1
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Hontecillas-Prieto L, García-Domínguez DJ, Palazón-Carrión N, Martín García-Sancho A, Nogales-Fernández E, Jiménez-Cortegana C, Sánchez-León ML, Silva-Romeiro S, Flores-Campos R, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Salar-Silvestre A, Rodríguez-Abreu D, Gálvez-Carvajal L, Labrador J, Guirado-Risueño M, Provencio-Pulla M, Sánchez-Beato M, Marylene L, Álvaro-Naranjo T, Casanova-Espinosa M, Rueda-Domínguez A, Sánchez-Margalet V, de la Cruz-Merino L. CD8+ NKs as a potential biomarker of complete response and survival with lenalidomide plus R-GDP in the R2-GDP-GOTEL trial in recurrent/refractory diffuse large B cell lymphoma. Front Immunol 2024; 15:1293931. [PMID: 38469299 PMCID: PMC10926187 DOI: 10.3389/fimmu.2024.1293931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Background Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma worldwide. DLBCL is an aggressive disease that can be cured with upfront standard chemoimmunotherapy schedules. However, in approximately 35-40% of the patients DLBCL relapses, and therefore, especially in this setting, the search for new prognostic and predictive biomarkers is an urgent need. Natural killer (NK) are effector cells characterized by playing an important role in antitumor immunity due to their cytotoxic capacity and a subset of circulating NK that express CD8 have a higher cytotoxic function. In this substudy of the R2-GDP-GOTEL trial, we have evaluated blood CD8+ NK cells as a predictor of treatment response and survival in relapsed/refractory (R/R) DLBCL patients. Methods 78 patients received the R2-GDP schedule in the phase II trial. Blood samples were analyzed by flow cytometry. Statistical analyses were carried out in order to identify the prognostic potential of CD8+ NKs at baseline in R/R DLBCL patients. Results Our results showed that the number of circulating CD8+ NKs in R/R DLBCL patients were lower than in healthy donors, and it did not change during and after treatment. Nevertheless, the level of blood CD8+ NKs at baseline was associated with complete responses in patients with R/R DLBCL. In addition, we also demonstrated that CD8+ NKs levels have potential prognostic value in terms of overall survival in R/R DLBCL patients. Conclusion CD8+ NKs represent a new biomarker with prediction and prognosis potential to be considered in the clinical management of patients with R/R DLBCL. Clinical trial registration https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001620-29 EudraCT, ID:2014-001620-29.
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Affiliation(s)
- Lourdes Hontecillas-Prieto
- Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Daniel J. García-Domínguez
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
| | - Natalia Palazón-Carrión
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Alejandro Martín García-Sancho
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, CIBERONC, University of Salamanca, Salamanca, Spain
| | - Esteban Nogales-Fernández
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - María L. Sánchez-León
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Silvia Silva-Romeiro
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Rocío Flores-Campos
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | | | | | | | | | | | - Natividad Martínez-Banaclocha
- Oncology Dept., Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Josep Gumà-Padrò
- Department of Clinical Oncology, Hospital Universitari Sant Joan de Reus URV, IISPV, Reus, Spain
| | - José Gómez-Codina
- Department of Clinical Oncology, Hospital Universitario La Fé, Valencia, Spain
| | | | - Delvys Rodríguez-Abreu
- Department of Clinical Oncology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Laura Gálvez-Carvajal
- Department of Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - María Guirado-Risueño
- Department of Clinical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Mariano Provencio-Pulla
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain
| | - Margarita Sánchez-Beato
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, CIBERONC, Madrid, Spain
| | - Lejeune Marylene
- Department of Pathology, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro-Naranjo
- Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | | | | | - Víctor Sánchez-Margalet
- Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
| | - Luis de la Cruz-Merino
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
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2
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Jiménez-Cortegana C, Salamanca E, Palazón-Carrión N, Sánchez-Jiménez F, Pérez-Pérez A, Vilariño-García T, Fuentes S, Martín S, Jiménez M, Galván R, Rodríguez-Chacón C, Sánchez-Mora C, Moreno-Mellado E, Gutiérrez-Gutiérrez B, Álvarez N, Sosa A, Garnacho-Montero J, de la Cruz-Merino L, Rodríguez-Baño J, Sánchez-Margalet V. Circulating myeloid-derived suppressor cells may be a useful biomarker in the follow-up of unvaccinated COVID-19 patients after hospitalization. Front Immunol 2023; 14:1266659. [PMID: 38035104 PMCID: PMC10685891 DOI: 10.3389/fimmu.2023.1266659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
SARS-CoV-2 infection is the cause of the disease named COVID-19, a major public health challenge worldwide. Differences in the severity, complications and outcomes of the COVID-19 are intriguing and, patients with similar baseline clinical conditions may have very different evolution. Myeloid-derived suppressor cells (MDSCs) have been previously found to be recruited by the SARS-CoV-2 infection and may be a marker of clinical evolution in these patients. We have studied 90 consecutive patients admitted in the hospital before the vaccination program started in the general population, to measure MDSCs and lymphocyte subpopulations at admission and one week after to assess the possible association with unfavorable outcomes (dead or Intensive Care Unit admission). We analyzed MDSCs and lymphocyte subpopulations by flow cytometry. In the 72 patients discharged from the hospital, there were significant decreases in the monocytic and total MDSC populations measured in peripheral blood after one week but, most importantly, the number of MDSCs (total and both monocytic and granulocytic subsets) were much higher in the 18 patients with unfavorable outcome. In conclusion, the number of circulating MDSCs may be a good marker of evolution in the follow-up of unvaccinated patients admitted in the hospital with the diagnosis of COVID-19.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Elena Salamanca
