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Davis L, Miller RE, Wong YNS. The Landscape of Adoptive Cellular Therapies in Ovarian Cancer. Cancers (Basel) 2023; 15:4814. [PMID: 37835509 PMCID: PMC10571827 DOI: 10.3390/cancers15194814] [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: 09/06/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Ovarian cancers are typically poorly immunogenic and have demonstrated disappointing responses to immune checkpoint inhibitor (ICI) therapy. Adoptive cellular therapy (ACT) offers an alternative method of harnessing the immune system that has shown promise, especially with the success of chimeric antigen receptor T-cell (CAR-T) therapy in haematologic malignancies. So far, ACT has led to modest results in the treatment of solid organ malignancies. This review explores the possibility of ACT as an effective alternative or additional treatment to current standards of care in ovarian cancer. We will highlight the potential of ACTs, such as CAR-T, T-cell receptor therapy (TCR-T), tumour-infiltrating lymphocytes (TILs) and cell-based vaccines, whilst also discussing their challenges. We will present clinical studies for these approaches in the treatment of immunologically 'cold' ovarian cancer and consider the rationale for future research.
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Affiliation(s)
- Lucy Davis
- Royal Free Hospital, London NW3 2QG, UK;
| | - Rowan E Miller
- Department of Medical Oncology, University College London Hospital, London NW1 3PG, UK;
- Department of Medical Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Yien Ning Sophia Wong
- Royal Free Hospital, London NW3 2QG, UK;
- Department of Medical Oncology, University College London Hospital, London NW1 3PG, UK;
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Pinato DJ, Aguilar-Company J, Ferrante D, Hanbury G, Bower M, Salazar R, Mirallas O, Sureda A, Plaja A, Cucurull M, Mesia R, Townsend S, Jackson A, Dalla Pria A, Newsom-Davis T, Handford J, Sita-Lumsden A, Apthorp E, Vincenzi B, Bertuzzi A, Brunet J, Lambertini M, Maluquer C, Pedrazzoli P, Biello F, Sinclair A, Bawany S, Khalique S, Rossi S, Rogers L, Murphy C, Belessiotis K, Carmona-García MC, Sharkey R, García-Illescas D, Rizzo G, Perachino M, Saoudi-Gonzalez N, Doonga K, Fox L, Roldán E, Gaidano G, Ruiz-Camps I, Bruna R, Patriarca A, Martinez-Vila C, Cantini L, Zambelli A, Giusti R, Mazzoni F, Caliman E, Santoro A, Grosso F, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Prat A, Tucci M, Libertini M, Grisanti S, Mukherjee U, Diamantis N, Fusco V, Generali D, Provenzano S, Gennari A, Tabernero J, Cortellini A, Evans JS, Swallow J, Chung C, Patel M, Dettorre G, Ottaviani D, Chowdhury A, Merry E, Chopra N, Lee AJX, Sng CCT, Yu T, Shawe-Taylor M, Bain HDC, Wong YNS, Galazi M, Benafif S, Dileo P, Earnshaw I, Patel G, Wu A, Soosaipillai G, Cooper L, Andaleeb R, Dolly S, Apthorp E, Srikandarajah K, Jones E, Van Hemelrijck M, Moss C, Russell B, Chester J, Loizidou A, Piccart M, Cruz CA, Reyes R, Segui E, Marco-Hernández J, Viladot M, Eremiev S, Fort-Culillas R, Garcia I, Liñan R, Roqué Lloveras A, Harbeck N, Wuerstlein R, Henze F, Mahner S, Felip E, Pous A, D'Avanzo F, Scotti L, Krengli M, Marrari A, Delfanti S, Maconi A, Betti M, Tonini G, Di Fazio GR, Tondini C, Chiudinelli L, Franchi M, Libertini M, Bertulli R, Baggi A, Tovazzi V, Ficorella C, Porzio G, Saponara M, Filetti M, Zoratto F, Paoloni F, Berardi R, Guida A, Bracarda S, Iglesias M, Sanchez de Torre A, Tagliamento M, Colomba E, Pommeret F. Outcomes of the SARS-CoV-2 omicron (B.1.1.529) variant outbreak among vaccinated and unvaccinated patients with cancer in Europe: results from the retrospective, multicentre, OnCovid registry study. Lancet Oncol 2022; 23:865-875. [PMID: 35660139 PMCID: PMC9162476 DOI: 10.1016/s1470-2045(22)00273-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The omicron (B.1.1.529) variant of SARS-CoV-2 is highly transmissible and escapes vaccine-induced immunity. We aimed to describe outcomes due to COVID-19 during the omicron outbreak compared with the prevaccination period and alpha (B.1.1.7) and delta (B.1.617.2) waves in patients with cancer in Europe. METHODS In this retrospective analysis of the multicentre OnCovid Registry study, we recruited patients aged 18 years or older with laboratory-confirmed diagnosis of SARS-CoV-2, who had a history of solid or haematological malignancy that was either active or in remission. Patient were recruited from 37 oncology centres from UK, Italy, Spain, France, Belgium, and Germany. Participants were followed up from COVID-19 diagnosis until death or loss to follow-up, while being treated as per standard of care. For this analysis, we excluded data from centres that did not actively enter new data after March 1, 2021 (in France, Germany, and Belgium). We compared measures of COVID-19 morbidity, which were complications from COVID-19, hospitalisation due to COVID-19, and requirement of supplemental oxygen and COVID-19-specific therapies, and COVID-19 mortality across three time periods designated as the prevaccination (Feb 27 to Nov 30, 2020), alpha-delta (Dec 1, 2020, to Dec 14, 2021), and omicron (Dec 15, 2021, to Jan 31, 2022) phases. We assessed all-cause case-fatality rates at 14 days and 28 days after diagnosis of COVID-19 overall and in unvaccinated and fully vaccinated patients and in those who received a booster dose, after adjusting for country of origin, sex, age, comorbidities, tumour type, stage, and status, and receipt of systemic anti-cancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974, and is ongoing. FINDINGS As of Feb 4, 2022 (database lock), the registry included 3820 patients who had been diagnosed with COVID-19 between Feb 27, 2020, and Jan 31, 2022. 3473 patients were eligible for inclusion (1640 [47·4%] were women and 1822 [52·6%] were men, with a median age of 68 years [IQR 57-77]). 2033 (58·5%) of 3473 were diagnosed during the prevaccination phase, 1075 (31·0%) during the alpha-delta phase, and 365 (10·5%) during the omicron phase. Among patients diagnosed during the omicron phase, 113 (33·3%) of 339 were fully vaccinated and 165 (48·7%) were boosted, whereas among those diagnosed during the alpha-delta phase, 152 (16·6%) of 915 were fully vaccinated and 21 (2·3%) were boosted. Compared with patients diagnosed during the prevaccination period, those who were diagnosed during the omicron phase had lower case-fatality rates at 14 days (adjusted odds ratio [OR] 0·32 [95% CI 0·19-0·61) and 28 days (0·34 [0·16-0·79]), complications due to COVID-19 (0·26 [0·17-0·46]), and hospitalisation due to COVID-19 (0·17 [0·09-0·32]), and had less requirements for COVID-19-specific therapy (0·22 [0·15-0·34]) and oxygen therapy (0·24 [0·14-0·43]) than did those diagnosed during the alpha-delta phase. Unvaccinated patients diagnosed during the omicron phase had similar crude case-fatality rates at 14 days (ten [25%] of 40 patients vs 114 [17%] of 656) and at 28 days (11 [27%] of 40 vs 184 [28%] of 656) and similar rates of hospitalisation due to COVID-19 (18 [43%] of 42 vs 266 [41%] of 652) and complications from COVID-19 (13 [31%] of 42 vs 237 [36%] of 659) as those diagnosed during the alpha-delta phase. INTERPRETATION Despite time-dependent improvements in outcomes reported in the omicron phase compared with the earlier phases of the pandemic, patients with cancer remain highly susceptible to SARS-CoV-2 if they are not vaccinated against SARS-CoV-2. Our findings support universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19. FUNDING National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
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Reading JL, Rosenthal R, Pich O, Gamble S, Ung SA, Sahwangarrom T, Gration B, Wong YNS, Black L, Chain B, Hare J, Quezada SA, Swanton C. Abstract 1591: Convergence of antigenic diversity and Tex-cell stability fatally constrains immune surveillance in non-small cell lung cancer (TRACERx) and HIV-1 infection (Protocol C). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1591] [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
T cells recognize cognate antigen and elicit effector function to eliminate target cells. In chronic infection and cancer, exhausted T cells with impaired effector function and narrow TCR repertoires must respond to vast and diverse antigenic landscapes, favoring immune escape. Here we test whether T cell exhaustion and antigenic diversity converge to drive fatal immune failure in chronic infection and cancer. We leveraged over 600 primary longitudinal samples from the Protocol C (IAVI) and TRACERx (CRUK) studies to track the natural course of HIV-1 infection and non-small cell lung cancer (NSCLC), respectively, using high parameter flow cytometry, genome sequencing and TCRseq, complemented with focused scRNAseq and antigen specific profiling. In both diseases systemic Tcf1-Tox+Eomes+PD1+ T (Tex) cells track antigen burden and predict adverse outcome, independent of host clinical status. In HIV-1 infection, Tex cells are clonally restricted and rapid Gag RNA sequence divergence accompanies higher viral loads and lower CD4 counts. Similarly, in lung cancer peripheral Tex cells harbor hyper-expanded TCRs, contract after resection and reconstitute at recurrence with strikingly preserved clonal hierarchies, creating a ‘specificity gap’ that could be exploited by subclonal evolution. Commensurate with this model, we discover that a high level of systemic Tex cells coupled with either elevated Gag diversity in HIV-1 infection, or higher mutational or copy number heterogeneity in lung cancer defines patients with the poorest clinical outcome. We propose a unifying model of immune failure in chronic infection and cancer where genomic diversity and T cell exhaustion co-ordinately diminish human immune protection.
