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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Fox CP, Chaganti S, McIlroy G, Barrington SF, Burton C, Cwynarski K, Eyre TA, Illidge T, Kalakonda N, Kuhnl A, McKay P, Davies AJ. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol 2024; 204:1178-1192. [PMID: 38247115 DOI: 10.1111/bjh.19273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | - Sridhar Chaganti
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Graham McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Cathy Burton
- Department of Haematology, The Leeds Teaching Hospitals, Leeds, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Toby A Eyre
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, UK
| | - Timothy Illidge
- Division of Cancer Sciences, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andrew J Davies
- Cancer Sciences Division, Centre for Cancer Immunology, University of Southampton, Southampton, UK
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Smith V, Lee D, Reardon M, Shabbir R, Sahoo S, Hoskin P, Choudhury A, Illidge T, West CML. Hypoxia Is Associated with Increased Immune Infiltrates and Both Anti-Tumour and Immune Suppressive Signalling in Muscle-Invasive Bladder Cancer. Int J Mol Sci 2023; 24:ijms24108956. [PMID: 37240301 DOI: 10.3390/ijms24108956] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Hypoxia and a suppressive tumour microenvironment (TME) are both independent negative prognostic factors for muscle-invasive bladder cancer (MIBC) that contribute to treatment resistance. Hypoxia has been shown to induce an immune suppressive TME by recruiting myeloid cells that inhibit anti-tumour T cell responses. Recent transcriptomic analyses show hypoxia increases suppressive and anti-tumour immune signalling and infiltrates in bladder cancer. This study sought to investigate the relationship between hypoxia-inducible factor (HIF)-1 and -2, hypoxia, and immune signalling and infiltrates in MIBC. ChIP-seq was performed to identify HIF1α, HIF2α, and HIF1β binding in the genome of the MIBC cell line T24 cultured in 1% and 0.1% oxygen for 24 h. Microarray data from four MIBC cell lines (T24, J82, UMUC3, and HT1376) cultured under 1%, 0.2%, and 0.1% oxygen for 24 h were used. Differences in the immune contexture between high- and low-hypoxia tumours were investigated using in silico analyses of two bladder cancer cohorts (BCON and TCGA) filtered to only include MIBC cases. GO and GSEA were used with the R packages "limma" and "fgsea". Immune deconvolution was performed using ImSig and TIMER algorithms. RStudio was used for all analyses. Under hypoxia, HIF1α and HIF2α bound to ~11.5-13.5% and ~4.5-7.5% of immune-related genes, respectively (1-0.1% O2). HIF1α and HIF2α both bound to genes associated with T cell activation and differentiation signalling pathways. HIF1α and HIF2α had distinct roles in immune-related signalling. HIF1 was associated with interferon production specifically, whilst HIF2 was associated with generic cytokine signalling as well as humoral and toll-like receptor immune responses. Neutrophil and myeloid cell signalling was enriched under hypoxia, alongside hallmark pathways associated with Tregs and macrophages. High-hypoxia MIBC tumours had increased expression of both suppressive and anti-tumour immune gene signatures and were associated with increased immune infiltrates. Overall, hypoxia is associated with increased inflammation for both suppressive and anti-tumour-related immune signalling and immune infiltrates, as seen in vitro and in situ using MIBC patient tumours.
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Affiliation(s)
- Vicky Smith
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Dave Lee
- Computational Biology Support, CRUK Manchester Institute, Alderley Park SK10 4TG, UK
| | - Mark Reardon
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Rekaya Shabbir
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Sudhakar Sahoo
- Computational Biology Support, CRUK Manchester Institute, Alderley Park SK10 4TG, UK
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
- Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
| | - Timothy Illidge
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
| | - Catharine M L West
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
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Fiaccadori V, Neven A, Fortpied C, Aurer I, Andre M, Federico M, Counsell N, Phillips EH, Clifton-Hadley L, Barrington SF, Illidge T, Radford J, Raemaekers JMM. Relapse patterns in early-PET negative, limited-stage Hodgkin lymphoma (HL) after ABVD with or without radiotherapy-a joint analysis of EORTC/LYSA/FIL H10 and NCRI RAPID trials. Br J Haematol 2023; 200:731-739. [PMID: 36541117 DOI: 10.1111/bjh.18594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
In the H10 and RAPID randomised trials, chemotherapy+radiotherapy (combined modalities treatment, CMT) was compared with chemotherapy (C) in limited-stage Hodgkin lymphoma (HL), with negative early positron emission tomography (ePETneg). We analysed patterns of relapses in the H10 trial, validated findings in the RAPID trial and performed a combined analysis stratified by trial. The impact of radiotherapy (RT) on risk of relapse was studied using adjusted Cox models, with time-varying effects. In H10, 1,059 ePETneg patients were included (465 European Organisation for Research and Treatment of Cancer (EORTC) favourable [F], 594 unfavourable [U]). Among the F patients, 2/227 (1%) relapsed after CMT, 30/238 (13%) after C: of these relapses, 21/30 (70%) occurred in less than 2 years and 25/30 (83%) affected originally involved areas. Among the U group, 16/292 (5%) relapsed after CMT: 8/16 (50%) in less than 2 years, 11/16 (69%) in originally involved areas. After C 30/302 (10%) relapsed: 27/30 (90%) in less than 2 years, and 26/30 (87%) in originally involved areas. Similar results were observed in 419 ePETneg RAPID patients (241 F, 128 U, 50 unclassified): among F patients, 6/118 (5%) relapsed after CMT; 13/123 (11%) after C: 11/13 (85%) in less than 2 years and 11/13 (85%) affecting originally involved areas. In U patients, 3/65 (5%) relapsed after CMT and 5/63 (8%) after C. In both trials, omitting RT in ePETneg HL resulted in more early relapses, mainly affecting originally involved areas. RT significantly reduced risk of early relapses in the combined stratified analysis.
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Affiliation(s)
- Valeria Fiaccadori
- University College London Hospital, London, UK.,European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Cancer Institute, University College London, London, UK
| | - Anouk Neven
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | - Catherine Fortpied
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marc Andre
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | | | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Elizabeth H Phillips
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Clifton-Hadley
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Timothy Illidge
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - John Radford
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
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Smith V, Mukherjee D, Tsakiroglou AM, Baker A, Mistry H, Choudhury A, Hoskin P, Illidge T, West CML. Low CD8 T Cell Counts Predict Benefit from Hypoxia-Modifying Therapy in Muscle-Invasive Bladder Cancer. Cancers (Basel) 2022; 15:41. [PMID: 36612036 PMCID: PMC9817934 DOI: 10.3390/cancers15010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND As hypoxia can drive an immunosuppressive tumour microenvironment and inhibit CD8+ T cells, we investigated if patients with low tumour CD8+ T cells benefitted from hypoxia-modifying therapy. METHODS BCON was a phase III trial that randomised patients with muscle-invasive bladder cancer (MIBC) to radiotherapy alone or with hypoxia-modifying carbogen plus nicotinamide (CON). Tissue microarrays of diagnostic biopsies from 116 BCON patients were stained using multiplex immunohistochemistry (IHC) with the markers CD8, CD4, FOXP3, CD68 and PD-L1, plus DAPI. Hypoxia was assessed using CA9 IHC (n = 111). Linked transcriptomic data (n = 80) identified molecular subtype. Relationships with overall survival (OS) were investigated using Cox proportional hazard models. RESULTS High (upper quartile) vs. low CD8 T cell counts associated with a better OS across the whole cohort at 16 years (n = 116; HR 0.47, 95% CI 0.28-0.78, p = 0.003) and also in the radiotherapy alone group (n = 61; HR 0.39, 95% CI 0.19-0.76, p = 0.005). Patients with low CD8+ T cells benefited from CON (n = 87; HR 0.63, 95% CI 0.4-1.0, p = 0.05), but those with high CD8 T cells did not (n = 27; p = 0.95). CA9 positive tumours had fewer CD8+ T cells (p = 0.03). Prognostic significance of low CD8+ T cells in the whole cohort remained after adjusting for clinicopathologic variables. Basal vs. luminal subtype had more CD8+ cells (p = 0.02) but was not prognostic (n = 80; p = 0.26). Exploratory analyses with other immune markers did not improve on findings obtained with CD8 counts. CONCLUSIONS MIBC with low CD8+ T cell counts may benefit from hypoxia-modifying treatment.