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Palazón-Carrión
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Sandra Fuentes
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Salomón Martín
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Marta Jiménez
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Raquel Galván
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | - Catalina Sánchez-Mora
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Elisa Moreno-Mellado
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Nerissa Álvarez
- Intensive Care Unit, Virgen Macarena University Hospital, Seville, Spain
| | - Alberto Sosa
- Intensive Care Unit, Virgen Macarena University Hospital, Seville, Spain
| | | | - Luis de la Cruz-Merino
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
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3
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Gumà J, Palazón-Carrión N, Rueda-Domínguez A, Sequero S, Calvo V, García-Arroyo R, Gómez-Codina J, Llanos M, Martínez-Banaclocha N, Provencio M. SEOM-GOTEL clinical guidelines on diffuse large B cell lymphoma (2022). Clin Transl Oncol 2023; 25:2749-2758. [PMID: 37289353 PMCID: PMC10425474 DOI: 10.1007/s12094-023-03206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/09/2023]
Abstract
Diffuse large B-cell lymphoma is the most frequent histological subtype of NHL and the paradigm for the management of aggressive lymphoma. An excisional or incisional lymph node biopsy evaluated by an experienced hemopathologist is recommended to establish the diagnosis. Twenty years following its introduction, R-CHOP remains the standard first-line treatment. No modification of this scheme (increased chemotherapy dose intensity, new monoclonal antibodies, or the addition of immunomodulators or anti-target agents) has significatively improved the clinical outcomes, whereas therapy for recurrence or progression is evolving rapidly. The irruption of CART cells, polatuzumab vedotin, tafasitamab, and CD20/CD3 bispecific antibodies are changing the natural history of relapsed patients and will challenge R-CHOP as the benchmark for newly diagnosed patients.
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Affiliation(s)
- Josep Gumà
- Medical Oncology Department, Hospital Universitari Sant Joan de Reus, IISPV, URV, Reus, Tarragona, Spain
| | | | - Antonio Rueda-Domínguez
- UGCI Medical Oncology, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Silvia Sequero
- Medical Oncology Department, Hospital Universitario San Cecilio, Granada, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ramón García-Arroyo
- Medical Oncology Department, Complejo Hospitalario Universitario, Pontevedra, Spain
| | - José Gómez-Codina
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Llanos
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Natividad Martínez-Banaclocha
- Oncology Department, Hospital General Universitario Dr. Balmis, Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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4
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Jiménez-Cortegana C, Hontecillas-Prieto L, García-Domínguez DJ, Zapata F, Palazón-Carrión N, Sánchez-León ML, Tami M, Pérez-Pérez A, Sánchez-Jiménez F, Vilariño-García T, de la Cruz-Merino L, Sánchez-Margalet V. Obesity and Risk for Lymphoma: Possible Role of Leptin. Int J Mol Sci 2022; 23:ijms232415530. [PMID: 36555171 PMCID: PMC9779026 DOI: 10.3390/ijms232415530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity, which is considered a pandemic due to its high prevalence, is a risk factor for many types of cancers, including lymphoma, through a variety of mechanisms by promoting an inflammatory state. Specifically, over the last few decades, obesity has been suggested not only to increase the risk of lymphoma but also to be associated with poor clinical outcomes and worse responses to different treatments for those diseases. Within the extensive range of proinflammatory mediators that adipose tissue releases, leptin has been demonstrated to be a key adipokine due to its pleotropic effects in many physiological systems and diseases. In this sense, different studies have analyzed leptin levels and leptin/leptin receptor expressions as a probable bridge between obesity and lymphomas. Since both obesity and lymphomas are prevalent pathophysiological conditions worldwide and their incidences have increased over the last few years, here we review the possible role of leptin as a promising proinflammatory mediator promoting lymphomas.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY 10065, USA
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Daniel J. García-Domínguez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Fernando Zapata
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Natalia Palazón-Carrión
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - María L. Sánchez-León
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Malika Tami
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Luis de la Cruz-Merino
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Correspondence: (L.d.l.C.-M.); (V.S.-M.)
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Correspondence: (L.d.l.C.-M.); (V.S.-M.)