Citation Format: James L. Reading, Rachel Rosenthal, Oriol Pich, Samuel Gamble, Seng Anakin Ung, Teerapon Sahwangarrom, Betty Gration, Yien Ning Sophia Wong, Lucas Black, Benny Chain, Jonathan Hare, Sergio A. Quezada, Charles Swanton. Convergence of antigenic diversity and Tex-cell stability fatally constrains immune surveillance in non-small cell lung cancer (TRACERx) and HIV-1 infection (Protocol C) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1591.
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Affiliation(s)
| | | | - Oriol Pich
- 2The Francis Crick Institute, London, United Kingdom
| | | | | | | | | | | | - Lucas Black
- 3Imperial College London, London, United Kingdom
| | - Benny Chain
- 1University College London, London, United Kingdom
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Vesely C, Wong YNS, Childs A, Akarca AU, Dhami P, Vaikkinen H, Conde L, Herrero J, Ogunbiyi O, Gander A, Luong TV, Thirlwell C, Caplin M, Toumpanakis C, Peggs K, Quezada SA, Marafioti T, Meyer T. Systematic Evaluation of the Immune Environment of Small Intestinal Neuroendocrine Tumors. Clin Cancer Res 2022; 28:2657-2668. [PMID: 35320356 PMCID: PMC9359734 DOI: 10.1158/1078-0432.ccr-21-4203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The immune tumor microenvironment and the potential therapeutic opportunities for immunotherapy in small intestinal neuroendocrine tumors (siNET) have not been fully defined. EXPERIMENTAL DESIGN Herein, we studied 40 patients with primary and synchronous metastatic siNETs, and matched blood and normal tissue obtained during surgery. We interrogated the immune checkpoint landscape using multi-parametric flow cytometry. In addition, matched FFPE tissue was obtained for multi-parametric IHC to determine the relative abundance and distribution of T-cell infiltrate. Tumor mutational burden (TMB) was also assessed and correlated with immune infiltration. RESULTS Effector tumor-infiltrating lymphocytes (TIL) had a higher expression of PD-1 in the tumor microenvironment compared with the periphery. In addition, CD8+ TILs had a significantly higher co-expression of PD-1/ICOS and PD-1/CTLA-4 (cytotoxic T lymphocyte antigen-4) and higher levels of PD-1 expression compared with normal tissue. IHC revealed that the majority of cases have ≤10% intra-tumoral T cells but a higher number of peri-tumoral T cells, demonstrating an "exclusion" phenotype. Finally, we confirmed that siNETs have a low TMB compared with other tumor types in the TCGA database but did not find a correlation between TMB and CD8/Treg ratio. CONCLUSIONS Taken together, these results suggest that a combination therapy approach will be required to enhance the immune response, using PD-1 as a checkpoint immunomodulator backbone in combination with other checkpoint targeting molecules (CTLA-4 or ICOS), or with drugs targeting other pathways to recruit "excluded" T cells into the tumor microenvironment to treat patients with siNETs.
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Affiliation(s)
- Clare Vesely
- UCL Cancer Institute, UCL, London, United Kingdom
| | - Yien Ning Sophia Wong
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | - Alexa Childs
- UCL Cancer Institute, UCL, London, United Kingdom.,Royal Free Hospital, Pond Street, London, United Kingdom
| | | | - Pawan Dhami
- UCL Cancer Institute, UCL, London, United Kingdom
| | | | - Lucia Conde
- UCL Cancer Institute, UCL, London, United Kingdom
| | | | | | - Amir Gander
- Royal Free Hospital, Pond Street, London, United Kingdom
| | - Tu Vinh Luong
- Royal Free Hospital, Pond Street, London, United Kingdom
| | - Chrissie Thirlwell
- UCL Cancer Institute, UCL, London, United Kingdom.,The University of Exeter Medical School, Exeter, United Kingdom
| | - Martyn Caplin
- Royal Free Hospital, Pond Street, London, United Kingdom
| | | | - Karl Peggs
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | - Sergio A. Quezada
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | | | - Tim Meyer
- UCL Cancer Institute, UCL, London, United Kingdom.,Royal Free Hospital, Pond Street, London, United Kingdom.,Corresponding Author: Tim Meyer, UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD. Phone: 44-207-679-6731; E-mail;
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Wong YNS, Sng CCT, Ottaviani D, Patel G, Chowdhury A, Earnshaw I, Sinclair A, Merry E, Wu A, Galazi M, Benafif S, Soosaipillai G, Chopra N, Roylance R, Shaw H, Lee AJX. Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital. Cancers (Basel) 2021; 13:6085. [PMID: 34885194 PMCID: PMC8657102 DOI: 10.3390/cancers13236085] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March-May 2020; December 2020-February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30-0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.
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Affiliation(s)
- Yien Ning Sophia Wong
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - Christopher C. T. Sng
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Grisma Patel
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Amani Chowdhury
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Irina Earnshaw
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Alasdair Sinclair
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Eve Merry
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Anjui Wu
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Myria Galazi
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Sarah Benafif
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Gehan Soosaipillai
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Neha Chopra
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Rebecca Roylance
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- NIHR University College London Hospitals Biomedical Research Centre, London W1T 7DN, UK
| | - Heather Shaw
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
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Soosaipillai G, Wu A, Dettorre GM, Diamantis N, Chester J, Moss C, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Brunet J, Jones E, Mesia R, Jackson A, Mukherjee U, Sita-Lumsden A, Seguí E, Ottaviani D, Carbó A, Benafif S, Würstlein R, Carmona C, Chopra N, Cruz CA, Swallow J, Saoudi N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Wong YNS, Sureda A, Maluquer C, Ruiz-Camps I, Cabirta A, Prat A, Loizidou A, Gennari A, Ferrante D, Tabernero J, Russell B, Van Hemelrijck M, Dolly S, Hulbert-Williams NJ, Pinato DJ. Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective. Ther Adv Med Oncol 2021; 13:17588359211042224. [PMID: 34497669 PMCID: PMC8419540 DOI: 10.1177/17588359211042224] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.
