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Weber JS, Carlino MS, Khattak A, Meniawy T, Ansstas G, Taylor MH, Kim KB, McKean M, Long GV, Sullivan RJ, Faries M, Tran TT, Cowey CL, Pecora A, Shaheen M, Segar J, Medina T, Atkinson V, Gibney GT, Luke JJ, Thomas S, Buchbinder EI, Healy JA, Huang M, Morrissey M, Feldman I, Sehgal V, Robert-Tissot C, Hou P, Zhu L, Brown M, Aanur P, Meehan RS, Zaks T. Individualised neoantigen therapy mRNA-4157 (V940) plus pembrolizumab versus pembrolizumab monotherapy in resected melanoma (KEYNOTE-942): a randomised, phase 2b study. Lancet 2024; 403:632-644. [PMID: 38246194 DOI: 10.1016/s0140-6736(23)02268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/09/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Checkpoint inhibitors are standard adjuvant treatment for stage IIB-IV resected melanoma, but many patients recur. Our study aimed to evaluate whether mRNA-4157 (V940), a novel mRNA-based individualised neoantigen therapy, combined with pembrolizumab, improved recurrence-free survival and distant metastasis-free survival versus pembrolizumab monotherapy in resected high-risk melanoma. METHODS We did an open-label, randomised, phase 2b, adjuvant study of mRNA-4157 plus pembrolizumab versus pembrolizumab monotherapy in patients, enrolled from sites in the USA and Australia, with completely resected high-risk cutaneous melanoma. Patients with completely resected melanoma (stage IIIB-IV) were assigned 2:1 to receive open-label mRNA-4157 plus pembrolizumab or pembrolizumab monotherapy. mRNA-4157 was administered intramuscularly (maximum nine doses) and pembrolizumab intravenously (maximum 18 doses) in 3-week cycles. The primary endpoint was recurrence-free survival in the intention-to-treat population. This ongoing trial is registered at ClinicalTrials.gov, NCT03897881. FINDINGS From July 18, 2019, to Sept 30, 2021, 157 patients were assigned to mRNA-4157 plus pembrolizumab combination therapy (n=107) or pembrolizumab monotherapy (n=50); median follow-up was 23 months and 24 months, respectively. Recurrence-free survival was longer with combination versus monotherapy (hazard ratio [HR] for recurrence or death, 0·561 [95% CI 0·309-1·017]; two-sided p=0·053), with lower recurrence or death event rate (24 [22%] of 107 vs 20 [40%] of 50); 18-month recurrence-free survival was 79% (95% CI 69·0-85·6) versus 62% (46·9-74·3). Most treatment-related adverse events were grade 1-2. Grade ≥3 treatment-related adverse events occurred in 25% of patients in the combination group and 18% of patients in the monotherapy group, with no mRNA-4157-related grade 4-5 events. Immune-mediated adverse event frequency was similar for the combination (37 [36%]) and monotherapy (18 [36%]) groups. INTERPRETATION Adjuvant mRNA-4157 plus pembrolizumab prolonged recurrence-free survival versus pembrolizumab monotherapy in patients with resected high-risk melanoma and showed a manageable safety profile. These results provide evidence that an mRNA-based individualised neoantigen therapy might be beneficial in the adjuvant setting. FUNDING Moderna in collaboration with Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA.
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Affiliation(s)
- Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, NY, USA.
| | - Matteo S Carlino
- Westmead and Blacktown Hospitals, Melanoma Institute Australia, Sydney, NSW, Australia
| | - Adnan Khattak
- Hollywood Private Hospital, Perth, WA, Australia; Edith Cowan University, Perth, WA, Australia
| | - Tarek Meniawy
- Saint John of God Subiaco Hospital, Subiaco, WA, Australia
| | - George Ansstas
- Washington University School of Medicine, St Louis, MO, USA
| | - Matthew H Taylor
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | - Kevin B Kim
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Meredith McKean
- Sarah Cannon Research Institute at Tennessee Oncology, Nashville, TN, USA
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Ryan J Sullivan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Faries
- The Angeles Clinic and Research Institute, a Cedars-Sinai affiliate, Los Angeles, CA, USA
| | - Thuy T Tran
- Smilow Cancer Center at Yale New Haven Hospital, New Haven, CT, USA
| | | | - Andrew Pecora
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Montaser Shaheen
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | - Geoffrey T Gibney
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, Bolotin D, Bordeaux J, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Harms K, Ho AL, Lukens JN, Manber S, Mark L, Medina T, Nehal KS, Nghiem P, Olino K, Park S, Patel T, Puzanov I, Rich J, Sekulic A, Shaha AR, Srivastava D, Thomas V, Tomblinson C, Venkat P, Xu YG, Yu S, Yusuf M, McCullough B, Espinosa S. NCCN Guidelines® Insights: Merkel Cell Carcinoma, Version 1.2024. J Natl Compr Canc Netw 2024; 22:e240002. [PMID: 38244274 DOI: 10.6004/jnccn.2024.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
The NCCN Guidelines for Merkel Cell Carcinoma (MCC) provide recommendations for diagnostic workup, clinical stage, and treatment options for patients. The panel meets annually to discuss updates to the guidelines based on comments from expert review from panel members, institutional review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new page for locally advanced disease in the setting of clinical node negative status, entitled "Clinical N0 Disease, Locally Advanced MCC." This new algorithm page addresses locally advanced disease, and the panel clarifies the meaning behind the term "nonsurgical" by further defining locally advanced disease. In addition, the guideline includes the management of in-transit disease and updates to the systemic therapy options.
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Affiliation(s)
| | | | | | - Murad Alam
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Kristin Bibee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Jeremy Bordeaux
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Carlo M Contreras
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | - Alan L Ho
- Memorial Sloan Kettering Cancer Center
| | | | | | - Lawrence Mark
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | - Soo Park
- UC San Diego Moores Cancer Center
| | - Tejesh Patel
- The University of Tennessee Health Science Center
| | | | - Jason Rich
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington UniversitySchool of Medicine
| | | | | | | | | | | | | | | | - Siegrid Yu
- UCSF Helen Diller Family Comprehensive Cancer Center
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3
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, Bordeaux J, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Harms K, Ho AL, Lukens JN, Mark L, Medina T, Nehal KS, Nghiem P, Olino K, Park S, Patel T, Puzanov I, Rich J, Sekulic A, Shaha AR, Srivastava D, Thomas V, Tomblinson C, Venkat P, Xu YG, Yu S, Yusuf M, McCullough B, Espinosa S. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1181-1203. [PMID: 37935106 DOI: 10.6004/jnccn.2023.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Basal cell carcinoma (BCC) is the most common form of skin cancer in the United States. Due to the high frequency, BCC occurrences are not typically recorded, and annual rates of incidence can only be estimated. Current estimated rates are 2 million Americans affected annually, and this continues to rise. Exposure to radiation, from either sunlight or previous medical therapy, is a key player in BCC development. BCC is not as aggressive as other skin cancers because it is less likely to metastasize. However, surgery and radiation are prevalent treatment options, therefore disfigurement and limitation of function are significant considerations. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) outline an updated risk stratification and treatment options available for BCC.
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Affiliation(s)
| | | | | | - Murad Alam
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Kristin Bibee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Jeremy Bordeaux
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Carlo M Contreras
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | - Alan L Ho
- Memorial Sloan Kettering Cancer Center
| | | | - Lawrence Mark
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | - Soo Park
- UC San Diego Moores Cancer Center
| | | | | | - Jason Rich
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | | | - Siegrid Yu
- UCSF Helen Diller Family Comprehensive Cancer Center
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Luke JJ, Piha-Paul SA, Medina T, Verschraegen CF, Varterasian M, Brennan AM, Riese RJ, Sokolovska A, Strauss J, Hava DL, Janku F. Phase I Study of SYNB1891, an Engineered E. coli Nissle Strain Expressing STING Agonist, with and without Atezolizumab in Advanced Malignancies. Clin Cancer Res 2023; 29:2435-2444. [PMID: 37227176 DOI: 10.1158/1078-0432.ccr-23-0118] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 01/14/2023] [Revised: 03/18/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE SYNB1891 is a live, modified strain of the probiotic Escherichia coli Nissle 1917 (EcN) engineered to produce cyclic dinucleotides under hypoxia, leading to STimulator of INterferon Genes (STING) activation in phagocytic antigen-presenting cells in tumors and activating complementary innate immune pathways. PATIENTS AND METHODS This first-in-human study (NCT04167137) enrolled participants with refractory advanced cancers to receive repeat intratumoral injections of SYNB1891 either alone or in combination with atezolizumab, with the primary objective of evaluating the safety and tolerability of both regimens. RESULTS Twenty-four participants received monotherapy across six cohorts, and 8 participants received combination therapy in two cohorts. Five cytokine release syndrome events occurred with monotherapy, including one that met the criteria for dose-limiting toxicity at the highest dose; no other SYNB1891-related serious adverse events occurred, and no SYNB1891-related infections were observed. SYNB1891 was not detected in the blood at 6 or 24 hours after the first intratumoral dose or in tumor tissue 7 days following the first dose. Treatment with SYNB1891 resulted in activation of the STING pathway and target engagement as assessed by upregulation of IFN-stimulated genes, chemokines/cytokines, and T-cell response genes in core biopsies obtained predose and 7 days following the third weekly dose. In addition, a dose-related increase in serum cytokines was observed, as well as stable disease in 4 participants refractory to prior PD-1/L1 antibodies. CONCLUSIONS Repeat intratumoral injection of SYNB1891 as monotherapy and in combination with atezolizumab was safe and well tolerated, and evidence of STING pathway target engagement was observed.