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5
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de la Cruz-Merino L, Gion M, Cruz J, Alonso-Romero JL, Quiroga V, Moreno F, Andrés R, Santisteban M, Ramos M, Holgado E, Cortés J, López-Miranda E, Cortés A, Henao F, Palazón-Carrión N, Rodriguez LM, Ceballos I, Soto A, Puertes A, Casas M, Benito S, Chiesa M, Bezares S, Caballero R, Jiménez-Cortegana C, Sánchez-Margalet V, Rojo F. Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study. BMC Cancer 2022; 22:1258. [PMID: 36463104 PMCID: PMC9719636 DOI: 10.1186/s12885-022-10363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients. METHODS HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m2 [DL0]; 1,000 mg/m2 [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed. RESULTS Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment. CONCLUSION Pembrolizumab 200 mg and gemcitabine 1,250 mg/m2 were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit. TRIAL REGISTRATION ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.
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Affiliation(s)
- L. de la Cruz-Merino
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Gion
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J. Cruz
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - JL. Alonso-Romero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - V. Quiroga
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418701.b0000 0001 2097 8389Department of Medical Oncology, Badalona Applied Research Group in Oncology (B-ARGO Group), Catalan Institute of Oncology, Badalona, Spain
| | - F. Moreno
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411068.a0000 0001 0671 5785Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - R. Andrés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411050.10000 0004 1767 4212Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - M. Santisteban
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411730.00000 0001 2191 685XDepartment of Medical Oncology, Clínica Universidad de Navarra, Navarra, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M. Ramos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418394.3Department of Medical Oncology, Centro Oncológico de Galicia, A Coruña, Spain
| | - E. Holgado
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.414808.10000 0004 1772 3571Department of Medical Oncology, Hospital La Luz, Quironsalud, Madrid, Spain
| | - J. Cortés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,International Breast Cancer Center (IBCC), Quiron Group, Barcelona and Madrid, Spain ,grid.411083.f0000 0001 0675 8654Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain ,grid.119375.80000000121738416Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - E. López-Miranda
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A. Cortés
- grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F. Henao
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - N. Palazón-Carrión
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - L. M. Rodriguez
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - I. Ceballos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - A. Soto
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - A. Puertes
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - M. Casas
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Benito
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Chiesa
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Bezares
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - R. Caballero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - C. Jiménez-Cortegana
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - V. Sánchez-Margalet
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - F. Rojo
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Pathology Department, IIS-Fundación Jiménez Díaz, Madrid, Spain ,CIBERONC-ISCIII, Madrid, Spain
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6
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Palazón-Carrión N, Martín García-Sancho A, Nogales-Fernández E, Jiménez-Cortegana C, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Salar-Silvestre A, Rodríguez-Abreu D, Gálvez-Carvajal L, Labrador J, Guirado-Risueño M, García-Domínguez DJ, Hontecillas-Prieto L, Espejo-García P, Fernández-Román I, Provencio-Pulla M, Sánchez-Beato M, Navarro M, Marylene L, Álvaro-Naranjo T, Casanova-Espinosa M, Sánchez-Margalet V, Rueda-Domínguez A, de la Cruz-Merino L. Lenalidomide plus R-GDP (R2-GDP) in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Final Results of the R2-GDP-GOTEL Trial and Immune Biomarker Subanalysis. Clin Cancer Res 2022; 28:3658-3668. [PMID: 35727601 PMCID: PMC9433956 DOI: 10.1158/1078-0432.ccr-22-0588] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/06/2022] [Accepted: 06/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE New therapeutic options are needed in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Lenalidomide-based schedules can reverse rituximab refractoriness in lymphoma. PATIENTS AND METHODS In the phase II R2-GDP trial, 78 patients unsuitable for autologous stem cell transplant received treatment with the following schedule: lenalidomide 10 mg Days (D)1-14, rituximab 375 mg/m2 D1, cisplatin 60 mg/m2 D1, gemcitabine 750 mg/m2 D1 and D8, and dexamethasone 20 mg D1-3, up to 6 cycles (induction phase), followed by lenalidomide 10 mg (or last lenalidomide dose received) D1-21 every 28 days (maintenance phase). Primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety, and monitorization of key circulating immune biomarkers (EU Clinical Trials Register number: EudraCT 2014-001620-29). RESULTS After a median follow-up of 37 months, ORR was 60.2% [37.1% complete responses (CR) and 23.1% partial responses (PR)]. Median OS was 12 months (47 vs. 6 months in CR vs. no CR); median PFS was 9 months (34 vs. 5 months in CR vs. no CR). In the primary refractory population, ORR was 45.5% (21.2% CR and 24.3% PR). Most common grade 3-4 adverse events were thrombocytopenia (60.2%), neutropenia (60.2%), anemia (26.9%), infections (15.3%), and febrile neutropenia (14.1%). Complete responses were associated with a sharp decrease in circulating myeloid-derived suppressor cells and regulatory T cells. CONCLUSIONS R2-GDP schedule is feasible and highly active in R/R DLBCL, including the primary refractory population. Immune biomarkers showed differences in responders versus progressors.