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Affiliation(s)
| | - Anjui Wu
- Cancer Division, University College London Hospitals, London, UK
- UCL Cancer Institute, Fitzrovia, London, UK
| | - Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC. Hospitalet de Llobregat, Spain
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Eleanor Jones
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sarah Benafif
- Cancer Division, University College London Hospitals, London, UK
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics, Breast Centre and Gynaecological Cancer Centre and CCC Munich, University Hospital Munich, Munich, Germany
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Judith Swallow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Haematology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Nicholas J Hulbert-Williams
- Professor of Behavioural Medicine, Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, Cheshire, CH1 4BJ, UK
| | - David J Pinato
- Department of Surgery and Cancer, Clinical Senior Lecturer and Consultant Medical Oncologist, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Linch MD, Wong YNS, Jones R, Sankey P, Josephs DH, Crabb SJ, Staffurth J, Zarkar A, White L, Duggan M, Pellizzari G, Wheeler G, Beare S, Cartwright H, Linares J, Akarca A, Quezada SA, Ensell L, Hartley J, Attard G, Burr J, Jayaram A, Kularatne B, Kayani M, Chung M, Pritchard CC, Freeman A, Haider A, Marafioti T. Abstract LB004: Nivolumab (NIVO) and ipilimumab (IPI) treatment in prostate cancer with an immunogenic signature: cohort 1 of the NEPTUNES multi-centre, two-stage biomarker-selected Phase II trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-lb004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Responses to checkpoint inhibitor (CPI) monotherapy in patients with metastatic castration resistant prostate cancer (mCRPC) have been limited. This is likely due to a “cold” tumour immune microenvironment. We hypothesised that patients with mCRPC will be more likely to respond if they have a positive immunogenic signature (ImS+). We report the response/safety for NIVO + IPI in pts with ImS+ mCRPC from cohort 1 of the NEPTUNES study.
Methods: Pts with mCRPC who progressed following ≥1 line of therapy and ImS+ were eligible. ImS+ was defined by ≥1 of the following: 1) mismatch repair deficient (MMRD) by immunohistochemistry (IHC); 2) DNA damage repair deficient (DDRD) excluding MMRD, detected by the UW-OncoPlex targeted exome sequencing assay and; 3) high tumour infiltrating lymphocytes (TILs) on multiplexed immunohistochemistry (CD4, CD8 or FoxP3+ >20% nucleated cells). Treatment was NIVO 1 mg/kg + IPI 3 mg/kg Q3W for 4 doses, then NIVO 480 mg every 4 weeks. Primary endpoint was composite response rate (CRR) defined by ≥1 of the following: 1) radiological response by RECIST 1.1; 2) PSA response ≥50%; 3) conversion of circulating tumour cells (CTC) at week 9. Treatment would be deemed ineffective if the CRR was <20%. Results: 50/211 pts were ImS+, and 35 patients were treated with NIVO/IPI with a median follow up of 7.2 months (range 2.1-20.5). The overall CRR was 9/35 (26%, 95%CI 12-43%). The ImS+ determinants in responding/all treated patients included MMRD (n=4/5), BRCA1/2 (n=3/4), exclusively high TILs (n=2/9) and CDK12 (n=1/7). In responders, median duration of response was 4.9 months (range 1.8-19.7). Grade 3-4 treatment-related adverse events occurred in 17/35 (49%).
Conclusions: NIVO + IPI demonstrated significant activity in biomarker selected, pre-treated pts with mCRPC. The safety profile is consistent with this dosing schedule. Accrual to expansion cohort 2 started in September 2020.
Determinants of immunogenic signature in responding patientsPatientInflammatory Infiltrate (%)MMRD (Y/N)DDRD (Y/N)TMB Mut/MBNEP-03340NN1NEP-03610NY Biallelic BRCA24NEP-0964NY Biallelic BRCA28NEP-1093Y MSH2/MSH6N14NEP-12625Y MSH2/MSH6N21NEP-13110Y PMS2/MLH1N13NEP-15920Y MSH2/MSH6Y BRCA127NEP-16525NY Biallelic CDK125NEP-06930NN1
Citation Format: Mark D. Linch, Yien Ning Sophia Wong, Robert Jones, Peter Sankey, Debra H. Josephs, Simon J. Crabb, John Staffurth, Anjali Zarkar, Laura White, Marian Duggan, Giulia Pellizzari, Graham Wheeler, Sandy Beare, Hayley Cartwright, Josep Linares, Ayse Akarca, Sergio A. Quezada, Leah Ensell, John Hartley, Gerhardt Attard, Joanna Burr, Anuradha Jayaram, Bihani Kularatne, Mahaz Kayani, Moon Chung, Colin C. Pritchard, Alex Freeman, Aiman Haider, Teresa Marafioti. Nivolumab (NIVO) and ipilimumab (IPI) treatment in prostate cancer with an immunogenic signature: cohort 1 of the NEPTUNES multi-centre, two-stage biomarker-selected Phase II trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB004.
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Affiliation(s)
| | | | | | - Peter Sankey
- 3University Hospitals Plymouth, Plymouth, United Kingdom
| | | | | | | | | | - Laura White
- 1University College London, London, United Kingdom
| | | | | | | | - Sandy Beare
- 1University College London, London, United Kingdom
| | | | | | - Ayse Akarca
- 1University College London, London, United Kingdom
| | | | - Leah Ensell
- 1University College London, London, United Kingdom
| | - John Hartley
- 1University College London, London, United Kingdom
| | | | - Joanna Burr
- 1University College London, London, United Kingdom
| | | | | | - Mahaz Kayani
- 1University College London, London, United Kingdom
| | | | | | - Alex Freeman
- 1University College London, London, United Kingdom
| | - Aiman Haider
- 1University College London, London, United Kingdom
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8
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Dettorre GM, Dolly S, Loizidou A, Chester J, Jackson A, Mukherjee U, Zambelli A, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Bertuzzi A, Brunet J, Mesia R, Sita-Lumsden A, Seguí E, Biello F, Generali D, Grisanti S, Seeva P, Rizzo G, Libertini M, Maconi A, Moss C, Russell B, Harbeck N, Vincenzi B, Bertulli R, Ottaviani D, Liñan R, Marrari A, Carmona-García MC, Chopra N, Tondini CA, Mirallas O, Tovazzi V, Fotia V, Cruz CA, Saoudi-Gonzalez N, Felip E, Roqué A, Lee AJX, Newsom-Davis T, García-Illescas D, Reyes R, Wong YNS, Ferrante D, Scotti L, Marco-Hernández J, Ruiz-Camps I, Patriarca A, Rimassa L, Chiudinelli L, Franchi M, Santoro A, Prat A, Gennari A, Van Hemelrijck M, Tabernero J, Diamantis N, Pinato DJ. Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score. J Immunother Cancer 2021; 9:e002277. [PMID: 33753569 PMCID: PMC7985977 DOI: 10.1136/jitc-2020-002277] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study. METHODS In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. RESULTS We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611). CONCLUSIONS Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.
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Affiliation(s)
- Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Cremona, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Pavetha Seeva
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Bruno Vincenzi
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rossella Bertulli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Andrea Marrari
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ariadna Roqué
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Tom Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - David García-Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | | | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | | | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | | | | | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | | | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
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9
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Sng CCT, Wong YNS, Wu A, Ottaviani D, Chopra N, Galazi M, Benafif S, Soosaipillai G, Roylance R, Lee AJX, Shaw H. Cancer History and Systemic Anti-Cancer Therapy Independently Predict COVID-19 Mortality: A UK Tertiary Hospital Experience. Front Oncol 2020; 10:595804. [PMID: 33330085 PMCID: PMC7714940 DOI: 10.3389/fonc.2020.595804] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond. It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19. METHODS We included patients at a London tertiary hospital with laboratory confirmed SARS-CoV-2 infection. All patients with a history of solid cancer were included. Age- and sex-matched patients without cancer were randomly selected. Patients with hematological malignancies were excluded. RESULTS We identified 94 patients with cancer, matched to 226 patients without cancer. After adjusting for age, ethnicity, and co-morbidities, patients with cancer had increased mortality following COVID-19 (HR 1.57, 95% CI:1.04-2.4, p = 0.03). Increasing age (HR 1.49 every 10 years, 95% CI:1.25-1.8, p < 0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73-4.9, p < 0.001), and cerebrovascular disease (HR 1.93, 95% CI:1.18-3.2, p = 0.008) also predicted mortality. Within the cancer cohort, systemic anti-cancer therapy (SACT) within 60 days of COVID-19 diagnosis was an independent risk factor for mortality (HR 2.30, 95% CI: 1.16-4.6, p = 0.02). CONCLUSIONS Along with known risk factors, cancer and SACT confer an independent risk for mortality following COVID-19. Further studies are needed to understand the socio-economic influences and pathophysiology of these associations.
