPK-signaling pathway and chromatin-remodeling gene mutations. These well-characterized melanoma PDXs and cell lines can be used not only as reagents for a large array of biological studies but also as pre-clinical models to facilitate drug development.
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Affiliation(s)
- Bradley Garman
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ioannis N Anastopoulos
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Clemens Krepler
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Patricia Brafford
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Katrin Sproesser
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Yuchao Jiang
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Bradley Wubbenhorst
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ravi Amaravadi
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Bennett
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE, USA
| | - Marilda Beqiri
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - David Elder
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Keith T Flaherty
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Dennie T Frederick
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Tara C Gangadhar
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Guarino
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE, USA
| | - David Hoon
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Giorgos Karakousis
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Qin Liu
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas J Petrelli
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE, USA
| | - Lynn Schuchter
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Batool Shannan
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Wargo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brandon Wenz
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A Wilson
- Perlmutter Cancer Center, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Min Xiao
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Wei Xu
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xaiowei Xu
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xiangfan Yin
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Nancy R Zhang
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Meenhard Herlyn
- The Wistar Institute, Molecular and Cellular Oncogenesis Program, Tumor Microenvironment and Metastasis Program, and Melanoma Research Center, Philadelphia, PA, USA
| | - Katherine L Nathanson
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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10
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Long GV, Eroglu Z, Infante J, Patel S, Daud A, Johnson DB, Gonzalez R, Kefford R, Hamid O, Schuchter L, Cebon J, Sharfman W, McWilliams R, Sznol M, Redhu S, Gasal E, Mookerjee B, Weber J, Flaherty KT. Long-Term Outcomes in Patients With BRAF V600-Mutant Metastatic Melanoma Who Received Dabrafenib Combined With Trametinib. J Clin Oncol 2018; 36:667-673. [PMID: 28991513 PMCID: PMC10466457 DOI: 10.1200/jco.2017.74.1025] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report 5-year landmark analysis efficacy and safety outcomes in patients with BRAF V600-mutant metastatic melanoma (MM) who received BRAF inhibitor dabrafenib (D) and MEK inhibitor trametinib (T) combination therapy versus D monotherapy in the randomized phase II BRF113220 study part C. Patients and Methods BRAF inhibitor-naive patients with BRAF V600-mutant MM were randomly assigned 1:1:1 to receive D 150 mg twice a day, D 150 mg twice a day plus T 1 mg once daily, or D 150 mg twice a day plus T 2 mg once daily (D + T 150/2). Patients who received D monotherapy could cross over to D + T 150/2 postprogression. Efficacy and safety were analyzed 4 and 5 years after initiation in patients with ≥ 5 years of follow-up. Results As of October 13, 2016, 18 patients who received D + T 150/2 remained in the study (13 [24%] of 54 enrolled at this dose plus five [11%] of 45 initially administered D who crossed over to D + T). With D + T 150/2, overall survival (OS; 4 years, 30%; 5 years, 28%) and progression-free survival (4 and 5 years, both 13%) appeared to stabilize with extended follow-up. Increased OS was observed in patients who received D + T with baseline normal lactate dehydrogenase (5 years, 45%) and normal lactate dehydrogenase with fewer than three organ sites with metastasis (5 years, 51%). With extended follow-up, one additional patient who received D + T 150/2 improved from a partial to a complete response. No new safety signals were observed. Conclusion This 5-year analysis represents the longest follow-up to date with BRAF + MEK inhibitor combination therapy in BRAF V600-mutant MM. Consistent with trends observed in landmark analyses with shorter follow-up, this therapy elicits durable plateaus of long-term OS and progression-free survival that last ≥ 5 years in some patients with MM.
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Affiliation(s)
- Georgina V. Long
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Zeynep Eroglu
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Jeffrey Infante
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Sapna Patel
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Adil Daud
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Douglas B. Johnson
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Rene Gonzalez
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Richard Kefford
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Omid Hamid
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Lynn Schuchter
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Jonathan Cebon
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - William Sharfman
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Robert McWilliams
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Mario Sznol
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Suman Redhu
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Eduard Gasal
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Bijoyesh Mookerjee
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Jeffrey Weber
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Keith T. Flaherty
- Georgina V. Long, University of Sydney, and Royal North Shore Hospital; Richard Kefford, Macquarie University, Sydney, and Westmead Hospital, Westmead, New South Wales; Jonathan Cebon, Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia; Zeynep Eroglu, Moffitt Cancer Center, Tampa, FL; Jeffrey Infante, Tennessee Oncology; Douglas B. Johnson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Sapna Patel, The University of Texas MD Anderson Cancer Center, Houston, TX; Adil Daud, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, University of Colorado, Denver, CO; Lynn Schuchter, University of Pennsylvania, Philadelphia, PA; William Sharfman, Sidney Kimmel Cancer Center, Baltimore, MD; Robert McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University, New Haven, CT; Suman Redhu, Eduard Gasal, and Bijoyesh Mookerjee, Novartis, East Hanover, NJ; Jeffrey Weber, New York University Langone Medical Center, New York, NY; and Keith T. Flaherty, Dana-Farber/Harvard Cancer Center, Boston, MA
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11
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Somasundaram R, Zhang G, Fukunaga-Kalabis M, Perego M, Krepler C, Xu X, Wagner C, Hristova D, Zhang J, Tian T, Wei Z, Liu Q, Garg K, Griss J, Hards R, Maurer M, Hafner C, Mayerhöfer M, Karanikas G, Jalili A, Bauer-Pohl V, Weihsengruber F, Rappersberger K, Koller J, Lang R, Hudgens C, Chen G, Tetzlaff M, Wu L, Frederick DT, Scolyer RA, Long GV, Damle M, Ellingsworth C, Grinman L, Choi H, Gavin BJ, Dunagin M, Raj A, Scholler N, Gross L, Beqiri M, Bennett K, Watson I, Schaider H, Davies MA, Wargo J, Czerniecki BJ, Schuchter L, Herlyn D, Flaherty K, Herlyn M, Wagner SN. Tumor-associated B-cells induce tumor heterogeneity and therapy resistance. Nat Commun 2017; 8:607. [PMID: 28928360 PMCID: PMC5605714 DOI: 10.1038/s41467-017-00452-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/30/2017] [Indexed: 01/19/2023] Open
Abstract
In melanoma, therapies with inhibitors to oncogenic BRAFV600E are highly effective but responses are often short-lived due to the emergence of drug-resistant tumor subpopulations. We describe here a mechanism of acquired drug resistance through the tumor microenvironment, which is mediated by human tumor-associated B cells. Human melanoma cells constitutively produce the growth factor FGF-2, which activates tumor-infiltrating B cells to produce the growth factor IGF-1. B-cell-derived IGF-1 is critical for resistance of melanomas to BRAF and MEK inhibitors due to emergence of heterogeneous subpopulations and activation of FGFR-3. Consistently, resistance of melanomas to BRAF and/or MEK inhibitors is associated with increased CD20 and IGF-1 transcript levels in tumors and IGF-1 expression in tumor-associated B cells. Furthermore, first clinical data from a pilot trial in therapy-resistant metastatic melanoma patients show anti-tumor activity through B-cell depletion by anti-CD20 antibody. Our findings establish a mechanism of acquired therapy resistance through tumor-associated B cells with important clinical implications.Resistance to BRAFV600E inhibitors often occurs in melanoma patients. Here, the authors describe a potential mechanism of acquired drug resistance mediated by tumor-associated B cells-derived IGF-1.
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Affiliation(s)
| | - Gao Zhang
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | | | | | - Xiaowei Xu
- Department of Pathology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Christine Wagner
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | | | - Jie Zhang
- New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Tian Tian
- New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Zhi Wei
- New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Kanika Garg
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | - Johannes Griss
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | - Rufus Hards
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Margarita Maurer
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | - Christine Hafner
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, St. Pölten, A-3100, Austria
| | - Marius Mayerhöfer
- Department of Radiology, Division of Nuclear Medicine, Medical University of Vienna, Vienna, A-1090, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, A-1090, Austria
| | - Ahmad Jalili
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | - Verena Bauer-Pohl
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria
| | - Felix Weihsengruber
- Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of the Medical University Vienna, Vienna, A-1030, Austria
| | - Klemens Rappersberger
- Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of the Medical University Vienna, Vienna, A-1030, Austria
| | - Josef Koller
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, A-5020, Austria
| | - Roland Lang
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, A-5020, Austria
| | - Courtney Hudgens
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77040, USA
| | - Guo Chen
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77040, USA
| | - Michael Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77040, USA
| | - Lawrence Wu
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | - Richard A Scolyer
- Melanoma Institute of Australia, and The University of Sydney, Sydney, 2065, Australia
| | - Georgina V Long
- Melanoma Institute of Australia, and The University of Sydney, Sydney, 2065, Australia
| | | | | | - Leon Grinman
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Harry Choi
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | - Margaret Dunagin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Arjun Raj
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nathalie Scholler
- Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, PA, 19104, USA
- SRI International, Menlo Park, CA, 94025, USA
| | - Laura Gross
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | - Keiryn Bennett
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, A-1090, Austria
| | - Ian Watson
- Department of Biochemistry, McGill University, Montreal, QC, Canada, H3A0G4
| | - Helmut Schaider
- Dermatology Research Center, University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, 4102, Australia
| | - Michael A Davies
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77040, USA
| | - Jennifer Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer, Center, Houston, TX, 77040, USA
| | - Brian J Czerniecki
- Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, PA, 19104, USA
- Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Lynn Schuchter
- Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | - Keith Flaherty
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02115, USA
| | | | - Stephan N Wagner
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, A-1090, Austria.
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12
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Tchou J, Zhang PJ, Levine BL, Zhao Y, Matro J, DeMichele A, Amy C, Schuchter L, Plesa G, Vonderheide RH, June C. Abstract P6-10-08: Preliminary results of a first in human Phase 1 clinical trial to demonstrate safety and feasibility of chimeric antigen receptor T (CART) cells directed against c-Met in the treatment of breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-10-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- J Tchou
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - PJ Zhang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - BL Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Y Zhao
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J Matro
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A DeMichele
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - C Amy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - L Schuchter
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - G Plesa
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - RH Vonderheide
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - C June
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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13
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Krepler C, Sproesser K, Beqiri M, Xiao M, Brafford P, Xu W, Garman B, Wargo J, Davies MA, Frederick DT, Flaherty KT, Hoon D, Bennett JJ, Guarino M, Petrelli NJ, Elder D, Xu X, Karakousis G, NATHANSON KATHERINEL, Schuchter L, Herlyn M. Abstract A01: A comprehensive collection of patient derived xenografts of human melanoma with clinical, genomic, and biological characterization. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.pdx16-a01] [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: 11/16/2022]
Abstract
Abstract
Advanced melanoma has seen dramatic changes in standard of care in the last years and many novel targeted small molecules and immune checkpoint inhibitors are in development. More than 200 clinical trials are currently ongoing for metastatic melanoma. Thus, accurate pre-clinical models to predict clinical responses are urgently needed. We have established a large bank of live tumor tissue (n=500) with more than 300 models expanded as PDX. Melanoma tumor tissue is uniquely suited to establish patient-derived xenograft (PDX) models, since only one tumor cell can initiate tumor growth. Thus, our success rate is at 90% using NSG mice and matrigel for s.c. implantation of minced tissue chunks. We have opted for such a large number of models due to the genomic and clinical heterogeneity of melanoma based on available TCGA data. Although almost half of all melanomas harbor BRAF V600 hotspot mutations, followed in frequency by NRAS and NF1 mutations, many driver mutations are only found in a small subset and many mutations are occurring concurrently in various confirmations. We used a custom targeted capture of 108 genes previously implicated in melanoma, and performed massively parallel sequencing on currently 200 PDX. Samples were then clustered into groups based on deleterious mutations which were detected in all but a very small subset of samples. The biological relevance of these multiple genomic subsets was then tested against latency, growth rate, and spontaneous metastasis in PDX. Further, clinical information such as age, gender, history, and response to therapies provided additional parameters to classify this collection into meaningful subgroups. In conclusion, this collection of melanoma PDX recapitulates the breadth of advanced melanoma in the clinic and therefore a comprehensive resource for precision medicine testing in an increasingly scattered therapy landscape.
Citation Format: Clemens Krepler, Katrin Sproesser, Marilda Beqiri, Min Xiao, Patricia Brafford, Wei Xu, Bradley Garman, Jennifer Wargo, Michael A. Davies, Dennie T. Frederick, Keith T. Flaherty, David Hoon, Joseph J. Bennett, Michael Guarino, Nicholas J. Petrelli, David Elder, Xiaowei Xu, Giorgos Karakousis, KATHERINE L. NATHANSON, Lynn Schuchter, Meenhard Herlyn. A comprehensive collection of patient derived xenografts of human melanoma with clinical, genomic, and biological characterization. [abstract]. In: Proceedings of the AACR Special Conference: Patient-Derived Cancer Models: Present and Future Applications from Basic Science to the Clinic; Feb 11-14, 2016; New Orleans, LA. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(16_Suppl):Abstract nr A01.
