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Yang H, Kang B, Ha Y, Lee SH, Kim I, Kim H, Lee WS, Kim G, Jung S, Rha SY, Gaillard VE, Cheon J, Kim C, Chon HJ. High serum IL-6 correlates with reduced clinical benefit of atezolizumab and bevacizumab in unresectable hepatocellular carcinoma. JHEP Rep 2023; 5:100672. [PMID: 36866388 PMCID: PMC9972403 DOI: 10.1016/j.jhepr.2023.100672] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023] Open
Abstract
Background & Aims We elucidated the clinical and immunologic implications of serum IL-6 levels in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab and bevacizumab (Ate/Bev). Methods We prospectively enrolled 165 patients with unresectable HCC (discovery cohort: 84 patients from three centres; validation cohort: 81 patients from one centre). Baseline blood samples were analysed using a flow cytometric bead array. The tumour immune microenvironment was analysed using RNA sequencing. Results In the discovery cohort, clinical benefit 6 months (CB6m) was defined as complete or partial response, or stable disease for ≥6 months. Among various blood-based biomarkers, serum IL-6 levels were significantly higher in participants without CB6m than in those with CB6m (mean 11.56 vs. 5.05 pg/ml, p = 0.02). Using maximally selected rank statistics, the optimal cut-off value for high IL-6 was determined as 18.49 pg/ml, and 15.2% of participants were found to have high IL-6 levels at baseline. In both the discovery and validation cohorts, participants with high baseline IL-6 levels had a reduced response rate and worse progression-free and overall survival after Ate/Bev treatment compared with those with low baseline IL-6 levels. In multivariable Cox regression analysis, the clinical implications of high IL-6 levels persisted, even after adjusting for various confounding factors. Participants with high IL-6 levels showed reduced interferon-γ and tumour necrosis factor-α secretion from CD8+ T cells. Moreover, excess IL-6 suppressed cytokine production and proliferation of CD8+ T cells. Finally, participants with high IL-6 levels exhibited a non-T-cell-inflamed immunosuppressive tumour microenvironment. Conclusions High baseline IL-6 levels can be associated with poor clinical outcomes and impaired T-cell function in patients with unresectable HCC after Ate/Bev treatment. Impact and implications Although patients with hepatocellular carcinoma who respond to treatment with atezolizumab and bevacizumab exhibit favourable clinical outcomes, a fraction of these still experience primary resistance. We found that high baseline serum levels of IL-6 correlate with poor clinical outcomes and impaired T-cell response in patients with hepatocellular carcinoma treated with atezolizumab and bevacizumab.
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Key Words
- AFP, alpha-foetoprotein
- Ate/Bev, atezolizumab and bevacizumab
- Atezolizumab
- BCLC, Barcelona Clinic Liver Cancer
- Bevacizumab
- CB6m, clinical benefit 6 months
- CONSORT, Consolidated Standards of Reporting Trials
- CR, complete response
- CRAFITY, C-reactive protein and AFP in immunotherapy
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- DC, dendritic cell
- ECOG, Eastern Cooperative Oncology Group
- FFPE, formalin-fixed paraffin-embedded
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- IFN-γ, interferon-γ
- IL-6
- Immunotherapy
- MDSC, myeloid-derived suppressor cell
- MSI, microsatellite instability
- MVI, macrovascular invasion
- ORR, objective response rate
- OS, overall survival
- PBMC, peripheral blood mononuclear cell
- PD, progressive disease
- PD-1, programmed-death-1
- PD-L1, programmed-death ligand-1
- PFS, progression-free survival
- PR, partial response
- RECIST, Response Evaluation Criteria in Solid Tumours
- SD, stable disease
- TME, tumour microenvironment
- TNF-α, tumour necrosis factor-α
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Hannah Yang
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Beodeul Kang
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea,Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeonjung Ha
- Department of Gastroenterology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Sung Hwan Lee
- Department of Surgery, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Ilhwan Kim
- Division of Oncology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Hyeyeong Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Won Suk Lee
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Sanghoon Jung
- Department of Radiology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Sun Young Rha
- Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea,Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Jaekyung Cheon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea,Corresponding authors. Address: Medical Oncology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea. Tel.: +82-31-780-7590; Fax: +82-31-780-3929.
| | - Chan Kim
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea,Corresponding authors. Address: Medical Oncology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea. Tel.: +82-31-780-7590; Fax: +82-31-780-3929.
| | - Hong Jae Chon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea,Corresponding authors. Address: Medical Oncology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea. Tel.: +82-31-780-7590; Fax: +82-31-780-3929.