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Affiliation(s)
- Christopher C. T. Sng
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Yien Ning Sophia Wong
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Anjui Wu
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Neha Chopra
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Myria Galazi
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sarah Benafif
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gehan Soosaipillai
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca Roylance
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Heather Shaw
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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10
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Pinato DJ, Zambelli A, Aguilar-Company J, Bower M, Sng C, Salazar R, Bertuzzi A, Brunet J, Mesia R, Segui E, Biello F, Generali D, Grisanti S, Rizzo G, Libertini M, Maconi A, Harbeck N, Vincenzi B, Bertulli R, Ottaviani D, Carbo A, Bruna R, Benafif S, Marrari A, Wuerstlein R, Carmona-Garcia MC, Chopra N, Tondini C, Mirallas O, Tovazzi V, Betti M, Provenzano S, Fotia V, Cruz CA, Dalla Pria A, D'Avanzo F, Evans JS, Saoudi-Gonzalez N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Patriarca A, Garcia-Illescas D, Reyes R, Dileo P, Sharkey R, Wong YNS, Ferrante D, Marco-Hernandez J, Sureda A, Maluquer C, Ruiz-Camps I, Gaidano G, Rimassa L, Chiudinelli L, Izuzquiza M, Cabirta A, Franchi M, Santoro A, Prat A, Tabernero J, Gennari A. Clinical portrait of the SARS-CoV-2 epidemic in European cancer patients. Cancer Discov 2020; 10:CD-20-0773. [PMID: 32737082 PMCID: PMC7668225 DOI: 10.1158/2159-8290.cd-20-0773] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
The SARS-Cov-2 pandemic significantly impacted on oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncological features on severity and mortality from Covid-19 and little guidance as to the role of anti-cancer and anti-Covid-19 therapy in this population. In a multi-center study of 890 cancer patients with confirmed Covid-19 we demonstrated a worsening gradient of mortality from breast cancer to haematological malignancies and showed that male gender, older age, and number of co-morbidities identifies a subset of patients with significantly worse mortality rates from Covid-19. Provision of chemotherapy, targeted therapy and immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk-stratification of patients and support further research into emerging anti-Covid-19 therapeutics in SARS-Cov-2 infected cancer patients.
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Affiliation(s)
| | | | | | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, UK
| | - Christopher Sng
- Cancer Division, University College London Hospitals NHS Foundation Trust
| | - Ramon Salazar
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Traslational Research Laboratory, ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, L'Hospitalet de Llobregat
| | | | - Joan Brunet
- Medical Oncology, Catalan Institute of Oncology Hospital Josep Trueta
| | - Ricard Mesia
- Institut Catala d'Oncologia - L'Hospitalet, Universitat de Barcelona, IDIBELL
| | | | | | - Daniele Generali
- US Terapia Molecolare e Farmacogenomica, Az Istituti Ospitalieri di Cremona
| | | | | | | | - Antonio Maconi
- Research Education Innovation Infrastrucure, Ospedale Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | - Rossella Bertulli
- Medical Oncology Unit 2 - Adult mesenchymal tumour and rare cancer network, Cancer Medicine department, Istituto Nazionale dei Tumori
| | | | - Anna Carbo
- Medical Oncology, Catalan Institute of Oncology, Girona
| | - Riccardo Bruna
- Department of Translational Medicine, Universita del Piemonte Orientale
| | | | | | | | - M Carmen Carmona-Garcia
- Medical Oncology Service, Hospital Universitari de Girona Doctor Josep Trueta- Catalan Insitute of Oncology
| | | | | | - Oriol Mirallas
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona
| | | | - Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo
| | - Salvatore Provenzano
- Medical Oncology Unit 2 - Adult mesenchymal tumour and rare cancer network, Cancer Medicine Department, Istituto Nazionale dei Tumori
| | | | | | | | | | | | | | - Eudald Felip
- Medical Oncology Department, Institut Catala d'Oncologia-Badalona, B-ARGO group- IGTP
| | | | | | | | | | - Andrea Patriarca
- Department of Translational Medicine, Universita del Piemonte Orientale
| | | | | | | | | | | | - Daniela Ferrante
- Department of Translational Medicine, Department of Translational Medicine, Unit of Medical Statistics, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara
| | | | - Anna Sureda
- Hospital Duran i Reynals, Institut Catala d'Oncología (ICO)
| | | | | | - Gianluca Gaidano
- Hematology, Division of Hematology, Amedeo Avogadro Univeristy of Eastern Piedmont
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS; Department of Biomedical Sciences, Humanitas University
| | - Lorenzo Chiudinelli
- Dipartimento di Ingegneria Industriale e dell'Informazione, University of Pavia
| | | | - Alba Cabirta
- Hematology, Vall d'Hebron University Hospital, Barcelona
| | - Michela Franchi
- FROM Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic de Barcelona
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital
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11
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Litchfield K, Reading JL, Lim EL, Xu H, Liu P, Al-Bakir M, Wong YNS, Rowan A, Funt SA, Merghoub T, Perkins D, Lauss M, Svane IM, Jönsson G, Herrero J, Larkin J, Quezada SA, Hellmann MD, Turajlic S, Swanton C. Escape from nonsense-mediated decay associates with anti-tumor immunogenicity. Nat Commun 2020; 11:3800. [PMID: 32733040 PMCID: PMC7393139 DOI: 10.1038/s41467-020-17526-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 06/30/2020] [Indexed: 12/30/2022] Open
Abstract
Frameshift insertion/deletions (fs-indels) are an infrequent but highly immunogenic mutation subtype. Although fs-indels are degraded through the nonsense-mediated decay (NMD) pathway, we hypothesise that some fs-indels escape degradation and elicit anti-tumor immune responses. Using allele-specific expression analysis, expressed fs-indels are enriched in genomic positions predicted to escape NMD, and associated with higher protein expression, consistent with degradation escape (NMD-escape). Across four independent melanoma cohorts, NMD-escape mutations are significantly associated with clinical-benefit to checkpoint inhibitor (CPI) therapy (Pmeta = 0.0039). NMD-escape mutations are additionally found to associate with clinical-benefit in the low-TMB setting. Furthermore, in an adoptive cell therapy treated melanoma cohort, NMD-escape mutation count is the most significant biomarker associated with clinical-benefit. Analysis of functional T cell reactivity screens from personalized vaccine studies shows direct evidence of fs-indel derived neoantigens eliciting immune response, particularly those with highly elongated neo open reading frames. NMD-escape fs-indels represent an attractive target for biomarker optimisation and immunotherapy design.
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Affiliation(s)
- Kevin Litchfield
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6DD, UK.
| | - James L Reading
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6DD, UK
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6BT, UK
| | - Emilia L Lim
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK
| | - Hang Xu
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK
| | - Po Liu
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK
| | - Maise Al-Bakir
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6BT, UK
| | - Andrew Rowan
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK
| | - Samuel A Funt
- Memorial Sloan Kettering Cancer Center, Division of Solid Tumor Oncology, Department of Medicine, Weill Cornell Medical College, and Parker Center for Cancer Immunotherapy, 885 2nd Avenue, New York, NY, 10017, USA
| | - Taha Merghoub
- Memorial Sloan Kettering Cancer Center, Division of Solid Tumor Oncology, Department of Medicine, Weill Cornell Medical College, and Parker Center for Cancer Immunotherapy, 885 2nd Avenue, New York, NY, 10017, USA
| | - David Perkins
- Mass Spectrometry Proteomics, The Francis Crick Institute, London, NW1 1AT, UK
| | - Martin Lauss
- Faculty of Medicine, Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Scheelegatan 2, Medicon Village, 22185, Lund, Sweden
| | - Inge Marie Svane
- Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Göran Jönsson
- Faculty of Medicine, Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Scheelegatan 2, Medicon Village, 22185, Lund, Sweden
| | - Javier Herrero
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, WC1E 6DD, UK
| | - James Larkin
- Renal and Skin Units, The Royal Marsden Hospital, London, SW3 6JJ, UK
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6BT, UK
| | - Matthew D Hellmann
- Memorial Sloan Kettering Cancer Center, Division of Solid Tumor Oncology, Department of Medicine, Weill Cornell Medical College, and Parker Center for Cancer Immunotherapy, 885 2nd Avenue, New York, NY, 10017, USA
| | - Samra Turajlic
- Renal and Skin Units, The Royal Marsden Hospital, London, SW3 6JJ, UK.
- Cancer Dynamics Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK.
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6DD, UK.