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Affiliation(s)
- Jason J Luke
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | - Theresa Medina
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | | | | | | | | - Filip Janku
- University of Texas, MD Anderson Cancer Center, Houston, Texas
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Rasco DW, Medina T, Corrie P, Pavlick AC, Middleton MR, Lorigan P, Hebert C, Plummer R, Larkin J, Agarwala SS, Daud AI, Qiu J, Bozon V, Kneissl M, Barry E, Olszanski AJ. Phase 1 study of the pan-RAF inhibitor tovorafenib in patients with advanced solid tumors followed by dose expansion in patients with metastatic melanoma. Cancer Chemother Pharmacol 2023; 92:15-28. [PMID: 37219686 PMCID: PMC10261210 DOI: 10.1007/s00280-023-04544-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/13/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Genomic alterations of BRAF and NRAS are oncogenic drivers in malignant melanoma and other solid tumors. Tovorafenib is an investigational, oral, selective, CNS-penetrant, small molecule, type II pan‑RAF inhibitor. This first-in-human phase 1 study explored the safety and antitumor activity of tovorafenib. METHODS This two-part study in adult patients with relapsed or refractory advanced solid tumors included a dose escalation phase and a dose expansion phase including molecularly defined cohorts of patients with melanoma. Primary objectives were to evaluate the safety of tovorafenib administered once every other day (Q2D) or once weekly (QW), and to determine the maximum-tolerated and recommended phase 2 dose (RP2D) on these schedules. Secondary objectives included evaluation of antitumor activity and tovorafenib pharmacokinetics. RESULTS Tovorafenib was administered to 149 patients (Q2D n = 110, QW n = 39). The RP2D of tovorafenib was defined as 200 mg Q2D or 600 mg QW. In the dose expansion phase, 58 (73%) of 80 patients in Q2D cohorts and 9 (47%) of 19 in the QW cohort had grade ≥ 3 adverse events. The most common of these overall were anemia (14 patients, 14%) and maculo-papular rash (8 patients, 8%). Responses were seen in 10 (15%) of 68 evaluable patients in the Q2D expansion phase, including in 8 of 16 (50%) patients with BRAF mutation-positive melanoma naïve to RAF and MEK inhibitors. In the QW dose expansion phase, there were no responses in 17 evaluable patients with NRAS mutation-positive melanoma naïve to RAF and MEK inhibitors; 9 patients (53%) had a best response of stable disease. QW dose administration was associated with minimal accumulation of tovorafenib in systemic circulation in the dose range of 400-800 mg. CONCLUSIONS The safety profile of both schedules was acceptable, with QW dosing at the RP2D of 600 mg QW preferred for future clinical studies. Antitumor activity of tovorafenib in BRAF-mutated melanoma was promising and justifies continued clinical development across multiple settings. CLINICALTRIALS GOV IDENTIFIER NCT01425008.
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Affiliation(s)
- Drew W Rasco
- South Texas Accelerated Research Therapeutics, LLC, San Antonio, TX, USA
| | | | - Pippa Corrie
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anna C Pavlick
- Laura & Isaac Perlmutter Cancer Center at NYU Langone, New York, NY, USA
| | - Mark R Middleton
- Department of Oncology, NIHR Biomedical Research Centre, Oxford, UK
| | - Paul Lorigan
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Chris Hebert
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - Ruth Plummer
- The Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - Adil I Daud
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Jiaheng Qiu
- Day One Biopharmaceuticals, 2000 Sierra Point Parkway, Suite 501, Brisbane, CA, 94005, USA
| | - Viviana Bozon
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Michelle Kneissl
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Elly Barry
- Day One Biopharmaceuticals, 2000 Sierra Point Parkway, Suite 501, Brisbane, CA, 94005, USA.
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Gilbert D, Hu J, Medina T, Kessler ER, Lam ET. Safety of COVID-19 vaccines in subjects with solid tumor cancers receiving immune checkpoint inhibitors. Hum Vaccin Immunother 2023:2207438. [PMID: 37157982 PMCID: PMC10294768 DOI: 10.1080/21645515.2023.2207438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The incidence of severe immune-related adverse events (irAEs) in cancer subjects receiving immune checkpoint inhibitors (ICIs) following COVID-19 vaccination and the relationship between the incidence of severe irAE and the interval between COVID-19 vaccination and ICI dose have not been established. We performed a retrospective study evaluating the incidence of irAEs in solid tumor subjects receiving ICI therapy who received any COVID-19 vaccinations since FDA authorization. irAEs were defined as severe with one or more grade 3 or above events (CTCAE v5.0), multiple organ involvement, or requiring hospitalization for management. Two hundred and eighty-four subjects who received COVID vaccinations from December 2020 and February 2022 were included in this analysis [median age at vaccination 67 years (IQR 59.0-75.0); 67.3% male]. Twenty-nine subjects (10.2%) developed severe irAEs, of which 12 subjects (41.4%) received ICI monotherapy, 10 subjects (34.5%) received combination ICI therapy with nivolumab and ipilimumab, and 7 subjects (24.1%) received ICI plus VEGFR-TKI therapy. Hospitalization occurred in 62% of subjects with severe irAEs, with a median duration of 3 days (IQR: 3.0-7.5 days). Immunosuppressive therapy was required in 79.3%, with a median duration of 103 days (IQR: 42.0-179.0). ICI therapy was discontinued in 51.7% of subjects with severe irAE; dosing was held or interrupted in 34.5%. Among severe irAEs, the median interval between vaccination and ICI treatment closest to the occurrence of severe irAE was 15.5 days (IQR: 10.0-23.0). In solid tumor cancer subjects receiving ICIs, COVID-19 vaccination is not associated with an increased incidence of severe irAEs compared to historical data and may be safely administered during ICI cancer therapy in subjects who lack contraindications.
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Affiliation(s)
- Danielle Gilbert
- Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, University of Anschutz Medical Campus, Aurora, CO, USA
| | - Junxiao Hu
- Department of Biostatistics, University of Colorado Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Theresa Medina
- Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, University of Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth R Kessler
- Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, University of Anschutz Medical Campus, Aurora, CO, USA
| | - Elaine T Lam
- Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, University of Anschutz Medical Campus, Aurora, CO, USA
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Sarnaik A, Chesney J, Medina T, Hamid O, Thomas S, Wermke M, Gontcharova V, Damirchi B, Dean J, Mastellar E, Wu X, Shi W, Kluger H. Response to Lifileucel Tumor-Infiltrating Lymphocyte (TIL) Cell Therapy after ICI Resistance Regardless of Definition: An Analysis of the C-144-01 Trial in Patients with Advanced Melanoma. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00359-7] [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: 02/07/2023]
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Chesney J, Lewis KD, Kluger H, Hamid O, Whitman E, Thomas S, Wermke M, Cusnir M, Domingo-Musibay E, Phan GQ, Kirkwood JM, Hassel JC, Orloff M, Larkin J, Weber J, Furness AJS, Khushalani NI, Medina T, Egger ME, Graf Finckenstein F, Jagasia M, Hari P, Sulur G, Shi W, Wu X, Sarnaik A. Efficacy and safety of lifileucel, a one-time autologous tumor-infiltrating lymphocyte (TIL) cell therapy, in patients with advanced melanoma after progression on immune checkpoint inhibitors and targeted therapies: pooled analysis of consecutive cohorts of the C-144-01 study. J Immunother Cancer 2022; 10:jitc-2022-005755. [PMID: 36600653 PMCID: PMC9748991 DOI: 10.1136/jitc-2022-005755] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 11/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with advanced melanoma have limited treatment options after progression on immune checkpoint inhibitors (ICI). Lifileucel, a one-time autologous tumor-infiltrating lymphocyte (TIL) cell therapy, demonstrated an investigator-assessed objective response rate (ORR) of 36% in 66 patients who progressed after ICI and targeted therapy. Herein, we report independent review committee (IRC)-assessed outcomes of 153 patients treated with lifileucel in a large multicenter Phase 2 cell therapy trial in melanoma. METHODS Eligible patients had advanced melanoma that progressed after ICI and targeted therapy, where appropriate. Melanoma lesions were resected (resected tumor diameter ≥1.5 cm) and shipped to a central good manufacturing practice facility for 22-day lifileucel manufacturing. Patients received a non-myeloablative lymphodepletion regimen, a single lifileucel infusion, and up to six doses of high-dose interleukin-2. The primary endpoint was IRC-assessed ORR (Response Evaluation Criteria in Solid Tumors V.1.1). RESULTS The Full Analysis Set consisted of 153 patients treated with lifileucel, including longer-term follow-up on the 66 patients previously reported. Patients had received a median of 3.0 lines of prior therapy (81.7% received both anti-programmed cell death protein 1 and anti-cytotoxic lymphocyte-associated protein 4) and had high disease burden at baseline (median target lesion sum of diameters (SOD): 97.8 mm; lactate dehydrogenase (LDH) >upper limit of normal: 54.2%). ORR was 31.4% (95% CI: 24.1% to 39.4%), with 8 complete responses and 40 partial responses. Median duration of response was not reached at a median study follow-up of 27.6 months, with 41.7% of the responses maintained for ≥18 months. Median overall survival and progression-free survival were 13.9 and 4.1 months, respectively. Multivariable analyses adjusted for Eastern Cooperative Oncology Group performance status demonstrated that elevated LDH and target lesion SOD >median were independently correlated with ORR (p=0.008); patients with normal LDH and SOD <median had greater likelihood of response than those with either (OR=2.08) or both (OR=4.42) risk factors. The most common grade 3/4 treatment-emergent adverse events (≥30%) were thrombocytopenia (76.9%), anemia (50.0%), and febrile neutropenia (41.7%). CONCLUSIONS Investigational lifileucel demonstrated clinically meaningful activity in heavily pretreated patients with advanced melanoma and high tumor burden. Durable responses and a favorable safety profile support the potential benefit of one-time lifileucel TIL cell therapy in patients with limited treatment options in ICI-refractory disease.