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Affiliation(s)
- Vicky Smith
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Debayan Mukherjee
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
| | | | - Alexander Baker
- Cancer Research UK Manchester Institute, Manchester M20 4BX, UK
| | - Hitesh Mistry
- Division of Pharmacy and Optometry, University of Manchester, Manchester M13 9PL, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
- Mount Vernon Cancer Centre, Northwood HA6 2RK, UK
| | - Timothy Illidge
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
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6
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Burnett A, Johnson P, Locke I, Illidge T. The Radiotherapy Learning Healthcare System - Working Together to Improve the Quality of Radiotherapy Nationally. Clin Oncol (R Coll Radiol) 2022; 34:411-414. [PMID: 35120791 DOI: 10.1016/j.clon.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A Burnett
- NHS England and NHS Improvement, London, UK.
| | - P Johnson
- NHS England and NHS Improvement, London, UK
| | - I Locke
- NHS England and NHS Improvement, London, UK
| | - T Illidge
- The University of Manchester, Manchester, UK
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7
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Horwitz S, O'Connor OA, Pro B, Trümper L, Iyer S, Advani R, Bartlett NL, Christensen JH, Morschhauser F, Domingo-Domenech E, Rossi G, Kim WS, Feldman T, Menne T, Belada D, Illés Á, Tobinai K, Tsukasaki K, Yeh SP, Shustov A, Hüttmann A, Savage KJ, Yuen S, Zinzani PL, Miao H, Bunn V, Fenton K, Fanale M, Puhlmann M, Illidge T. The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma. Ann Oncol 2021; 33:288-298. [PMID: 34921960 PMCID: PMC9447792 DOI: 10.1016/j.annonc.2021.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL. Patients and methods: ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group. Results: A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP. Conclusions: In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.
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Affiliation(s)
- S Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - O A O'Connor
- University of Virginia Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - B Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - L Trümper
- Universitätsmedizin Göttingen, Göttingen, Germany
| | - S Iyer
- MD Anderson Cancer Center/University of Texas, Houston, Texas, USA
| | - R Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford, California, USA
| | - N L Bartlett
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - E Domingo-Domenech
- Institut Catala D'oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G Rossi
- Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - W S Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - T Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack NJ
| | - T Menne
- Freeman Hospital, Newcastle upon Tyne, England
| | - D Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Á Illés
- Debreceni Egyetem, Debrecen, Hajdu-Bihar, Hungary
| | - K Tobinai
- National Cancer Center Hospital, Tokyo, Japan
| | - K Tsukasaki
- Saitama Medical University International Medical Center, Saitama, Japan
| | - S-P Yeh
- China Medical University Hospital, Taichung, Taiwan
| | - A Shustov
- University of Washington Medical Center, Seattle, Washington, USA
| | - A Hüttmann
- Universitatsklinikum Essen, Essen, Nordrhein-Westfalen, Germany
| | - K J Savage
- Department of Medical Oncology and University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - S Yuen
- Calvary Mater Newcastle Hospital, Australia
| | - P L Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italia
| | - H Miao
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - V Bunn
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - K Fenton
- Seagen Inc., Bothell, Washington, USA
| | - M Fanale
- Seagen Inc., Bothell, Washington, USA
| | | | - T Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust, Manchester, UK
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8
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Gunther J, Yang J, Hajj C, Ng A, Brady J, Cheng S, Levis M, Qi S, Mikhaeel G, Ricardi U, Illidge T, Turin A, Knafl M, Specht L, Dabaja B, Yahalom J. Efficacy and Toxicity of Alternative Radiation Treatment Schemes for Patients With Hematologic Malignancies: A Collaborative ILROG COVID Era Report. Int J Radiat Oncol Biol Phys 2021. [PMCID: PMC8536223 DOI: 10.1016/j.ijrobp.2021.07.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose/Objective(s) The COVID19 pandemic required radiation oncologists (ROs) to consider shorter treatment courses to minimize patient and staff exposure and conserve healthcare resources. Hematologic ROs adopted hypofractionated radiation therapy (hRT) regimens according to guidelines published by the International Lymphoma Radiation Oncology Group (ILROG). We report for the first time the preliminary efficacy and toxicity of these novel hypofractionated regimens in the treatment of hematologic malignancies. Materials/Methods We conducted a multicenter, multinational retrospective study under the direction of the ILROG. All patients receiving hRT according to ILROG guidelines from 1/1/2020 to 8/31/2020 were included. Patient and treatment details were abstracted from separate institutional databases. Toxicity was graded using CTCAE v5.0. Results Ninety-three patients from 4 institutions treated with 114 RT courses were included. Patient and treatment details are displayed in Table 1. Median follow up for the cohort was 179 days, and 77 patients (82%) were alive at last follow up. Maximal toxicity experienced by patients included Grade 1 (n = 16), Grade 2 (n = 1) and Grade 3 (n = 1) toxicities. Of 80 sites with response assessment within the RT field, 69% of patients achieved a complete response (n = 55), 20% partial response (n = 16), 9% stable disease (n = 7), and 2% progressive disease (n = 2). No COVID19 infections during or after RT have been documented in this patient cohort. Conclusion HRT according to ILROG guidelines resulted in low rates of acute toxicity and reasonable short-term treatment efficacy. Longer follow up and comparison with control groups is needed to draw more definitive conclusions and will be presented at the Annual Meeting.
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9
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Martinez-Calle N, Kirkwood AA, Lamb M, Smith A, Khwaja J, Manos K, Shrubsole C, Gray N, Lewis K, Tivey A, Bishton MJ, Hawkes E, Ahearne MJ, Osborne W, Collins GP, Illidge T, Linton KM, Cwynarski K, Burton C, Fox CP. Systemic ALCL Treated in Routine Clinical Practice: Outcomes Following First-Line Chemotherapy from a Multicentre Cohort. Adv Ther 2021; 38:3789-3802. [PMID: 34037958 PMCID: PMC8280044 DOI: 10.1007/s12325-021-01764-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Brentuximab vedotin (BV)-CHP is the new standard regimen for first-line treatment of systemic anaplastic large cell lymphoma (sALCL). We undertook a retrospective analysis of consecutive patients diagnosed with sALCL, treated in routine practice, to serve as a benchmark analysis for comparison BV-CHP efficacy in routine practice. METHODS Patients aged 16 years or older with sALCL treated in seven UK and Australian centres and from 14 additional centres from the UK Haematological Malignancy Research Network database (n = 214). Treatment allocation was clinician choice and included best supportive care (BSC). Main outcomes were time to treatment failure (TTF) and overall survival (OS). Multivariable analysis for predictors of both TTF and OS was also undertaken. RESULTS The median age 52 years (range 16-93), 18% ECOG ≥ 3 and 40% of cases were ALK positive. CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) was employed in 152 (71%) of patients and CHOEP (CHOP + etoposide) in 4% of patients. For CHOP-treated patients overall response rate (ORR) was 65% and complete response (CR) 47%. Only 9% of patients underwent autologous stem cell transplant (ASCT). With 57 months median follow-up, 4-year TTF and OS were 41.2% (95% CI 33.1-49.1) and 58.9% (95% CI 50.3-66.5) respectively. Multivariable analysis showed ALK+ status was independently associated with superior TTF (HR 0.36, 95% CI 0.21-0.63) but not OS (0.44, 95% CI 0.18-1.07). DISCUSSION We present a retrospective analysis with mature follow-up of one of the largest multicentre populations of sALCL available, comparable to similar large retrospective studies. ALK status remains a strong predictor of outcomes. CONCLUSION These data serve as a robust benchmark for BV-CHP as the new standard of care for sALCL. Similar real-world evidence with BV-CHP will be desirable to confirm the findings of ECHELON-2.