- Department of Medical Oncology, University College London Hospitals, 235 Euston Rd, Fitzrovia, London, NW1 2BU, UK.
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12
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Pinato DJ, Lee AJX, Biello F, Seguí E, Aguilar-Company J, Carbó A, Bruna R, Bower M, Rizzo G, Benafif S, Carmona C, Chopra N, Cruz CA, D’Avanzo F, Evans JS, Galazi M, Garcia-Fructuoso I, Dalla Pria A, Newsom-Davis T, Ottaviani D, Patriarca A, Reyes R, Sharkey R, Sng CCT, Wong YNS, Ferrante D, Scotti L, Avanzi GC, Bellan M, Castello LM, Marco-Hernández J, Mollà M, Pirisi M, Ruiz-Camps I, Sainaghi PP, Gaidano G, Brunet J, Tabernero J, Prat A, Gennari A. Presenting Features and Early Mortality from SARS-CoV-2 Infection in Cancer Patients during the Initial Stage of the COVID-19 Pandemic in Europe. Cancers (Basel) 2020; 12:E1841. [PMID: 32650523 PMCID: PMC7408670 DOI: 10.3390/cancers12071841] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 06/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged > 18 (mean = 69) and diagnosed with COVID-19 between February 26th and April 1st, 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had > 1 co-morbidity. A total of 141 (69%) patients had > 1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged > 65 (36% versus 16%), in those with > 2 co-morbidities (40% versus 18%) and developing > 1 complication from COVID-19 (38% versus 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and > 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic.
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Affiliation(s)
- David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Alvin J. X. Lee
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Federica Biello
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Juan Aguilar-Company
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Riccardo Bruna
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Gianpiero Rizzo
- Department of Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Sarah Benafif
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Neha Chopra
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Claudia Andrea Cruz
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Francesca D’Avanzo
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Joanne S. Evans
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Myria Galazi
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Diego Ottaviani
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Andrea Patriarca
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Rachel Sharkey
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Christopher C. T. Sng
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Yien Ning Sophia Wong
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Lorenza Scotti
- Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy;
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Mattia Bellan
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Luigi Mario Castello
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | | | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic, 08035 Barcelona, Spain;
| | - Mario Pirisi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Gianluca Gaidano
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, 08035 Barcelona, Spain
| | - Alessandra Gennari
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
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13
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Joshi K, de Massy MR, Ismail M, Reading JL, Uddin I, Woolston A, Hatipoglu E, Oakes T, Rosenthal R, Peacock T, Ronel T, Noursadeghi M, Turati V, Furness AJS, Georgiou A, Wong YNS, Ben Aissa A, Sunderland MW, Jamal-Hanjani M, Veeriah S, Birkbak NJ, Wilson GA, Hiley CT, Ghorani E, Guerra-Assunção JA, Herrero J, Enver T, Hadrup SR, Hackshaw A, Peggs KS, McGranahan N, Swanton C, Quezada SA, Chain B. Publisher Correction: Spatial heterogeneity of the T cell receptor repertoire reflects the mutational landscape in lung cancer. Nat Med 2020; 26:1148. [PMID: 32494063 DOI: 10.1038/s41591-020-0866-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Kroopa Joshi
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marc Robert de Massy
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, UK
| | - James L Reading
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, UK
| | - Annemarie Woolston
- Division of Infection and Immunity, University College London, London, UK
| | - Emine Hatipoglu
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, UK
| | - Rachel Rosenthal
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Thomas Peacock
- Division of Infection and Immunity, University College London, London, UK
- Computation, Mathematics and Physics in the Life Sciences and Experimental Biology, Department of Computer Science, University College London, London, UK
| | - Tahel Ronel
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Virginia Turati
- Department of Cancer Biology, University College London Cancer Institute, London, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Nicolai J Birkbak
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Gareth A Wilson
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Crispin T Hiley
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | | | - Javier Herrero
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Tariq Enver
- University College London Cancer Institute, London, UK
| | - Sine R Hadrup
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Allan Hackshaw
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, UK.
- Department of Computer Sciences, University College London, London, UK.
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14
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Jayaram A, Goh G, Kularatne BY, Waterhouse J, Shanmugabavan Y, Rowan A, Wong YNS, Freeman A, Akarca A, Herrero J, Rosenthal R, McGranahan N, Hung M, Emberton M, Attard G, Quezada SA, Marafioti T, Ahmed HU, Swanton C, Linch MD. Intratumoural (IT) evolutionary landscape of high-risk prostate cancer and outcome: The PROGENY (PROstate cancer GENomic heterogeneitY) study of genomic and immune parameters. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17500 Background: IT heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease and patient outcomes are uncertain. Methods: This was a prospective, single-arm, translational study using targeted multi-region prostate biopsies to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies. A pre-defined exploratory objective was to evaluate the association of ITH, median inflammatory infiltrate (MII), total, clonal and neoantigens, with overall survival (OS) and time-to-next-line of therapy (TTNL). Results: 49 men with elevated prostate-specific antigen (PSA) and multiparametric-magnetic resonance imaging (MRI) detected PC underwent image-guided multiregion transperineal biopsy. 79 tumour regions from 25 patients (pts) with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification. The median follow-up was 60 months (m) with 10 death events. For %ITH, MII, total, clonal and subclonal neoantigens, patients were split by the median. Conclusions: The PROGENY study provides a diagnostic platform suitable for studying tumour ITH and has the potential to identify poor outcome subgroups in PC. Larger sample numbers in prospective trials are warranted to further investigate this hypothesis. [Table: see text]
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Affiliation(s)
- Anuradha Jayaram
- University College London Cancer Institute, London, United Kingdom
| | | | | | | | | | - Andrew Rowan
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK, London, United Kingdom
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Alex Freeman
- University College London Hospital, London, United Kingdom
| | - Ayse Akarca
- University College London, London, United Kingdom
| | | | - Rachel Rosenthal
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, United Kingdom
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, United Kingdom
| | - Michelle Hung
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | | | - Gerhardt Attard
- Institute of Cancer Research and The Royal Marsden Hospital, Sutton, United Kingdom
| | - Sergio A. Quezada
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | | | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Mark David Linch
- Department of Oncology, UCL Cancer Institute, London, United Kingdom
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15
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Ghorani E, Reading JL, Henry JY, Massy MRD, Rosenthal R, Turati V, Joshi K, Furness AJS, Ben Aissa A, Saini SK, Ramskov S, Georgiou A, Sunderland MW, Wong YNS, Mucha MVD, Day W, Galvez-Cancino F, Becker PD, Uddin I, Oakes T, Ismail M, Ronel T, Woolston A, Jamal-Hanjani M, Veeriah S, Birkbak NJ, Wilson GA, Litchfield K, Conde L, Guerra-Assunção JA, Blighe K, Biswas D, Salgado R, Lund T, Bakir MA, Moore DA, Hiley CT, Loi S, Sun Y, Yuan Y, AbdulJabbar K, Turajilic S, Herrero J, Enver T, Hadrup SR, Hackshaw A, Peggs KS, McGranahan N, Chain B, Swanton C, Quezada SA. The T cell differentiation landscape is shaped by tumour mutations in lung cancer. Nat Cancer 2020; 1:546-561. [PMID: 32803172 PMCID: PMC7115931 DOI: 10.1038/s43018-020-0066-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/20/2020] [Indexed: 01/06/2023]
Abstract
Tumour mutational burden (TMB) predicts immunotherapy outcome in non-small cell lung cancer (NSCLC), consistent with immune recognition of tumour neoantigens. However, persistent antigen exposure is detrimental for T cell function. How TMB affects CD4 and CD8 T cell differentiation in untreated tumours, and whether this affects patient outcomes is unknown. Here we paired high-dimensional flow cytometry, exome, single-cell and bulk RNA sequencing from patients with resected, untreated NSCLC to examine these relationships. TMB was associated with compartment-wide T cell differentiation skewing, characterized by loss of TCF7-expressing progenitor-like CD4 T cells, and an increased abundance of dysfunctional CD8 and CD4 T cell subsets, with significant phenotypic and transcriptional similarity to neoantigen-reactive CD8 T cells. A gene signature of redistribution from progenitor-like to dysfunctional states associated with poor survival in lung and other cancer cohorts. Single-cell characterization of these populations informs potential strategies for therapeutic manipulation in NSCLC.