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Affiliation(s)
- Natalia Palazón-Carrión
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Esteban Nogales-Fernández
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | - Josep Gumà-Padrò
- Department of Clinical Oncology, Hospital Universitari Sant Joan de Reus URV, IISPV, Reus, Spain
| | - José Gómez-Codina
- Department of Clinical Oncology, Hospital Universitario La Fé, Valencia, Spain
| | | | - Delvys Rodríguez-Abreu
- Department of Clinical Oncology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Laura Gálvez-Carvajal
- Department of Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - María Guirado-Risueño
- Department of Clinical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Daniel J. García-Domínguez
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pablo Espejo-García
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Mariano Provencio-Pulla
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain
| | - Margarita Sánchez-Beato
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, CIBERONC, Madrid, Spain
| | - Marta Navarro
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Madrid, Spain
| | - Lejeune Marylene
- Department of Pathology, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro-Naranjo
- Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | | | - Victor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Antonio Rueda-Domínguez
- Department of Hematology/Clinical Oncology, Hospital Costa del Sol, Marbella, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
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7
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Martínez-Chinchilla C, Vazquez-Montero L, Palazón-Carrión N, Fernández-Román IM, López-Barba J, de la Cruz-Merino L, Rodríguez-Baño J, Palacios-Baena ZR. Persistence of SARS-CoV-2 Infection in Severely Immunocompromised Patients With Complete Remission B-Cell Lymphoma and Anti-CD20 Monoclonal Antibody Therapy: A Case Report of Two Cases. Front Immunol 2022; 13:860891. [PMID: 35493500 PMCID: PMC9046988 DOI: 10.3389/fimmu.2022.860891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/15/2022] [Indexed: 12/18/2022] Open
Abstract
Immunosuppressant conditions such as hematological malignancies increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It has been described in the literature that patients on anti-CD20 maintenance therapies for lymphoid malignancies are susceptible to having recurrent flares together with viral replication or reinfections, although these cases are scarce. These patients are not well represented in randomized controlled trials, and as a consequence, the evidence for the use of certain treatments in this scenario is lacking. We present two cases of patients with B-cell lymphoma on remission and treated with rituximab on maintenance. They developed at least 1 flare of coronavirus disease 2019 (COVID-19) after acute infection and always after receiving rituximab. RT-PCR was positive in the nasopharyngeal swab and also in plasma. Patients were treated during flares with remdesivir, hyperimmune plasma, and corticosteroids. These two cases showed the unresolved problem of COVID-19 in immunosuppressant patients and showed that despite the vast amount of information available on SARS-CoV-2, information in this subgroup of patients is lacking.
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Affiliation(s)
| | | | - Natalia Palazón-Carrión
- Clinical Oncology Department, University Hospital Virgen Macarena, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | | | - José López-Barba
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
| | - Luis de la Cruz-Merino
- Clinical Oncology Department, University Hospital Virgen Macarena, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Department of Medicine, University of Seville, Seville, Spain
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- *Correspondence: Jesús Rodríguez-Baño,
| | - Zaira R. Palacios-Baena
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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8
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Jiménez-Cortegana C, Liró J, Palazón-Carrión N, Salamanca E, Sojo-Dorado J, de la Cruz-Merino L, Pascual Á, Rodríguez-Baño J, Sánchez-Margalet V. Increased Blood Monocytic Myeloid Derived Suppressor Cells but Low Regulatory T Lymphocytes in Patients with Mild COVID-19. Viral Immunol 2021; 34:639-645. [PMID: 34529510 DOI: 10.1089/vim.2021.0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may produce a systemic disease, the coronavirus disease-19 (COVID-19), with high morbidity and mortality. Even though we do not fully understand the interaction of innate and adaptive immunity in the control and complications of the viral infection, it is well recognized that SARS-CoV-2 induces an immunodepression that impairs the elimination of the virus and favors its rapid dissemination in the organism. Even less is known about the possible participation of inhibitory cells of the innate immune system, such as the myeloid-derived suppressor cells (MDSCs), or the adaptive immune system, such as the T regulatory cells (Tregs). That is why we aimed to study blood levels of MDSCs, as well as lymphocyte subpopulations, including Tregs, and activated (OX-40+) and inhibited (PD-1) T lymphocytes in patients with mild COVID-19 in comparison with data obtained from control donors. We have found that 20 hospitalized patients with COVID-19 and no health history of immunosuppression had a significant increase in the number of peripheral monocytic MDSCs (M-MDSC), but a decrease in Tregs, as well as an increase in the number of inhibited or exhausted T cells, whereas the number of activated T cells was significantly decreased compared with that from 20 healthy controls. Moreover, there was a significant negative correlation (r = 0.496) between the number of M-MDSC and the number of activated T cells. Therefore, M-MDSC rather than Tregs may contribute to the immunosuppression observed in patients with COVID-19.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Julia Liró