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Affiliation(s)
- Nicolas Martinez-Calle
- Russell Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Amy A Kirkwood
- CRUK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Maxine Lamb
- Haematological Malignancy Research Network, University of York, York, UK
| | - Alex Smith
- Haematological Malignancy Research Network, University of York, York, UK
| | - Jahanzaib Khwaja
- University College of London Hospitals, NHS Foundation Trust, London, UK
| | | | | | - Nicola Gray
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Ann Tivey
- Cancer Sciences, University of Manchester and the Christie, NHS Foundation Trust, Manchester, UK
| | - Mark J Bishton
- Russell Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Eliza Hawkes
- Olivia Newton-John Cancer Research Institute, Austin, Australia
| | | | - Wendy Osborne
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Timothy Illidge
- Cancer Sciences, University of Manchester and the Christie, NHS Foundation Trust, Manchester, UK
| | - Kim M Linton
- Cancer Sciences, University of Manchester and the Christie, NHS Foundation Trust, Manchester, UK
| | - Kate Cwynarski
- University College of London Hospitals, NHS Foundation Trust, London, UK
| | | | - Christopher P Fox
- Russell Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
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Aurer I, Neven A, Fiaccadori V, Counsell N, Phillips E, Clifton‐Hadley L, Fortpied C, Andre M, Federico M, Barrington S, Illidge T, Radford J, Raemaekers J. RELAPSES IN INTERIM PET NEGATIVE LIMITED STAGE HODGKIN LYMPHOMA PATIENTS RECEIVING ABVD WITH OR WITHOUT RADIOTHERAPY–ANALYSIS OF EORTC/FIL/LYSA H10 AND UK NCRI RAPID TRIALS. Hematol Oncol 2021. [DOI: 10.1002/hon.71_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- I. Aurer
- University Hospital Centre Zagreb Division of Hematology Department of Internal Medicine Zagreb Croatia
| | - A. Neven
- European Organisation for Research and Treatment of Cancer Lymphoma Group Brussels Belgium
| | - V. Fiaccadori
- University College London Cancer Institute London UK
| | - N. Counsell
- University College London Cancer Research UK and University College London Cancer Trials Centre London UK
| | - E. Phillips
- University of Manchester The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
| | - L. Clifton‐Hadley
- University College London Cancer Research UK and University College London Cancer Trials Centre London UK
| | - C. Fortpied
- European Organisation for Research and Treatment of Cancer Lymphoma Group Brussels Belgium
| | - M. Andre
- Université Catholique de Louvain Department of Hematology Yvoir Belgium
| | - M. Federico
- University of Modena and Reggio Emilia CHIMOMO Department Modena Italy
| | - S. Barrington
- King's College London King's College London and Guy's and St Thomas' PET Centre London UK
| | - T. Illidge
- University of Manchester The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
| | - J. Radford
- University of Manchester The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
| | - J. Raemaekers
- Radboud University Medical Centre Department of Hematology Nijmegen Netherlands
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Phillips EH, Counsell N, Illidge T, Andre M, Aurer I, Fiaccadori V, Fortpied C, Neven A, Federico M, Clifton‐Hadley L, Barrington S, Raemaekers J, Radford J. BASELINE MAXIMUM TUMOUR DIAMETER IS ASSOCIATED WITH EVENT‐FREE SURVIVAL FOR PET‐NEGATIVE PATIENTS WITH LIMITED‐STAGE HODGKIN LYMPHOMA: ANALYSIS OF THE H10 AND RAPID TRIALS. Hematol Oncol 2021. [DOI: 10.1002/hon.115_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- E. H. Phillips
- University of Manchester, The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
| | - N. Counsell
- University College London, Cancer Research UK and UCL Cancer Trials Centre London UK
| | - T. Illidge
- University of Manchester, The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
| | - M. Andre
- CHU UCL Namur, Department of Haematology Yvoir Belgium
| | - I. Aurer
- University Hospital Centre Zagreb, Division of Hematology, Department of Internal Medicine Zagreb Croatia
| | - V. Fiaccadori
- University College London, Cancer Institute London UK
| | - C. Fortpied
- European Organisation for Research and Treatment of Cancer, EORTC Headquarters Brussels Belgium
| | - A. Neven
- European Organisation for Research and Treatment of Cancer, EORTC Headquarters Brussels Belgium
| | - M. Federico
- University of Modena and Reggio Emilia, CHIMOMO Department Modena Italy
| | - L. Clifton‐Hadley
- University College London, Cancer Research UK and UCL Cancer Trials Centre London UK
| | - S. Barrington
- King's College London and King's Health Partners, King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences London UK
| | - J. Raemaekers
- Radboud University Medical Center, Department of Haematology Nijmegen Netherlands
| | - J. Radford
- University of Manchester, The Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre Manchester UK
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12
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Haughey CM, Mukherjee D, Steele RE, Popple A, Dura-Perez L, Pickard A, Patel M, Jain S, Mullan PB, Williams R, Oliveira P, Buckley NE, Honeychurch J, S. McDade S, Illidge T, Mills IG, Eddie SL. Investigating Radiotherapy Response in a Novel Syngeneic Model of Prostate Cancer. Cancers (Basel) 2020; 12:E2804. [PMID: 33003551 PMCID: PMC7599844 DOI: 10.3390/cancers12102804] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 01/03/2023] Open
Abstract
The prostate cancer (PCa) field lacks clinically relevant, syngeneic mouse models which retain the tumour microenvironment observed in PCa patients. This study establishes a cell line from prostate tumour tissue derived from the Pten-/-/trp53-/- mouse, termed DVL3 which when subcutaneously implanted in immunocompetent C57BL/6 mice, forms tumours with distinct glandular morphology, strong cytokeratin 8 and androgen receptor expression, recapitulating high-risk localised human PCa. Compared to the commonly used TRAMP C1 model, generated with SV40 large T-antigen, DVL3 tumours are immunologically cold, with a lower proportion of CD8+ T-cells, and high proportion of immunosuppressive myeloid derived suppressor cells (MDSCs), thus resembling high-risk PCa. Furthermore, DVL3 tumours are responsive to fractionated RT, a standard treatment for localised and metastatic PCa, compared to the TRAMP C1 model. RNA-sequencing of irradiated DVL3 tumours identified upregulation of type-1 interferon and STING pathways, as well as transcripts associated with MDSCs. Upregulation of STING expression in tumour epithelium and the recruitment of MDSCs following irradiation was confirmed by immunohistochemistry. The DVL3 syngeneic model represents substantial progress in preclinical PCa modelling, displaying pathological, micro-environmental and treatment responses observed in molecular high-risk disease. Our study supports using this model for development and validation of treatments targeting PCa, especially novel immune therapeutic agents.
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Affiliation(s)
- Charles M. Haughey
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Debayan Mukherjee
- Targeted Therapy Group, Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (D.M.); (A.P.); (M.P.); (J.H.)
| | - Rebecca E. Steele
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
- The Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London SM2 5NG, UK
| | - Amy Popple
- Targeted Therapy Group, Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (D.M.); (A.P.); (M.P.); (J.H.)
| | - Lara Dura-Perez
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
| | - Adam Pickard
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
- Wellcome Centre for Cell Matrix Research, University of Manchester, Manchester M13 9PL, UK
| | - Mehjabin Patel
- Targeted Therapy Group, Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (D.M.); (A.P.); (M.P.); (J.H.)
| | - Suneil Jain
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
| | - Paul B. Mullan
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
| | - Rich Williams
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
| | - Pedro Oliveira
- The Christie Hospital Foundation Trust, Manchester M20 4BX, UK;
| | - Niamh E. Buckley
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Jamie Honeychurch
- Targeted Therapy Group, Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (D.M.); (A.P.); (M.P.); (J.H.)
| | - Simon S. McDade
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
| | - Timothy Illidge
- Targeted Therapy Group, Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK; (D.M.); (A.P.); (M.P.); (J.H.)
- The Christie Hospital Foundation Trust, Manchester M20 4BX, UK;
| | - Ian G. Mills
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Sharon L. Eddie
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (C.M.H.); (R.E.S.); (L.D.-P.); (A.P.); (S.J.); (P.B.M.); (R.W.); (N.E.B.); (S.S.M.)