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Affiliation(s)
- Ehsan Ghorani
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - James L Reading
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
| | - Jake Y Henry
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Marc Robert de Massy
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Rachel Rosenthal
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Virginia Turati
- Department of Cancer Biology, University College London Cancer Institute, London, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Andrew J S Furness
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Sunil Kumar Saini
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Sofie Ramskov
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Andrew Georgiou
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Maria Vila De Mucha
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - William Day
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Felipe Galvez-Cancino
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Pablo D Becker
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, UK
| | - Tahel Ronel
- Division of Infection and Immunity, University College London, London, UK
| | - Annemarie Woolston
- Division of Infection and Immunity, University College London, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Nicolai J Birkbak
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Gareth A Wilson
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Kevin Litchfield
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Lucia Conde
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | | | - Kevin Blighe
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Dhruva Biswas
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | | | - Tom Lund
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maise Al Bakir
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - David A Moore
- Department of Pathology, University College London Cancer Institute, London, UK
| | - Crispin T Hiley
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuxin Sun
- Division of Infection and Immunity, University College London, London, UK
| | - Yinyin Yuan
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Khalid AbdulJabbar
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajilic
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Javier Herrero
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Tariq Enver
- Department of Cancer Biology, University College London Cancer Institute, London, UK
| | - Sine R Hadrup
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Allan Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Karl S Peggs
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, UK
- Department of Computer Sciences, University College London, London, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
- University College London Hospitals, London, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
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16
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Joshi K, de Massy MR, Ismail M, Reading JL, Uddin I, Woolston A, Hatipoglu E, Oakes T, Rosenthal R, Peacock T, Ronel T, Noursadeghi M, Turati V, Furness AJS, Georgiou A, Wong YNS, Ben Aissa A, Sunderland MW, Jamal-Hanjani M, Veeriah S, Birkbak NJ, Wilson GA, Hiley CT, Ghorani E, Guerra-Assunção JA, Herrero J, Enver T, Hadrup SR, Hackshaw A, Peggs KS, McGranahan N, Swanton C, Quezada SA, Chain B. Spatial heterogeneity of the T cell receptor repertoire reflects the mutational landscape in lung cancer. Nat Med 2019; 25:1549-1559. [PMID: 31591606 PMCID: PMC6890490 DOI: 10.1038/s41591-019-0592-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [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] [Received: 05/02/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Somatic mutations together with immunoediting drive extensive heterogeneity within non-small-cell lung cancer (NSCLC). Herein we examine heterogeneity of the T cell antigen receptor (TCR) repertoire. The number of TCR sequences selectively expanded in tumors varies within and between tumors and correlates with the number of nonsynonymous mutations. Expanded TCRs can be subdivided into TCRs found in all tumor regions (ubiquitous) and those present in a subset of regions (regional). The number of ubiquitous and regional TCRs correlates with the number of ubiquitous and regional nonsynonymous mutations, respectively. Expanded TCRs form part of clusters of TCRs of similar sequence, suggestive of a spatially constrained antigen-driven process. CD8+ tumor-infiltrating lymphocytes harboring ubiquitous TCRs display a dysfunctional tissue-resident phenotype. Ubiquitous TCRs are preferentially detected in the blood at the time of tumor resection as compared to routine follow-up. These findings highlight a noninvasive method to identify and track relevant tumor-reactive TCRs for use in adoptive T cell immunotherapy.
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MESH Headings
- Aged
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Female
- Genetic Heterogeneity
- Humans
- Immunotherapy, Adoptive
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/pathology
- Male
- Middle Aged
- Mutation
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
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Affiliation(s)
- Kroopa Joshi
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marc Robert de Massy
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, UK
| | - James L Reading
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, UK
| | - Annemarie Woolston
- Division of Infection and Immunity, University College London, London, UK
| | - Emine Hatipoglu
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, UK
| | - Rachel Rosenthal
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Thomas Peacock
- Division of Infection and Immunity, University College London, London, UK
- Computation, Mathematics and Physics in the Life Sciences and Experimental Biology, Department of Computer Science, University College London, London, UK
| | - Tahel Ronel
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Virginia Turati
- Department of Cancer Biology, University College London Cancer Institute, London, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Nicolai J Birkbak
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Gareth A Wilson
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Crispin T Hiley
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | | | - Javier Herrero
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Tariq Enver
- University College London Cancer Institute, London, UK
| | - Sine R Hadrup
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Allan Hackshaw
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, UK.
- Department of Computer Sciences, University College London, London, UK.
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17
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Wong YNS, Sankey P, Josephs DH, Jones RJ, Crabb SJ, Beare S, Duggan M, White L, Charlaftis N, Wheeler G, Linares J, Quezada SA, Ensell L, Flanagan C, Kularatne BY, Chung M, Pritchard CC, Freeman A, Marafioti T, Linch MD. Nivolumab and ipilimumab treatment in prostate cancer with an immunogenic signature (NEPTUNES). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps5090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5090 Background: Responses to checkpoint inhibitor (CPI) monotherapy in patients with metastatic castration resistant prostate cancer (mCRPC) have been limited. This is in part attributed to low tumour mutational burden (TMB) and low tumour infiltrating lymphocytes (TILs). Previously ~20% patients with prostate cancer have demonstrated high TILs or TMB1. We hypothesize that patients with higher TMB due to mismatch repair deficiency (dMMR) or defective DNA damage response (dDDR) and patients with high TILs are more likely to respond to combination CPI with anti PD-1 and anti CTLA-4 therapy. Methods: NEPTUNES is a single arm phase II trial designed to assess the efficacy of nivolumab and ipilimumab in biomarker selected patients with mCRPC that have progressed following ≥1 line of therapy. The immunogenic signature (ImS) biomarker is defined by ≥1 of the following: 1) dMMR by immunohistochemistry (IHC); 2) dDDR detected by the UW-OncoPlex sequencing assay and; 3) high TILs on multiplexed IHC. The UW-OncoPlex assay detects mutations in >260 genes and provides an estimation of TMB. Assuming an ImS+ rate of 20%, we aim to pre-screen 175 patients in order to enrol 35 patients into the main study. The primary endpoint is composite response rate (CRR), achieved if ≥1 of the following criteria are satisfied: 1) radiological response by RECIST 1.1; 2) PSA response ≥50%; 3) conversion of circulating tumour cells (CTC) count from ≥5 cells at baseline to <5 cells at week 9. The treatment will be deemed ineffective if the CRR is <20%. Nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) is dosed every three weeks for up to 4 times, followed by a 480mg flat dose of nivolumab every 4 weeks for up to one year. Baseline biopsies are mandated and paired biopsy at week 12 is encouraged. The secondary endpoints include safety, overall survival, and radiological and PSA progression free survival. Exploratory biological markers including TMB, mutational profiles, change in TILs and liquid biomarkers will be correlated with the primary clinical endpoint. Since opening in February 2018, 126 patients have been pre-screened with 25 ImS+. To date, 9/25 ImS+ patients have been enrolled into the main study. The trial is ongoing, with patient accrual expected to complete by late 2019. References: 1Linch, M., Goh, G., Hiley, C., Shanmugabavan, Y., McGranahan, N., Rowan, A., . . . Swanton, C. (2017). Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters. Ann Oncol, 28(10), 2472-2480. doi:10.1093/annonc/mdx355. Clinical trial information: NCT03061539.