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain.,Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Natalia Palazón-Carrión
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Elena Salamanca
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Jesús Sojo-Dorado
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Luis de la Cruz-Merino
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Álvaro Pascual
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
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9
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Palazón-Carrión N, Jiménez-Cortegana C, Sánchez-León ML, Henao-Carrasco F, Nogales-Fernández E, Chiesa M, Caballero R, Rojo F, Nieto-García MA, Sánchez-Margalet V, de la Cruz-Merino L. Circulating immune biomarkers in peripheral blood correlate with clinical outcomes in advanced breast cancer. Sci Rep 2021; 11:14426. [PMID: 34257359 PMCID: PMC8277895 DOI: 10.1038/s41598-021-93838-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022] Open
Abstract
Identification of the different elements intervening at the tumor microenvironment seems key to explain clinical evolution in several tumor types. In this study, a set of immune biomarkers (myeloid derived suppressor cells, regulatory T cells, and OX40 + and PD-1 + T lymphocytes counts) in peripheral blood of patients diagnosed with advanced breast cancer were analyzed along of first line antineoplastic therapy. Subsequently, a comparison between groups with clinical benefit versus progression of disease and with a healthy women cohort was executed. Results reflected that patients showed higher basal levels of myeloid derived suppressor cells (35.43, IR = 180.73 vs 17.53, IR = 16.96 cells/μl; p = 0.001) and regulatory T cells (32.05, IR = 29.84 vs 22.61, IR = 13.57 cells/μl; p = 0.001) in comparison with healthy women. Furthermore, an increase in the number of activated T lymphocytes (expressing OX40), a decrease of immune inhibitory cells (MDSCs and Tregs) and inhibited T lymphocytes (expressing PD-1) were observed along the treatment in patients with clinical benefit (p ≤ 0.001). The opposite trend was observed in the case of disease progression. These findings suggest that some critical immune elements can be easily detected and measured in peripheral blood, which open a new opportunity for translational research, as they seem to be correlated with clinical evolution, at least in ABC.
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Affiliation(s)
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - M Luisa Sánchez-León
- Clinical Oncology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | | | - Massimo Chiesa
- GEICAM (Spanish Breast Cancer Research Group), Madrid, Spain
| | | | - Federico Rojo
- Pathology Department, IIS-Fundación Jimenez Diaz-CIBERONC, Madrid, Spain
| | | | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain.
| | - Luis de la Cruz-Merino
- Clinical Oncology Department, Virgen Macarena University Hospital, Seville, Spain.
- GEICAM (Spanish Breast Cancer Research Group), Madrid, Spain.
- Medicine Department, University of Seville, Seville, Spain.
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10
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Jiménez-Cortegana C, Palazón-Carrión N, Martin Garcia-Sancho A, Nogales-Fernandez E, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Rueda Dominguez A, Casanova-Espinosa M, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Labrador J, Salar-Silvestre A, Rodriguez-Abreu D, Galvez-Carvajal L, Provencio M, Sánchez-Beato M, Guirado-Risueño M, Espejo-García P, Lejeune M, Álvaro T, Sánchez-Margalet V, de la Cruz-Merino L. Circulating myeloid-derived suppressor cells and regulatory T cells as immunological biomarkers in refractory/relapsed diffuse large B-cell lymphoma: translational results from the R2-GDP-GOTEL trial. J Immunother Cancer 2021; 9:jitc-2020-002323. [PMID: 34158317 PMCID: PMC8728348 DOI: 10.1136/jitc-2020-002323] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background The search for immunological markers with ability of predicting clinical outcome is a priority in lymphomas, and in cancer in general. It is well known that some immunomodulatory cells, such as myeloid derived suppressor cells (MDSCs) or regulatory T cells (Tregs), are recruited by tumors, jeopardizing antitumor immunosurveillance. In this work, we have studied blood levels of these immunosuppressive cells in patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), prior to and along the course of the experimental rituximab, gemcitabine, dexamethasone, and cisplatin (R2-GDP) schedule, as a translational substudy of the R2-GDP-GOTEL trial (EudraCT Number: 2014-001620-29), which included lenalidomide as an immunomodulator. Methods Blood samples were taken before treatment, at cycle 3 and end of induction. Samples were analyzed by flow cytometry. Non-parametric tests were used. Mann-Whitney U test was used to compare basal cells distributions, and Wilcoxon test was considered to compare cells distribution at different times. Spearman test was performed to measure the degree of association between cell populations. Results In this