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13
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Hoskin P, Kirkwood A, Popova B, Schofield O, Brammer C, Robinson M, Brunt M, Krishnaswamy M, Illidge T, Gallop-Evans E, Syndikus I, Clifton-Hadley L. LONG TERM FOLLOW-UP OF FoRT: A PHASE 3 MULTI-CENTER PROSPECTIVE RANDOMIZED TRIAL OF RADIATION THERAPY FOR FOLLICULAR AND MARGINAL ZONE LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.34_2630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- P. Hoskin
- Cancer Centre; Mount Vernon Cancer Centre and University of Manchester; Northwood United Kingdom
| | - A. Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre; University College London; London United Kingdom
| | - B. Popova
- Cancer Research UK & UCL Cancer Trials Centre; University College London; London United Kingdom
| | - O. Schofield
- Cancer Research UK & UCL Cancer Trials Centre; University College London; London United Kingdom
| | - C. Brammer
- Cancer Centre; Clatterbridge Cancer Centre; Wirral United Kingdom
| | - M. Robinson
- Radiotherapy; Weston Park Hospital; Sheffield United Kingdom
| | - M. Brunt
- Cancer Centre; Royal Stoke University Hospital & Keele University, Stoke-on-Trent; Staffordshire United Kingdom
| | - M. Krishnaswamy
- Oncology; Southend University Hospital; Westcliff-on-Sea United Kingdom
| | - T. Illidge
- Manchester Cancer Research Institute; University of Manchester; Manchester United Kingdom
| | - E. Gallop-Evans
- Velindre Hospital; Velindre Cancer Centre; Cardiff United Kingdom
| | - I. Syndikus
- Cancer Centre; Clatterbridge Cancer Centre; Wirral United Kingdom
| | - L. Clifton-Hadley
- Cancer Research UK & UCL Cancer Trials Centre; University College London; London United Kingdom
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14
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Bagot M, Illidge T, Waser N, He M, Li T, Sambrook R, Zomas A, Bent-Ennakhil N, Little M, Ortiz P, Pimpinelli N, Dalal M, Assaf C. SURVIVAL AMONG A PATIENT COHORT OF RELAPSED/REFRACTORY MYCOSIS FUNGOIDES IN FRANCE, GERMANY, ITALY, SPAIN AND THE UNITED KINGDOM. Hematol Oncol 2019. [DOI: 10.1002/hon.164_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M. Bagot
- Polyclinique de Dermatologie; Hopital Saint-Louis; Paris France
| | - T. Illidge
- The Christie Trust; University of Manchester; Manchester United Kingdom
| | - N.A. Waser
- Real World Evidence Strategy and Analytics (RWESA); ICON plc; Vancouver Canada
| | - M. He
- Real World Evidence Strategy and Analytics (RWESA); ICON plc; Vancouver Canada
| | - T. Li
- Real World Evidence Strategy and Analytics (RWESA); ICON plc; Vancouver Canada
| | - R. Sambrook
- Real World Evidence Strategy and Analytics (RWESA); ICON plc; Vancouver Canada
| | - A. Zomas
- EUCAN Medical Affairs; Takeda Pharmaceutical International AG; Zurich Switzerland
| | - N. Bent-Ennakhil
- EUCAN Medical Affairs; Takeda Pharmaceutical International AG; Zurich Switzerland
| | - M. Little
- Millenium Pharmaceuticals Inc; A wholly owned subsidiary of Takeda Pharmaceutical Company Ltd; Cambridge United States
| | - P. Ortiz
- Facultad de Medicina; Hospital Universitario 12 de Octubre; Madrid Spain
| | | | - M. Dalal
- Millenium Pharmaceuticals Inc; A wholly owned subsidiary of Takeda Pharmaceutical Company Ltd; Cambridge United States
| | - C. Assaf
- Dermatology and Venerology; HELIOS Klinikum Krefeld; Krefeld Germany
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Illidge T, Bagot M, Waser N, He M, Li T, Sambrook R, Athanasios Z, Gavini F, Little M, Ortiz P, Pimpinelli N, Dalal M, Assaf C. PS1256 CONTEMPORARY TREATMENT PATTERNS AND RESPONSE IN RELAPSE/REFRACTORY CUTANEOUS T-CELL LYMPHOMA (CTCL) IN CLINICAL PRACTICE IN FRANCE, GERMANY ITALY, SPAIN AND THE UNITED KINGDOM. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563304.35039.6b] [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: 11/25/2022] Open
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16
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Illidge T, Horwitz S, Iyer S, Bartlett N, Kim W, Tilly H, Belada D, Feldman T, Illés Á, Jacobsen E, Hüttmann A, Zinzani P, O'Connor O, Trepicchio W, Miao H, Rao S, Onsum M, Manley T, Advani R. RESPONSE TO A+CHP BY CD30 EXPRESSION IN THE ECHELON-2 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.92_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T. Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health; University of Manchester, National Institutes of Health and Research Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital National Health Service Foundation Trust; Manchester United Kingdom
| | - S. Horwitz
- Department of Medicine; Lymphoma Service, Memorial Sloan Kettering Cancer Center; New York United States
| | - S. Iyer
- Department of Lymphoma and Myeloma; Division of Cancer Medicine, MD Anderson Cancer Center; Houston United States
| | - N. Bartlett
- Department of Medicine; Oncology Division, Washington University School of Medicine, Siteman Cancer Center; Saint Louis United States
| | - W. Kim
- Division of Hematology-Oncology; Department of Medicine, Samsung Medical Center; Seoul Republic of Korea
| | - H. Tilly
- Department of Hematology; Centre Henri Becquerel, Université of Rouen Normandie; Rouen France
| | - D. Belada
- 4th Department of Internal Medicine - Haematology; Charles University, Hospital and Faculty of Medicine; Hradec Králové Czech Republic
| | - T. Feldman
- Hematology Division; Hackensack University Medical Center; Hackensack United States
| | - Á. Illés
- Department of Hematology; University of Debrecen, Faculty of Medicine; Debrecen Hungary
| | - E. Jacobsen
- Division of Hematologic Malignancies; Dana-Farber Cancer Institute; Boston United States
| | - A. Hüttmann
- Department of Haematology; Universitatsklinikum Essen; Essen Germany
| | - P. Zinzani
- Institute of Hematology; “Seràgnoli” University of Bologna; Bologna France
| | - O.A. O'Connor
- Department of Medicine; Columbia University Medical Center; New York United States
| | - W. Trepicchio
- Clinical Development; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceuticals Limited; Cambridge United States
| | - H. Miao
- Clinical Development; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceuticals Limited; Cambridge United States
| | - S. Rao
- Development; Seattle Genetics, Inc.; Bothell United States
| | - M. Onsum
- Development; Seattle Genetics, Inc.; Bothell United States
| | - T. Manley
- Development; Seattle Genetics, Inc.; Bothell United States
| | - R. Advani
- Medicine - Med/Oncology; Stanford Cancer Institute; Stanford United States
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Ng AK, Yahalom J, Goda JS, Constine LS, Pinnix CC, Kelsey CR, Hoppe B, Oguchi M, Suh CO, Wirth A, Qi S, Davies A, Moskowitz CH, Laskar S, Li Y, Mauch PM, Specht L, Illidge T. Role of Radiation Therapy in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2019; 100:652-669. [PMID: 29413279 DOI: 10.1016/j.ijrobp.2017.12.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/16/2017] [Accepted: 12/03/2017] [Indexed: 01/15/2023]
Abstract
Approximately 30% to 40% of patients with diffuse large B-cell lymphoma (DLBCL) will have either primary refractory disease or relapse after chemotherapy. In transplant-eligible patients, those with disease sensitive to salvage chemotherapy will significantly benefit from high-dose therapy with autologous stem cell transplantation. The rationale for considering radiation therapy (RT) for selected patients with relapsed/refractory DLBCL as a part of the salvage program is based on data regarding the patterns of relapse and retrospective series showing improved local control and clinical outcomes for patients who received peritransplant RT. In transplant-ineligible patients, RT can provide effective palliation and, in selected cases, be administered with curative intent if the relapsed/refractory disease is localized. We have reviewed the indications for RT in the setting of relapsed/refractory DLBCL and provided recommendations regarding the optimal timing of RT, dose fractionation scheme, and treatment volume in the context of specific case scenarios.