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Affiliation(s)
| | | | | | - Min Xiao
- 1The Wistar Institute, Philadelphia, PA,
| | | | - Wei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA,
| | - Bradley Garman
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA,
| | | | | | | | | | - David Hoon
- 5John Wayne Cancer Institute, Santa Monica, CA,
| | | | | | | | - David Elder
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA,
| | - Xiaowei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA,
| | | | | | - Lynn Schuchter
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA,
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14
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Merlino G, Herlyn M, Fisher DE, Bastian BC, Flaherty KT, Davies MA, Wargo JA, Curiel-Lewandrowski C, Weber MJ, Leachman SA, Soengas MS, McMahon M, Harbour JW, Swetter SM, Aplin AE, Atkins MB, Bosenberg MW, Dummer R, Gershenwald JE, Halpern AC, Herlyn D, Karakousis GC, Kirkwood JM, Krauthammer M, Lo RS, Long GV, McArthur G, Ribas A, Schuchter L, Sosman JA, Smalley KS, Steeg P, Thomas NE, Tsao H, Tueting T, Weeraratna A, Xu G, Lomax R, Martin A, Silverstein S, Turnham T, Ronai ZA. The state of melanoma: challenges and opportunities. Pigment Cell Melanoma Res 2016; 29:404-16. [PMID: 27087480 DOI: 10.1111/pcmr.12475] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The Melanoma Research Foundation (MRF) has charted a comprehensive assessment of the current state of melanoma research and care. Intensive discussions among members of the MRF Scientific Advisory Council and Breakthrough Consortium, a group that included clinicians and scientists, focused on four thematic areas - diagnosis/early detection, prevention, tumor cell dormancy (including metastasis), and therapy (response and resistance). These discussions extended over the course of 2015 and culminated at the Society of Melanoma Research 2015 International Congress in November. Each of the four groups has outlined their thoughts as per the current status, challenges, and opportunities in the four respective areas. The current state and immediate and long-term needs of the melanoma field, from basic research to clinical management, are presented in the following report.
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Affiliation(s)
- Glenn Merlino
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Meenhard Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - David E Fisher
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Boris C Bastian
- Departments of Dermatology and Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Keith T Flaherty
- Developmental Therapeutics, Cancer Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Michael A Davies
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer A Wargo
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Michael J Weber
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sancy A Leachman
- Department of Dermatology, Knight Cancer Institute Melanoma and Skin Cancer Program, Oregon Health Science University, Portland, OR, USA
| | - Maria S Soengas
- Molecular Oncology Program, Melanoma Laboratory, CNIO, Madrid, Spain
| | - Martin McMahon
- Department of Dermatology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - J William Harbour
- Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute/VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael B Atkins
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Marcus W Bosenberg
- Department of Dermatology and Dermatopathology, Cancer Center, Yale University, New Haven, CT, USA
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zürich, Switzerland
| | - Jeffrey E Gershenwald
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allan C Halpern
- Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dorothee Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | | | - John M Kirkwood
- Melanoma and Skin Cancer Program, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Roger S Lo
- Department of Medical Oncology and Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgina V Long
- Melanoma Institute, University of Sydney, Sydney, NSW, Australia
| | - Grant McArthur
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - Antoni Ribas
- Department of Medical Oncology and Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lynn Schuchter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey A Sosman
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical School, Nashville, TN, USA
| | - Keiran S Smalley
- Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Patricia Steeg
- Women Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nancy E Thomas
- Melanoma Program, Department of Dermatology, Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Hensin Tsao
- Melanoma and Pigmented Lesion Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Thomas Tueting
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Ashani Weeraratna
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - George Xu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Randy Lomax
- Melanoma Research Foundation, Washington, DC, USA
| | | | | | - Tim Turnham
- Melanoma Research Foundation, Washington, DC, USA
| | - Ze'ev A Ronai
- Tumor Initiation and Maintenance Program, Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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15
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Budina-Kolomets A, Webster MR, Leu JIJ, Jennis M, Krepler C, Guerrini A, Kossenkov AV, Xu W, Karakousis G, Schuchter L, Amaravadi RK, Wu H, Yin X, Liu Q, Lu Y, Mills GB, Xu X, George DL, Weeraratna AT, Murphy ME. HSP70 Inhibition Limits FAK-Dependent Invasion and Enhances the Response to Melanoma Treatment with BRAF Inhibitors. Cancer Res 2016; 76:2720-30. [PMID: 26984758 DOI: 10.1158/0008-5472.can-15-2137] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/28/2016] [Indexed: 01/12/2023]
Abstract
The stress-inducible chaperone protein HSP70 (HSPA1) is implicated in melanoma development, and HSP70 inhibitors exert tumor-specific cytotoxic activity in cancer. In this study, we documented that a significant proportion of melanoma tumors express high levels of HSP70, particularly at advanced stages, and that phospho-FAK (PTK2) and BRAF are HSP70 client proteins. Treatment of melanoma cells with HSP70 inhibitors decreased levels of phospho-FAK along with impaired migration, invasion, and metastasis in vitro and in vivo Moreover, the HSP70 inhibitor PET-16 reduced levels of mutant BRAF, synergized with the BRAF inhibitor PLX4032 in vitro, and enhanced the durability of response to BRAF inhibition in vivo Collectively, these findings provide strong support for HSP70 inhibition as a therapeutic strategy in melanoma, especially as an adjuvant approach for overcoming the resistance to BRAF inhibitors frequently observed in melanoma patients. Cancer Res; 76(9); 2720-30. ©2016 AACR.
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Affiliation(s)
- Anna Budina-Kolomets
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Marie R Webster
- Program in Tumor Microenvironment and Metastasis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Julia I-Ju Leu
- Department of Genetics, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Jennis
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Clemens Krepler
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Anastasia Guerrini
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Andrew V Kossenkov
- Center for Systems and Computational Biology, The Wistar Institute, Philadelphia, Pennsylvania
| | - Wei Xu
- Department of Medicine, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos Karakousis
- Department of Surgery, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn Schuchter
- Department of Medicine, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ravi K Amaravadi
- Department of Medicine, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hong Wu
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Xiangfan Yin
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Qin Liu
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Yiling Lu
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gordon B Mills
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, and Abramson Cancer Center, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna L George
- Department of Genetics, The Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashani T Weeraratna
- Program in Tumor Microenvironment and Metastasis, The Wistar Institute, Philadelphia, Pennsylvania
| | - Maureen E Murphy
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, Pennsylvania.
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16
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Victor CTS, Rech A, Benci J, Maity A, Rengan R, Pauken K, Stelekati E, Xu B, Dada H, Odorizzi P, Herati R, Amaravadi R, Schuchter L, Ishwaran H, Mick R, Pryma D, Xu X, Feldman M, Gangadhar T, Hahn S, Wherry J, Vonderheide R, Minn A. Abstract PR05: Mechanisms of tumor response and resistance to radiation and dual checkpoint blockade in mice and patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.fbcr15-pr05] [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: 11/16/2022]
Abstract
Abstract
Immune checkpoint inhibitors result in impressive clinical responses but optimal results will require combination with each other and other therapies. This raises fundamental questions about mechanisms of non-redundancy and resistance. Here, we report major tumor regressions in a subset of patients with metastatic melanoma treated with an anti-CTLA4 antibody (anti-CTLA4) and radiation (RT) on a phase one clinical trial and reproduced this effect in mouse models. Although combined treatment improved responses in irradiated and unirradiated tumors, resistance was common. Computational analysis of genome-wide and immune profiles of mice revealed resistance was due to T cell exhaustion driven by adaptive resistance and prolonged interferon-gamma exposure, resulting in STAT1-mediated upregulation of PD-L1 on melanoma cells and tumor macrophages. Accordingly, optimal response in melanoma and other cancer types requires RT, anti-CTLA4, and anti-PD-L1/PD-1. Anti-CTLA4 predominantly inhibits T regulatory cells, and macrophage depletion and/or PD-L1 blockade reverses T cell exhaustion. RT promotes the infiltration of intratumoral antigen-specific CD8 T cells and enhances the diversity of the T cell receptor (TCR) repertoire. RT with dual checkpoint blockade shapes the TCR repertoire of the expanded peripheral clones in a manner consistent with antigen-driven selection. Similar to results from mice, patients on our clinical trial with tumors showing high PD-L1 did not respond to RT + anti-CTLA4, demonstrated persistent T cell exhaustion, and rapidly progressed. In contrast, patients with low PD-L1 on melanoma cells or macrophages had markedly improved survival, with the best survival observed among those patients with low PD-L1 on both cell types. Thus, our results suggest that 1) RT can enhance response to anti-CTLA4 when the TCR and/or antigen repertoire are sub-optimal, 2) upregulation of PD-L1 through STAT1-mediated adaptive resistance mechanisms inhibits response to anti-CTLA4-based therapy unless PD-L1/PD-1 is blocked, and 3) the combination of RT, anti-CTLA4, and anti-PD-L1 promotes response and immunity through distinct mechanisms. Finally, although PD-L1 was a dominant resistance mechanism in our models, PD-L1-independent resistance mechanisms were also evident. The next generation of clinical trials based on these findings are underway.
Citation Format: Christina Twyman-Saint Victor, Andrew Rech, Joseph Benci, Amit Maity, Ramesh Rengan, Kristen Pauken, Erietta Stelekati, Bihui Xu, Hannah Dada, Pamela Odorizzi, Ramin Herati, Ravi Amaravadi, Lynn Schuchter, Hemant Ishwaran, Rosemarie Mick, Daniel Pryma, Xiaowei Xu, Michael Feldman, Tara Gangadhar, Steve Hahn, John Wherry, Robert Vonderheide, Andy Minn. Mechanisms of tumor response and resistance to radiation and dual checkpoint blockade in mice and patients. [abstract]. In: Proceedings of the Fourth AACR International Conference on Frontiers in Basic Cancer Research; 2015 Oct 23-26; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2016;76(3 Suppl):Abstract nr PR05.
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Affiliation(s)
| | - Andrew Rech
- 1University of Pennsylvania, Philadelphia, PA,
| | | | - Amit Maity
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | | | - Bihui Xu
- 1University of Pennsylvania, Philadelphia, PA,
| | - Hannah Dada
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | | | | | | | | | | | - Xiaowei Xu
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | - Steve Hahn
- 4The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Wherry
- 1University of Pennsylvania, Philadelphia, PA,
| | | | - Andy Minn
- 1University of Pennsylvania, Philadelphia, PA,
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Long GV, Weber JS, Infante JR, Kim KB, Daud A, Gonzalez R, Sosman JA, Hamid O, Schuchter L, Cebon J, Kefford RF, Lawrence D, Kudchadkar R, Burris HA, Falchook GS, Algazi A, Lewis K, Puzanov I, Ibrahim N, Sun P, Cunningham E, Kline AS, Del Buono H, McDowell DO, Patel K, Flaherty KT. Overall Survival and Durable Responses in Patients With BRAF V600-Mutant Metastatic Melanoma Receiving Dabrafenib Combined With Trametinib. J Clin Oncol 2016; 34:871-8. [PMID: 26811525 DOI: 10.1200/jco.2015.62.9345] [Citation(s) in RCA: 224] [Impact Index Per Article: 28.0] [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
PURPOSE To report the overall survival (OS) and clinical characteristics of BRAF inhibitor-naive long-term responders and survivors treated with dabrafenib plus trametinib in a phase I and II study of patients with BRAF V600 mutation-positive metastatic melanoma. METHODS BRAF inhibitor-naive patients treated with dabrafenib 150 mg twice daily plus trametinib 2 mg daily (the 150/2 group) from the non-randomly assigned (part B) and randomly assigned (part C) cohorts of the study were analyzed for progression-free and OS separately. Baseline characteristics and factors on treatment were analyzed for associations with durable responses and OS. RESULTS For BRAF inhibitor-naive patients in the 150/2 groups (n = 78), the progression-free survival at 1, 2, and 3 years was 44%, 22%, and 18%, respectively, for part B (n = 24) and 41%, 25%, and 21%, respectively, for part C (n = 54). Median OS was 27.4 months in part B and 25 months in part C. OS at 1, 2, and 3 years was 72%, 60%, and 47%, respectively, for part B and 80%, 51%, and 38%, respectively, for part C. Prolonged survival was associated with metastases in fewer than three organ sites and lower baseline lactate dehydrogenase. OS at 3 years was 62% in patients with normal baseline lactate dehydrogenase and 63% in patients with a complete response. CONCLUSION Dabrafenib plus trametinib results in a median OS of more than 2 years in BRAF inhibitor-naive patients with BRAF V600 mutation-positive metastatic melanoma, and approximately 20% were progression free at 3 years. Durable responses occurred in patients with good prognostic features at baseline, which may be predictive.