study, MDSC and Treg circulating concentration was found increased in all patients compared with a healthy control group and decreased after treatment only in patients with longest overall survival (>24 months), reaching the levels of the healthy group. Likewise, the number of inhibited T lymphocytes expressing Programmed Death-1 (PD-1) were increased in peripheral blood from patients and decreased on the treatment, whereas activated T lymphocytes increased after therapy in those with better overall survival. Conclusions In conclusion, blood concentration of MDSCs and Treg cells may be good prognostic markers for overall survival after 2 years in R/R DLBCL. These results point to a possible role of these elements in the immunosuppression of these patients, as assessed by the circulating activated and inhibited T lymphocytes, and therefore, they may be considered as therapeutic targets in DLBCL.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Medical Biochemistry and Molecular Biology and Immunology, Virgen Macarena University Hospital, Sevilla, Seville, Spain
| | | | | | - Esteban Nogales-Fernandez
- Clinical Oncology Dept. Medicine Department, University of Seville, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | | | | | | | | | | | - Josep Gumà-Padrò
- Clinical Oncology Dept, Sant Joan de Reus University Hospital URV, IISPV, Reus, Spain
| | | | - Jorge Labrador
- Hematology Dept, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Laura Galvez-Carvajal
- Unidad de Gestión Clínica Intercentros de Oncología Médica de Málaga, Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - Mariano Provencio
- Clinical Oncology Dept, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Margarita Sánchez-Beato
- Lymphoma Research Group, Clinical Oncology Dept, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - María Guirado-Risueño
- Clinical Oncology Dept, Elche General University Hospital General, Elche, Alicante, Spain
| | - Pablo Espejo-García
- Clinical Oncology Dept. Medicine Department, University of Seville, Virgen Macarena University Hospital, Seville, Spain
| | - Marylene Lejeune
- Pathology Department, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro
- Pathology Dept, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | - Victor Sánchez-Margalet
- Medical Biochemistry and Molecular Biology and Immunology, Virgen Macarena University Hospital, Sevilla, Seville, Spain
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11
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de la Cruz Merino L, Martin A, Nogales Fernández E, Carnicero González F, Ríos Herranz E, de la Cruz-Vicente F, Rodriguez G, Nicolás C, Martinez-Banaclocha N, Guma J, Gómez-Codina J, Salar Silvestre A, Rodriguez-Abreu D, Quero Blanco C, Labrador Gómez J, Guirado M, Palazón-Carrión N, Espejo García P, Provencio-Pulla M, Rueda Dominguez A. Lenalidomide plus R-GDP (R2-GDP) in relapsed/refractory diffuse large B-cell lymphoma: Final results of the R2-GDP-GOTEL trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
8019 Background: Lenalidomide is an immunomodulatory drug that could reverse rituximab refractoriness in lymphoma patients (pts). We conducted an open label multicenter phase 2 trial testing the efficacy and toxicity of a combination of lenalidomide and rituximab (R2) plus GDP schedule (R2-GDP) in Relapsed/Refractory Diffuse Large B Cell Lymphoma (R/R DLBCL) pts, not suitable for autologous stem cell transplant (ASCT). Methods: Patients with R/R DLBCL previously treated with at least 1 prior line of immunochemotherapy including rituximab, and not candidates for ASCT, were eligible. After a run-in phase period, treatment consisted of an induction phase with lenalidomide (LEN) 10 mg po d1-14, rituximab 375 mg/m2 iv d1, cisplatin 60 mg/m2 iv d1, gemcitabine 750 mg/m2 iv d1 and d8 and dexamethasone 20 mg d1-3, up to a maximum of 6 cycles. Pts without disease progression (DP) entered into a maintenance phase with LEN 10 mg, or last LEN dose received in the induction phase, d1-21 in cycles every 28 days. Primary endpoint was overall response rate (ORR) by investigator assessment. Secondary endpoints included disease free survival (DFS), event free survival (EFS), overall survival (OS), safety and response by cell of origin (COO), type of DLBCL (double-triple hit) and other microenvironment and genomic biomarkers. Results: 79 pts were enrolled between April 2015 and September 2018. Median age was 70 years (range 23-86), 48,7% women. 78 pts were considered for efficacy and safety in the intention to treat (ITT) analysis. With a median follow-up of 13 months at the time of cut-off (November 2019), ORRwas 59.0%, with 32.1% complete responses (CR) and 26.9% partial responses (PR). In the primary refractory population (n = 33), ORR was 45.5%, with 21.2% CR and 24.3% PR. There were no statistically significant differences in ORR with respect to COO. In Double-Hit R/R DLBCL (n = 16), ORR was 37.5% with 25% CR. Median OS was 12.0 months (6.9-17.0). Most common grade 3/4 (G3/4) adverse events were thrombocytopenia (60.2%), neutropenia (60.2%) and anemia (26.9%). Febrile neutropenia occurred in 14.1% pts. Most frequent non-hematologic G3/4 events were asthenia (19.2%), infection (15.3%) and renal insufficiency (6.4%). There were 4 toxic deaths related to the R2-GDP schedule. Conclusions: LEN with Rituximab and GDP (R2-GDP) is feasible and active in R/R DLBCL. Results in the primary refractory DLBCL population are particularly promising. Analysis of COO did not revealed differences in response rates. Immune biomarkers results will be showed at the meeting. Clinical trial information: EudraCT 2014-001620-29 .