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Affiliation(s)
- Andrea K Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jayant S Goda
- Department of Radiation Oncology, Tata Memorial Center, Navi, Mumbai, India
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Bradford Hoppe
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Masahiko Oguchi
- Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Andrew Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Andrew Davies
- Cancer Research UK Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Center, Navi, Mumbai, India
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Peter M Mauch
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Timothy Illidge
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Cwynarski K, Marzolini MAV, Barrington SF, Follows G, Illidge T, Stern S, Davies A. The management of primary mediastinal B‐cell lymphoma: a British Society for Haematology Good Practice Paper. Br J Haematol 2019; 185:402-409. [DOI: 10.1111/bjh.15731] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kate Cwynarski
- Department of Haematology University College London Hospitals NHS Foundation TrustLondonUK
| | - Maria A. V. Marzolini
- Department of Haematology University College London Hospitals NHS Foundation TrustLondonUK
| | - Sally F. Barrington
- King's College London and Guy's and St Thomas’ PET Centre School of Biomedical Engineering and Imaging Sciences King's College London King's Health Partners LondonUK
| | - George Follows
- Department of Haematology Addenbrooke's Hospital CambridgeUK
| | - Timothy Illidge
- Department of Clinical Oncology Christie Hospital ManchesterUK
| | - Simon Stern
- Department of Haematology St Helier Hospital CarshaltonUK
| | - Andrew Davies
- Department of Medical Oncology Southampton General Hospital Southampton UK
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Illidge T, Bagot M, Waser N, He M, Li T, Sambrook R, Zomas A, Trinchese F, Gavini F, Little M, Ortiz P, Pimpinelli N, Dalal M, Assaf C. Contemporary treatment patterns and response in relapse/refractory cutaneous T-cell lymphoma (CTCL) in clinical practice in France, Germany Italy, Spain and the United Kingdom. Eur J Cancer 2019. [DOI: 10.1016/s0959-8049(19)30608-2] [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: 11/26/2022]
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20
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Eichenauer DA, Aleman BMP, André M, Federico M, Hutchings M, Illidge T, Engert A, Ladetto M. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv19-iv29. [PMID: 29796651 DOI: 10.1093/annonc/mdy080] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - B M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M André
- Université Catholique de Louvain, Yvoir
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - M Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T Illidge
- Division of Cancer Sciences, University of Manchester, Manchester
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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21
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Armstrong CW, Coulter JA, Ong CW, Maxwell PJ, Butterworth KT, Lyubomska O, LaBonte MJ, Berlingeri S, Gallagher R, Walker SM, O’Sullivan JM, Jain S, Mills IG, Salto-Tellez M, Illidge T, Kennedy RD, Prise KM, Waugh DJ. Abstract B035: Radio-resistance of PTEN-deficient prostate tumors is enhanced by treatment-induced chemokine signaling and is associated with biochemical recurrence and development of metastasis. Cancer Res 2018. [DOI: 10.1158/1538-7445.prca2017-b035] [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
Copy number alterations of the tumor-suppressor gene PTEN occur frequently in primary prostate cancer and are prognostic for relapse post-radiotherapy (RT). Preclinical modelling supports elevated CXC-chemokine signaling as a critical mediator of PTEN-depleted disease progression, and therapeutic resistance. Our objective was to establish the correlation of PTEN-deficiency with CXC-chemokine signaling and its association with clinical outcome following RT. Techniques employed included gene cluster and survival analysis of prostate cancer datasets; in vitro biologic assays extending to RT-PCR, immunoblotting, clonogenic survival assays and flow cytometry; and the use of two in vivo PTEN-deficient xenograft models. Analysis of gene expression data from the MSKCC cohort characterized a PTENLOW/CXCR1HIGH/CXCR2HIGH cluster of tumors that associates with earlier time to biochemical recurrence (HR 5.87, p<0.001). Further analysis was conducted on a gene expression profile derived from the FASTMAN retrospective radiotherapy patient sample cohort (248 diagnostic biopsy samples with median follow-up data >90 months). Kaplan-Meier analysis confirmed that PTENLOW/CXCR1HIGH/CXCR2HIGH tumors were associated with a significantly reduced time to biochemical recurrence (HR 2.65, p<0.001) and the development of metastasis (HR: 3.51, p<0.001) following RT treatment. In vitro, CXCL-signaling was further amplified following exposure of PTEN-deficient CaP cell lines to ionizing radiation (IR; 2-3 Gy). Inhibition of CXCR1/2-signaling in all PTEN-depleted cell-based models increased IR sensitivity (dose enhancement range 1.13 to 1.39), mediated by apoptosis induction in DU145 cells (p53-mutant) or senescence in 22RV1 cells (p53-WT). Reconstitution of PTEN in PTEN-null PC3 cells abrogated the radiosensitivity afforded by a CXCR1/2-signaling blockade. In vivo, administration of a CXCR1/2-targeted pepducin (x1/2pal-i3) in combination with IR to PTEN-null PC3 and PTEN-depleted DU145 xenografts attenuated tumor growth and progression compared to control or radiation alone (p<0.001). Post-mortem analysis confirmed that x1/2pal-i3 administration attenuated IR-induced CXCL-signaling and antiapoptotic protein expression (Bcl-2, c-FLIP). Our data confirm the clinical association of PTEN-deficiency with elevated CXC-chemokine signaling in human prostate cancer, the association of this cluster with adverse clinical outcomes, and demonstrates that IR exposure selectively potentiates this signaling pathway in PTEN-deficient tumor cells. Interventions targeting CXC-chemokine signaling may provide an effective strategy to combine with radiotherapy, especially in locally advanced prostate cancers with known presence of PTEN-deficient foci.
Citation Format: Chris W.D. Armstrong, Jonathan A. Coulter, Chee Wee Ong, Pamela J. Maxwell, Karl T. Butterworth, Oksana Lyubomska, Melissa J. LaBonte, Silvia Berlingeri, Rebecca Gallagher, Steven M. Walker, Joe M. O’Sullivan, Suneil Jain, Ian G. Mills, Manuel Salto-Tellez, Timothy Illidge, Richard D. Kennedy, Kevin M. Prise, David J.J. Waugh. Radio-resistance of PTEN-deficient prostate tumors is enhanced by treatment-induced chemokine signaling and is associated with biochemical recurrence and development of metastasis [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B035.
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Affiliation(s)
| | | | - Chee Wee Ong
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Pamela J. Maxwell
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | | | - Oksana Lyubomska
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | | | - Silvia Berlingeri
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Rebecca Gallagher
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Steven M. Walker
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Joe M. O’Sullivan
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Suneil Jain
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - Ian G. Mills
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | | | | | | | - Kevin M. Prise
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
| | - David J.J. Waugh
- 1Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom,
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Yip K, Melcher A, Harrington K, Illidge T, Nobes J, Webster A, Smith D, Lorigan P, Nathan P, Larkin J. Pembrolizumab in Combination with Radiotherapy for Metastatic Melanoma - Introducing the PERM Trial. Clin Oncol (R Coll Radiol) 2018; 30:201-203. [PMID: 29402599 DOI: 10.1016/j.clon.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/26/2022]
Affiliation(s)
- K Yip
- Ipswich Hospital, Ipswich, UK.
| | - A Melcher
- Institute of Cancer Research, Sutton, London, UK; The Royal Marsden Hospital, Chelsea, London, UK
| | - K Harrington
- Institute of Cancer Research, Sutton, London, UK; The Royal Marsden Hospital, Chelsea, London, UK
| | - T Illidge
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Withington, Manchester, UK
| | - J Nobes
- Norfolk and Norwich University Hospital, Norwich, UK
| | - A Webster
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - D Smith
- The Royal Marsden Hospital, Chelsea, London, UK
| | - P Lorigan
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Withington, Manchester, UK
| | - P Nathan
- Mount Vernon Cancer Centre, Northwood, UK
| | - J Larkin
- The Royal Marsden Hospital, Chelsea, London, UK
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23
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Illidge T. SP-0013: Understanding the mechanisms of adding immunoregulatory agents together with radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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24
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Kordbacheh T, Honeychurch J, Blackhall F, Faivre-Finn C, Illidge T. Radiotherapy and anti-PD-1/PD-L1 combinations in lung cancer: building better translational research platforms. Ann Oncol 2018; 29:301-310. [PMID: 29309540 DOI: 10.1093/annonc/mdx790] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
Despite the unheralded success of immune checkpoint blockade in delivering durable responses for some patients with non-small-cell lung cancer (NSCLC), the majority of patients do not respond. PD-L1 tumour expression and pre-existing tumour T-cell infiltration have been correlated with improved clinical outcomes to anti-PD-1/anti-PD-L1. However, patients with tumours that are negative for PD-L1 expression can also respond to treatment. Strategies to combine other treatment modalities like radiotherapy (RT) with immune checkpoint inhibitors are being investigated as means of improving the response rates to PD-1/PD-L1 antibody blockade. RT induces immunogenic changes in cancer cells, can adaptively upregulate tumour cell PD-L1 expression and can improve the efficacy of anti-PD-1/anti-PD-L1 therapy. How we design future clinical trials in NSCLC also depends on practical considerations of delivering these treatment combinations, such as RT dose, fractionation and field volume, as well as scheduling with immune checkpoint blockade. Here, we review reasons for resistance to anti-PD-1/anti-PD-L1 and how RT may be utilised in combination with these drugs to enhance their effect by building better translational research platforms.