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Zhou H, Xie Z, Morikawa N, Sakurai F, Mizuguchi H, Okuzaki D, Okada N, Tachibana M. Modified method for differentiation of myeloid-derived suppressor cells in vitro enhances immunosuppressive ability via glutathione metabolism. Biochem Biophys Rep 2023; 33:101416. [PMID: 36605123 DOI: 10.1016/j.bbrep.2022.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Myeloid-derived suppressor cells (MDSCs), which accumulate in tumor bearers, are known to suppress anti-tumor immunity and thus promote tumor progression. MDSCs are considered a major cause of resistance against immune checkpoint inhibitors in patients with cancer. Therefore, MDSCs are potential targets in cancer immunotherapy. In this study, we modified an in vitro method of MDSC differentiation. Upon stimulating bone marrow (BM) cells with granulocyte-macrophage colony-stimulating factor in vitro, we obtained both lymphocyte antigen 6G positive (Ly-6G+) and negative (Ly-6G-) MDSCs (collectively, hereafter referred to as conventional MDSCs), which were non-immunosuppressive and immunosuppressive, respectively. We then found that MDSCs differentiated from Ly-6G- BM (hereafter called 6G- BM-MDSC) suppressed T-cell proliferation more strongly than conventional MDSCs, whereas the cells differentiated from Ly-6G+ BM (hereafter called 6G+ BM-MDSC) were non-immunosuppressive. In line with this, conventional MDSCs or 6G- BM-MDSC, but not 6G+ BM-MDSC, promoted tumor progression in tumor-bearing mice. Moreover, we identified that activated glutathione metabolism was responsible for the enhanced immunosuppressive ability of 6G- BM-MDSC. Finally, we showed that Ly-6G+ cells in 6G- BM-MDSC, which exhibited weak immunosuppression, expressed higher levels of Cybb mRNA, an immunosuppressive gene of MDSCs, than 6G+ BM-MDSC. Together, these data suggest that the depletion of Ly-6G+ cells from the BM cells leads to differentiation of immunosuppressive Ly-6G+ MDSCs. In summary, we propose a better method for MDSC differentiation in vitro. Moreover, our findings contribute to the understanding of MDSC subpopulations and provide a basis for further research on MDSCs.
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Key Words
- Ab, antibody
- BM, bone marrow
- BM-MDSC
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- Cybb, Cytochrome b-245 beta polypeptide
- FBS, fetal bovine serum
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- Glutathione metabolism
- ICI, immune checkpoint inhibitor
- Immunosuppression
- Ly-6G
- Ly-6G, lymphocyte antigen 6G
- M-MDSCs, monocytic MDSCs
- MDSCs, myeloid-derived suppressor cells
- Myeloid-derived suppressor cell
- PBS, phosphate-buffered saline
- PD-1, programmed cell death 1
- PD-L1, programmed cell death 1 ligand 1
- PMN-MDSCs, polymorphonuclear MDSCs
- ROS, reactive oxygen species
- Rb1, retinoblastoma 1
- Tumor progression
- iNOS, inducible nitric oxide synthase
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Ren H, Yong J, Yang Q, Yang Z, Liu Z, Xu Y, Wang H, Jiang X, Miao W, Li X. Self-assembled FeS-based cascade bioreactor with enhanced tumor penetration and synergistic treatments to trigger robust cancer immunotherapy. Acta Pharm Sin B 2021; 11:3244-61. [PMID: 34729313 DOI: 10.1016/j.apsb.2021.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/29/2022] Open
Abstract
Major challenges for cancer treatment are how to effectively eliminate primary tumor and sufficiently induce immunogenic cell death (ICD) to provoke a robust immune response for metastasis control. Here, a self-assembled cascade bioreactor was developed to improve cancer treatment with enhanced tumor penetration and synergistic therapy of starvation, chemodynamic (CDT) and photothermal therapy. Ultrasmall FeS-GOx nanodots were synthesized with glucose oxidase (GOx) as template and induced by paclitaxel (PTX) to form self-assembling FeS-GOx@PTX (FGP) via hydrophobic interaction. After accumulated at tumor sites, FGP disassembles to smaller FeS-GOx for enhanced deep tumor