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Affiliation(s)
| | - Alejandro Martin
- Hematology Department, Hospital Universitario de Salamanca and IBSAL, CIBERONC, Salamanca, Spain
| | | | | | | | | | - Guillermo Rodriguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Concepción Nicolás
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Josep Guma
- Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | | | | | | | | | | | - Maria Guirado
- Clinical Oncology Department, Hospital General de Elche, Elche, Alicante, Spain
| | | | - Pablo Espejo García
- Clinical Oncology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Mariano Provencio-Pulla
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Rueda Dominguez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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12
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Palazón-Carrión N, Jiménez-Cortegana C, Holgado E, Jurado JC, Alonso Romero JL, Sánchez Leon ML, Sanchez Margalet V, Nogales E, Moreno Anton F, Quiroga Garcia V, Andres R, Santisteban M, Cortes J, Rodríguez-Rodríguez LM, Soto Gutierrez A, Cortes MG, Nieto Garcia A, Chiesa M, Bezares S, De la Cruz-Merino L. Evolution of the myeloid-derived suppressor cells in advanced breast cancer and comparative analysis with a healthy population cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
2543 Background: High levels of myeloid-derived suppressor cells (MDSCs) seem a negative prognostic factor in advanced breast cancer (ABC) patients (pts). Preclinical studies suggest an immunomodulatory effect of some classical anti-tumor agents through alteration of MDSCs homeostasis. We analyzed the association of MDSCs and clinical evolution of ABC pts, taking into account the systemic treatment (tx) modulation of MDSCs levels in pts from two studies (“A”: GEICAM/2015-04 PANGEA-BREAST, NCT03025880 “Efficacy and Safety of Pembrolizumab and Gemcitabine in HER2-negative ABC”, and “B”: PI-0502-2014 “Peripheral blood analyses of immune response induced by 1st line tx of ABC according to clinical guidelines”). Methods: MDSCs (CD33+ CD11b+) levels were determined by flow-cytometry in peripheral blood samples at three time points (basal, at cycles 3 and 6) from: 39 HER2-negative heavily pretreated pts from study “A”, 43 non-pretreated pts (all subtypes) from study “B” and 20 women from a healthy cohort (HC), with no cancer diagnosis. MDSCs levels from the different cohorts were compared and correlated with pts with Clinical Benefit (CB: partial/complete response + disease stabilization) vs pts with Progressive Disease (PD). Results: Tx response was assessed in 33 pts (85%) from study “A” and 39 pts (91%) from study “B”. CB was observed in 11 pts (28%) from study “A” and in 34 (79%) from study “B” while PD was observed in 22 pts (56%) from study “A” and in 5 (12%) from study “B”. Basal MDSCs levels were significantly higher in ABC pts (studies “A”+”B”) than in HC (15.95 vs 0.81 cells/µl, p = 0.009). At cycle 6, MDSCs were considerably lower in pts with CB vs DP (2.90 vs 13.75 cells/µl, p < 0.001). This decrease was more pronounced in study “B” than in study “A” pts (p < 0.001 vs p = 0.074, respectively), probably due to differences in number of events, tumor subtypes and tx between both studies. Conclusions: Our results suggest that ABC pts show alterations in MDSCs and that their decrease along tx may have a positive predictive value, highlighting the importance that immune-competent status may play in the evolution of ABC. MDSCs may represent a target for therapeutic purposes in ABC.
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Affiliation(s)
| | | | - Esther Holgado
- Hospital Universitario Ramón y Cajal, GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Josefina Cruz Jurado
- Hospital Universitario de Canarias, GEICAM Spanish Breast Cancer Group, Santa Cruz de Tenerife, Spain
| | - Jose Luis Alonso Romero
- Hospital Clinico Universitario Virgen de la Arrixaca, GEICAM Spanish Breast Cancer Group, Murcia, Spain
| | | | | | | | - Fernando Moreno Anton
- Hospital Clínico Universitario San Carlos, Madrid, GEICAM, Spanish Breast Cancer Group, Madrid, Spain
| | - Vanesa Quiroga Garcia
- Badalona-Applied Research Group in Oncology: B-ARGO Group, Catalan Institute of Oncology, Spain-GEICAM, Spanish Breast Cancer Group, Barcelona, Spain
| | - Raquel Andres
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Marta Santisteban
- Clínica Universidad de Navarra, Pamplona, GEICAM, Spanish Breast Cancer Group, Pamplona, Spain
| | - Javier Cortes
- IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, GEICAM, Spanish Breast Cancer Group, Madrid & Barcelona, Spain
| | | | - Asuncion Soto Gutierrez
- Hospital Universitario Virgen de la Arrixaca, GEICAM, Spanish Breast Cancer Group, Murcia, Spain
| | - Mana Gion Cortes
- Hospital Ramon y Cajal. GEICAM, Spanish Breast Cancer Group, Madrid, Spain
| | | | | | | | - Luis De la Cruz-Merino
- Hospital Universitario Virgen Macarena, GEICAM Spanish Breast Cancer Group, Seville, Spain
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13
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Sánchez-Margalet V, Barco-Sánchez A, Vilariño-García T, Jiménez-Cortegana C, Pérez-Pérez A, Henao-Carrasco F, Virizuela-Echaburu JA, Nogales-Fernández E, Álamo-de la Gala MC, Lobo-Acosta MA, Palazón-Carrión N, Nieto A, de la Cruz-Merino L. Circulating regulatory T cells from breast cancer patients in response to neoadjuvant chemotherapy. Transl Cancer Res 2019; 8:59-65. [PMID: 35116734 PMCID: PMC8798280 DOI: 10.21037/tcr.2018.12.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/07/2018] [Indexed: 12/21/2022]