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Affiliation(s)
- T Kordbacheh
- Targeted Therapy Group, Division of Cancer Sciences, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester Cancer Research Centre, Manchester, M20 4BX, UK; The Christie NHS Foundation Trust, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M20 4BX, UK.
| | - J Honeychurch
- Targeted Therapy Group, Division of Cancer Sciences, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester Cancer Research Centre, Manchester, M20 4BX, UK
| | - F Blackhall
- Targeted Therapy Group, Division of Cancer Sciences, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester Cancer Research Centre, Manchester, M20 4BX, UK; The Christie NHS Foundation Trust, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M20 4BX, UK
| | - C Faivre-Finn
- Targeted Therapy Group, Division of Cancer Sciences, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester Cancer Research Centre, Manchester, M20 4BX, UK; The Christie NHS Foundation Trust, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M20 4BX, UK
| | - T Illidge
- Targeted Therapy Group, Division of Cancer Sciences, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester Cancer Research Centre, Manchester, M20 4BX, UK; The Christie NHS Foundation Trust, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M20 4BX, UK
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Kolstad A, Madsbu U, Beasley M, Bayne M, Illidge T, O'Rourke N, Lagerlöf I, Hájek R, Jurczak W, Willenbacher E, Blakkisrud J, Muftuler Løndalen A, Rojkjaer L, Baylor Curtis L, Bloma M, Turner S, Bolstad N, Spetalen S, Erlanson M, Nygaard S, Holte H. LYMRIT 37-01: UPDATED RESULTS OF A PHASE I/II STUDY OF 177
LU-LILOTOMAB SATETRAXETAN, A NOVEL CD37-TARGETED ANTIBODY- RADIONUCLIDE-CONJUGATE IN RELAPSED NHL PATIENTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Kolstad
- Department of Oncology; Oslo University Hospital; Oslo Norway
| | - U. Madsbu
- Dept of Radiology and Nuclear Medicine; Oslo University Hospital; Oslo Norway
| | - M. Beasley
- Bristol Hospitals NHS Foundation Trust; Bristol Haematology and Oncology Centre; Bristol UK
| | - M. Bayne
- Poole General Hospital; Dorset Cancer Centre; Poole UK
| | - T. Illidge
- Manchester Academic Health Science Centre; The Christie NHS Foundation Trust; Manchester UK
| | - N. O'Rourke
- Beatson West of Scotland Cancer Centre; Gartnavel General Hospital; Glasgow Norway
| | - I. Lagerlöf
- Hematologic Clinic; University Hospital Linköping; Linköping Sweden
| | - R. Hájek
- Klinika hematoonkologie, FNsP Ostrava; Ostrava Czech Republic
| | - W. Jurczak
- Oncology; Małopolskie Centrum Medyczne; Kraków Poland
| | - E. Willenbacher
- Innere Medizin V (Hämato/Onkologie); Universitätsklinikum Innsbruck; Innsbruck Austria
| | - J. Blakkisrud
- The Intervention Centre; Oslo University Hospital; Oslo Norway
| | | | - L. Rojkjaer
- Clinical Department; Nordic Nanovector; Oslo Norway
| | | | - M. Bloma
- Clinical Department; Nordic Nanovector; Oslo Norway
| | - S. Turner
- Clinical Department; Nordic Nanovector; Oslo Norway
| | - N. Bolstad
- Department of Medical Biochemistry; Oslo University Hospital; Oslo Norway
| | - S. Spetalen
- Department of Pathology; Oslo University Hospital; Oslo Norway
| | - M. Erlanson
- Dept of Oncology; Norrland University Hospital; Umeå Sweden
| | - S. Nygaard
- Department of Oncology; Oslo University Hospital; Oslo Norway
| | - H. Holte
- Department of Oncology; Oslo University Hospital; Oslo Norway
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Marshall R, Popple A, Kordbacheh T, Honeychurch J, Faivre-Finn C, Illidge T. Immune Checkpoint Inhibitors in Lung Cancer - An Unheralded Opportunity? Clin Oncol (R Coll Radiol) 2017; 29:207-217. [PMID: 28063623 DOI: 10.1016/j.clon.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/24/2016] [Revised: 10/04/2016] [Accepted: 11/01/2016] [Indexed: 02/04/2023]
Abstract
Lung cancer remains the leading cause of cancer-related death worldwide, with non-small cell lung cancer accounting for 85% of the disease. Over 70% of patients present with locally advanced, non-resectable or metastatic disease and despite improvements in chemoradiotherapy regimens and the development of molecularly targeted agents, 5 year survival rates remain poor, with acquired resistance to novel targeted therapies becoming a growing concern. Currently there remains an unmet need in effectively treating and inducing durable responses in advanced disease. Targeting the immune system has, however, recently given hope of improving therapeutic outcomes for these patients. The notion that the immune system is capable of recognising and eliminating cancer cells is now a widely accepted phenomenon and growing evidence suggests lung cancer is an attractive target for such intervention. Recent success targeting the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) axis of immune checkpoint inhibition suggests a major immunotherapeutic advance in treating lung cancer and unheralded opportunity for such approaches to further improve outcome for patients. Currently there is considerable interest in combining anti-PD-1 or PD-L1 monoclonal antibodies with established standard of care therapies such as radiotherapy. Radiotherapy is known to be immunostimulatory and efforts are underway to combine and augment the efficacy of the immune checkpoint inhibitors further. This review outlines the interaction between lung cancer and the immune system, summarises current evidence supporting the use of monoclonal antibodies targeting the PD-1 axis in lung cancer and explores the potential of combining radiotherapy with immunotherapy to augment anti-tumour immune responses.
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Affiliation(s)
- R Marshall
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Popple
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - T Kordbacheh
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - J Honeychurch
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C Faivre-Finn
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - T Illidge
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
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Kordbacheh T, Chan C, Bossons A, Franks K, McDonald F, Forster M, Mendes R, Quezada S, Dovedi S, Ralph C, Popat S, Harrington K, Melcher A, Popple A, Illidge T, Faivre-Finn C. 164: PARIS: A phase I study of pembrolizumab anti-PD-1 monoclonal antibody in combination with radiotherapy (RT) in locally advanced non-small cell lung cancer (NSCLC). Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30214-3] [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: 11/29/2022]
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28
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Kordbacheh T, Chan C, Faivre-Finn C, Franks K, McDonald F, Forster M, Mendes R, Quezada S, Dovedi S, Ralph C, Popat S, Harrington K, Melcher A, Popple A, Illidge T. 168: PD-RAD: A translational study investigating PD-L1 expression after radiotherapy for non-small cell lung cancer (NSCLC). Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Hanna GG, Illidge T. Radiotherapy and Immunotherapy Combinations in Non-small Cell Lung Cancer: A Promising Future? Clin Oncol (R Coll Radiol) 2016; 28:726-731. [PMID: 27519157 DOI: 10.1016/j.clon.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/06/2016] [Revised: 07/18/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
The goal of re-programming the host immune system to target malignancy with durable anti-tumour clinical responses has been speculated for decades. In the last decade such speculation has been transformed into reality with unprecedented and durable responses to immune checkpoint inhibitors seen in solid tumours. This mini-review considers the mechanism of action of immune modulating agents and the potential for combination with radiotherapy in the treatment of non-small cell lung cancer.
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Affiliation(s)
- G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - T Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK
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Vitolo U, Seymour J, Martelli M, Illerhaus G, Illidge T, Zucca E, Campo E, Ladetto M. Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v91-v102. [DOI: 10.1093/annonc/mdw175] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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31
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Mukherjee D, Ani E, Honeychurch J, Illidge T. Modeling the immunological response to clinically relevant radiotherapy in a murine prostate tumour model. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61754-9] [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: 11/25/2022]
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32
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Searle E, Telfer B, Forster D, Williams K, Davies B, Illidge T, Stratford I. Treatment with the novel Akt inhibitor AZD5363 following radiotherapy improves tumour control in mouse models of head and neck cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Ng AK, Dabaja BS, Hoppe RT, Illidge T, Yahalom J. Re-Examining the Role of Radiation Therapy for Diffuse Large B-Cell Lymphoma in the Modern Era. J Clin Oncol 2016; 34:1443-7. [DOI: 10.1200/jco.2015.64.9418] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea K. Ng
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Timothy Illidge
- University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Illidge T. Turning Radiotherapy into an Effective Systemic Anti-cancer Treatment in Combination with Immunotherapy. Clin Oncol (R Coll Radiol) 2015; 27:696-9. [PMID: 26414754 DOI: 10.1016/j.clon.2015.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022]
Affiliation(s)
- T Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK.
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35
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Illidge T. Balancing Risks in Developing a Personalised Approach to the Treatment of Early Hodgkin Lymphoma: Have We Got the Balance Right? Clin Oncol (R Coll Radiol) 2015; 27:454-6. [PMID: 26108883 DOI: 10.1016/j.clon.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester, UK.