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Affiliation(s)
- Georgina V Long
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA.
| | - Jeffrey S Weber
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jeffrey R Infante
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Kevin B Kim
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Adil Daud
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Rene Gonzalez
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jeffrey A Sosman
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Omid Hamid
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Lynn Schuchter
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jonathan Cebon
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Richard F Kefford
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Donald Lawrence
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ragini Kudchadkar
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Howard A Burris
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Gerald S Falchook
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Alain Algazi
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Karl Lewis
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Igor Puzanov
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nageatte Ibrahim
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Peng Sun
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Elizabeth Cunningham
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Amy S Kline
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Heather Del Buono
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Diane Opatt McDowell
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Kiran Patel
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Keith T Flaherty
- Georgina V. Long, Melanoma Institute Australia; The University of Sydney; Richard F. Kefford, Melanoma Institute Australia; The University of Sydney; Macquarie University, Sydney; Westmead Hospital, Westmead; Jonathan Cebon, Austin Health, Melbourne, Victoria, Australia; Jeffrey S. Weber and Ragini Kudchadkar, Moffitt Cancer Center, Tampa, FL; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute/Tennessee Oncology; Kevin B. Kim, California Pacific Medical Center; Adil Daud, Alain Algazi, University of California, San Francisco, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Rene Gonzalez, Karl Lewis, University of Colorado; Gerald S. Falchook, Sarah Cannon Research Institute at HealthONE, Denver, CO; Jeffrey A. Sosman, Igor Puzanov, Vanderbilt University Medical Center, Nashville, TN; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Elizabeth Cunningham, Merck; Peng Sun, Amy S. Kline, Heather Del Buono, Diane Opatt McDowell, GlaxoSmithKline, Philadelphia, PA; Donald Lawrence and Kiran Patel, Incyte Corporation, Wilmington, DE; and Keith T. Flaherty, Massachusetts General Hospital Cancer Center, Boston, MA
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Shah NN, Casella E, Capozzi D, McGettigan S, Gangadhar TC, Schuchter L, Myers JS. Improving the Safety of Oral Chemotherapy at an Academic Medical Center. J Oncol Pract 2016; 12:e71-6. [PMID: 26733627 DOI: 10.1200/jop.2015.007260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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
PURPOSE Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. METHODS A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. RESULTS Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). CONCLUSION OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders.
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Affiliation(s)
- Nirav N Shah
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Casella
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Donna Capozzi
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Suzanne McGettigan
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Tara C Gangadhar
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lynn Schuchter
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer S Myers
- Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Huang A, Xu W, Harmon S, Quagliarello F, Herati R, Pauken K, Bengsch B, Schuchter L, Amaravadi R, McGettigan S, Gangadhar T, Wherry J. Abstract A036: Anti-PD1 therapy and CD8 T cell invigoration in metastatic melanoma. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6074.cricimteatiaacr15-a036] [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: 11/16/2022]
Abstract
Abstract
Antibodies targeting the PD-1 pathway can reverse T cell exhaustion resulting in re-invigoration of immune responses. Anti-PD1 therapies such as pembrolizumab have been shown to be efficacious across a broad range of human cancers including melanoma with clinical responses correlating with immune changes in the tumor microenvironment. However, our understanding of the immune mechanism of anti-PD1 therapy in humans remains incomplete. Specifically, there is relatively little information about changes in the differentiation, activation and reversal of exhaustion in peripheral blood CD8 T cells and correlation with clinical outcome. We collected peripheral blood at serial time points before and after pembrolizumab therapy on 39 consecutive patients with Stage IV melanoma and analyzed changes in T cell subsets and differentiation using 16 parameter flow cytometry. Here we show that pembrolizumab treatment results in increases in the peripheral blood CD8/Treg ratio, as well as invigoration of CD8 T cells. Focusing on key CD8 T cell subsets expressing combinations of T-bet, Eomes, PD-1 and other inhibitory receptors has allowed greater focus on populations responding to re-invigoration by pembrolizumab treatment. This invigoration can be demonstrated by upregulation of granzyme B (GzmB) and Ki67 in key CD8 T cell subsets. An early increase in GzmB+Ki67+ cells translates into a later increase in GzmB+ cells suggesting an early wave of proliferation giving rise to a pool of re-invigorated CD8 T cells. T cell subsets that express markers of exhaustion including T-bet, Eomes, and inhibitory receptors may represent populations that are invigorated by anti-PD1 therapy. These changes may also correlate with clinical outcomes and therefore may be useful as a biomarker of response. These results show that T cell responses to pembrolizumab treatment can be tracked in an easily accessible peripheral blood compartment during therapy. The kinetics of immune response in key CD8 T cell subsets may inform us of optimal treatment duration as well as the nature and timing of cancer response to therapy.
Citation Format: Alexander Huang, Wei Xu, Shannon Harmon, Felix Quagliarello, Ramin Herati, Kristen Pauken, Bertram Bengsch, Lynn Schuchter, Ravi Amaravadi, Suzanne McGettigan, Tara Gangadhar, John Wherry. Anti-PD1 therapy and CD8 T cell invigoration in metastatic melanoma. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A036.
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Affiliation(s)
| | - Wei Xu
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | - John Wherry
- University of Pennsylvania, Philadelphia, PA
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20
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Chowdhury IH, Ojerholm E, McMillan MT, Miller D, Kolker JD, Kurtz G, Dorsey JF, Nagda SN, Geiger GA, Brem S, O'Rourke DM, Zager EL, Gangadhar T, Schuchter L, Lee JYK, Alonso-Basanta M. Novel risk scores for survival and intracranial failure in patients treated with radiosurgery alone to melanoma brain metastases. Radiat Oncol 2015; 10:248. [PMID: 26626714 PMCID: PMC4666036 DOI: 10.1186/s13014-015-0553-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) alone is an increasingly common treatment strategy for brain metastases. However, existing prognostic tools for overall survival (OS) were developed using cohorts of patients treated predominantly with approaches other than SRS alone. Therefore, we devised novel risk scores for OS and distant brain failure (DF) for melanoma brain metastases (MBM) treated with SRS alone. Methods and materials We retrospectively reviewed 86 patients treated with SRS alone for MBM from 2009-2014. OS and DF were estimated using the Kaplan-Meier method. Cox proportional hazards modeling identified clinical risk factors. Risk scores were created based on weighted regression coefficients. OS scores range from 0-10 (0 representing best OS), and DF risk scores range from 0-5 (0 representing lowest risk of DF). Predictive power was evaluated using c-index statistics. Bootstrapping with 200 resamples tested model stability. Results The median OS was 8.1 months from SRS, and 54 (70.1 %) patients had DF at a median of 3.3 months. Risk scores for OS were predicated on performance status, extracranial disease (ED) status, number of lesions, and gender. Median OS for the low-risk group (0-3 points) was not reached. For the moderate-risk (4-6 points) and high-risk (6.5-10) groups, median OS was 7.6 months and 2.4 months, respectively (p < .0001). Scores for DF were predicated on performance status, ED status, and number of lesions. Median time to DF for the low-risk group (0 points) was not reached. For the moderate-risk (1-2 points) and high-risk (3-5 points) groups, time to DF was 4.8 and 2.0 months, respectively (p < .0001). The novel scores were more predictive (c-index = 0.72) than melanoma-specific graded prognostic assessment or RTOG recursive partitioning analysis tools (c-index = 0.66 and 0.57, respectively). Conclusions We devised novel risk scores for MBM treated with SRS alone. These scores have implications for prognosis and treatment strategy selection (SRS versus whole-brain radiotherapy).
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Affiliation(s)
- Imran H Chowdhury
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Matthew T McMillan
- Department of Surgery, University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, 19104, PA, USA.
| | - Denise Miller
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA.
| | - James D Kolker
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Goldie Kurtz
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Jay F Dorsey
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Suneel N Nagda
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Geoffrey A Geiger
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
| | - Steven Brem
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA.
| | - Donald M O'Rourke
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA.
| | - Eric L Zager
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA.
| | - Tara Gangadhar
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104, PA, USA.
| | - Lynn Schuchter
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104, PA, USA.
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA.
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA.
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Xu MJ, Dorsey JF, Amaravadi R, Karakousis G, Simone CB, Xu X, Xu W, Carpenter EL, Schuchter L, Kao GD. Circulating Tumor Cells, DNA, and mRNA: Potential for Clinical Utility in Patients With Melanoma. Oncologist 2015; 21:84-94. [PMID: 26614709 DOI: 10.1634/theoncologist.2015-0207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED : Circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and messenger RNA (mRNA), collectively termed circulating tumor products (CTPs), represent areas of immense interest from scientists' and clinicians' perspectives. In melanoma, CTP analysis may have clinical utility in many areas, from screening and diagnosis to clinical decision-making aids, as surveillance biomarkers or sources of real-time genetic or molecular characterization. In addition, CTP analysis can be useful in the discovery of new biomarkers, patterns of treatment resistance, and mechanisms of metastasis development. Here, we compare and contrast CTCs, ctDNA, and mRNA, review the extent of translational evidence to date, and discuss how future studies involving both scientists and clinicians can help to further develop this tool for the benefit of melanoma patients. IMPLICATIONS FOR PRACTICE Scientific advancement has enabled the rapid development of tools to analyze circulating tumor cells, tumor DNA, and messenger RNA, collectively termed circulating tumor products (CTPs). A variety of techniques have emerged to detect and characterize melanoma CTPs; however, only a fraction has been applied to human subjects. This review summarizes the available human data that investigate clinical utility of CTP in cancer screening, melanoma diagnosis, prognosis, prediction, and genetic or molecular characterization. It provides a rationale for how CTPs may be useful for future research and discusses how clinicians can be involved in developing this exciting new technology.
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Affiliation(s)
- Melody J Xu
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jay F Dorsey
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Amaravadi
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos Karakousis
- Division of Surgical Oncology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaowei Xu
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Xu
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica L Carpenter
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynn Schuchter
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary D Kao
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rech AJ, Twyman C, Maity A, Rengan R, Pauken KE, Stelekati E, Xu B, Dada H, Odorizzi PM, Herati RD, Mansfield KD, Patsch D, Amaravadi R, Schuchter L, Ishwaran H, Mick R, Pryma D, Xu G, Feldman M, Gangadhar TC, Hahn S, Wherry EJ, Minn AJ, Vonderheide RH. Abstract A52: Radiation and dual PD-L1 and CTLA4 checkpoint blockade non-redundantly improves tumor resistance, response, and immunity. Cancer Immunol Res 2015. [DOI: 10.1158/2326-6074.tumimm14-a52] [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: 11/16/2022]
Abstract
Abstract
Background: Immune checkpoint inhibitors such as CTLA4 and PD-1 result in impressive clinical responses, but optimal results will require combination therapy. This raises fundamental questions about non-redundancy and mechanisms of resistance. Emerging data indicate that combining immune checkpoint inhibitors with radiation (RT) may hold promise. We therefore evaluated this combination for metastatic melanoma using parallel studies in mice and humans.
Methods: In a phase I clinical trial with 19 patients with multiple melanoma metastases, a single index lesion was irradiated with hypofractionated RT, delivered over two or three fractions, followed by four cycles of the anti-CTLA4 antibody ipilimumab. We reproduced this therapy in mice using the melanoma cell line B16-F10. For this, each flank of C57BL/6 mice was implanted with tumors to model multiple metastases. Mice received anti-CTLA4 (on days 5, 8, and 11), irradiation of one tumor using an image-guided micro-irradiator (20 Gy x 1 on day 8), or both treatments. Mechanistic studies were performed on material obtained from patients and mice at baseline and thereafter.
Results: Overall, treatment in the phase I study was well tolerated and toxicity was similar to that reported for anti-CTLA4. Major tumor regressions were observed in a subset of patients with metastatic melanoma treated with anti-CTLA4 + RT. In mice, although combined treatment enhanced the CD8 T cell to Treg ratios and improved responses in irradiated and unirradiated tumors, resistance was common. Genome-wide and unbiased analyses revealed that resistant tumors have increased PD-L1, interferon-stimulated genes, and exhausted T cells that depress the CD8/Treg ratio. Patients and mice with high PD-L1 tumors that were treated with RT + anti-CTLA4 poorly reinvigorated exhausted T cells, did not respond, and rapidly progressed. In mice, adding anti-PD-L1/PD-1 to RT + anti-CTLA4 reinvigorated exhausted T cells, leading to complete responses and immunity across multiple cancer types. The extent of T cell exhaustion/reinvigoration predicts response and can be assessed through peripheral blood.
Conclusions: Resistance to RT + anti-CTLA4 results from depression in the CD8/Treg ratio due to elevated tumor PD-L1 and persistent T cell exhaustion. Both clinical and pre-clinical data suggest that the combination of RT, anti-CTLA4, and anti-PDL1 is a rational and non-redundant approach to improving resistance, response, and immunity to melanoma and other cancer types.