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Affiliation(s)
- Jason Chesney
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Karl D Lewis
- Medical Oncology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Harriet Kluger
- Medical Oncology, Hematology & Oncology, Melanoma and Onco-Dermatology, Genitourinary Oncology, Yale New Haven Health Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Omid Hamid
- Hematology Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | - Eric Whitman
- Atlantic Health System Cancer Care, Morristown, New Jersey, USA
| | - Sajeve Thomas
- Hematology and Oncology, Orlando Health Cancer Institute, Orlando, Florida, USA
| | - Martin Wermke
- Technische Universität Dresden - NCT/UCC Early Clinical Trial Unit, Dresden, Sachsen, Germany
| | - Mike Cusnir
- Division of Hematology & Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Evidio Domingo-Musibay
- Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giao Q Phan
- Surgery, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia, USA
| | - John M Kirkwood
- Medicine, Dermatology and Translational Science, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica C Hassel
- Skin Cancer Center, Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Marlana Orloff
- Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeffrey Weber
- Department of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | | | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Theresa Medina
- Medical Oncology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael E Egger
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | - Madan Jagasia
- Iovance Biotherapeutics Inc, San Carlos, California, USA
| | | | - Giri Sulur
- Iovance Biotherapeutics Inc, San Carlos, California, USA
| | - Wen Shi
- Iovance Biotherapeutics Inc, San Carlos, California, USA
| | - Xiao Wu
- Iovance Biotherapeutics Inc, San Carlos, California, USA
| | - Amod Sarnaik
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center, Tampa, Florida, USA
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Hassel J, Sarnaik A, Chesney J, Medina T, Hamid O, Thomas S, Wermke M, Domingo-Musibay E, Kirkwood J, Larkin J, Weber J, Arance Fernandez A, Rodriguez J, Thomas I, Corrie P, Gontcharova V, Wu X, Shi W, Kluger H. 35MO Number of IL-2 doses and clinical outcomes of tumor-infiltrating lymphocyte (TIL) cell therapy: Post hoc analysis of the C-144-01 trial of lifileucel in patients with advanced melanoma. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Thompson JA, Schneider BJ, Brahmer J, Achufusi A, Armand P, Berkenstock MK, Bhatia S, Budde LE, Chokshi S, Davies M, Elshoury A, Gesthalter Y, Hegde A, Jain M, Kaffenberger BH, Lechner MG, Li T, Marr A, McGettigan S, McPherson J, Medina T, Mohindra NA, Olszanski AJ, Oluwole O, Patel SP, Patil P, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wang Y, Zaha VG, Lyons M, Dwyer M, Hang L. Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:387-405. [PMID: 35390769 DOI: 10.6004/jnccn.2022.0020] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions, consisting of medical and hematologic oncologists with expertise across a wide range of disease sites, and experts from the areas of dermatology, gastroenterology, endocrinology, neurooncology, nephrology, cardio-oncology, ophthalmology, pulmonary medicine, and oncology nursing. The content featured in this issue is an excerpt of the recommendations for managing toxicities related to CAR T-cell therapies and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to immune checkpoint inhibitors, visit NCCN.org.
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Affiliation(s)
- John A Thompson
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Saurin Chokshi
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Benjamin H Kaffenberger
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Nisha A Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Pradnya Patil
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Vlad G Zaha
- UT Southwestern Simmons Comprehensive Cancer Center; and
| | | | | | - Lisa Hang
- National Comprehensive Cancer Network
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11
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Andersen JS, Baumann BC, Bordeaux J, Chen PL, Chin R, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Grekin RC, Harms K, Ho AL, Holder A, Lukens JN, Medina T, Nehal KS, Nghiem P, Park S, Patel T, Puzanov I, Scott J, Sekulic A, Shaha AR, Srivastava D, Stebbins W, Thomas V, Xu YG, McCullough B, Dwyer MA, Nguyen MQ. NCCN Guidelines® Insights: Squamous Cell Skin Cancer, Version 1.2022. J Natl Compr Canc Netw 2021; 19:1382-1394. [PMID: 34902824 DOI: 10.6004/jnccn.2021.0059] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Squamous Cell Skin Cancer provide recommendations for diagnostic workup, clinical stage, and treatment options for patients with cutaneous squamous cell carcinoma. The NCCN panel meets annually to discuss updates to the guidelines based on comments from panel members and the Institutional Review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new surgical recommendation terminology (peripheral and deep en face margin assessment), as well as recent updates on topical prophylaxis, immunotherapy for regional and metastatic disease, and radiation therapy.
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Affiliation(s)
| | | | | | - Murad Alam
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Brian C Baumann
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Jeremy Bordeaux
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Carlo M Contreras
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Roy C Grekin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Alan L Ho
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | - Paul Nghiem
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Soo Park
- UC San Diego Moores Cancer Center
| | - Tejesh Patel
- St. Jude Children's Research Hospital/University of Tennessee Health Science Center
| | | | - Jeffrey Scott
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Yaohui G Xu
- University of Wisconsin Carbone Cancer Center; and
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12
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Kirkwood J, Zakharia Y, Davar D, Buchbinder E, Medina T, Daud A, Ribas A, Chmielowski B, Niu J, Gibney G, Margolin K, Olszanski A, Mehmi I, Sato T, Shaheen M, Zhao L, Liu H, Kelley H, Weiner G, Luke J, Bobilev D, Krieg A, Wooldridge J, Milhem M. 950 Final analysis: phase 1b study investigating intratumoral injection of toll-like receptor 9 agonist vidutolimod ± pembrolizumab in patients with PD-1 blockade–refractory melanoma. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
BackgroundThere are limited therapeutic options for patients with progressive disease (PD) on or after PD-1–blocking antibody therapy. Vidutolimod (CMP-001) is a first-in-class, immunostimulatory virus-like particle containing a CpG-A Toll-like receptor 9 (TLR9) agonist. This phase 1b study evaluated the safety and clinical activity of intratumoral vidutolimod with and without pembrolizumab in patients with refractory melanoma.MethodsThis two-part, open-label, multicenter, phase 1b study (NCT02680184) enrolled adults with histologically confirmed metastatic or unresectable cutaneous melanoma who had stable disease after ≥12 weeks or PD on anti−PD-1 treatment, measurable disease per RECIST v1.1, ECOG PS 0/1, and ≥1 lesion accessible for intratumoral injection. Part 1 evaluated vidutolimod + pembrolizumab and Part 2 evaluated vidutolimod monotherapy. Key objectives included assessment of safety and clinical activity, and exploratory analyses were performed on available tumor biopsies using immunohistochemistry and RNAseq.ResultsAt data cutoff (August 17, 2021), 159 patients had enrolled in Part 1 and 40 patients in Part 2. The median age was 64 years in Part 1 (range, 30-90) and 68 years in Part 2 (range, 30-89). Most patients had PD as their last response to prior anti–PD-1 therapy (Part 1, 93.1%; Part 2, 80.0%). Grade 3/4 treatment-related adverse events (TRAEs) occurred in 37.1% of patients treated with vidutolimod + pembrolizumab and in 22.5% of patients treated with vidutolimod monotherapy. No treatment-related deaths occurred. Based on the efficacy data presented in Table 1, vidutolimod polysorbate 20 (PS20) A was selected for further development as this formulation in combination with pembrolizumab had a best objective response rate (ORR; RECIST v1.1) of 23.5%, with a median duration of response (DOR) of 25.2 months. Vidutolimod monotherapy had an ORR of 20.0%, with a median DOR of 5.6 months. Exploratory translational analyses identified association of unique biomarkers with response among patients with T cell–inflamed versus non-T cell–inflamed tumors at baseline.Abstract 950 Table 1Safety and clinical activity of vidutolomod ± pembrolizumabConclusionsPromising clinical activity was observed with vidutolimod + pembrolizumab and vidutolimod monotherapy in patients with PD-1 blockade–refractory melanoma. A manageable safety profile was observed. The DOR with vidutolimod + pembrolizumab was substantially longer than with vidutolimod monotherapy. Clinical studies to confirm the efficacy of vidutolimod + PD-1 blockade in patients with previously untreated unresectable/metastatic melanoma (phase 2/3, NCT04695977) or PD-1 blockade–refractory melanoma (phase 2, NCT04698187) are ongoing.AcknowledgementsThis work was supported by Checkmate Pharmaceuticals. Medical writing assistance was provided by Steffen Biechele, PhD (ApotheCom, San Francisco, CA, USA), and funded by Checkmate Pharmaceuticals.Trial RegistrationNCT02680184Ethics ApprovalThis study was approved by the WCG-WIRB; WIRB approval tracking number: 20152597.