penetration. GOx maintains high enzymatic activity to catalyze glucose with assistant of oxygen to generate hydrogen peroxide (H2O2) as starvation therapy. Fenton reaction involving the regenerated H2O2 in turn produced more hydroxyl radicals for enhanced CDT. Following near-infrared laser at 808 nm, FGPs displayed pronounced tumor inhibition in vitro and in vivo by the combination therapy. The consequent increased exposure to calreticulin amplified ICD and promoted dendritic cells maturation. In combination with anti-CTLA4 checkpoint blockade, FGP can absolutely eliminate primary tumor and avidly inhibit distant tumors due to the enhanced intratumoral infiltration of cytotoxic T lymphocytes. Our work presents a promising strategy for primary tumor and metastasis inhibition.
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Key Words
- ALP, alkaline phosphatise
- ALT, alanine transaminase
- AST, aspartate aminotransferase
- ATP, adenosine triphosphate
- BUN, blood urea nitrogen
- CDT, chemodynamic therapy
- CLSM, confocal laser scanning microscope
- CREA, creatinine
- CRT, calreticulin
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- CTLs, cytotoxic T lymphocytes
- Cancer immunotherapy
- Ce6, Chlorin e6
- DAMPs, damage-related molecular patterns
- DAPI, 2-(4-amidinophenyl)-6-indolecarbamidine dihydrochloride
- DCs, dendritic cells
- DLS, dynamic light scattering
- DMPO, dimethyl pyridine N-oxide
- EDC, 1-ethyl-3-(3ʹ-dimethylaminopropyl) carbodiimide
- EDS, energy-dispersive spectrometry
- EPR, enhanced permeability and retention
- ESR, electron spin resonance
- FG, FeS-GOx nanodots
- FGP, FeS-GOx@PTX nanoparticles
- FITC, fluorescein Isothiocyanate
- FeCl2·4H2O, iron dichloride tetrahydrate
- FeS-based cascade bioreactor
- GOx, glucose oxidase
- Glu, glucose
- Glucose oxidase
- H&E, hematoxylin and eosin
- H2DCFDA, 2,7-dichlorodihydrofluorescein acetoacetic acid
- HMGB-1, high mobility group box protein 1
- HPF, 2-[6-(4,-hydroxy) phenoxy-3H-xanthene-3-on-9-yl
- HSA, human serum albumin
- ICB, immune checkpoint blockade
- ICD amplifier
- ICD, immunogenic cell death
- IFN-γ, interferon-γ
- MB, methylene blue
- MCTS, multicellular tumor spheroids
- MFI, median fluorescence Intensity
- Metastasis inhibition
- NHS, N-hydroxy succinimide
- Na2S, sodium sulfide
- OH, hydroxyl
- PBS, phosphate buffer saline
- PTT, photothermal therapy
- PTX, paclitaxel
- ROS, reactive oxygen species
- SEM, scanning electron microscope
- Synergistic therapy
- TAA, tumor-associated antigens
- TDLN, tumor-draining lymph nodes
- TEM, transmission microscope
- TMB, 3,3ʹ,5,5ʹ-tetramathylbenzidine
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labelling
- Tumor penetration
- XPS, X-ray photoelectron spectroscopy
- XRD, X-ray diffraction patterns
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Chen J, Qiao Y, Chen G, Chang C, Dong H, Tang B, Cheng X, Liu X, Hua Z. Salmonella flagella confer anti-tumor immunological effect via activating Flagellin/TLR5 signalling within tumor microenvironment. Acta Pharm Sin B 2021; 11:3165-3177. [PMID: 34729307 PMCID: PMC8546927 DOI: 10.1016/j.apsb.2021.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
mediated cancer therapy has achieved remarkable anti-tumor effects in experimental animal models, but the detailed mechanism remains unsolved. In this report, the active involvement of the host immune response in this process was confirmed by comparing the tumor-suppressive effects of Salmonella in immunocompetent and immunodeficient mice bearing melanoma allografts. Since flagella are key inducers of the host immune response during bacterial infection, flagella were genetically disrupted to analyse their involvement in Salmonella-mediated cancer therapy. The results showed that flagellum-deficient strains failed to induce significant anti-tumor effects, even when more bacteria were administered to offset the difference in invasion efficiency. Flagella mainly activate immune cells via Flagellin/Toll-like receptor 5 (TLR5) signalling pathway. Indeed, we showed that exogenous activation of TLR5 signalling by recombinant Flagellin and exogenous expression of TLR5 both enhanced the therapeutic efficacy of flagellum-deficient Salmonella against melanoma. Our study highlighted the therapeutic value of the interaction between Salmonella and the host immune response through Flagellin/TLR5 signalling pathway during Salmonella-mediated cancer therapy, thereby suggesting the potential application of TLR5 agonists in the cancer immune therapy.