Citation Format: Andrew J. Rech, Christina Twyman, Amit Maity, Ramesh Rengan, Kristen E. Pauken, Erietta Stelekati, Bihui Xu, Hannah Dada, Pamela M. Odorizzi, Ramin D. Herati, Kathleen D. Mansfield, Dana Patsch, Ravi Amaravadi, Lynn Schuchter, Hemant Ishwaran, Rosemarie Mick, Daniel Pryma, George Xu, Michael Feldman, Tara C. Gangadhar, Stephen Hahn, E. John Wherry, Andy J. Minn, Robert H. Vonderheide. Radiation and dual PD-L1 and CTLA4 checkpoint blockade non-redundantly improves tumor resistance, response, and immunity. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr A52.
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Affiliation(s)
| | | | - Amit Maity
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | | | - Bihui Xu
- 1University of Pennsylvania, Philadelphia, PA,
| | - Hannah Dada
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | | | - Dana Patsch
- 1University of Pennsylvania, Philadelphia, PA,
| | | | | | | | | | | | - George Xu
- 1University of Pennsylvania, Philadelphia, PA,
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Krepler C, Xiao M, Sproesser K, Brafford P, Shannan B, Beqiri M, Xu W, Garman B, Nathanson KL, Xu X, Karakousis G, Mills GB, Lu Y, Caponigro G, Boehm M, Peters M, Schuchter L, Herlyn M. Abstract 2842: Personalized pre-clinical trials in BRAF inhibitor resistant patient derived xenograft models of melanoma identify c-Met as an effective second line combination therapy target. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2842] [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: 11/16/2022]
Abstract
Abstract
Melanoma has seen a remarkable improvement in the treatment of advanced disease. However, the majority of patients still relapse with the emergence of resistant disease. This is especially true for BRAF inhibitors, were multiple mechanisms of resistance have been uncovered. However, the lack of dependable models to develop approaches to overcome resistance, poses a real challenge for clinical decisions on second line therapies. In addition, combination therapies necessary to achieve long term responses increase the number of possibilities to be assessed. In this study, we developed patient derived xenograft (PDX) models from BRAF inhibitor resistant patients and, after characterization, tested rational second line combination therapies in co-clinical trials.Fresh tumor tissue from 12 patients after progression on vemurafenib or dabrafenib was implanted into immune deficient NSG mice. Once the tumor grafts were established, mice were continually dosed with PLX4720 to approximate clinical plasma levels to preserve the resistant phenotype. Xenografts were then characterized for genomic alterations and pathway activation status using a targeted sequencing array and a reverse phase protein array, respectively. We found at least 2 and up to 9 known deleterious alterations in all samples, many of which have been described as conferring resistance. The protein array clustered into two major groups: MAPK pathway activated and PI3K pathway activated, again consistent with previous reports. Integrating these data allowed us to design rational combination therapies for in vivo testing. We treated a PDX model with MET amplification and high phospho c-Met with the BRAF inhibitor LGX818 20mg/kg QD, the MEK inhibitor MEK162 3mg/kg QD, and the c-Met inhibitor INC280 25mg/kg QD (all p.o.). Although INC280 alone led to significant decrease in tumor growth, only the LGX818/ MEK162/ INC280 triple combination led to complete and sustained tumor regression in all mice. Further, we tested a second PDX model with a MET amplification (albeit broader and lower) but baseline pMET on the protein level. In this model, INC280 did not show any antitumor effect confirming the specificity for c-Met and the importance of validating genomic data.In summary, using our BRAF inhibitor resistant PDX model pipeline we were not only able to identify actionable alterations in all models, but also to test rational second line combination therapies in pre-clinical in vivo trials. Genomic data alone might not be sufficient to accurately predict therapy responses and protein arrays were a valuable tool to validate deleterious alteration calls. This study represents an important step towards improving personalized medicine in melanoma, and highlights the potential use of c-Met inhibitors in melanoma combination therapy in a defined subset of patients.
Citation Format: Clemens Krepler, Min Xiao, Katrin Sproesser, Patricia Brafford, Batool Shannan, Marilda Beqiri, Wei Xu, Bradley Garman, Katherine L. Nathanson, Xiaowei Xu, Giorgos Karakousis, Gordon B. Mills, Yiling Lu, Giordano Caponigro, Markus Boehm, Malte Peters, Lynn Schuchter, Meenhard Herlyn. Personalized pre-clinical trials in BRAF inhibitor resistant patient derived xenograft models of melanoma identify c-Met as an effective second line combination therapy target. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2842. doi:10.1158/1538-7445.AM2015-2842
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Affiliation(s)
| | - Min Xiao
- 1The Wistar Institute, Philadelphia, PA
| | | | | | | | | | - Wei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Bradley Garman
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | - Xiaowei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | - Yiling Lu
- 3University of Texas MD Anderson Cancer Center, Huston, TX
| | | | - Markus Boehm
- 4Novartis Oncology Translational Medicine, Cambridge, MA
| | - Malte Peters
- 4Novartis Oncology Translational Medicine, Cambridge, MA
| | - Lynn Schuchter
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
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Garman B, Krepler C, Sproesser K, Brafford P, Wilson M, Wubbenhorst B, Amaravadi R, Bennett J, Beqiri M, Davies M, Elder D, Flaherty K, Frederick D, Gangadhar TC, Guarino M, Hoon D, Karakousis G, Mitra N, Petrelli NJ, Schuchter L, Shannan B, Wargo J, Xiao M, Xu W, Xu X, Herlyn M, Nathanson K. Abstract 4668: Targeted, massively parallel sequencing identifies novel genetic subsets of cutaneous melanoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4668] [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: 11/16/2022]
Abstract
Abstract
Despite the prevalence of recurrent, high activating BRAF V600 mutations in 45% of tumors, cutaneous melanoma (CM) is a heterogeneous malignancy resulting from aberrant signaling in multiple pathways. It has been traditionally characterized by activation of the MAPK and PI3K signaling pathways, as well as cell cycle disruption. In recent years, whole-genome and exome sequencing studies have identified several new genes associated with melanomagenesis. However, a comprehensive understanding of concurrent, and mutually exclusive, mutations in tumors is currently lacking. Using a custom targeted capture of 108 genes previously implicated in melanoma pathogenesis, massively parallel sequencing was performed on 94 human melanoma cell lines, 67 patient-derived xenografts (PDX), and 5 cell lines made from PDX, all untreated. Samples were then clustered into groups based on deleterious mutations. 83% of samples had deleterious mutations in the MAPK signaling pathway, including 92 high activity BRAF (55%), 35 RAS codon 61 (21%), 7 with multiple mutations (e.g. low activity BRAF/RAS codons 12/13) (4%) and 10 NF1 (6%) mutated samples. Likely deleterious NF1 mutations were found in several BRAF or NRAS-mutated samples. PI3K pathway mutations were found in 10% of samples, predominantly associated with BRAF mutations. TP53 mutations were found in 24% of samples and were associated with all MAPK signaling mutations. Mutations in chromatin remodeling genes (ARID1A/1B, ARID2, TRRAP, and BAP1) were mutually exclusive with each other and primarily found in tumors with high activity BRAF or NRAS mutations. The majority of BRAF or RAS-mutated samples with a mutation in a chromatin remodeling gene lacked mutations in cell cycle, TP53, and PI3K signaling genes; however, 100% of deleterious, or likely deleterious, NF1-mutated samples with a chromatin remodeling gene mutation harbored additional mutations in cell cycle, TP53, and/or PI3K signaling genes. Of particular interest, five of the 10 NF1-mutated samples (50%) lacked BRAF, RAS, and MEK1/2 mutations but harbored likely deleterious mutations in MAP3K5 or MAP3K9, suggesting the potential involvement of the JNK signal transduction pathway in this particular cohort. Only 4% of samples did not have a deleterious mutation in any of the genes on the panel. These data reveal novel insights into the genetics of melanomas lacking a canonical BRAF V600 mutation. Functional assays are needed to confirm the biological relevance of likely deleterious mutations, which will further facilitate a more thorough classification of CM subsets.
Citation Format: Bradley Garman, Clemens Krepler, Katrin Sproesser, Patrica Brafford, Melissa Wilson, Bradley Wubbenhorst, Ravi Amaravadi, Joseph Bennett, Marilda Beqiri, Michael Davies, David Elder, Keith Flaherty, Dennie Frederick, Tara C. Gangadhar, Michael Guarino, David Hoon, Giorgos Karakousis, Nandita Mitra, Nicholas J. Petrelli, Lynn Schuchter, Batool Shannan, Jennifer Wargo, Min Xiao, Wei Xu, Xaiowei Xu, Meenhard Herlyn, Katherine Nathanson. Targeted, massively parallel sequencing identifies novel genetic subsets of cutaneous melanoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4668. doi:10.1158/1538-7445.AM2015-4668
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Affiliation(s)
- Bradley Garman
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Clemens Krepler
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | - Katrin Sproesser
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | - Patrica Brafford
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | - Melissa Wilson
- 3Perlmutter Cancer Center, NYU School of Medicine, NYU Langone Medical Center, New York, NY
| | - Bradley Wubbenhorst
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ravi Amaravadi
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | - Marilda Beqiri
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | | | - David Elder
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | - Tara C. Gangadhar
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | - David Hoon
- 8John Wayne Cancer Institute, Santa Monica, CA
| | | | - Nandita Mitra
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Lynn Schuchter
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Batool Shannan
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | | | - Min Xiao
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | - Wei Xu
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Xaiowei Xu
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Meenhard Herlyn
- 2The Wistar Institute, Melanoma Research Center, Philadelphia, PA
| | - Katherine Nathanson
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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25
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Liu S, Tetzlaff MT, Wang T, Yang R, Xie L, Zhang G, Krepler C, Xiao M, Beqiri M, Xu W, Karakousis G, Schuchter L, Amaravadi RK, Xu W, Wei Z, Herlyn M, Yao Y, Zhang L, Wang Y, Zhang L, Xu X. miR-200c/Bmi1 axis and epithelial-mesenchymal transition contribute to acquired resistance to BRAF inhibitor treatment. Pigment Cell Melanoma Res 2015; 28:431-41. [PMID: 25903073 DOI: 10.1111/pcmr.12379] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 01/05/2015] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Abstract
Resistance to BRAF inhibitors (BRAFi) is one of the major challenges for targeted therapies for BRAF-mutant melanomas. However, little is known about the role of microRNAs in conferring BRAFi resistance. Herein, we demonstrate that miR-200c expression is significantly reduced whereas miR-200c target genes including Bmi1, Zeb2, Tubb3, ABCG5, and MDR1 are significantly increased in melanomas that acquired BRAFi resistance compared to pretreatment tumor biopsies. Similar changes were observed in BRAFi-resistant melanoma cell lines. Overexpression of miR-200c or knock-down of Bmi1 in resistant melanoma cells restores their sensitivities to BRAFi, leading to deactivation of the PI3K/AKT and MAPK signaling cascades, and acquisition of epithelial-mesenchymal transition-like phenotypes, including upregulation of E-cadherin, downregulation of N-cadherin, and ABCG5 and MDR1 expression. Conversely, knock-down of miR-200c or overexpression of Bmi1 in BRAFi-sensitive melanoma cells activates the PI3K/AKT and MAPK pathways, upregulates N-cadherin, ABCG5, and MDR1 expression, and downregulates E-cadherin expression, leading to BRAFi resistance. Together, our data identify miR-200c as a critical signaling node in BRAFi-resistant melanomas impacting the MAPK and PI3K/AKT pathways, suggesting miR-200c as a potential therapeutic target for overcoming acquired BRAFi resistance.
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Affiliation(s)
- Shujing Liu
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tao Wang
- The Wistar Institute, Philadelphia, PA, USA
| | - Ruifeng Yang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lin Xie
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gao Zhang
- The Wistar Institute, Philadelphia, PA, USA
| | | | - Min Xiao
- The Wistar Institute, Philadelphia, PA, USA
| | | | - Wei Xu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Lynn Schuchter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravi K Amaravadi
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Weiting Xu
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, USA
| | - Zhi Wei
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, USA
| | | | - Yuan Yao
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Litao Zhang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Yingjie Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lin Zhang
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Menzies AM, Ashworth MT, Swann S, Kefford RF, Flaherty K, Weber J, Infante JR, Kim KB, Gonzalez R, Hamid O, Schuchter L, Cebon J, Sosman JA, Little S, Sun P, Aktan G, Ouellet D, Jin F, Long GV, Daud A. Characteristics of pyrexia in BRAFV600E/K metastatic melanoma patients treated with combined dabrafenib and trametinib in a phase I/II clinical trial. Ann Oncol 2014; 26:415-21. [PMID: 25411413 DOI: 10.1093/annonc/mdu529] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pyrexia is a frequent adverse event with combined dabrafenib and trametinib therapy (CombiDT), but little is known of its clinical associations, etiology, or appropriate management. PATIENTS AND METHODS All patients on the BRF133220 phase I/II trial of CombiDT treated at the standard dose (150/2) were included for assessment of pyrexia (n = 201). BRAF and MEK inhibitor-naïve patients (n = 117) were included for efficacy analyses. Pyrexia was defined as temperature ≥38°C (≥100.4(°)F) or related symptoms. RESULTS Fifty-nine percent of patients developed pyrexia during treatment, 24% of which had pyrexia symptoms without a recorded elevation in body temperature. Pyrexia was grade 2+ in 60% of pyrexia patients. Median time to onset of first pyrexia was 19 days, with a median duration of 9 days. Pyrexia patients had a median of two pyrexia events, but 21% had three or more events. Various pyrexia management approaches were conducted in this study. A trend was observed between dabrafenib and hydroxy-dabrafenib exposure and pyrexia. No baseline clinical characteristics predicted pyrexia, and pyrexia was not statistically significantly associated with treatment outcome. CONCLUSIONS Pyrexia is a frequent and recurrent toxicity with CombiDT treatment. No baseline features predict pyrexia, and it is not associated with clinical outcome. Dabrafenib and metabolite exposure may contribute to the etiology of pyrexia. The optimal secondary prophylaxis for pyrexia is best studied in a prospective trial.