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13
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Kondapalli L, Medina T, Groves DW. Practical cardiovascular imaging approach to diagnose immune checkpoint inhibitor myocarditis. Eur Heart J Cardiovasc Imaging 2021; 22:372-374. [PMID: 33367684 DOI: 10.1093/ehjci/jeaa340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Immuno-oncology employs various therapeutic strategies that harness a patient's own immune system to fight disease and has been a promising new strategy for cancer therapy over the last decade. Immune checkpoint inhibitors (ICI), are monoclonal antibodies, that increase antitumor immunity by blocking intrinsic down-regulators of immunity, such as cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1). Seven ICIs are currently approved by the Food and Drug Administration and have increased the overall survival for patients with various cancer subtypes. These are used either as single agents or in combination with other checkpoint inhibitors, small molecular kinase inhibitors or cytotoxic chemotherapies. There are also many other immune modifying agents including other checkpoint inhibitor antibodies that are under investigation in clinical trials.
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Affiliation(s)
- Lavanya Kondapalli
- Division of Cardiology, Department of Medicine, University of Colorado, 12631 E. 17th Avenue, Mail Stop B130, Aurora, CO, USA
| | - Theresa Medina
- Division of Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel W Groves
- Division of Cardiology, Department of Medicine, University of Colorado, 12631 E. 17th Avenue, Mail Stop B130, Aurora, CO, USA.,Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado, Aurora, CO, USA
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14
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Ribas A, Medina T, Kirkwood JM, Zakharia Y, Gonzalez R, Davar D, Chmielowski B, Campbell KM, Bao R, Kelley H, Morris A, Mauro D, Wooldridge JE, Luke JJ, Weiner GJ, Krieg AM, Milhem MM. Overcoming PD-1 Blockade Resistance With CpG-A Toll-Like Receptor 9 Agonist Vidutolimod in Patients With Metastatic Melanoma. Cancer Discov 2021; 11:2998-3007. [PMID: 34326162 DOI: 10.1158/2159-8290.cd-21-0425] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/09/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
Patients with advanced melanoma that is resistant to programmed death-1 (PD-1) blockade therapy have limited treatment options. Vidutolimod (formerly CMP-001), a virus-like particle containing a CpG-A Toll-like receptor 9 (TLR9) agonist, may reverse PD-1 blockade resistance by triggering a strong interferon response to induce and attract antitumor T cells. In the dose-escalation part of this phase 1b study, vidutolimod was administered intratumorally at escalating doses with intravenous pembrolizumab to 44 patients with advanced melanoma who had progressive disease or stable disease on prior anti-PD-1 therapy. The combination of vidutolimod and pembrolizumab had a manageable safety profile and durable responses were observed in 25% of patients, with tumor regression in both injected and noninjected lesions, including visceral lesions. Patients who responded to vidutolimod and pembrolizumab had noninflamed tumors at baseline and induction of an interferon-γ gene signature following treatment, as well as increased systemic expression of the interferon-inducible chemokine CXCL10.
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Affiliation(s)
- Antoni Ribas
- Department of Medicine, Jonsson Comprehensive Cancer Center at University of California, Los Angeles, Los Angeles
| | - Theresa Medina
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus
| | - John M Kirkwood
- Medicine; Division of Hematology/Oncology, University of Pittsburgh
| | - Yousef Zakharia
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics
| | - Rene Gonzalez
- Department of Medicine, University of Colorado Denver
| | - Diwakar Davar
- Division of Hematology-Oncology, University of Pittsburgh Medical Center
| | | | | | - Riyue Bao
- University of Pittsburgh Medical Center
| | | | | | | | | | - Jason J Luke
- Cancer Immunotherapeutics Center, University of Pittsburgh Medical Center
| | | | | | - Mohammed M Milhem
- Clinical Services, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine
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15
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Luke JJ, Bao R, Kirkwood JM, Zakharia Y, Davar D, Buchbinder E, Medina T, Daud A, Ribas A, Niu J, Gibney G, Margolin K, Olszanski AJ, Mehmi I, Sato T, Shaheen M, Morris A, Bobilev D, Campbell K, Weiner G, Wooldridge JE, Krieg AM, Milhem M. Abstract CT032: CMP-001 demonstrates improved response in noninflamed anti-PD-1 refractory melanoma and response is associated with serum CXCL10. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct032] [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
In the treatment-naive setting, PD-1 blockade is associated with greater response in T cell-inflamed vs non-T cell-inflamed tumors. CMP-001 is a CpG-A oligonucleotide TLR9 agonist in a virus-like particle that is hypothesized to activate tumor-associated plasmacytoid dendritic cells (pDCs) to secrete type I interferons. Through this activity, CMP-001 may convert the tumor microenvironment to a Th1-like chemokine milieu (eg, increased CXCL10) and induce an antitumor CD8+ T-cell response. We have recently reported that intratumoral injection of CMP-001 + IV pembrolizumab (pembro) had an acceptable safety profile and can reverse PD-1 blockade resistance in patients (pts) with melanoma (Milhem et al, SITC 2019). Regression was observed in injected and uninjected lesions. Herein we report pharmacodynamic and translational data.
Methods
This 2-part, open-label, multicenter, phase 1b study (NCT02680184) enrolled pts with metastatic/unresectable melanoma and stable disease (SD) or progressive disease (PD) on/after anti−PD-1 therapy. In part 1 (3+3 dose-escalation and dose-expansion), pts received CMP-001 + pembro. In part 2, pts received CMP-001 monotherapy. Determination of safety and clinical activity were the study's main objectives. Prespecified pharmacodynamic and translational studies evaluated serum chemokines and evaluated tumor biopsies using RNA and/or whole exome sequencing and immunohistochemistry for PD-L1 (reported as H-score), CD8, and CD303 (pDC marker).
Results
As of September 30, 2020, 159 pts (part 1) and 40 pts (part 2) have been treated. A greater median fold increase of serum CXCL10 (a marker of innate immunity, n=40) was observed in responders (R) to CMP-001 + pembro (18.8x) vs nonresponders (NR) after treatment (9.9x in SD; 6.15x in PD; differences were not statistically significant). Preliminary analyses showed that interferon gene expression distinguished R vs NR. Tumor biopsy analyses (part 1, n=139; part 2, n=34) showed that pts with high PD-L1, high CD8+ T cells, or inflamed transcriptional signatures at baseline were less likely to respond to CMP-001 + pembro vs pts without inflammation markers at baseline. Baseline mean PD-L1 expression (H-score) was 8.1 in R (n=10) vs 21.8 in NR (n=49). Posttreatment biopsies generally showed increased PD-L1, CD8+ T cells, and inflamed transcriptional signatures in R vs NR. Neither tumor mutational burden nor baseline pDC density distinguished R vs NR.
Conclusions
In pts with anti-PD-1 refractory melanoma, intratumoral CMP-001 ± pembro appears to disproportionately induce antitumor responses in noninflamed tumors. Clinical response to CMP-001 ± pembro was associated with induction of markers of both innate and adaptive antitumor immunity.
Citation Format: Jason John Luke, Riyue Bao, John M. Kirkwood, Yousef Zakharia, Diwakar Davar, Elizabeth Buchbinder, Theresa Medina, Adil Daud, Antoni Ribas, Jiaxin Niu, Geoffrey Gibney, Kim Margolin, Anthony J. Olszanski, Inderjit Mehmi, Takami Sato, Montaser Shaheen, Aaron Morris, Dmitri Bobilev, Katie Campbell, George Weiner, James E. Wooldridge, Arthur M. Krieg, Mohammed Milhem. CMP-001 demonstrates improved response in noninflamed anti-PD-1 refractory melanoma and response is associated with serum CXCL10 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT032.
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Affiliation(s)
| | - Riyue Bao
- 1University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Diwakar Davar
- 1University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Adil Daud
- 5University of California San Francisco, San Francisco, CA
| | - Antoni Ribas
- 6University of California Los Angeles, Los Angeles, CA
| | - Jiaxin Niu
- 7Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Geoffrey Gibney
- 8Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | - Inderjit Mehmi
- 11The Angeles Clinic and Research Institute, Los Angeles, CA
| | - Takami Sato
- 12Thomas Jefferson University, Philadelphia, PA
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16
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Sarnaik AA, Hamid O, Khushalani NI, Lewis KD, Medina T, Kluger HM, Thomas SS, Domingo-Musibay E, Pavlick AC, Whitman ED, Martin-Algarra S, Corrie P, Curti BD, Oláh J, Lutzky J, Weber JS, Larkin JMG, Shi W, Takamura T, Jagasia M, Qin H, Wu X, Chartier C, Graf Finckenstein F, Fardis M, Kirkwood JM, Chesney JA. Lifileucel, a Tumor-Infiltrating Lymphocyte Therapy, in Metastatic Melanoma. J Clin Oncol 2021; 39:2656-2666. [PMID: 33979178 PMCID: PMC8376325 DOI: 10.1200/jco.21.00612] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [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] [Indexed: 01/01/2023] Open
Abstract
Effective treatment options are limited for patients with advanced (metastatic or unresectable) melanoma who progress after immune checkpoint inhibitors and targeted therapies. Adoptive cell therapy using tumor-infiltrating lymphocytes has demonstrated efficacy in advanced melanoma. Lifileucel is an autologous, centrally manufactured tumor-infiltrating lymphocyte product.