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Key Words
- AKT, Akt serine/threonine kinase
- Bacteria-mediated cancer therapy
- CFU, colony-forming units
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- Cancer immune therapy
- DN, dominant-negative
- ERBB2, Erb-B2 receptor tyrosine kinase 2
- ERKl, extracellular regulated protein kinase 1
- Flagellin
- Flagellum
- GAPDH, glyceraldehyde-3-phosphate dehydrogenase
- GFP, green fluorescent protein
- IFN-γ, interferon-γ
- IL, interleukins
- IκB, inhibitor of NF-κB
- JNK, c-Jun N-terminal kinase
- LPS, lipopolysaccharide
- LRR, leucine-rich repeat
- MyD88, myeloid differentiation factor 88
- NF-κB
- NF-κB, nuclear factor kappa-B
- PBS, phosphate-buffered saline
- PCR, polymerase chain reaction
- PD-1, programmed cell death protein-1
- PD-L1, programmed cell death-ligand 1
- PEI, polyethylenimine
- Salmonella
- TIR, Toll/Interleukin-1 receptor
- TLR, Toll-like receptor
- TLR5
- TME, tumor microenvironment
- TRAF6, TNF receptor associated factor 6
- VNP20009
- i.p., intraperitoneally
- i.t., intratumorally
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Skertich NJ, Chu F, Tarhoni IA, Szajek S, Borgia JA, Madonna MB. Expression of programmed death ligand 1 in drug-resistant osteosarcoma: An exploratory study. Surg Open Sci 2021; 6:10-4. [PMID: 34386763 DOI: 10.1016/j.sopen.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background Inhibition of the programmed death ligand 1, programmed death 1 pathway has been successfully used for treatment of multiple advanced adult cancers. However, its use in pediatric osteosarcoma is still in its infancy. In this study, we investigated programmed death ligand 1 and other checkpoint molecules' expression to determine the potential usefulness as targets for drug therapy. Methods We incubated human wild-type osteosarcoma cells with incremental concentrations of doxorubicin to create a doxorubicin-resistant cell line. Matrigel in vitro invasion assays were used to compare invasiveness. Comparative programmed death ligand 1 expression was evaluated by Western blot assays. An immuno-oncology checkpoint protein panel was used to compare concentrations of 16 other checkpoint molecules. Chi-square tests and Wilcoxon rank-sum tests were used to determine significant differences. Results A doxorubicin-resistant cell line was successfully created and was significantly more invasive than wild-type cells (0.47 vs 0.07, P < .001). On Western blot assay, doxorubicin-resistant but not wild-type cells expressed programmed death ligand 1. Doxorubicin-resistant cells had significantly higher levels of T-cell immunoglobulin-3 and cluster of differentiation 86 and higher cluster of differentiation 27, cluster of differentiation 40, lymphocyte-activation gene-3, cluster of differentiation 80, programmed death ligand 1, programmed death ligand 2, and inducible T-cell costimulatory expression than wild-type cells. Both lines expressed B- and T-lymphocyte attenuator, cluster of differentiation 28, herpesvirus entry mediator, and programmed death 1. Herpesvirus entry mediator, cluster of differentiation 40, and programmed death ligand 2 were also present in the culture media of both cell lines. Conclusion Doxorubicin-resistant osteosarcoma seems to express higher programmed death ligand 1 than nonresistant wild-type cells. Benchmarking checkpoint molecules may provide the basis for future studies that elucidate pathways of drug resistance and tumor metastasis, biomarkers for cancer prognosis or recurrence, and future targets for directed drug therapy.