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Affiliation(s)
- A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - M T Ashworth
- University of California San Francisco, San Francisco
| | - S Swann
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - R F Kefford
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Hospital, University of Sydney, Sydney Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - K Flaherty
- Massachusetts General Hospital Center, Boston
| | - J Weber
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa
| | - J R Infante
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville
| | - K B Kim
- California Pacific Medical Center, San Francisco
| | - R Gonzalez
- Department of Medical Oncology, The University of Colorado Cancer Center, Aurora
| | - O Hamid
- Department of Oncology, The Angeles Clinic and Research Institute, Santa Monica
| | - L Schuchter
- Penn Medicine, The University of Pennsylvania, Philadelphia, USA
| | - J Cebon
- Oncology Unit, Ludwig Institute for Cancer Research, Heidelberg, Australia
| | - J A Sosman
- Department of Oncology, Vanderbilt University Medical Centre, Nashville, USA
| | - S Little
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - P Sun
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G Aktan
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - D Ouellet
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - F Jin
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - A Daud
- University of California San Francisco, San Francisco
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Johnson DB, Flaherty KT, Weber JS, Infante JR, Kim KB, Kefford RF, Hamid O, Schuchter L, Cebon J, Sharfman WH, McWilliams RR, Sznol M, Lawrence DP, Gibney GT, Burris HA, Falchook GS, Algazi A, Lewis K, Long GV, Patel K, Ibrahim N, Sun P, Little S, Cunningham E, Sosman JA, Daud A, Gonzalez R. Combined BRAF (Dabrafenib) and MEK inhibition (Trametinib) in patients with BRAFV600-mutant melanoma experiencing progression with single-agent BRAF inhibitor. J Clin Oncol 2014; 32:3697-704. [PMID: 25287827 DOI: 10.1200/jco.2014.57.3535] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Preclinical and early clinical studies have demonstrated that initial therapy with combined BRAF and MEK inhibition is more effective in BRAF(V600)-mutant melanoma than single-agent BRAF inhibitors. This study assessed the safety and efficacy of dabrafenib and trametinib in patients who had received prior BRAF inhibitor treatment. PATIENTS AND METHODS In this open-label phase I/II study, we evaluated the pharmacology, safety, and efficacy of dabrafenib and trametinib. Here, we report patients treated with combination therapy after disease progression with BRAF inhibitor treatment administered before study enrollment (part B; n = 26) or after cross-over at progression with dabrafenib monotherapy (part C; n = 45). RESULTS In parts B and C, confirmed objective response rates (ORR) were 15% (95% CI, 4% to 35%) and 13% (95% CI, 5% to 27%), respectively; an additional 50% and 44% experienced stable disease ≥ 8 weeks, respectively. In part C, median progression-free survival (PFS) was 3.6 months (95% CI, 2 to 4), and median overall survival was 11.8 months (95% CI, 8 to 25) from cross-over. Patients who previously received dabrafenib ≥ 6 months had superior outcomes with the combination compared with those treated < 6 months; median PFS was 3.9 (95% CI, 3 to 7) versus 1.8 months (95% CI, 2 to 4; hazard ratio, 0.49; P = .02), and ORR was 26% (95% CI, 10% to 48%) versus 0% (95% CI, 0% to 15%). CONCLUSION Dabrafenib plus trametinib has modest clinical efficacy in patients with BRAF inhibitor-resistant melanoma. This regimen may be a therapeutic strategy for patients who previously benefited from BRAF inhibitor monotherapy ≥ 6 months but demonstrates minimal efficacy after rapid progression with BRAF inhibitor therapy.
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Affiliation(s)
- Douglas B Johnson
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE.
| | - Keith T Flaherty
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Jeffrey S Weber
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Jeffrey R Infante
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Kevin B Kim
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Richard F Kefford
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Omid Hamid
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Lynn Schuchter
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Jonathan Cebon
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - William H Sharfman
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Robert R McWilliams
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Mario Sznol
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Donald P Lawrence
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Geoffrey T Gibney
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Howard A Burris
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Gerald S Falchook
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Alain Algazi
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Karl Lewis
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Georgina V Long
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Kiran Patel
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Nageatte Ibrahim
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Peng Sun
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Shonda Little
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Elizabeth Cunningham
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Jeffrey A Sosman
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Adil Daud
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
| | - Rene Gonzalez
- Douglas B. Johnson and Jeffrey A. Sosman, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center; Jeffrey R. Infante and Howard A. Burris III, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Keith T. Flaherty and Donald P. Lawrence, Massachusetts General Hospital Cancer Center, Boston MA; Jeffrey S. Weber and Geoffrey T. Gibney, Moffitt Cancer Center, Tampa, FL; Kevin B. Kim and Gerald S. Falchook, University of Texas MD Anderson Cancer Center, Houston, TX; Richard F. Kefford and Georgina V. Long, Melanoma Institute Australia, University of Sydney and Westmead Hospital, Sydney, New South Wales; Jonathan Cebon, Joint Ludwig-Austin Oncology Unit, Austin Health, Melbourne, Victoria, Australia; Omid Hamid, Angeles Clinic and Research Institute, Los Angeles; Alain Algazi and Adil Daud, University of California, San Francisco, San Francisco, CA; Lynn Schuchter, University of Pennsylvania Abramson Cancer Center; Nageatte Ibrahim, Peng Sun, Shonda Little, and Elizabeth Cunningham, GlaxoSmithKline, Philadelphia, PA; William H. Sharfman, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Robert R. McWilliams, Mayo Clinic, Rochester, MN; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Karl Lewis and Rene Gonzalez, University of Colorado, Denver, CO; and Kiran Patel, Incyte, Wilmington, DE
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Krepler C, Sproesser K, Brafford P, Xiao M, Beqiri M, Xu W, Nathanson K, Wargo J, Flaherty K, Morton DL, Hoon DS, Ryan R, Guarino M, Petrelli NJ, Elder D, Xu X, Karakousis G, Schuchter L, Herlyn M. Abstract 1182: Patient derived xenograft (PDX) of human melanoma to predict clinical responses. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-1182] [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: 11/16/2022]
Abstract
Abstract
The approval of three drugs targeting the MAPK pathway has led to new standard therapies for melanoma with BRAFV600E mutations. The excitement about these therapeutic successes is somewhat dampened by the relapse of most if not all treated patients due to the development of acquired (secondary) resistance. Early clinical trial results indicate that combining BRAF and MEK inhibitors can improve survival and delay the onset of resistance. Currently, there is a lack of good translational models to study resistance pathways found in patients. We have developed a patient-derived xenograft (PDX) bank for assessing patients' responses to therapies.
Human melanoma tissues were obtained following surgery, and small pieces were implanted subcutaneously with Matrigel® into NSG mice. This technique was advantageous over injecting single tumor cells. It also allows prior dissociation and freezing for extended time periods prior to injection. The xenografts maintained a histological architecture similar to the respective patients' lesions. NSG mice injected with tumor fragments and single cells allow a high rate of tumor growth of approximately 90%, even if few malignant cells from fine needle aspirates are injected. When injecting decreasing numbers of tumor cells after removal of endothelial cells, hematopoietic cells and red blood cells (but not fibroblasts), in 5 out of 7 cases single malignant cells induced tumors. Our current tumor bank contains 125 samples linked to patients' clinical data and characterized for mutational status and spontaneous metastasis rates (25%). DNA fingerprinting was matched to normal blood DNA if available to assure identity of the samples. The samples had a similar distribution pattern of genetic abnormalities to those in patients, thus allowing their use for mutation-specific therapy strategies. As an example, a PDX from a patient with intrinsic resistance to vemurafenib was grown to compare tumor growth on a 200 ppm BRAF inhibitor (PLX4720) diet, 200 ppm PLX4720 + 7 ppm MEK inhibitor (PD0325901) combination diet, or control diet for 21 days. As in the original patient, the BRAF inhibitor alone did not inhibit tumor growth, while the combination of BRAF and MEK inhibition showed significant tumor growth inhibition demonstrating that a PDX can predict clinical outcome.
Citation Format: Clemens Krepler, Katrin Sproesser, Patricia Brafford, Min Xiao, Marilda Beqiri, Wei Xu, Katherine Nathanson, Jennifer Wargo, Keith Flaherty, Donald L. Morton, Dave S. Hoon, Randall Ryan, Michael Guarino, Nicholas J. Petrelli, David Elder, Xiawei Xu, Giorgos Karakousis, Lynn Schuchter, Meenhard Herlyn. Patient derived xenograft (PDX) of human melanoma to predict clinical responses. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1182. doi:10.1158/1538-7445.AM2014-1182
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Affiliation(s)
| | | | | | - Min Xiao
- 1The Wistar Institute, Philadelphia, PA
| | | | - Wei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | | | | | - David Elder
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Xiawei Xu
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | - Lynn Schuchter
- 2University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
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Bartlett EK, Gimotty PA, Sinnamon AJ, Wachtel H, Roses RE, Schuchter L, Xu X, Elder DE, Ming M, Elenitsas R, Guerry D, Kelz RR, Czerniecki BJ, Fraker DL, Karakousis GC. Clark level risk stratifies patients with mitogenic thin melanomas for sentinel lymph node biopsy. Ann Surg Oncol 2013; 21:643-9. [PMID: 24121883 DOI: 10.1245/s10434-013-3313-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role for sentinel lymph node biopsy (SLNB) in patients with thin melanoma (≤1 mm) remains controversial. We examined a large cohort of patients with thin melanoma to better define predictors of SLN positivity. METHODS From 1995 to 2011, 781 patients with thin primary melanoma and evaluable clinicopathologic data underwent SLNB at our institution. Predictors of SLN positivity were determined using univariate and multivariate regression analyses, and patients were risk-stratified using a classification and regression tree (CART) analysis. RESULTS In the study cohort (n = 781), 29 patients (3.7%) had nodal metastases. In the univariate analysis, mitotic rate [odds ratio (OR) = 8.11, p = 0.005], Clark level (OR 4.04, p = 0.003), and thickness (OR 3.33, p = 0.011) were significantly associated with SLN positivity. In the multivariate analysis, MR (OR 7.01) and level IV-V (OR 3.45) remained significant predictors of SLN positivity. CART analysis initially stratified lesions by mitotic rate; nonmitogenic lesions (n = 273) had a 0.7% SLN positivity rate versus 5.6% in mitogenic lesions (n = 425). Mitogenic lesions were further stratified by Clark level; patients with level II-III had a 2.9% SLN positivity rate (n = 205) versus 8.2% with level IV-V (n = 220). With median follow-up of 6.3 years, five SLN-negative patients developed nodal recurrence and four SLN-positive patients died of disease. CONCLUSIONS SLN positivity is low in patients with thin melanoma (3.7%) and exceedingly so in nonmitogenic lesions (0.7%). Appreciable rates of SLN positivity can be identified in patients with mitogenic lesions, particularly with concurrent level IV-V regardless of thickness. These factors may guide appropriate selection of patients with thin melanoma for SLNB.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA,
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Trunzer K, Pavlick AC, Schuchter L, Gonzalez R, McArthur GA, Hutson TE, Moschos SJ, Flaherty KT, Kim KB, Weber JS, Hersey P, Long GV, Lawrence D, Ott PA, Amaravadi RK, Lewis KD, Puzanov I, Lo RS, Koehler A, Kockx M, Spleiss O, Schell-Steven A, Gilbert HN, Cockey L, Bollag G, Lee RJ, Joe AK, Sosman JA, Ribas A. Pharmacodynamic effects and mechanisms of resistance to vemurafenib in patients with metastatic melanoma. J Clin Oncol 2013; 31:1767-74. [PMID: 23569304 DOI: 10.1200/jco.2012.44.7888] [Citation(s) in RCA: 299] [Impact Index Per Article: 27.2] [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
PURPOSE To assess pharmacodynamic effects and intrinsic and acquired resistance mechanisms of the BRAF inhibitor vemurafenib in BRAF(V600)-mutant melanoma, leading to an understanding of the mechanism of action of vemurafenib and ultimately to optimization of metastatic melanoma therapy. METHODS In the phase II clinical study NP22657 (BRIM-2), patients received oral doses of vemurafenib (960 mg twice per day). Serial biopsies were collected to study changes in mitogen-activated protein kinase (MAPK) signaling, cell-cycle progression, and factors causing intrinsic or acquired resistance by immunohistochemistry, DNA sequencing, or somatic mutation profiling. Results Vemurafenib inhibited MAPK signaling and cell-cycle progression. An association between the decrease in extracellular signal-related kinase (ERK) phosphorylation and objective response was observed in paired biopsies (n = 22; P = .013). Low expression of phosphatase and tensin homolog showed a modest association with lower response. Baseline mutations in MEK1(P124) coexisting with BRAF(V600) were noted in seven of 92 samples; their presence did not preclude objective tumor responses. Acquired resistance to vemurafenib associated with reactivation of MAPK signaling as observed by elevated ERK1/2 phosphorylation levels in progressive lesions and the appearance of secondary NRAS(Q61) mutations or MEK1(Q56P) or MEK1(E203K) mutations. These two activating MEK1 mutations had not previously been observed in vivo in biopsies of progressive melanoma tumors. CONCLUSION Vemurafenib inhibits tumor proliferation and oncogenic BRAF signaling through the MAPK pathway. Acquired resistance results primarily from MAPK reactivation driven by the appearance of secondary mutations in NRAS and MEK1 in subsets of patients. The data suggest that inhibition downstream of BRAF should help to overcome acquired resistance.