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Affiliation(s)
| | - Omid Hamid
- The Angeles Clinic and Research Institute, A Cedars Sinai Affiliate, Los Angeles, CA
| | | | - Karl D Lewis
- University of Colorado Cancer Center-Anschutz Medical Campus, Aurora, CO
| | - Theresa Medina
- University of Colorado Cancer Center-Anschutz Medical Campus, Aurora, CO
| | - Harriet M Kluger
- Yale University School of Medicine, Smilow Cancer Center, New Haven Hospital, New Haven, CT
| | - Sajeve S Thomas
- University of Florida Health Cancer Center at Orlando Health, Orlando, FL
| | - Evidio Domingo-Musibay
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Anna C Pavlick
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | | | | | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust-Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Brendan D Curti
- Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR
| | - Judit Oláh
- University of Szeged-Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami, FL
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | | | - Wen Shi
- Iovance Biotherapeutics Inc, San Carlos, CA
| | | | | | - Harry Qin
- Iovance Biotherapeutics Inc, San Carlos, CA
| | - Xiao Wu
- Iovance Biotherapeutics Inc, San Carlos, CA
| | | | | | | | - John M Kirkwood
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jason A Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
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17
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Morton JJ, Alzofon N, Keysar SB, Chimed TS, Reisinger J, Perrenoud L, Le PN, Nieto C, Gomez K, Miller B, Yeager R, Gao D, Tan AC, Somerset H, Medina T, Wang XJ, Wang JH, Robinson W, Roop DR, Gonzalez R, Jimeno A. Studying Immunotherapy Resistance in a Melanoma Autologous Humanized Mouse Xenograft. Mol Cancer Res 2020; 19:346-357. [PMID: 33087417 DOI: 10.1158/1541-7786.mcr-20-0686] [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] [Received: 08/05/2020] [Revised: 09/08/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022]
Abstract
Resistance to immunotherapy is a significant challenge, and the scarcity of human models hinders the identification of the underlying mechanisms. To address this limitation, we constructed an autologous humanized mouse (aHM) model with hematopoietic stem and progenitor cells (HSPC) and tumors from 2 melanoma patients progressing to immunotherapy. Unlike mismatched humanized mouse (mHM) models, generated from cord blood-derived HSPCs and tumors from different donors, the aHM recapitulates a patient-specific tumor microenvironment (TME). When patient tumors were implanted on aHM, mHM, and NOD/SCID/IL2rg-/- (NSG) cohorts, tumors appeared earlier and grew faster on NSG and mHM cohorts. We observed that immune cells differentiating in the aHM were relatively more capable of circulating peripherally, invading into tumors and interacting with the TME. A heterologous, human leukocyte antigen (HLA-A) matched cohort also yielded slower growing tumors than non-HLA-matched mHM, indicating that a less permissive immune environment inhibits tumor progression. When the aHM, mHM, and NSG cohorts were treated with immunotherapies mirroring what the originating patients received, tumor growth in the aHM accelerated, similar to the progression observed in the patients. This rapid growth was associated with decreased immune cell infiltration, reduced interferon gamma (IFNγ)-related gene expression, and a reduction in STAT3 phosphorylation, events that were replicated in vitro using tumor-derived cell lines. IMPLICATIONS: Engrafted adult HSPCs give rise to more tumor infiltrative immune cells, increased HLA matching leads to slower tumor initiation and growth, and continuing immunotherapy past progression can paradoxically lead to increased growth.
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Affiliation(s)
- J Jason Morton
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Nathaniel Alzofon
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen B Keysar
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Tugs-Saikhan Chimed
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie Reisinger
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Loni Perrenoud
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Phuong N Le
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Cera Nieto
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Karina Gomez
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Bettina Miller
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Randi Yeager
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Dexiang Gao
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado
| | - Aik-Choon Tan
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado
| | - Hilary Somerset
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Theresa Medina
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Xiao-Jing Wang
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado.,Charles C. Gates Center for Regenerative Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Jing H Wang
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado
| | - William Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Dennis R Roop
- Charles C. Gates Center for Regenerative Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Rene Gonzalez
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. .,Charles C. Gates Center for Regenerative Medicine, University of Colorado School of Medicine, Aurora, Colorado
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18
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Newell F, Wilmott JS, Johansson PA, Nones K, Addala V, Mukhopadhyay P, Broit N, Amato CM, Van Gulick R, Kazakoff SH, Patch AM, Koufariotis LT, Lakis V, Leonard C, Wood S, Holmes O, Xu Q, Lewis K, Medina T, Gonzalez R, Saw RPM, Spillane AJ, Stretch JR, Rawson RV, Ferguson PM, Dodds TJ, Thompson JF, Long GV, Levesque MP, Robinson WA, Pearson JV, Mann GJ, Scolyer RA, Waddell N, Hayward NK. Whole-genome sequencing of acral melanoma reveals genomic complexity and diversity. Nat Commun 2020; 11:5259. [PMID: 33067454 PMCID: PMC7567804 DOI: 10.1038/s41467-020-18988-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [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: 03/31/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
To increase understanding of the genomic landscape of acral melanoma, a rare form of melanoma occurring on palms, soles or nail beds, whole genome sequencing of 87 tumors with matching transcriptome sequencing for 63 tumors was performed. Here we report that mutational signature analysis reveals a subset of tumors, mostly subungual, with an ultraviolet radiation signature. Significantly mutated genes are BRAF, NRAS, NF1, NOTCH2, PTEN and TYRP1. Mutations and amplification of KIT are also common. Structural rearrangement and copy number signatures show that whole genome duplication, aneuploidy and complex rearrangements are common. Complex rearrangements occur recurrently and are associated with amplification of TERT, CDK4, MDM2, CCND1, PAK1 and GAB2, indicating potential therapeutic options.
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Affiliation(s)
- Felicity Newell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | - Katia Nones
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Venkateswar Addala
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Natasa Broit
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carol M Amato
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Robert Van Gulick
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Ann-Marie Patch
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Vanessa Lakis
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Oliver Holmes
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Qinying Xu
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karl Lewis
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Theresa Medina
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Rene Gonzalez
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- New South Wales Health Pathology, Sydney, NSW, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- New South Wales Health Pathology, Sydney, NSW, Australia
| | - Tristan J Dodds
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Mitchell P Levesque
- Dermatology Clinic, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - William A Robinson
- Center for Rare Melanomas, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- New South Wales Health Pathology, Sydney, NSW, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Milhem M, Zakharia Y, Davar D, Buchbinder E, Medina T, Daud A, Ribas A, Niu J, Gibney G, Margolin K, Olszanski A, Mehmi I, Sato T, Shaheen M, Morris A, Mauro D, Campbell K, Bao R, Weiner G, Luke J, Krieg A, Kirkwood J. O85 Durable responses in anti-PD-1 refractory melanoma following intratumoral injection of a toll-like receptor 9 (TLR9) agonist, CMP-001, in combination with pembrolizumab. J Immunother Cancer 2020. [DOI: 10.1136/lba2019.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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
BackgroundIntratumoral (IT) injection of CMP-001, a CpG-A TLR9 agonist packaged within a virus-like particle, is designed to activate tumor-associated plasmacytoid dendritic cells, inducing an interferon-rich tumor microenvironment and anti-tumor CD8+ T cell responses.MethodsCMP-001-001 is an ongoing Phase 1b trial evaluating the safety and efficacy of CMP-001 in combination with pembrolizumab (Part 1; N = 144) or alone (Part 2; N = 23) in patients with advanced melanoma resistant to prior anti-PD-1 therapy (Tables 1). CMP-001 is administered IT into accessible lesion(s) either with, or without on-site saline dilution (table 1), and response assessed by RECIST v1.1. Monotherapy patients who progress can be rolled over onto combination therapy and continue on study. Baseline and on-therapy serum is analyzed for cytokines, and immunohistochemistry and RNA-Seq are performed on available tumor biopsies.Abstract O85 Table 1Advanced anti-PD-1 Refractory melanoma patient population by treatment allocationResultsAdverse events (AEs) attributed to CMP-001 in combination with pembrolizumab or as monotherapy consisted predominately of transient low-Grade flu-like symptoms and injection site reactions: Grade 3+ related AEs were reported in 33% of patients treated with combination therapy and 22% of patients with monotherapy.The Objective Response Rate (ORR) with undiluted CMP-001 in combination with pembrolizumab was 24% (18/75; 95% confidence interval: 15%-35% (table 1); on-site dilution of CMP-001 was associated with a substantial decrease in ORR to 12% (7/61; 95% confidence interval: 5%-22% (table 1). Three additional patients had a delayed partial response after an initial period of disease progression. Anti-tumor response was comparable between injected and uninjected lesions. The median duration of response to combination therapy has not been reached. The ORR to CMP-001 monotherapy was 22% (5/23; 95% confidence interval: 7%-44% (table 1); time from last anti-PD-1 therapy before CMP-001 was 1.5 to >20 months in responders; 3 of the patients responding to CMP-001 monotherapy achieved PR at the first evaluation, but progressed by the second evaluation.Serum and tumor biopsy translational studies in the patients receiving combination therapy supported the proposed mechanism of TLR9 activation and identified a possible association between induction of serum CXCL10 and response.ConclusionsIT CMP-001 alone and in combination with pembrolizumab appears well tolerated, can reverse resistance to anti-PD-1 therapy, and can produce deep and durable clinical responses in patients with advanced melanoma.Ethics ApprovalCMP-001-001 was centrally approved by the WCG-WIRB, WIRB approval tracking number 20152597.