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Dovedi SJ, Lipowska-Bhalla G, Cheadle E, Poon E, Morrow M, Stewart R, Wilkinson R, Honeychurch J, Illidge T. Abstract 5034: The antitumor immune response generated by radiation therapy may be limited by tumor cell adaptive resistance and can be circumvented by PD-L1 blockade. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Radiation therapy (RT) is administered to around 50% of all cancer patients making it one of the most important cancer treatments. In addition to the direct cytoreductive effect of RT there is increasing evidence that radiation-induces immunogenic tumor cell death. Despite the immunogenicity of RT-induced tumor cell death, RT delivered to tumours in the clinic rarely generates therapeutic systemic anti-cancer immune responses or ‘abscopal effects’.
Here we show that tumor infiltrating CD8+ cytotoxic T lymphocytes (CTL) have increased expression of PD-1 following RT in vivo. Moreover, our data demonstrate that treatment of established syngeneic tumors with RT leads to upregulation of tumor cell expression of PD-L1 in vivo but not when cells are irradiated in vitro. Using depleting antibodies we determined that the depletion of CD8+ T cells but not CD4+ T cells or NK cells could abrogate this RT-induced increase in tumor cell expression of PD-L1 in vivo. Furthermore, silencing of IFNγR1 using ShRNA confirmed that this process was dependent on CD8+ T cell production of IFNγ suggesting an adaptive upregulation of PD-L1 following RT occurs in response to CTL activation. This novel finding suggests that the immunogenicity of RT may be limited via the PD-L1/PD-1 signalling axis and may contribute to treatment failure.
We next sought to determine whether blockade of the PD-1/PD-L1 signalling axis could enhance the therapeutic response to RT. Our study demonstrates that administration of either an anti-PD-1 or anti-PD-L1 mAb in combination with RT leads to substantially improved survival when compared to either monotherapy alone with approximately 60% of treated mice undergoing a complete response. In addition, our data reveal that combination therapy generates long-term immunological memory in mice that have undergone complete response protecting against tumor rechallenge.
This is the first report to our knowledge that demonstrates adaptive resistance through the upregulation of tumour cell PD-L1 expression in response to an RT-induced CTL response. This study demonstrates the potential for enhancing the efficacy of conventional RT through blockade of the PD-1/PD-L1 axis and warrants clinical evaluation.
Citation Format: Simon J. Dovedi, Graznya Lipowska-Bhalla, Eleanor Cheadle, Edmund Poon, Michelle Morrow, Ross Stewart, Robert Wilkinson, Jamie Honeychurch, Timothy Illidge. The antitumor immune response generated by radiation therapy may be limited by tumor cell adaptive resistance and can be circumvented by PD-L1 blockade. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5034. doi:10.1158/1538-7445.AM2014-5034
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Illidge T, Lipowska-Bhalla G, Cheadle E, Honeychurch J, Poon E, Morrow M, Stewart R, Wilkinson R, Dovedi S. Radiation Therapy Induces an Adaptive Upregulation of PD-L1 on Tumor Cells Which May Limit the Efficacy of the Anti-Tumor Immune Response But Can Be Circumvented by Anti-PD-L1. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fanale M, Horwitz S, Forero-Torres A, Bartlett N, Advani R, Pro B, Chen R, Davies A, Illidge T, Huebner D, Kennedy D, Shustov A. Brentuximab Vedotin in Combination with Chp in Patients (Pts) with Newly-Diagnosed Cd30+ Peripheral T-Cell Lymphomas (Ptcl): 2-Year Follow-Up. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu339.1] [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: 11/12/2022] Open
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Illidge T, Pro B, Trümper L, Larsen E, Huebner D, Kennedy D, O'Connor O. Phase 3 Trial of Brentuximab Vedotin and Chp Versus Chop in the Frontline Treatment of Patients (Pts) with Cd30+ Mature T-Cell Lymphomas (Mtcl). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu339.41] [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: 11/12/2022] Open
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Eichenauer DA, Engert A, André M, Federico M, Illidge T, Hutchings M, Ladetto M. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii70-5. [PMID: 25185243 DOI: 10.1093/annonc/mdu181] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne and German Hodgkin Study Group (GHSG), Cologne, Germany
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne and German Hodgkin Study Group (GHSG), Cologne, Germany
| | - M André
- CHU Dinant-Godinne, UCL Namur, Yvoir, Belgium
| | - M Federico
- Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - T Illidge
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Hoskin PJ, Kirkwood AA, Popova B, Smith P, Robinson M, Gallop-Evans E, Coltart S, Illidge T, Madhavan K, Brammer C, Diez P, Jack A, Syndikus I. 4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial. Lancet Oncol 2014; 15:457-63. [PMID: 24572077 DOI: 10.1016/s1470-2045(14)70036-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Follicular lymphoma has been shown to be highly radiosensitive with responses to doses as low as 4 Gy in two fractions. This trial was designed to explore the dose response for follicular lymphoma comparing 4 Gy in two fractions with 24 Gy in 12 fractions METHODS FORT is a prospective randomised, unblinded, phase 3 non-inferiority study comparing radiotherapy given as 4 Gy in two fractions with a standard dose of 24 Gy in 12 fractions. Entry criteria included all patients aged over 18 years, having local radiotherapy for radical or palliative local control, with follicular lymphoma or marginal zone lymphoma, who had received no previous treatment for at least 1 month before. The primary outcome was time to local progression analysed on an intention-to-treat basis. Randomisation was centralised through the Cancer Research UK and University College London Cancer Trials Centre. Radiotherapy target sites were randomised (1:1) with minimisation stratified by histology (follicular lymphoma vs marginal zone lymphoma), treatment intent (palliative or curative) and centre. This trial is registered with ClinicalTrials.gov number, NCT00310167. FINDINGS 299 sites were randomly assigned to 24 Gy and 315 sites to 4 Gy between April 7, 2006, and June 8, 2011, at 43 centres in the UK. After a median follow-up of 26 months (range 0·39-75·4), 91 local progressions had been recorded (21 in the 24 Gy group and 70 in the 4 Gy group). Time to local progression with 4 Gy was not non-inferior to 24 Gy (hazard ratio 3·42, 95% CI 2·09-5·55, p<0·0001). Eight (3%) of 282 patients in the 24 Gy group and four (1%) of 300 in the 4 Gy group had acute grade 3-4 toxic effects. Four (1%) patients in the 24 Gy group and four (1%) patients in the 4 Gy group had late toxic effects. Mucositis was the most common event in the 24 Gy group (two patients with acute mucositis and two with late mucositis; all grade 3) and was not reported in the 4 Gy group. The most common acute effect was pain at the site of irradiation (two patients in the 4 Gy group, one patient in the 24 Gy group; all grade 3), and the most common late effect was fatigue (two patients in the 4 Gy group, one patient in the 24 Gy group; all grade 3). INTERPRETATION 24 Gy in 12 fractions is the more effective radiation schedule for indolent lymphoma and should be regarded as the standard of care. However, 4 Gy remains a useful alternative for palliative treatment. FUNDING Cancer Research UK.
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Affiliation(s)
| | - Amy A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Bilyana Popova
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | | | | | | | | | | | - Patricia Diez
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
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Chan C, Cornelissen B, Vallis K, Honeychurch J, Illidge T. PO-0939: Surface EGFR levels rather than intrinsic radiosensitivity predict response to In-DTPA-hEGF in solid cancers. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31057-4] [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: 11/30/2022]
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Illidge T. SP-0556: Radiotherapy and immunotherapy combinations - unlocking the potential. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Illidge T, Chan C, Counsell N, Morris S, Scarisbrick J, Gilson D, Popova B, Patrick P, Smith P, Whittaker S, Cowan R. Phase II study of gemcitabine and bexarotene (GEMBEX) in the treatment of cutaneous T-cell lymphoma. Br J Cancer 2013; 109:2566-73. [PMID: 24136145 PMCID: PMC3833210 DOI: 10.1038/bjc.2013.616] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both gemcitabine and bexarotene are established single agents for the treatment of cutaneous T-cell lymphoma (CTCL). We investigated the feasibility and efficacy of combining these drugs in a single-arm phase II study. METHODS Cutaneous T-cell lymphoma patients who had failed standard skin-directed therapy and at least one prior systemic therapy were given four cycles of gemcitabine and concurrent bexarotene for 12 weeks. Responders were continued on bexarotene maintenance until disease progression or unacceptable toxicity. RESULTS The median age was 65 years, stage IB (n=5), stage IIA (n=2), stage IIB (n=8), stage III (n=8) and stage IVA (n=12), 17 patients were erythrodermic, 17 patients were B1, and 10 patients were both erythrodermic and B1. Thirty (86%) patients completed four cycles of gemcitabine. In all, 80.0% of patients demonstrated a reduction in modified Severity-Weighted Assessment Tool (mSWAT) score although the objective disease response rate at 12 weeks was 31% (partial response (PR) 31%) and at 24 weeks 14% (PR 14%, stable disease (SD) 23%, progressive disease (PD) 54%, not evaluable 9%). Median progression-free survival was 5.3 months and median overall survival was 21.2 months. CONCLUSION The overall response rate of the combination did not reach the specified target to proceed further and is lower than that previously reported for gemcitabine as a single agent.