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Affiliation(s)
- Kerstin Trunzer
- Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN 37232-6307, USA.
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Abstract
Over-expression of the HER2/neu receptor occurs in 20 to 30 percent of breast tumors and is linked to poorer prognosis. The HER2/neu expression status determines whether or not patient will receive trastuzumab-based treatment. In clinical practice, over-expression of HER2/neu is routinely identified using Immunohistochemistry (IHC) or Fluorescence in Situ Hybridization (FISH), both of which are invasive approaches requiring tissue samples. Serum assays for the Extra Cellular Domain of HER2/neu receptor (HER2 ECD) have been reported but the use is very limited due to serum interference factors (e.g. human anti-animal immunoglobulin antibodies) that lead to false test results and inconsistency with tissue Her2 status. We have developed an ELISA based approach using an MBB buffer to eliminate false results and to obtain more accurate assessment of HER2 ECD levels. Using this refined assay we retroactively measured HER2/neu levels from breast cancer patients and controls. Abnormal HER2 ECD levels were detected in about 32% of invasive breast cancer patients but not in controls or patients with benign diseases. In addition, we also showed that patients with elevated serum HER2 levels appeared to have worse survival regardless of treatments. In a small group of 12 Ductal Carcinoma in situ (DCIS) patients who received HER2/neu peptide vaccination and surgery, only one patient showed constantly rising HER2 levels after treatment and this patient had recurrence of HER2 positive tumor within 5 years. Our studies indicate that once the serum interference issue is resolved, serum HER2 ECD can have potential clinical utility to supplement the tissue based tests.
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Affiliation(s)
- Lian Lam
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elizabeth Fitzpatrick
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Shuwen Xu
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Lynn Schuchter
- Division of Hematology-Oncology, HUP, 16 Penn Tower, Philadelphia, U.S.A
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
| | - Hongtao Zhang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
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Schayowitz A, Bertenshaw G, Jeffries E, Schatz T, Cotton J, Villanueva J, Herlyn M, Krepler C, Vultur A, Xu W, Yu GH, Schuchter L, Clark DP. Functional profiling of live melanoma samples using a novel automated platform. PLoS One 2012; 7:e52760. [PMID: 23285177 PMCID: PMC3532357 DOI: 10.1371/journal.pone.0052760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/22/2012] [Indexed: 01/07/2023] Open
Abstract
Aims This proof-of-concept study was designed to determine if functional, pharmacodynamic profiles relevant to targeted therapy could be derived from live human melanoma samples using a novel automated platform. Methods A series of 13 melanoma cell lines was briefly exposed to a BRAF inhibitor (PLX-4720) on a platform employing automated fluidics for sample processing. Levels of the phosphoprotein p-ERK in the mitogen-activated protein kinase (MAPK) pathway from treated and untreated sample aliquots were determined using a bead-based immunoassay. Comparison of these levels provided a determination of the pharmacodynamic effect of the drug on the MAPK pathway. A similar ex vivo analysis was performed on fine needle aspiration (FNA) biopsy samples from four murine xenograft models of metastatic melanoma, as well as 12 FNA samples from patients with metastatic melanoma. Results Melanoma cell lines with known sensitivity to BRAF inhibitors displayed marked suppression of the MAPK pathway in this system, while most BRAF inhibitor-resistant cell lines showed intact MAPK pathway activity despite exposure to a BRAF inhibitor (PLX-4720). FNA samples from melanoma xenografts showed comparable ex vivo MAPK activity as their respective cell lines in this system. FNA samples from patients with metastatic melanoma successfully yielded three categories of functional profiles including: MAPK pathway suppression; MAPK pathway reactivation; MAPK pathway stimulation. These profiles correlated with the anticipated MAPK activity, based on the known BRAF mutation status, as well as observed clinical responses to BRAF inhibitor therapy. Conclusion Pharmacodynamic information regarding the ex vivo effect of BRAF inhibitors on the MAPK pathway in live human melanoma samples can be reproducibly determined using a novel automated platform. Such information may be useful in preclinical and clinical drug development, as well as predicting response to targeted therapy in individual patients.
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Affiliation(s)
- Adam Schayowitz
- BioMarker Strategies, Baltimore, Maryland, United States of America
| | - Greg Bertenshaw
- BioMarker Strategies, Baltimore, Maryland, United States of America
| | - Emiko Jeffries
- BioMarker Strategies, Baltimore, Maryland, United States of America
| | - Timothy Schatz
- BioMarker Strategies, Baltimore, Maryland, United States of America
| | - James Cotton
- BioMarker Strategies, Baltimore, Maryland, United States of America
| | - Jessie Villanueva
- Melanoma Research Center, The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Meenhard Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Clemens Krepler
- Melanoma Research Center, The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Adina Vultur
- Melanoma Research Center, The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Wei Xu
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Gordon H. Yu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Lynn Schuchter
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Douglas P. Clark
- BioMarker Strategies, Baltimore, Maryland, United States of America
- * E-mail:
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Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, Hamid O, Schuchter L, Cebon J, Ibrahim N, Kudchadkar R, Burris HA, Falchook G, Algazi A, Lewis K, Long GV, Puzanov I, Lebowitz P, Singh A, Little S, Sun P, Allred A, Ouellet D, Kim KB, Patel K, Weber J. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med 2012; 367:1694-703. [PMID: 23020132 PMCID: PMC3549295 DOI: 10.1056/nejmoa1210093] [Citation(s) in RCA: 2023] [Impact Index Per Article: 168.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resistance to therapy with BRAF kinase inhibitors is associated with reactivation of the mitogen-activated protein kinase (MAPK) pathway. To address this problem, we conducted a phase 1 and 2 trial of combined treatment with dabrafenib, a selective BRAF inhibitor, and trametinib, a selective MAPK kinase (MEK) inhibitor. METHODS In this open-label study involving 247 patients with metastatic melanoma and BRAF V600 mutations, we evaluated the pharmacokinetic activity and safety of oral dabrafenib (75 or 150 mg twice daily) and trametinib (1, 1.5, or 2 mg daily) in 85 patients and then randomly assigned 162 patients to receive combination therapy with dabrafenib (150 mg) plus trametinib (1 or 2 mg) or dabrafenib monotherapy. The primary end points were the incidence of cutaneous squamous-cell carcinoma, survival free of melanoma progression, and response. Secondary end points were overall survival and pharmacokinetic activity. RESULTS Dose-limiting toxic effects were infrequently observed in patients receiving combination therapy with 150 mg of dabrafenib and 2 mg of trametinib (combination 150/2). Cutaneous squamous-cell carcinoma was seen in 7% of patients receiving combination 150/2 and in 19% receiving monotherapy (P=0.09), whereas pyrexia was more common in the combination 150/2 group than in the monotherapy group (71% vs. 26%). Median progression-free survival in the combination 150/2 group was 9.4 months, as compared with 5.8 months in the monotherapy group (hazard ratio for progression or death, 0.39; 95% confidence interval, 0.25 to 0.62; P<0.001). The rate of complete or partial response with combination 150/2 therapy was 76%, as compared with 54% with monotherapy (P=0.03). CONCLUSIONS Dabrafenib and trametinib were safely combined at full monotherapy doses. The rate of pyrexia was increased with combination therapy, whereas the rate of proliferative skin lesions was nonsignificantly reduced. Progression-free survival was significantly improved. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT01072175.).
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Long G, Sosman J, Daud A, Weber J, Flaherty K, Infante J, Hamid O, Schuchter L, Cebon J, Puzanov I, Algazi A, Kudchakar R, Lewis K, Hwu W, Kefford R, Sun P, Little S, Gonzalez R, Patel K, Kim K. Phase II Three-Arm Randomised Study of the Braf Inhibitor (BRAFI) Dabrafenib Alone vs Combination with Mek1/2 Inhibitor (MEKI) Trametinib in Pts with Braf V600 Mutation-Positive Metastatic Melanoma (MM). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34335-0] [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: 10/25/2022] Open
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Sosman JA, Kim KB, Schuchter L, Gonzalez R, Pavlick AC, Weber JS, McArthur GA, Hutson TE, Moschos SJ, Flaherty KT, Hersey P, Kefford R, Lawrence D, Puzanov I, Lewis KD, Amaravadi RK, Chmielowski B, Lawrence HJ, Shyr Y, Ye F, Li J, Nolop KB, Lee RJ, Joe AK, Ribas A. Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. N Engl J Med 2012; 366:707-14. [PMID: 22356324 PMCID: PMC3724515 DOI: 10.1056/nejmoa1112302] [Citation(s) in RCA: 1678] [Impact Index Per Article: 139.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approximately 50% of melanomas harbor activating (V600) mutations in the serine-threonine protein kinase B-RAF (BRAF). The oral BRAF inhibitor vemurafenib (PLX4032) frequently produced tumor regressions in patients with BRAF V600-mutant metastatic melanoma in a phase 1 trial and improved overall survival in a phase 3 trial. METHODS We designed a multicenter phase 2 trial of vemurafenib in patients with previously treated BRAF V600-mutant metastatic melanoma to investigate the efficacy of vemurafenib with respect to overall response rate (percentage of treated patients with a tumor response), duration of response, and overall survival. The primary end point was the overall response rate as ascertained by the independent review committee; overall survival was a secondary end point. RESULTS A total of 132 patients had a median follow-up of 12.9 months (range, 0.6 to 20.1). The confirmed overall response rate was 53% (95% confidence interval [CI], 44 to 62; 6% with a complete response and 47% with a partial response), the median duration of response was 6.7 months (95% CI, 5.6 to 8.6), and the median progression-free survival was 6.8 months (95% CI, 5.6 to 8.1). Primary progression was observed in only 14% of patients. Some patients had a response after receiving vemurafenib for more than 6 months. The median overall survival was 15.9 months (95% CI, 11.6 to 18.3). The most common adverse events were grade 1 or 2 arthralgia, rash, photosensitivity, fatigue, and alopecia. Cutaneous squamous-cell carcinomas (the majority, keratoacanthoma type) were diagnosed in 26% of patients. CONCLUSIONS Vemurafenib induces clinical responses in more than half of patients with previously treated BRAF V600-mutant metastatic melanoma. In this study with a long follow-up, the median overall survival was approximately 16 months. (Funded by Hoffmann-La Roche; ClinicalTrials.gov number, NCT00949702.).
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Xu X, Chen L, Guerry D, Dawson PR, Hwang WT, VanBelle P, Elder DE, Zhang PJ, Ming ME, Schuchter L, Gimotty PA. Lymphatic invasion is independently prognostic of metastasis in primary cutaneous melanoma. Clin Cancer Res 2011; 18:229-37. [PMID: 22096024 DOI: 10.1158/1078-0432.ccr-11-0490] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Lymphatic invasion (LI) in primary cutaneous melanomas was recently found to be common. In this study, we evaluated LI as an independent prognostic factor. EXPERIMENTAL DESIGN This study included 251 patients with vertical growth phase (VGP) primary cutaneous melanomas who had paraffin-fixed lesional tissue and were in a prospective cohort seen between 1972 and 1991, had no clinical evidence of regional nodal disease at diagnosis, and had at least ten years of follow-up. Dual immunohistochemical staining was used to detect lymphatic endothelium (podoplanin) and melanoma cells (S-100). Multivariate logistic regression for ten-year metastasis was used to define independent prognostic factors, and a prognostic tree was developed to characterize and discriminate risk groups. Kaplan-Meier disease-free survival curves for those with and without LI within current American Joint Committee on Cancer stages were compared using the log-rank statistic. RESULTS LI was observed in 43% (108 of 251) of the study melanomas. The multivariate model for ten-year metastasis identified four independent prognostic factors: tumor thickness, mitotic rate, LI, and anatomic site. The prognostic tree identified a group of patients with thin (≤1 mm thick) melanomas and poor prognosis: stage IB melanomas with LI. Survival curves for time to first metastasis showed significantly poorer prognosis for patients with LI compared with those without it for both stages IB and IIA. CONCLUSIONS LI is common across the range of tumor thicknesses in primary VGP melanomas. It is an independent prognostic factor and significantly increases the risk of metastasis in patients in clinical stages IB and IIA.