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20
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Carmichael H, King BBT, Friedman C, Torphy RJ, Medina T, Gleisner A, McCarter MD, Kwak JJ, Kounalakis N. Frequency and implications of occipital and posterior auricular sentinel lymph nodes in scalp melanoma. J Surg Oncol 2019; 120:1470-1475. [PMID: 31614003 DOI: 10.1002/jso.25715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/30/2019] [Accepted: 09/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with scalp melanoma have poor oncologic outcomes compared with those with other cutaneous sites. Sentinel lymph node (SLN) biopsy provides prognostic information but is challenging in the head and neck. We explore the anatomic distribution of scalp melanoma and describe the most common sites of SLN drainage and of SLN metastatic disease. METHODS Retrospective review of scalp melanoma patients who underwent SLN biopsy. Melanoma location was classified as frontal, coronal apex, coronal temporal, or posterior scalp. SLN location was classified by lymph node level and region. RESULTS We identified 128 patients with scalp melanoma. The most common primary tumor location was the posterior scalp (43%) and the most frequent SLN drainage site was the level 2 lymph node basin (48%). Total 31 patients (24%) had metastatic disease in an SLN. Scalp SLNs, classified as being in the posterior auricular or occipital region, were localized in 26% of patients. For patients in which a scalp SLN was identified, 30% had a positive scalp SLN (n = 10). CONCLUSIONS Scalp SLNs are frequent drainage sites for scalp melanoma and, when found, have a 30% chance of harboring metastatic disease. Surgeons, radiologists, and pathologists should be vigilant in identifying, removing, and analyzing scalp SLNs.
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Affiliation(s)
| | - Becky B T King
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Chloe Friedman
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Robert J Torphy
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Theresa Medina
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Ana Gleisner
- Department of Surgery, University of Colorado, Aurora, Colorado
| | | | - Jennifer J Kwak
- Department of Radiology-Nuclear Medicine, University of Colorado, Aurora, Colorado
| | - Nicole Kounalakis
- Melanoma and Sarcoma Specialists of Georgia, Northside Hospital, Atlanta, Georgia
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21
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Sandhu S, Atkinson V, Cao MG, Medina T, Rivas AS, Caro I, Roberts L, Song Y, Yan Y, Long G. Interim analysis of a phase Ib study of cobimetinib plus atezolizumab in patients with advanced BRAFV600 wild type melanoma progressing on prior anti-PD-L1 therapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Guidry J, Brown M, Medina T. PD-1 inhibitor induced alopecia areata. Dermatol Online J 2018; 24:13030/qt2vj8b7cv. [PMID: 30677804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023] Open
Abstract
Immune checkpoint modulators are becoming more prevalent in clinical use for the treatment of metastatic melanoma and other malignancies. These drugs, including programmed death 1 (PD-1) inhibitors, have a high incidence of immune adverse events, including cutaneous manifestations. Alopecia is a known side effect with these drugs, but previous reports describe chemotherapy-induced alopecia. We report a case of alopecia areata in a patient on monotherapy with pembrolizumab (PD-1 inhibitor). It is important for the dermatologist to recognize and appropriately treat to decrease morbidity for these patients.
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Affiliation(s)
| | | | - Theresa Medina
- Division of Cutaneous Oncology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
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23
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Long G, Milhem M, Amin A, Hoimes C, Medina T, Conry R, Lao C, Daniels G, Reddy S, Mehmi I, Andtbacka R, Barve M, Shaheen M, Tueting T, Chisamore M, Xing B, Candia A, Gamelin E, Janssen R, Ribas A. Phase Ib/II, open label, multicenter, study of the combination of SD-101 and pembrolizumab in patients with advanced melanoma who are naïve to anti-PD-1 therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Ribas A, Mehmi I, Medina T, Lao C, Kummar S, Amin A, Deva S, Salama A, Tueting T, Milhem M, Hoimes C, Daniels G, Shaheen M, Jang S, Barve M, Powell A, Chandra S, Schmidt E, Janssen R, Long G. Phase Ib/II study of the combination of SD-101 and pembrolizumab in patients with advanced melanoma who had progressive disease on or after prior anti-PD-1 therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Harris R, Sato Y, Berkley AJ, Reis M, Altomare F, Amin MH, Boothby K, Bunyk P, Deng C, Enderud C, Huang S, Hoskinson E, Johnson MW, Ladizinsky E, Ladizinsky N, Lanting T, Li R, Medina T, Molavi R, Neufeld R, Oh T, Pavlov I, Perminov I, Poulin-Lamarre G, Rich C, Smirnov A, Swenson L, Tsai N, Volkmann M, Whittaker J, Yao J. Phase transitions in a programmable quantum spin glass simulator. Science 2018; 361:162-165. [PMID: 30002250 DOI: 10.1126/science.aat2025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/15/2018] [Indexed: 11/02/2022]
Abstract
Understanding magnetic phases in quantum mechanical systems is one of the essential goals in condensed matter physics, and the advent of prototype quantum simulation hardware has provided new tools for experimentally probing such systems. We report on the experimental realization of a quantum simulation of interacting Ising spins on three-dimensional cubic lattices up to dimensions 8 × 8 × 8 on a D-Wave processor (D-Wave Systems, Burnaby, Canada). The ability to control and read out the state of individual spins provides direct access to several order parameters, which we used to determine the lattice's magnetic phases as well as critical disorder and one of its universal exponents. By tuning the degree of disorder and effective transverse magnetic field, we observed phase transitions between a paramagnetic, an antiferromagnetic, and a spin-glass phase.
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Affiliation(s)
- R Harris
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada.
| | - Y Sato
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - A J Berkley
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - M Reis
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - F Altomare
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - M H Amin
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada.,Department of Physics, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - K Boothby
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - P Bunyk
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - C Deng
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - C Enderud
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - S Huang
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - E Hoskinson
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - M W Johnson
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - E Ladizinsky
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - N Ladizinsky
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - T Lanting
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - R Li
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - T Medina
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - R Molavi
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada.,Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - R Neufeld
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - T Oh
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - I Pavlov
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - I Perminov
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | | | - C Rich
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - A Smirnov
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - L Swenson
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - N Tsai
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - M Volkmann
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - J Whittaker
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
| | - J Yao
- D-Wave Systems, 3033 Beta Avenue, Burnaby, BC V5G 4M9, Canada
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Ribas A, Medina T, Kummar S, Amin A, Kalbasi A, Drabick JJ, Barve M, Daniels GA, Wong DJ, Schmidt EV, Candia AF, Coffman RL, Leung ACF, Janssen RS. SD-101 in Combination with Pembrolizumab in Advanced Melanoma: Results of a Phase Ib, Multicenter Study. Cancer Discov 2018; 8:1250-1257. [PMID: 30154193 DOI: 10.1158/2159-8290.cd-18-0280] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/20/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
PD-1 inhibitors are approved for treating advanced melanoma, but resistance has been observed. This phase Ib trial evaluated intratumoral SD-101, a synthetic CpG oligonucleotide that stimulates Toll-like receptor 9 (TLR9), in combination with pembrolizumab in patients with unresectable or metastatic malignant melanoma. The most common adverse events related to SD-101 were injection-site reactions and transient, mild-to-moderate "flu-like" symptoms. Among the 9 patients naïve to anti-PD-1 therapy, the overall response rate (ORR) was 78%. The estimated 12-month progression-free survival rate was 88%, and the overall survival rate was 89%. Among 13 patients having prior anti-PD-1 therapy, the ORR was 15%. RNA profiling of tumor biopsies demonstrated increased CD8+ T cells, natural killer cells, cytotoxic cells, dendritic cells, and B cells. The combination of intratumoral SD-101 and pembrolizumab was well tolerated and induced broad immune activation in the tumor microenvironment with durable tumor responses in both peripheral and visceral lesions.Significance: These early data demonstrate that the combination of pembrolizumab with intratumoral SD-101 is well tolerated and can induce immune activation at the tumor site. Combining an intratumoral TLR9 innate immune stimulant with PD-1 blockade can potentially increase clinical efficacy with minimal additional toxicity relative to PD-1 blockade alone. Cancer Discov; 8(10); 1250-7. ©2018 AACR. This article is highlighted in the In This Issue feature, p. 1195.