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Affiliation(s)
- T Illidge
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, University of Manchester, The Christie, Wilmslow Road, Manchester, M20 4BX, UK
| | - C Chan
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, University of Manchester, The Christie, Wilmslow Road, Manchester, M20 4BX, UK
| | - N Counsell
- Cancer Research UK and University College London Cancer Trials Centre, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - S Morris
- Guys and St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
| | - J Scarisbrick
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - D Gilson
- St James's Institute of Oncology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - B Popova
- Cancer Research UK and University College London Cancer Trials Centre, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - P Patrick
- Cancer Research UK and University College London Cancer Trials Centre, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - P Smith
- Cancer Research UK and University College London Cancer Trials Centre, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - S Whittaker
- St John's Institute of Dermatology, Guys and St Thomas NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
| | - R Cowan
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, University of Manchester, The Christie, Wilmslow Road, Manchester, M20 4BX, UK
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Cooke R, Jones ME, Cunningham D, Falk SJ, Gilson D, Hancock BW, Harris SJ, Horwich A, Hoskin PJ, Illidge T, Linch DC, Lister TA, Lucraft HH, Radford JA, Stevens AM, Syndikus I, Williams MV, Swerdlow AJ. Breast cancer risk following Hodgkin lymphoma radiotherapy in relation to menstrual and reproductive factors. Br J Cancer 2013; 108:2399-406. [PMID: 23652303 PMCID: PMC3681009 DOI: 10.1038/bjc.2013.219] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/02/2013] [Accepted: 04/14/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Women treated with supradiaphragmatic radiotherapy (sRT) for Hodgkin lymphoma (HL) at young ages have a substantially increased breast cancer risk. Little is known about how menarcheal and reproductive factors modify this risk. METHODS We examined the effects of menarcheal age, pregnancy, and menopausal age on breast cancer risk following sRT in case-control data from questionnaires completed by 2497 women from a cohort of 5002 treated with sRT for HL at ages <36 during 1956-2003. RESULTS Two-hundred and sixty women had been diagnosed with breast cancer. Breast cancer risk was significantly increased in patients treated within 6 months of menarche (odds ratio (OR) 5.52, 95% confidence interval (CI) (1.97-15.46)), and increased significantly with proximity of sRT to menarche (Ptrend<0.001). It was greatest when sRT was close to a late menarche, but based on small numbers and needing reexamination elsewhere. Risk was not significantly affected by full-term pregnancies before or after treatment. Risk was significantly reduced by early menopause (OR 0.55, 95% CI (0.35-0.85)), and increased with number of premenopausal years after treatment (Ptrend=0.003). CONCLUSION In summary, this paper shows for the first time that sRT close to menarche substantially increases breast cancer risk. Careful consideration should be given to follow-up of these women, and to measures that might reduce their future breast cancer risk.
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Affiliation(s)
- R Cooke
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK.
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Scarisbrick JJ, Morris S, Azurdia R, Illidge T, Parry E, Graham-Brown R, Cowan R, Gallop-Evans E, Wachsmuth R, Eagle M, Wierzbicki AS, Soran H, Whittaker S, Wain EM. U.K. consensus statement on safe clinical prescribing of bexarotene for patients with cutaneous T-cell lymphoma. Br J Dermatol 2012; 168:192-200. [PMID: 22963233 DOI: 10.1111/bjd.12042] [Citation(s) in RCA: 69] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bexarotene is a synthetic retinoid from the subclass of retinoids called rexinoids which selectively activate retinoid X receptors. It has activity in cutaneous T-cell lymphoma (CTCL) and has been approved by the European Medicines Agency since 1999 for treatment of the skin manifestations of advanced-stage (IIB-IVB) CTCL in adult patients refractory to at least one systemic treatment. In vivo bexarotene produces primary hypothyroidism which may be managed with thyroxine replacement. It also affects lipid metabolism, typically resulting in raised triglycerides, which requires prophylactic lipid-modification therapy. Effects on neutrophils, glucose and liver function may also occur. These side-effects are dose dependent and may be controlled with corrective therapy or dose adjustments. OBJECTIVES To produce a U.K. statement outlining a bexarotene dosing schedule and monitoring protocol to enable bexarotene prescribers to deliver bexarotene safely for optimal effect. METHODS Leaders from U.K. supraregional centres produced this consensus statement after a series of meetings and a review of the literature. RESULTS The statement outlines a bexarotene dosing schedule and monitoring protocol. This gives instructions on monitoring and treating thyroid, lipid, liver, blood count, creatine kinase, glucose and amylase abnormalities. The statement also includes algorithms for a bexarotene protocol and lipid management, which may be used in the clinical setting. CONCLUSION Clinical prescribing of bexarotene for patients with CTCL requires careful monitoring to allow safe administration of bexarotene at the optimal dose.
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Ferrer L, Malek E, Bodet-Milin C, Legouill S, Prangère T, Robu D, Jeans S, Tipping J, Huglo D, Carpentier P, Illidge T, Kraeber-Boderé F, Morschhauser F, Bardiès M. Comparisons of dosimetric approaches for fractionated radioimmunotherapy of non-Hodgkin lymphoma. Q J Nucl Med Mol Imaging 2012; 56:529-537. [PMID: 23358406] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study was to compare different dosimetric approaches on therapy naïve patients enrolled in a multicentre fractionated radioimmunotherapy trial, to determine which methodological approach correlates with bone marrow toxicity. METHODS Twenty-height non-Hodgkin lymphoma patients were treated with one or two fractions of 90Y-Ibritumomab-Tiuxetan (11.1 MBq/kg) 8 to 12 weeks apart in four different institutions. Quantitative imaging with 111In-Ibritumomab-Tiuxetan (185 MBq) was performed at 0, 1, 4 and 7 days after infusion, starting two weeks before the therapeutic administration. A whole-body (WB) CT scan was also acquired prior to the 111In-Ibritumomab injection, for attenuation correction purposes and was segmented to derive patient-specific organ masses. All dosimetry processing was centralized in a single institution. The first method (M_2D) was based on geometric mean WB scans, corrected for attenuation, scatter and organs superposition. The second method (M_2.5D) was based on the computed assisted matrix inversion approach and used segmented CT scans. The third method (M_3D) used iterative reconstruction of tomographic scans, corrected for attenuation, scatter and collimator response. Absorbed doses were estimated for lungs, liver, kidneys and spleen using MIRD S values adjusted for organ masses. Bone marrow (BM) absorbed doses were evaluated according to imaging methods (3) and compared to blood-based approaches. RESULTS For some patients, organ masses such as liver or spleen significantly differed from male/female reference masses, whereas lungs and kidneys masses were relatively constant. Except for lungs, absorbed doses estimated by M_2D were higher than those from M_2.5D and these, in turn, were higher that those calculated from M_3D (Wilcoxon P<8.6e-4). Median organ absorbed dose estimates were equivalent for both fractions except for the spleen. In fact, spleen absorbed doses for the second fraction were lower than those for the first fraction, regardless of the approach. Possible explanations are that patient spleen masses were kept constant for analysis of both fractions and/or that spleen uptake was lowered after the first fraction. Estimation of BM absorbed doses from blood sampling was unable to predict platelet toxicity, but image-based methods performed better. Additionally, for most organs, the absorbed dose delivered by the first fraction could predict that delivered by the second fraction. CONCLUSION These results confirm that different acquisition/processing protocols will lead to statistically different absorbed doses. Additionally, image-based dosimetric approaches are needed in order to correlate absorbed dose to bone marrow toxicity.
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Affiliation(s)
- L Ferrer
- ICO René Gauducheau, St Herblain, France.
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Fanale M, Advani R, Bartlett N, Davies A, Illidge T, Kennedy D, Shustov A. Sequential Therapy with Brentuximab Vedotin in Newly Diagnosed Patients with Systemic Anaplastic Large Cell Lymphoma. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33626-7] [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: 11/16/2022] Open
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Gilson D, Illidge T, Ford D. Current developments in specialty training. Clin Oncol (R Coll Radiol) 2011; 23:431-3. [PMID: 21723714 DOI: 10.1016/j.clon.2011.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/06/2011] [Indexed: 11/26/2022]
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