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Affiliation(s)
- Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Flaherty KT, Lathia C, Frye RF, Schuchter L, Redlinger M, Rosen M, O'Dwyer PJ. Interaction of sorafenib and cytochrome P450 isoenzymes in patients with advanced melanoma: a phase I/II pharmacokinetic interaction study. Cancer Chemother Pharmacol 2011; 68:1111-8. [PMID: 21350850 DOI: 10.1007/s00280-011-1585-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 02/03/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND In vitro data indicate that the sorafenib is a moderate inhibitor of cytochrome P450 (CYP) enzymes, including CYP3A4, CYP2C19, and CYP2D6. This phase I/II study in patients with advanced melanoma evaluated the potential effect of sorafenib on the pharmacokinetics of midazolam, omeprazole, and dextromethorphan, specific substrates of CYP3A4, CYP2C19, and CYP2D6, respectively. METHODS Twenty-one patients received sorafenib 400 mg twice daily for 28 consecutive days. On days 1 and 28, a cocktail containing midazolam 2 mg, omeprazole 20 mg, and dextromethorphan 30 mg was administered. Pharmacokinetic analyses were performed on day 1 without sorafenib and day 28 after steady-state sorafenib exposure; sorafenib pharmacokinetics were evaluated on day 28. We defined an interaction to be excluded if the 90% confidence interval of the ratio of all day 28:day 1 analyses fell within a range from 0.80 to 1.25. RESULTS In all, 18 patients were evaluable. On day 28, area under the plasma concentration-time curve from time 0 to 12 h (AUC(0-12)) and maximum plasma concentration (C(max)) for sorafenib were 38.1 mg h/l and 4.9 mg/l, respectively. Day 28:day 1 ratios for AUC from time 0 extrapolated to infinity (AUC(0-inf)) and C(max) for midazolam were 0.85 and 0.98, respectively. Day 28:day 1 ratio for 5-OH-omeprazole:omeprazole plasma concentration at 3 h postdose was 1.26, slightly outside of the 0.80-1.25 range. Thus, an interaction could not be excluded, but is considered unlikely to be clinically significant. Day 28:day 1 ratio for dextromethorphan:dextrorphan concentration in urine was 0.94. Sorafenib had an acceptable safety profile. The most frequently observed grade 3-4 toxicities in cycle 1 included elevated lipase (19%) and hypertension (10%). CONCLUSIONS In this patient population, our results demonstrate that exposures of probes of CYP3A4, CYP2D6, or CYP2C19 activity are potentially altered by administration of sorafenib at 400 mg twice daily. However, these differences are sufficiently small that a clinically significant inhibition or induction of these important drug metabolizing P450 isoenzymes is unlikely. Clinical and, where possible, drug level monitoring may still be appropriate for drugs of narrow therapeutic range co-administered with sorafenib.
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Affiliation(s)
- Keith T Flaherty
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
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Schwid SR, Bausch J, Oakes D, Schuchter L, Tanner C, Forrest M, Lang AE, Shoulson I. Cancer incidence in a trial of an antiapoptotic agent for Parkinson's disease. Mov Disord 2010; 25:1801-8. [DOI: 10.1002/mds.23006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kanetsky PA, Panossian S, Elder DE, Guerry D, Ming ME, Schuchter L, Rebbeck TR. Does MC1R genotype convey information about melanoma risk beyond risk phenotypes? Cancer 2010; 116:2416-28. [PMID: 20301115 DOI: 10.1002/cncr.24994] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A study was carried out to describe associations of MC1R variants and melanoma in a US population and to investigate whether genetic risk is modified by pigmentation characteristics and sun exposure measures. METHODS Melanoma patients (n = 960) and controls (n = 396) self-reported phenotypic characteristics and sun exposure via structured questionnaire and underwent a skin examination. Logistic regression was used to estimate associations of high- and low-risk MC1R variants and melanoma, overall and within phenotypic and sun exposure strata. A meta-analysis of results from published studies was undertaken. RESULTS Carriage of 2 low-risk or any high-risk MC1R variants was associated with increased risk of melanoma (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.0-2.8; and OR, 2.2; 95% CI, 1.5-3.0, respectively). However, risk was stronger in or limited to individuals with protective phenotypes and limited sun exposure, such as those who tanned well after repeated sun exposure (OR, 2.4; 95% CI, 1.6-3.6), had dark hair (OR, 2.4; 95% CI, 1.5-3.6), or had dark eyes (OR, 3.2; 95% CI, 1.8-5.9). We noted this same pattern of increased melanoma risk among persons who did not freckle, tanned after exposure to first strong summer sun, reported little or average recreational or occupational sun exposure, or reported no sun burning events. Meta-analysis of published literature supported these findings. CONCLUSIONS These data indicate that MC1R genotypes provide information about melanoma risk in those individuals who would not be identified as high risk based on their phenotypes or exposures alone.
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Affiliation(s)
- Peter A Kanetsky
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA.
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Yun S, Gimotty P, Hwang W, Dawson P, VanBelle P, Elder D, Elenitsas R, Guerry D, Schuchter L, Xu X. The biology and prognostic value of lymphatic vessel density (LD) and lymphatic invasion (LI) in regression in melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9017] [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
9017 Background: Regression in melanoma is characterized by increased vascularity, lymphocytic infiltrate and fibroplasia in the papillary dermis, accompanied by the absence (complete regression, CoR) or presence (partial regression, PaR) of melanoma cells in the epidermis. The prognostic value of regression is controversial. We noticed that LD and LI were increased in the areas of regression (AR) or areas with brisk lymphocytic infiltration (AB). Our goal was to clarify the prognostic value of regression in melanoma. Methods: Dual immunohistochemical staining was done using antibodies to podoplanin (lymphatic vessels) and S100 (melanoma cells) on paraffin tissues from 321 patients with vertical growth phase (VGP) primary melanomas who had 10 years or more of follow-up. LD in AR (both CoR and PaR) was compared with that of normal dermis adjacent and distant, as well as LD in the AB. LI in these areas was also scored. Unadjusted and adjusted hazard rates were obtained from univariate and multivariate Cox models for time to melanoma-specific death using established melanoma prognostic factors. Results: 116 patients (36%) had regression: 75 CoR (23%) and 41 PaR (13%). LD significantly decreased stepwise from CoR (mean ± se, 23.7 ± 2.7) to PaR (15.5 ± 1.1), adjacent normal dermis (7.3 ± 0.28) and distant normal dermis (5.4±0.31) and it was significantly elevated in the AB (18.5±0.78). Melanomas with CoR had the highest percentage of LI in both AR and AB. In addition, the percentage of LI in AB was highest for men and for those with VGP tumor infiltrating lymphocytes (TILs). Both high LD in AR and more LI in AB were associated with poor prognosis (p=0.004 and p=0.002, respectively). Six factors were significant in the final multivariate model: LI in AB (HR=2.3), LD in AR (HR=1.04), thickness (HR=1.44), axial (HR=7.7), ulceration (HR=2.5) and no VGP TILs (HR=2.8). Conclusions: AR and AB were associated with increased LD and higher incidence of LI in primary melanomas. LD and LI in AR or AB are independent prognostic factors. Our data suggest that the effects of regression on prognosis are mediated at least in part through lymphangiogenesis and LI. No significant financial relationships to disclose.
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Affiliation(s)
- S. Yun
- University of Pennsylvania, Philadelphia, PA
| | - P. Gimotty
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | - P. Dawson
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
| | | | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | | | - X. Xu
- University of Pennsylvania, Philadelphia, PA
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Gimotty P, Guerry D, VanBelle P, Montone K, Guerra M, Hwang W, Schuchter L, Xu X, Elder D. Ki67 as a prognostic biomarker for patients with vertical growth phase (VGP) melanomas. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9043] [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
9043 Background: In VGP melanomas proliferation is reflected in dermal mitotic figures (“mitogenic” VGP) and/or tumor cell nests larger than any epidermal nest. An alternative to mitotic rate (MR) to characterize cell proliferation is the expression of Ki67 protein. Since Ki67 is expressed in all phases of the cell cycle except G0, it is potentially a more robust biomarker for proliferation and prognosis than mitoses. Methods: To test the hypothesis that Ki67 would replace MR as a prognostic factor, we did a retrospective cohort study of 432 patients with Stage I/II primary VGP melanomas who had at least 10 years of follow up. Tissue sections were stained using the monoclonal antibody MIB-1 to Ki67 and the % of positive melanoma cells were evaluated by two readers. ROC curves for Ki67 and MR were computed. Predicted probabilities (PP) of 10-year melanoma-specific death were computed from 3 multivariate logistic regression models, one for each biomarker (Models 1 and 2) and one with both (Model 3), controlling for established melanoma prognostic factors (thickness, gender, anatomic site, ulceration, regression and tumor infiltrating lymphocytes), and compared. Cross-validation was used to assess differences between using Ki67 and using MR including the differences in PP, Brier scores and the misclassification rates. A decision curve analysis was done to assess the clinical net benefit of the two. Results: The areas under the ROC curve (AUCs) for Ki67 and MR, both continuous factors, were 0.69 and 0.79, respectively. In the multivariate analysis, Ki67 expression was significant in Model 1 (OR=1.03, 95% CI: 1.01–1.05), mitotic rate was not significant in Model 2 (1.05, 0.99–1.1), and only Ki67 was significant in Model 3 (1.03, 1.01–1.05). The AUCs for the three models were 0.84, 0.84, and 0.85, respectively. Based on cross-validation, there was no difference between the two biomarkers in PP, Brier scores, or misclassification rates. The decision cost analysis demonstrated the same net benefit for the two. Conclusions: A prospective study needs to be conducted to confirm that Ki67 and MR are equivalent. No significant financial relationships to disclose.
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Affiliation(s)
- P. Gimotty
- University of Pennsylvania, Philadelphia, PA
| | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - K. Montone
- University of Pennsylvania, Philadelphia, PA
| | - M. Guerra
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | | | - X. Xu
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
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Xu X, Chen L, Hwang W, Dawson P, Guerry D, VanBelle P, Elder D, Schuchter L, Gimotty P. The prognostic significance of lymphatic invasion in primary melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9050] [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
9050 Background: Lymphatic invasion (LI) is an under-observed phenomenon in primary malignancies that can be better detected by immunostaining and that may associate with prognosis. In this study we sought to test the hypothesis that LI was associated with melanoma-specific survival (MSS) and was an independent prognostic factor. Methods: This study included 277 patients with stage I/II melanomas in vertical growth phase (VGP) who had at least 10 years of follow up. The log-rank test was used to test the study hypothesis - 72 melanoma-specific deaths were needed for 80% power to detect an odds ratio of 2.1. Paraffin sections were stained with antibodies to podoplanin (lymphatic vessels) and S-100 (melanoma cells) to identify LI. Univariate and multivariate Cox models were used to evaluate the prognostic significance of LI. An independent cohort of 106 similar patients was used for validation of the 10-year MSS rates. Results: LI was observed in 44.5% (95% CI: 38.6% - 50.4%) of the melanomas and its presence was significantly associated with thickness, mitotic rate, gender, age, and ulceration (U). The Kaplan-Meier survival curves for those with and without LI were significantly different (log-rank test p=0.022). The final multivariate model for time to MSD identified 4 independent prognostic factors: thickness (HR=1.5, p<0.001), U (HR=2.2 p=0.013), site (HR=3.9, p<0.001) and LI (HR=1.9, p=0.015). These factors were used to define a prognostic tree with 5 risk groups defined by melanomas that were thin (≤1.0mm) with no LI or U; thin with LI but no U; 1–3mm with no U; 1–3mm with U; and >3mm. Respectively, MSS rates were 100%, 88.6%, 77%, 48% and 42%. In the validation set, observed 10-year MSS rates in each risk group were not significantly different from those predicted from the survival curves for the tree-based risk groups. Conclusions: LI is an independent prognostic factor for MSS. Among patients with thin melanomas without U the 10-year MSS was lower for those patients with LI (89%, 95% CI=78% - 99%; n=41) compared to those without (100%, n=78). LI is an important prognostic factor that needs further validation in a population of patients from the sentinel node biopsy era. No significant financial relationships to disclose.