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Affiliation(s)
- Antoni Ribas
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.
| | - Theresa Medina
- Medicine/Medical Oncology, University of Colorado Comprehensive Cancer Center, Aurora, Colorado
| | - Shivaani Kummar
- Division of Oncology, Stanford University, Palo Alto, California
| | - Asim Amin
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Anusha Kalbasi
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Joseph J Drabick
- Division of Hematology-Oncology, Milton S. Hershey Medical Center, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Minal Barve
- Mary Crowley Cancer Research Center, Dallas, Texas
| | - Gregory A Daniels
- Department of Medicine, University of California, San Diego, San Diego, California
| | - Deborah J Wong
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
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Ribas A, Medina T, Kummar S, Amin A, Drabick JJ, Barve M, Daniels G, Wong DL, Schmidt EV, Leung AC, Janssen R. Abstract CT139: Durability of responses to the combination of SD-101 and pembrolizumab in advanced metastatic melanoma: Results of a phase Ib, multicenter study. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct139] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background: This phase 1b trial evaluates the safety and antitumor efficacy of the combination of SD-101, a synthetic CpG-oligonucleotide that stimulates Toll-like receptor 9 (TLR9), and pembrolizumab in patients with recurrent Stage IIIC/IV malignant melanoma.
Methods: Dose escalation of SD-101 used a modified 3+3 design. SD-101 was injected in a single tumor lesion (weekly x 4 doses then every 3 weeks x 7 doses over 6 months) at 1, 2, 4, or 8 mg and pembrolizumab was administered intravenously at 200 mg every 3 weeks up to 2 years. Tumor responses were assessed per investigator using RECIST v1.1 taking into account both injected and non-injected lesions.
Results: Of the 22 patients, 9 were naïve to anti-PD-1/L1 therapy at baseline and 13 had progressive disease while receiving prior anti-PD-1/L1 therapy. Treatment was well tolerated with no Grade 3 or higher treatment-related AEs in longer term follow up. Among the 9 patients who were anti-PD-1/L1 naïve, best objective responses were CR: 2, PR: 5, PD: 1, not evaluated [NE]: 1. Median PFS, duration of response, and OS have not been reached. Estimated 12 month PFS was 88% and OS was 89%. After a median of 18 months of follow-up, 86% of responses were ongoing. One patient with a PR developed progressive disease after 20 months of treatment. Among patients who had received prior anti-PD-1/L1 therapy, best objective responses were PR: 2, SD: 5, PD: 5, NE: 1. One patient with stable disease and 1 patient with a PR continued on combination therapy without progression for at least 10.5 months. The other 10 patients developed progressive disease ranging from 1.5 to 8 months after enrollment. Percent change in tumor size from baseline in injected and non-injected lesions will also be presented.
Conclusion: These early results suggest that combining an intratumoral TLR9 innate immune stimulant with PD-1 blockade can potentially provide more clinical responses that are meaningfully durable than PD-1 blockade alone based on historical data.
Citation Format: Antoni Ribas, Theresa Medina, Shivaani Kummar, Asim Amin, Joseph J. Drabick, Minal Barve, Gregory Daniels, Deborah L. Wong, Emmett V. Schmidt, Abraham C. Leung, Robert Janssen. Durability of responses to the combination of SD-101 and pembrolizumab in advanced metastatic melanoma: Results of a phase Ib, multicenter study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT139.
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Affiliation(s)
| | | | | | - Asim Amin
- 4Levine Cancer Institute, Charlotte, NC
| | | | - Minal Barve
- 6Mary Crowley Cancer Research Center, Dallas, TX
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28
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Milhem M, Gonzales R, Medina T, Kirkwood JM, Buchbinder E, Mehmi I, Niu J, Shaheen M, Weight R, Margolin K, Luke J, Morris A, Mauro D, Krieg AM, Ribas A. Abstract CT144: Intratumoral toll-like receptor 9 (TLR9) agonist, CMP-001, in combination with pembrolizumab can reverse resistance to PD-1 inhibition in a phase Ib trial in subjects with advanced melanoma. Clin Trials 2018. [DOI: 10.1158/1538-7445.am2018-ct144] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Couts KL, Bemis J, Turner JA, Bagby SM, Murphy D, Christiansen J, Hintzsche JD, Le A, Pitts TM, Wells K, Applegate A, Amato C, Multani P, Chow-Maneval E, Tentler JJ, Shellman YG, Rioth MJ, Tan AC, Gonzalez R, Medina T, Doebele RC, Robinson WA. ALK Inhibitor Response in Melanomas Expressing EML4-ALK Fusions and Alternate ALK Isoforms. Mol Cancer Ther 2018; 17:222-231. [PMID: 29054983 PMCID: PMC5752582 DOI: 10.1158/1535-7163.mct-17-0472] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 05/22/2017] [Revised: 08/25/2017] [Accepted: 09/28/2017] [Indexed: 01/08/2023]
Abstract
Oncogenic ALK fusions occur in several types of cancer and can be effectively treated with ALK inhibitors; however, ALK fusions and treatment response have not been characterized in malignant melanomas. Recently, a novel isoform of ALK (ALKATI ) was reported in 11% of melanomas but the response of melanomas expressing ALKATI to ALK inhibition has not been well characterized. We analyzed 45 melanoma patient-derived xenograft models for ALK mRNA and protein expression. ALK expression was identified in 11 of 45 (24.4%) melanomas. Ten melanomas express wild-type (wt) ALK and/or ALKATI and one mucosal melanoma expresses multiple novel EML4-ALK fusion variants. Melanoma cells expressing different ALK variants were tested for response to ALK inhibitors. Whereas the melanoma expressing EML4-ALK were sensitive to ALK inhibitors in vitro and in vivo, the melanomas expressing wt ALK or ALKATI were not sensitive to ALK inhibitors. In addition, a patient with mucosal melanoma expressing ALKATI was treated with an ALK/ROS1/TRK inhibitor (entrectinib) on a phase I trial but did not respond. Our results demonstrate ALK fusions occur in malignant melanomas and respond to targeted therapy, whereas melanomas expressing ALKATI do not respond to ALK inhibitors. Targeting ALK fusions is an effective therapeutic option for a subset of melanoma patients, but additional clinical studies are needed to determine the efficacy of targeted therapies in melanomas expressing wt ALK or ALKATIMol Cancer Ther; 17(1); 222-31. ©2017 AACR.
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Affiliation(s)
- Kasey L Couts
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Judson Bemis
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jacqueline A Turner
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stacey M Bagby
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Jennifer D Hintzsche
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anh Le
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Todd M Pitts
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Keith Wells
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Applegate
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carol Amato
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - John J Tentler
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Yiqun G Shellman
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew J Rioth
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Aik-Choon Tan
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rene Gonzalez
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Theresa Medina
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert C Doebele
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William A Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Araos J, Cruces P, Tapia P, Alegria L, García P, Salomon T, Rodriguez F, Amthauer M, Castro G, Erranz B, Soto D, Carreño P, Medina T, Damiani F, Bugedo G, Bruhn A. Effect of a Lung Rest Strategy During Ecmo in a Porcine Acute Lung Injury Model. Intensive Care Med Exp 2015. [PMCID: PMC4796540 DOI: 10.1186/2197-425x-3-s1-a503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thompson CM, Carlo JP, Flacau R, Aharen T, Leahy IA, Pollichemi JR, Munsie TJS, Medina T, Luke GM, Munevar J, Cheung S, Goko T, Uemura YJ, Greedan JE. Long-range magnetic order in the 5d(2) double perovskite Ba2CaOsO6: comparison with spin-disordered Ba2YReO6. J Phys Condens Matter 2014; 26:306003. [PMID: 25001885 DOI: 10.1088/0953-8984/26/30/306003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The B-site ordered double perovskite Ba2CaOsO6 was studied by dc magnetic susceptibility, powder neutron diffraction and muon spin relaxation methods. The lattice parameter is a = 8.3619(6) Å at 280 K and cubic symmetry [Formula: see text] is retained to 3.5 K with a = 8.3462(7) Å. Curie-Weiss susceptibility behaviour is observed for T > 100 K and the derived constants are C = 0.3361(3) emu K mol(-1) and ΘCW = -156.2(3) K, in excellent agreement with literature values. This Curie constant is much smaller than the spin-only value of 1.00 emu K mol(-1) for a 5d(2) Os(6+) configuration, indicating a major influence of spin-orbit coupling. Previous studies had detected both susceptibility and heat capacity anomalies near 50 K but no definitive conclusion was drawn concerning the nature of the ground state. While no ordered Os moment could be detected by powder neutron diffraction, muon spin relaxation (µSR) data show clear long-lived oscillations indicative of a continuous transition to long-range magnetic order below TC = 50 K. An estimate of the ordered moment on Os(6+) is ∼ 0.2 μB, based upon a comparison with µSR data for Ba2YRuO6 with a known ordered moment of 2.2 μB. These results are compared with those for isostructural Ba2YReO6 which contains Re(5+), also 5d(2), and has a nearly identical unit cell constant, a = 8.36278(2) Å-a structural doppelgänger. In contrast, Ba2YReO6 shows ΘCW = - 616 K, and a complex spin-disordered and, ultimately, spin-frozen ground state below 50 K, indicating a much higher level of geometric frustration than in Ba2CaOsO6. The results on these 5d(2) systems are compared to recent theory, which predicts a variety of ferromagnetic and antiferromagnetic ground states. In the case of Ba2CaOsO6, our data indicate that a complex four-sublattice magnetic structure is likely. This is in contrast to the spin-disordered ground state in Ba2YReO6, despite a lack of evidence for structural disorder, for which theory currently provides no clear explanation.