Abstract
Background Immune escape of tumor cells is a new hallmark of cancer in general, and breast cancer, in particular. Previous studies have demonstrated that the immunological profile in peripheral blood may be a prognostic and/or predictive biomarker in breast cancer. Thus, higher number of regulatory T cells (Tregs) in blood from patients with breast cancer has been reported in relation to normal donors. In the present study, we planned to evaluate the changes in different cell populations in peripheral blood: neutrophils, monocytes and lymphocytes, as well as lymphocyte subpopulations [natural killer (NK), B lymphocytes, T lymphocytes, both CD4+ and CD8+, and Tregs] from patients with local breast cancer (both Her2+ and Her2−), before, during and after neoadjuvant chemotherapy. Methods We have employed flow cytometry for the cell analysis of fresh samples obtained before and whilst the neoadjuvant treatment was accomplished. We have studied 50 successive patients from the Breast Cancer Unit of the Virgen Macarena University Hospital during 2 years. Results Neoadjuvant chemotherapy induced a significant reduction in B cells, especially in Her2− patients, and a reduction in NK cells. CD4+ T cells decreased, whereas CD8+ cells only decreased in Her2− patients. Tregs were also diminished, especially in Her2+ patients, in response to treatment. Thus, higher CD8/Treg ratio was observed in Her2+ patients. A higher percentage of Her2+ patients (66.6%) achieved complete response than Her2− patients (27.5%). Monocytes and neutrophils were not changed in peripheral blood. Conclusions Even though the decrease in B cells and NK cells in response to chemotherapy may be deleterious in the neoadjuvant treatment of breast cancer, the decrease in Tregs and CD4 T cells, but not CD8 T cells, increasing the CD8/Treg ratio, especially in Her2+ patients, may reveal a new tool to monitor the immune response in breast cancer treated with chemotherapy in the neoadjuvant setting.
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Affiliation(s)
- Víctor Sánchez-Margalet
- Department of Clinical Biochemistry, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Antonio Barco-Sánchez
- Department of Clinical Biochemistry, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Teresa Vilariño-García
- Department of Clinical Biochemistry, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Clinical Biochemistry, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Clinical Biochemistry, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | | | | | | | | | - María A Lobo-Acosta
- Department of Clinical Oncology, Virgen Macarena University Hospital, Seville, Spain
| | | | - Adoración Nieto
- Department of Preventive Medicine and Public Health, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology, Virgen Macarena University Hospital, Seville, Spain.,Medicine Department, University of Seville, Seville, Spain
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14
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de la Cruz-Merino L, Palazón-Carrión N, Henao-Carrasco F, Nogales-Fernández E, Álamo-de la Gala M, Vallejo-Benítez A, Chiesa M, Sánchez-Margalet V. New horizons in breast cancer: the promise of immunotherapy. Clin Transl Oncol 2018; 21:117-125. [PMID: 29916188 DOI: 10.1007/s12094-018-1907-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/28/2018] [Accepted: 06/04/2018] [Indexed: 12/29/2022]
Abstract
Immunology and immunotherapy of cancer is an expanding field in oncology, with recent great achievements obtained through the new successful approaches implemented to circumvent immune evasion, which is undoubtedly considered a novel hallmark of cancer. Translational research in this topic has revealed targets that can be modulated in the clinical setting with new compounds and strategies. Like most of the tumors, breast cancer is considered a complex and heterogeneous disease in which host immune responses have been also recently demonstrated of critical relevance. T infiltrating lymphocyte measurement is suggested as a powerful new tool necessary to predict early breast cancer evolution, especially for the her2-positive and triple-negative subtypes. Other biomarkers in tissue and peripheral blood are under intense scrutiny to ascertain their eventual role as prognostic and/or predictive factors. This background has fueled the interest in developing clinical research strategies to test activity of modern immunotherapy in breast cancer, which constitutes the main focus of this review.
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Affiliation(s)
- L de la Cruz-Merino
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain.
| | - N Palazón-Carrión
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
| | - F Henao-Carrasco
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
| | - E Nogales-Fernández
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
| | - M Álamo-de la Gala
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
| | - A Vallejo-Benítez
- Pathology Department, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
| | - M Chiesa
- Spanish Breast Cancer Research Group (GEICAM), 28703, Madrid, Spain
| | - V Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Avda Dr Fedriani s/n, 41009, Seville, Spain
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