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Affiliation(s)
- Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Peter Sankey
- Plymouth Hospital NHS Trust, Plymouth, United Kingdom
| | | | - Robert J Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Simon J. Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Sandy Beare
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Marian Duggan
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Laura White
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Nikolaos Charlaftis
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Graham Wheeler
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Josep Linares
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Sergio A. Quezada
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Leah Ensell
- University College London Cancer Institute, London, United Kingdom
| | - Cliona Flanagan
- University College London Cancer Institute, London, United Kingdom
| | | | | | | | - Alex Freeman
- University College London, London, United Kingdom
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Mark David Linch
- University College London Cancer Institute, London, United Kingdom
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18
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Wong YNS, Joshi K, Khetrapal P, Ismail M, Reading JL, Sunderland MW, Georgiou A, Furness AJS, Ben Aissa A, Ghorani E, Oakes T, Uddin I, Tan WS, Feber A, McGovern U, Swanton C, Freeman A, Marafioti T, Briggs TP, Kelly JD, Powles T, Peggs KS, Chain BM, Linch MD, Quezada SA. Urine-derived lymphocytes as a non-invasive measure of the bladder tumor immune microenvironment. J Exp Med 2018; 215:2748-2759. [PMID: 30257862 PMCID: PMC6219732 DOI: 10.1084/jem.20181003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/03/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Despite the advances in cancer immunotherapy, only a fraction of patients with bladder cancer exhibit responses to checkpoint blockade, highlighting a need to better understand drug resistance and identify rational immunotherapy combinations. However, accessibility to the tumor prior and during therapy is a major limitation in understanding the immune tumor microenvironment (TME). Herein, we identified urine-derived lymphocytes (UDLs) as a readily accessible source of T cells in 32 patients with muscle invasive bladder cancer (MIBC). We observed that effector CD8+ and CD4+ cells and regulatory T cells within the urine accurately map the immune checkpoint landscape and T cell receptor repertoire of the TME. Finally, an increased UDL count, specifically high expression of PD-1 (PD-1hi) on CD8+ at the time of cystectomy, was associated with a shorter recurrence-free survival. UDL analysis represents a dynamic liquid biopsy that is representative of the bladder immune TME that may be used to identify actionable immuno-oncology (IO) targets with potential prognostic value in MIBC.
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Affiliation(s)
- Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Department of Oncology, UCL Cancer Institute, London, England, UK
- Department of Oncology, University College London Hospital, London, England, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Division of Infection and Immunity, University College London, London, England, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Pramit Khetrapal
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, England, UK
| | - James L Reading
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, England, UK
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, England, UK
| | - Wei Shen Tan
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Andrew Feber
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Ursula McGovern
- Department of Oncology, University College London Hospital, London, England, UK
| | | | - Alex Freeman
- Department of Cellular Pathology, University College London Hospital, London, England, UK
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, England, UK
| | - Timothy P Briggs
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
| | - John D Kelly
- Department of Urology, University College London Hospital at Westmoreland Street, London, England, UK
- Division of Surgical and Interventional Sciences, University College London, London, England, UK
| | - Thomas Powles
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, England, UK
| | - Karl S Peggs
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
| | - Benjamin M Chain
- Division of Infection and Immunity, University College London, London, England, UK
| | - Mark D Linch
- Department of Oncology, UCL Cancer Institute, London, England, UK
- Department of Oncology, University College London Hospital, London, England, UK
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London, England, UK
- Research Department of Haematology, UCL Cancer Institute, London, England, UK
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19
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Joshi K, Ismail M, Reading JL, Robert De Massy M, Uddin I, Jamal-Hanjani M, Veeriah S, Oakes T, Wong YNS, Furness AJS, Ghorani E, Georgiou A, Beastall C, Mangal N, Ben Aissa A, Werner Sunderland M, Peggs K, Swanton C, Chain B, Quezada SA. Characterisation of the TCR repertoire in NSCLC to reveal the relationship between TCR heterogeneity and genetic heterogeneity that is influenced by mutational load and is associated with disease recurrence. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12009] [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: 11/20/2022] Open
Affiliation(s)
- Kroopa Joshi
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Mazlina Ismail
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - James L Reading
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Marc Robert De Massy
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mariam Jamal-Hanjani
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
| | - Selvaraju Veeriah
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
| | - Theres Oakes
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | | | - Ehsan Ghorani
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Carmella Beastall
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Nagina Mangal
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
| | | | - Karl Peggs
- University College London Cancer Institute, London, United Kingdom
| | - Charles Swanton
- Translation Cancer Therapeutics Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Benjamin Chain
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London Cancer Institute, London, United Kingdom
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20
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Arce Vargas F, Furness AJS, Litchfield K, Joshi K, Rosenthal R, Ghorani E, Solomon I, Lesko MH, Ruef N, Roddie C, Henry JY, Spain L, Ben Aissa A, Georgiou A, Wong YNS, Smith M, Strauss D, Hayes A, Nicol D, O'Brien T, Mårtensson L, Ljungars A, Teige I, Frendéus B, Pule M, Marafioti T, Gore M, Larkin J, Turajlic S, Swanton C, Peggs KS, Quezada SA. Fc Effector Function Contributes to the Activity of Human Anti-CTLA-4 Antibodies. Cancer Cell 2018; 33:649-663.e4. [PMID: 29576375 PMCID: PMC5904288 DOI: 10.1016/j.ccell.2018.02.010] [Citation(s) in RCA: 393] [Impact Index Per Article: 65.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/13/2017] [Accepted: 02/15/2018] [Indexed: 12/31/2022]
Abstract
With the use of a mouse model expressing human Fc-gamma receptors (FcγRs), we demonstrated that antibodies with isotypes equivalent to ipilimumab and tremelimumab mediate intra-tumoral regulatory T (Treg) cell depletion in vivo, increasing the CD8+ to Treg cell ratio and promoting tumor rejection. Antibodies with improved FcγR binding profiles drove superior anti-tumor responses and survival. In patients with advanced melanoma, response to ipilimumab was associated with the CD16a-V158F high affinity polymorphism. Such activity only appeared relevant in the context of inflamed tumors, explaining the modest response rates observed in the clinical setting. Our data suggest that the activity of anti-CTLA-4 in inflamed tumors may be improved through enhancement of FcγR binding, whereas poorly infiltrated tumors will likely require combination approaches.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/pharmacology
- CTLA-4 Antigen/antagonists & inhibitors
- Cell Line, Tumor
- Female
- Humans
- Ipilimumab/administration & dosage
- Ipilimumab/pharmacology
- Melanoma/drug therapy
- Melanoma/genetics
- Melanoma/immunology
- Mice
- Polymorphism, Single Nucleotide
- Receptors, IgG/genetics
- Receptors, IgG/metabolism
- T-Lymphocytes, Regulatory/immunology
- Treatment Outcome
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Frederick Arce Vargas
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kevin Litchfield
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Rachel Rosenthal
- Bill Lyons Informatics Centre, UCL Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London WC1E 6DD, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Isabelle Solomon
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Marta H Lesko
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Nora Ruef
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Claire Roddie
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Jake Y Henry
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Lavinia Spain
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Myles Smith
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Dirk Strauss
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Andrew Hayes
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - David Nicol
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Tim O'Brien
- Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | | | | | | | | | - Martin Pule
- Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Martin Gore
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Samra Turajlic
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London WC1E 6DD, UK; Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London WC1E 6DD, UK
| | - Karl S Peggs
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
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21
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Linch M, Goh G, Hiley C, Shanmugabavan Y, McGranahan N, Rowan A, Wong YNS, King H, Furness A, Freeman A, Linares J, Akarca A, Herrero J, Rosenthal R, Harder N, Schmidt G, Wilson GA, Birkbak NJ, Mitter R, Dentro S, Cathcart P, Arya M, Johnston E, Scott R, Hung M, Emberton M, Attard G, Szallasi Z, Punwani S, Quezada SA, Marafioti T, Gerlinger M, Ahmed HU, Swanton C. Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters. Ann Oncol 2017; 28:2472-2480. [PMID: 28961847 PMCID: PMC5815564 DOI: 10.1093/annonc/mdx355] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies. PATIENTS AND METHODS Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification. RESULTS We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion. CONCLUSIONS The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies. CLINICAL TRIALS.GOV IDENTIFIER NCT02022371.
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Affiliation(s)
- M Linch
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Goh
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - C Hiley
- Division of Cancer Studies, King's College London, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y Shanmugabavan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N McGranahan
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - A Rowan
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y N S Wong
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - H King
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK
| | - A Furness
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Linares
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Akarca
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - R Rosenthal
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | | | | | - G A Wilson
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - N J Birkbak
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - R Mitter
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - S Dentro
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK;; Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, UK
| | - P Cathcart
- The Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - E Johnston
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - R Scott
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Hung
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - G Attard
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - Z Szallasi
- Centre for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark;; Computational Health Informatics Program (CHIP), Harvard Medical School, Boston, USA;; MTA-SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
| | - S Punwani
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - S A Quezada
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - T Marafioti
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Gerlinger
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK;; Division of Surgery, Department of Surgery and Cancer, Imperial College London, UK;; Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - C Swanton
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK;.