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Affiliation(s)
- C M Thompson
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4M1, Canada. Brockhouse Institute for Materials Research, McMaster University, Hamilton, ON L8S 4M1, Canada
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Mercedes-Acosta S, Fragoso-Báez A, Sabala R, Matos D, Medina T. Estudio de los trastornos postabdominoplastia de la sensibilidad cutánea superficial. Cir plást iberolatinoam 2013. [DOI: 10.4321/s0376-78922013000300002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Advanced melanoma has long been a challenging malignancy to treat due to a relative paucity of efficacious therapeutic options. However, the identification of activating BRAF mutations in approximately 50% of patients with cutaneous melanoma has ushered in the era of targeted therapy for melanoma patients. Similar to the first-in-class selective serine/threonine-protein kinase B-raf inhibitor vemurafenib, dabrafenib is highly efficacious in melanoma patients with BRAF V600E mutations, with response rates of approximately 50% and progression-free survival of 6 months. There is data to suggest that dabrafenib not only shows activity in V600E-mutated melanoma, but also in non-V600E BRAF-mutated disease such as V600K. There is also early data to suggest that dabrafenib is effective in controlling metastases in the brain. Combining dabrafenib with the selective mitogen-activated protein kinase kinase (MEK) inhibitor trametinib has been effective in improving both the progression-free survival and overall survival of melanoma patients over those patients treated with dabrafenib alone. Dabrafenib is still being evaluated in several clinical trials in melanoma as well as a variety of other solid tumors with BRAF mutations. The U.S. Food and Drug Administration has recently approved dabrafenib as a single agent for the treatment of unresectable or metastatic melanoma in adult patients with BRAF V600E mutation.
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Affiliation(s)
- T Medina
- Division of Hematology and Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
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Medina T, Richer J, Horwitz K. 8 STUDY OF DIFFERENTIALLY EXPRESSED GENES IN LEIOMYOMATA AS COMPARED TO NORMAL MYOMETRIUM. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.7] [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: 11/18/2022]
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Sánchez López AM, Moreno-Torres Herrera R, Pérez de la Cruz AJ, Orduña Espinosa R, Medina T, López Martínez C. [Malnutrition prevalence in patients admitted to a rehabilitation and orthopedic surgery hospital]. NUTR HOSP 2005; 20:121-30. [PMID: 15813396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE Different studies show the scarce attention granted to the nutritional state in historical and clinical practice, what determines the ignorance of the patient's nutritional status to their entrance in the hospital and, therefore, the impossibility to prevent the hospital malnutrition. The objective of our study has been to determine the prevalence of patients' malnutrition entered in a Hospital of Orthopedic surgery and Rehabilitation. METHODS Observational and analytical study in 250 randomized patients (60% men and 40% women), who were nutritionally evaluated when entering, the hospital, by means of anthropometry (Weigh, height, BMI, skin-fold, corporal circumferences) and biochemical tests (Albumin, Prealbumin and Transferrin). RESULTS According to the BMI the prevalence of malnutrition was of 8%, the average of caloric malnutrition was of 2.8% (according to anthropometry) and the prevalence of many-sided malnutrition rises to 54.8% (according to biochemical markers). CONCLUSIONS The high prevalence of fundamental malnutrition (54.8%) demonstrated in this study, it shows the importance of determining the nutritional status when entering the hospital, particularly surgical type' patiens as is the case of most of those who enter the Orthopedic surgery hospitals.
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Affiliation(s)
- A Maria Sánchez López
- Unidad de Nutrición Clínica y Dietética, Hospital Universitario Virgen de las Nieves, Granada, España
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Lozano JM, Collado JA, Medina T, Muntané J. Protection against liver injury by PGE1 or anti-TNF-alpha is associated with a reduction of TNF-R1 expression in hepatocytes. Scand J Gastroenterol 2003; 38:1169-75. [PMID: 14686721 DOI: 10.1080/00365520310006063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tumour necrosis factor-alpha (TNF-5) has been shown to exacerbate or protect against liver injury in different experimental models. In a previous study, we observed that enhancement of TNF-alpha expression in hepatocytes by prostaglandin E1 (PGE1) pre-administration induced iNOS expression and cytoprotection against experimental liver injury in rats. Nevertheless, the reduction of TNF-alpha bioactivity by anti-TNF-alpha antibodies also reduced liver injury by D-GalN. The purpose of the present study was to evaluate whether protection by PGE1 or anti-TNF-alpha was related to a common effect on the membrane-bound TNF-alpha receptor expression. METHODS Liver injury was induced in male Wistar rats by intraperitoneal injection of D-galactosamine (D-GalN) (1 g/kg). PGE1 or anti-TNF-alpha was administered at 30 or 60 min before D-GalN, respectively. Liver injury was evaluated by alanine aminotransferase (ALT) activity in serum and histological examination in liver sections. TNF-alpha was determined by ELISA in serum. The expression of TNF-alpha receptor type 1 (TNF-R1) and TNF-alpha receptor type 2 (TNF-R2) in hepatocytes was assessed by immunohistochemistry and immunoprecipitation + Western-blot analysis. RESULTS PGE1 or anti-TNF-alpha reduced liver injury induced by D-GalN. Although PGE1 enhanced and anti-TNF-alpha reduced TNF-alpha concentration in serum, both protective treatments reduced the expression of TNF-R1 in hepatocytes. TNF-R2 was not detected in our experimental conditions. CONCLUSIONS Our study showed that reduction of liver injury by PGE1 or anti-TNF-alpha antibodies was related to a reduction of TNF-R1 expression in hepatocytes.
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Affiliation(s)
- J M Lozano
- Unidad Clínica Aparato Digestivo, Servicio Anatomía Patológica, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba, Spain
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Oller JD, Gómez JD, Kortazar JF, García JD, Navarro AA, Albertino RJ, Díaz JJ, Llorente JA, Andreu MN, Arcas RF, Medina T, Vázquez RJ. Scapular hibernoma fortuitously discovered on myocardial perfusion imaging through Tc-99m tetrofosmin. Clin Nucl Med 2001; 26:69-70. [PMID: 11139063 DOI: 10.1097/00003072-200101000-00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old man was hospitalized for precordial pain. The result of a resting electrocardiograph was normal. Tc-99m tetrofosmin stress myocardial imaging was performed and uptake in the area of the left scapula was seen. The abnormality was caused by a subcutaneous tumor. Histologic examination revealed a hibernoma.
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Affiliation(s)
- J D Oller
- Surgery Service, San Agustín Hospital, Linares, Spain.
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Abstract
Galectin-3 is a 31 kD beta-galactoside-binding lectin which is expressed by several types of non-neoplastic and neoplastic cells and which may be involved in cell-extracellular matrix interactions. An immunohistochemical study has been made of the expression of galectin-3, as well as its ligand, laminin, in a spectrum of benign and malignant thyroid neoplasms and in some non-neoplastic conditions. Immunohistochemistry with anti-human recombinant galectin-3 antibody showed consistent, intense positivity in the neoplastic cells of 18 cases of papillary carcinoma and less intense staining in the five anaplastic carcinomas studied. In addition, two out of three poorly differentiated carcinomas, three out of six medullary carcinomas, and four out of eight follicular carcinomas had less intense or focal positivity. One case of Hürthle cell carcinoma showed scattered strongly positive cells. Eight follicular adenomas, three hyperplastic nodules, five nodular goitres, and normal thyroid tissue were negative. Galectin-3 mRNA expression was also evaluated in three of the papillary carcinomas, two follicular adenomas, and one hyperplastic nodule with matched normal tissue. Northern blot analysis demonstrated mRNA overexpression in the three cases of papillary carcinomas, whereas normal and benign tissues were negative. Laminin distribution in neoplastic and non-neoplastic tissue varied with architectural patterns but did not correlate with galectin-3 immunohistochemical expression. We conclude that expression of galectin-3 is limited to inflammatory foci in normal and benign thyroid tissue and is a phenotypic feature of malignant thyroid neoplasms, especially papillary carcinomas.
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Affiliation(s)
- P L Fernández
- Department of Anatomical Pathology, Hospital Clinico, University of Barcelona Medical School, Spain.
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Abstract
This article presents the advantages of design modifications and fabrication techniques for mandibular osseointegrated fixed prostheses. These design features provide definite mechanical advantages and access for oral hygiene maintenance. A review of implant surface properties is presented that affect bacterial plaque and food debris adherence. The suggested design involves a lingual contour of the cast alloy suprastructure to yield an environment for reduced plaque and debris accumulation. The right angle cross-section ensures strength and increased stress distribution in structurally compromised areas when compared with conventional implant framework designs.
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Affiliation(s)
- A S von Gonten
- Combined Prosthodontics Program, William Beaumont Army Medical Center, US Army Dental Activity, Fort Bliss, Texas, USA
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