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Affiliation(s)
- X. Xu
- University of Pennsylvania, Philadelphia, PA
| | - L. Chen
- University of Pennsylvania, Philadelphia, PA
| | - W. Hwang
- University of Pennsylvania, Philadelphia, PA
| | - P. Dawson
- University of Pennsylvania, Philadelphia, PA
| | - D. Guerry
- University of Pennsylvania, Philadelphia, PA
| | - P. VanBelle
- University of Pennsylvania, Philadelphia, PA
| | - D. Elder
- University of Pennsylvania, Philadelphia, PA
| | | | - P. Gimotty
- University of Pennsylvania, Philadelphia, PA
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43
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Winer E, Gralow J, Diller L, Karlan B, Loehrer P, Pierce L, Demetri G, Ganz P, Kramer B, Kris M, Markman M, Mayer R, Pfister D, Raghavan D, Ramsey S, Reaman G, Sandler H, Sawaya R, Schuchter L, Sweetenham J, Vahdat L, Schilsky RL. Clinical cancer advances 2008: major research advances in cancer treatment, prevention, and screening--a report from the American Society of Clinical Oncology. J Clin Oncol 2009; 27:812-26. [PMID: 19103723 PMCID: PMC2645086 DOI: 10.1200/jco.2008.21.2134] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/21/2008] [Indexed: 12/27/2022] Open
Abstract
A message from ASCO'S president: Nearly 40 years ago, President Richard Nixon signed the National Cancer Act, mobilizing the country's resources to make the "conquest of cancer a national crusade." That declaration led to a major investment in cancer research that has significantly improved cancer prevention, treatment, and survival. As a result, two thirds of people diagnosed with cancer today will live at least 5 years after diagnosis, compared with just half in the 1970s. In addition, there are now more than 12 million cancer survivors in the United States--up from 3 million in 1971. Scientifically, we have never been in a better position to advance cancer treatment. Basic scientific research, fueled in recent years by the tools of molecular biology, has generated unprecedented knowledge of cancer development. We now understand many of the cellular pathways that can lead to cancer. We have learned how to develop drugs that block those pathways; increasingly, we know how to personalize therapy to the unique genetics of the tumor and the patient. Yet in 2008, 1.4 million people in the United States will still be diagnosed with cancer, and more than half a million will die as a result of the disease. Some cancers remain stubbornly resistant to treatment, whereas others cannot be detected until they are in their advanced, less curable stages. Biologically, the cancer cell is notoriously wily; each time we throw an obstacle in its path, it finds an alternate route that must then be blocked. To translate our growing basic science knowledge into better treatments for patients, a new national commitment to cancer research is urgently needed. However, funding for cancer research has stagnated. The budgets of the National Institutes of Health and the National Cancer Institute have failed to keep pace with inflation, declining up to 13% in real terms since 2004. Tighter budgets reduce incentives to support high-risk research that could have the largest payoffs. The most significant clinical research is conducted increasingly overseas. In addition, talented young physicians in the United States, seeing less opportunity in the field of oncology, are choosing other specialties instead. Although greater investment in research is critical, the need for new therapies is only part of the challenge. Far too many people in the United States lack access to the treatments that already exist, leading to unnecessary suffering and death. Uninsured cancer patients are significantly more likely to die than those with insurance, racial disparities in cancer incidence and mortality remain stark, and even insured patients struggle to keep up with the rapidly rising cost of cancer therapies. As this annual American Society of Clinical Oncology report of the major cancer research advances during the last year demonstrates, we are making important progress against cancer. But sound public policies are essential to accelerate that progress. In 2009, we have an opportunity to reinvest in cancer research, and to support policies that will help ensure that every individual in the United States receives potentially life-saving cancer prevention, early detection, and treatment. Sincerely, Richard L. Schilsky, MD President American Society of Clinical Oncology.
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Affiliation(s)
- Eric Winer
- American Society of Clinical Oncology, Alexandria, VA 22314, USA
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44
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Fisher DE, Medrano EE, McMahon M, Soengas MS, Schuchter L, Wolchok JD, Merlino G. Meeting report: fourth international congress of the Society for Melanoma Research. Pigment Cell Melanoma Res 2008; 21:15-26. [PMID: 18353140 DOI: 10.1111/j.1755-148x.2007.00437.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 4th international melanoma congress of the Society for Melanoma Research (SMR), organized by Marianne Berwick (University of New Mexico), Paul Chapman (Memorial Sloan-Kettering Cancer Center), Rene Gonzalez (University of Colorado) and Ze'ev Ronai (Burnham Institute), was held at the Marriott Hotel in downtown New York on November 2007. The congress was attended by a record high number of attendees (over 500 delegates) who joined to discuss recent advances in melanoma biology and therapy. About 40% of the participants arrived from 39 countries, a testament to the high impact of this annual gathering on the international melanoma community. Over 120 of the participants were students or postdoctoral fellows, representing a most impressive fraction of young scientists engaged in melanoma research. The meeting consisted of more than 50 plenary and minisymposia presentations, stimulating the exchange of unpublished data and novel ideas, and helping to forge new collaborations that are anticipated to facilitate significant advances in basic, translational and clinical melanoma research. Another major focus of this meeting was over 160 posters, which were heavily attended and provided an effective forum for extensive informal discussions. This report will highlight the major scientific themes and advances of this most successful meeting, and provide a useful perspective on the current state of melanoma research, as well as where the field should be heading.
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Affiliation(s)
- David E Fisher
- Department of Pediatric Hematology/Oncology and Melanoma Program, Dana-Farber Cancer Institute and Children's Hospital of Boston, Boston, MA 02115, USA
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45
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Edwards R, Guerry D, Piris A, Elenitsas R, Seykora J, Schuchter L, Mihm M, Xu X, Gimotty P. Phospho-ERK (pERK) and Ki67 expression as compared to thickness and mitotic rate (MR) as prognostic factors in patients with stage I/II melanomas. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9020] [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: 11/20/2022] Open
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46
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Fecher LA, Nathanson K, Flaherty KT, Amaravadi R, Giles L, McGettigan S, Carberry M, Elder D, Schuchter L. Phase I/II trial of imatinib and temozolomide in advanced unresectable melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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47
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Abstract
Investigators representing all major melanoma research areas present an overview of the most important challenges for the field. Four major research areas are covered plus the training of new investigators. For each area we first describe the present status, its strengths and weaknesses, and then outline specific recommendations. In basic research of melanoma, we outline the pertinent issues for melanoma classification, understanding melanocyte development and transformation, melanoma resistance, tumor microenvironment, metastasis, animal models, immune response, and blood and tissue diagnostics. In clinical research we provide an overview of the current challenges and the strategies for characterization, monitoring, and therapy. It will be important to develop strong research and clinical infrastructures by establishing tumor banks, identifying and validating biomarkers, developing new imaging techniques, and increasing multidisciplinary collaboration and communication. To strengthen the field we need to recruit both young and established investigators and foster career development plans that cover all disciplines. Recent research advances provide significant opportunities to have a major impact on this devastating disease. This group provides recommendations for both short- and long-term strategies that build on research strengths and opportunities established by the many members of the research community.
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Affiliation(s)
- Meenhard Herlyn
- Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA 19104, USA.
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48
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Morton DL, Mozzillo N, Thompson JF, Kelley MC, Faries M, Wagner J, Schneebaum S, Schuchter L, Gammon G, Elashoff R. An international, randomized, phase III trial of bacillus Calmette-Guerin (BCG) plus allogeneic melanoma vaccine (MCV) or placebo after complete resection of melanoma metastatic to regional or distant sites. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8508] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [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
8508 Background: Active specific immunotherapy with BCG and an allogeneic, melanoma cell vaccine can induce antibody and T-lymphocyte immune responses to numerous antigens expressed by melanoma cells. This study compared overall and disease-free survival in patients receiving BCG plus placebo versus BCG plus MCV. Methods: Between June 1998 and November 2005, 1,656 patients without evidence of residual disease after resection of stage III (n = 1,160) or stage IV (n = 496) melanoma were randomly assigned to the two treatment arms (1:1). BCG was given as an immunologic adjuvant for the first two injections of both MCV and placebo, which thereafter were administered by intradermal injection every two weeks for the next three injections, every month for the remainder of the first year, every two months for the second year and every three months for years three, four and five. Results: Based on the recommendation of the independent Data and Safety Monitoring Board (DSMB), both studies were terminated after the interim analysis. The recommendation was based on a low probability of demonstrating significant improvement in survival of the BCG plus MCV arm if the study had continued to completion of follow-up and final analysis. Conclusions: This is the largest multicenter clinical trial of postoperative adjuvant immunotherapy after resection of melanoma metastatic to regional lymph nodes or distant sites. It is a landmark study not only because it represents the first randomized multicenter trial to use surgical resection as initial therapy for stage IV melanoma patients with up to five metastatic sites, but also because its results demonstrate excellent survival for the entire study population with 42.3% of stage IV and 63.4% of stage III patients projected to be alive at five years. Updated data for survival and immunologic endpoints which show a significant correlation between immune responses and survival will be provided at the meeting. [Table: see text]
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Affiliation(s)
- D. L. Morton
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - N. Mozzillo
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - J. F. Thompson
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - M. C. Kelley
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - M. Faries
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - J. Wagner
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - S. Schneebaum
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - L. Schuchter
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - G. Gammon
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
| | - R. Elashoff
- John Wayne Cancer Institute, Santa Monica, CA; National Cancer Institute, Naples, Italy; Sydney Melanoma Unit, Camperdown NSW, Australia; Vanderbilt University, Nashville, TN; Indiana University Cancer Center Melanoma Program, Indianapolis, IN; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; University of Pennsylvania, Philadelphia, PA; CancerVax Corporation, Carlsbad, CA; UCLA School of Medicine, Los Angeles, CA
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Swoboda RK, Somasundaram R, Caputo L, Ochoa EM, Gimotty PA, Marincola FM, Van Belle P, Barth S, Elder D, Guerry D, Czerniecki B, Schuchter L, Vonderheide RH, Herlyn D. Shared MHC class II-dependent melanoma ribosomal protein L8 identified by phage display. Cancer Res 2007; 67:3555-9. [PMID: 17440064 DOI: 10.1158/0008-5472.can-06-2763] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antigens recognized by T helper (Th) cells in the context of MHC class II molecules have vaccine potential against cancer and infectious agents. We have described previously a melanoma patient's HLA-DR7-restricted Th cell clone recognizing an antigen, which is shared among melanoma and glioma cells derived from various patients. Here, this antigen was cloned using a novel antigen phage display approach. The antigen was identified as the ribosomal protein L8 (RPL8). A peptide of RPL8 significantly stimulated proliferation and/or cytokine expression of the Th cell clone and lymphocytes in four of nine HLA-DR7(+) melanoma patients but not in healthy volunteers. The RPL8 antigen may represent a relevant vaccine target for patients with melanoma, glioma, and breast carcinoma whose tumors express this protein.
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Affiliation(s)
- Rolf K Swoboda
- Immunology Program, The Wistar Institute, 3601 Spruce Street, Philadelphia, PA 19104, USA
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50
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Gimotty PA, Elder DE, Fraker DL, Botbyl J, Sellers K, Elenitsas R, Ming ME, Schuchter L, Spitz FR, Czerniecki BJ, Guerry D. Identification of high-risk patients among those diagnosed with thin cutaneous melanomas. J Clin Oncol 2007; 25:1129-34. [PMID: 17369575 DOI: 10.1200/jco.2006.08.1463] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most patients with melanoma have microscopically thin (< or = 1 mm) primary lesions and are cured with excision. However, some develop metastatic disease that is often fatal. We evaluated established prognostic factors to develop classification schemes with better discrimination than current American Joint Committee on Cancer (AJCC) staging. PATIENTS AND METHODS We studied patients with thin melanomas from the US population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry (1988 to 2001; n = 26,291) and those seen by the University of Pennsylvania's Pigmented Lesion Group (PLG; 1972 to 2001; n = 2,389; Philadelphia, PA). AJCC prognostic factors were thickness, anatomic level, ulceration, site, sex, and age; PLG prognostic factors also included a set of biologically based candidate prognostic factors. Recursive partitioning was used to develop a SEER-based classification tree that was validated using PLG data. Next, a new PLG-based classification tree was developed using the expanded set of prognostic factors. RESULTS The SEER-based classification tree identified additional criteria to explain survival heterogeneity among patients with thin, nonulcerated lesions; 10-year survival rates ranged from 89.1% to 99%. The new PLG-based tree identified groups using level, tumor cell mitotic rate, and sex. With survival rates from 83.4% to 100%, it had better discrimination. CONCLUSION Prognostication and related clinical decision making in the majority of patients with melanoma can be improved now using the validated, SEER-based classification. Tumor cell mitotic rate should be incorporated into the next iteration of AJCC staging.
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Affiliation(s)
- Phyllis A Gimotty
- The Melanoma Program of the Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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