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22
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Wong YNS, Joshi K, Pule M, Peggs KS, Swanton C, Quezada SA, Linch M. Evolving adoptive cellular therapies in urological malignancies. Lancet Oncol 2017; 18:e341-e353. [PMID: 28593860 DOI: 10.1016/s1470-2045(17)30327-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 12/18/2022]
Abstract
Immunotherapies have long been used to treat urological cancers but rarely lead to cure. In the past 5 years, success of immune checkpoint inhibition has led to a resurgence of enthusiasm for immunotherapy in the treatment of solid tumours. Increased understanding of tumour immune biology, technological advancements of gene transfer and cell culture, and improved clinical infrastructures for routine delivery of cell products, has made cell-based immunotherapeutics a real prospect for cancer therapy. These scientific and clinical activities, attempting to exploit the innate and adaptive immune systems for therapeutic gain, are well exemplified by the urological malignancies of renal, bladder, prostate, and penile cancer, a group of anatomically localised diseases, each with a distinct biology and different immunotherapeutic challenges. In this Review, we present the results of clinical studies investigating autologous cellular therapies in urological malignancies. Specifically, we discuss the rationale for upcoming studies, and how novel therapies and adoptive cell combinations can be used for personalised cancer therapy.
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Affiliation(s)
- Yien Ning Sophia Wong
- Department of Oncology, University College London Cancer Institute, London, UK; Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, UK; Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, UK
| | - Kroopa Joshi
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, UK; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - Martin Pule
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, UK; Department of Haematology, University College London Hospitals, London, UK
| | - Karl S Peggs
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, UK; Department of Haematology, University College London Hospitals, London, UK
| | - Charles Swanton
- Department of Oncology, University College London Cancer Institute, London, UK; Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, UK; Department of Oncology, University College London Hospitals, London, UK; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Sergio A Quezada
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, UK
| | - Mark Linch
- Department of Oncology, University College London Cancer Institute, London, UK; Department of Oncology, University College London Hospitals, London, UK.
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23
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Arce Vargas F, Furness AJS, Solomon I, Joshi K, Mekkaoui L, Lesko MH, Miranda Rota E, Dahan R, Georgiou A, Sledzinska A, Ben Aissa A, Franz D, Werner Sunderland M, Wong YNS, Henry JY, O'Brien T, Nicol D, Challacombe B, Beers SA, Turajlic S, Gore M, Larkin J, Swanton C, Chester KA, Pule M, Ravetch JV, Marafioti T, Peggs KS, Quezada SA. Fc-Optimized Anti-CD25 Depletes Tumor-Infiltrating Regulatory T Cells and Synergizes with PD-1 Blockade to Eradicate Established Tumors. Immunity 2017; 46:577-586. [PMID: 28410988 PMCID: PMC5437702 DOI: 10.1016/j.immuni.2017.03.013] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [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: 08/27/2016] [Revised: 01/26/2017] [Accepted: 02/09/2017] [Indexed: 02/08/2023]
Abstract
CD25 is expressed at high levels on regulatory T (Treg) cells and was initially proposed as a target for cancer immunotherapy. However, anti-CD25 antibodies have displayed limited activity against established tumors. We demonstrated that CD25 expression is largely restricted to tumor-infiltrating Treg cells in mice and humans. While existing anti-CD25 antibodies were observed to deplete Treg cells in the periphery, upregulation of the inhibitory Fc gamma receptor (FcγR) IIb at the tumor site prevented intra-tumoral Treg cell depletion, which may underlie the lack of anti-tumor activity previously observed in pre-clinical models. Use of an anti-CD25 antibody with enhanced binding to activating FcγRs led to effective depletion of tumor-infiltrating Treg cells, increased effector to Treg cell ratios, and improved control of established tumors. Combination with anti-programmed cell death protein-1 antibodies promoted complete tumor rejection, demonstrating the relevance of CD25 as a therapeutic target and promising substrate for future combination approaches in immune-oncology.
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Affiliation(s)
- Frederick Arce Vargas
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Isabelle Solomon
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Leila Mekkaoui
- Research Department of Oncology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Marta H Lesko
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | | | - Rony Dahan
- Leonard Wagner Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY 10065, USA
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Anna Sledzinska
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Dafne Franz
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Mariana Werner Sunderland
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Jake Y Henry
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Tim O'Brien
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - David Nicol
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Ben Challacombe
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Stephen A Beers
- Antibody and Vaccine Group, Cancer Sciences Unit, University of Southampton, Faculty of Medicine, Southampton SO17 1BJ, UK
| | - Samra Turajlic
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; The Francis Crick Institute, London NW1 1AT, UK
| | - Martin Gore
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Charles Swanton
- The Francis Crick Institute, London NW1 1AT, UK; Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London WC1E 6DD, UK
| | - Kerry A Chester
- Research Department of Oncology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Martin Pule
- Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Jeffrey V Ravetch
- Leonard Wagner Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY 10065, USA
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Karl S Peggs
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
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24
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Khetrapal P, Dong L, Wong YNS, Tan WS, Rodney S, Lamb B, Sridhar A, Briggs T, Kelly J, Feber A. MP44-13 MOLECULAR TRACKING OF BLADDER CANCERUSING MUTATIONS DETECTED IN PLASMA CELL-FREE DNA THROUGH RADICAL CYSTECTOMY AND CHEMOTHERAPY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1344] [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: 11/28/2022]
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25
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Joshi K, Furness AJ, Oakes T, Heather J, Spain LA, Wong YNS, Ben Aissa A, Stares M, Smith MJF, Strauss DC, Hayes AJ, Marafioti T, Turajlic S, Gore ME, Peggs K, Chain B, Quezada S, Larkin JMG. Defining the mechanisms of response and resistance to anti-PD-1 therapy: An exploratory phase II study of pembrolizumab in advanced melanoma (ADAPTeM). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps9599] [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: 11/20/2022] Open
Affiliation(s)
- Kroopa Joshi
- University College London Cancer Institute, London, United Kingdom
| | | | - Theres Oakes
- Department of Infection and Immunity, University College London, London, United Kingdom
| | - James Heather
- Department of Infection and Immunity, University College London, London, United Kingdom
| | | | | | - Assma Ben Aissa
- University College London Cancer Institute, London, United Kingdom
| | - Mark Stares
- The Francis Crick Institute, London, United Kingdom
| | - Myles JF Smith
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Dirk C Strauss
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andrew J Hayes
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Teresa Marafioti
- University College London Cancer Institute, London, United Kingdom
| | | | | | - Karl Peggs
- University College London Cancer Institute, London, United Kingdom
| | - Benjamin Chain
- Department of Infection and Immunity, University College London, London, United Kingdom
| | - Sergio Quezada
- University College London Cancer Institute, London, United Kingdom
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26
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Holmberg L, Wong YNS, Tabár L, Ringberg A, Karlsson P, Arnesson LG, Sandelin K, Anderson H, Garmo H, Emdin S. Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study. Br J Cancer 2013; 108:812-9. [PMID: 23370209 PMCID: PMC3590664 DOI: 10.1038/bjc.2013.26] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We studied the association between mammographic calcifications and local recurrence in the ipsilateral breast. METHODS Case-cohort study within a randomised trial of radiotherapy in breast conservation for ductal cancer in situ of the breast (SweDCIS). We studied mammograms from cases with an ipsilateral breast event (IBE) and from a subcohort randomly sampled at baseline. Lesions were classified as a density without calcifications, architectural distortion, powdery, crushed stone-like or casting-type calcifications. RESULTS Calcifications representing necrosis were found predominantly in younger women. Women with crushed stone or casting-type microcalcifications had higher histopathological grade and more extensive disease. The relative risk (RR) of a new IBE comparing those with casting-type calcifications to those without calcifications was 2.10 (95% confidence interval (CI) 0.92-4.80). This risk was confined to in situ recurrences; the RR of an IBE associated with casting-type calcifications on the mammogram adjusted for age and disease extent was 16.4 (95% CI 2.20-140). CONCLUSION Mammographic appearance of ductal carcinoma in situ of the breast is prognostic for the risk of an in situ IBE and may also be an indicator of responsiveness to RT in younger women.
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Affiliation(s)
- L Holmberg
- King's College London, Medical School, Division of Cancer Studies, London SE1 9RT, UK.
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27
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Sophia Wong YN, Wilson R, Roche N, Rusby J. Axillary node staging by axillary ultrasonography (AUS) and fine needle aspiration cytology (FNAC) in patients with invasive breast cancer. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.042] [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: 11/28/2022] Open
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