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Key Words
- BTLA, B- and T-lymphocyte attenuator
- CD27, cluster of differentiation 27
- CD28, cluster of differentiation 28
- CD40, cluster of differentiation 40
- CD80, cluster of differentiation 80
- CD86, cluster of differentiation 86
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- DoxR, doxorubicin resistant
- FDA, Food and Drug Administration
- GITR, glucocorticoid-induced TNFR-related protein
- GITRL, ligand for receptor TNFRSF18/AITR/GITR
- HVEM, herpesvirus entry mediator
- ICOS, inducible T-cell costimulatory (ICOS)
- LAG-3, lymphocyte-activation gene-3
- PD-1, programmed death 1
- PD-L1, programmed death ligand 1
- PD-L2, programmed death ligand 2
- TIM-3, T-cell immunoglobulin-3
- TLR-2, Toll like receptor 2
- WT, wild type
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Abstract
T cells are critical to fight pathogenic microbes and combat malignantly transformed cells in the fight against cancer. To exert their effector function, T cells produce effector molecules, such as the pro-inflammatory cytokines IFN-γ, TNF-α and IL-2. Tumors possess many inhibitory mechanisms that dampen T cell effector function, limiting the secretion of cytotoxic molecules. As a result, the control and elimination of tumors is impaired. Through recent advances in genomic editing, T cells can now be successfully modified via CRISPR/Cas9 technology. For instance, engaging (post-)transcriptional mechanisms to enhance T cell cytokine production, the retargeting of T cell antigen specificity or rendering T cells refractive to inhibitory receptor signaling can augment T cell effector function. Therefore, CRISPR/Cas9-mediated genome editing might provide novel strategies for cancer immunotherapy. Recently, the first-in-patient clinical trial was successfully performed with CRISPR/Cas9-modified human T cell therapy. In this review, a brief overview of currently available techniques is provided, and recent advances in T cell genomic engineering for the enhancement of T cell effector function for therapeutic purposes are discussed.
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Key Words
- AP-1, activator protein 1
- ARE, AU-rich element
- ARE-Del, deletion of the 3′UTR AREs from the Ifng/IFNG gene
- CAR T cells
- CAR, Chimeric Antigen Receptor
- CRISPR
- CRISPR, Clustered Regularly Interspaced Short Palindromic Repeat
- CRS, cytokine release syndrome
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- Cas, CRISPR-associated
- Cas9
- Cytokines
- DGK, Diacylglycerol kinase
- DHX37, DEAH-box helicase 37
- EBV, Epstein Barr virus
- FOXP3, Forkhead box P3
- GATA, GATA binding protein
- Genome editing
- IFN, interferon
- IL, interleukin
- LAG-3, Lymphocyte Activating 3
- NF-κB, nuclear factor of activated B cells
- PD-1, Programmed cell Death 1
- PD-L1, Programmed Death Ligand 1
- PTPN2, Protein Tyrosine Phosphatase Non-Receptor 2
- Pdia3, Protein Disulfide Isomerase Family A Member 3
- RBP, RNA-binding protein
- RNP, ribonuclear protein
- T cell effector function
- T cells
- TCR, T cell receptor
- TGF, transforming growth factor
- TIL, Tumor Infiltrating Lymphocyte
- TLRs, Toll-like receptors
- TNF, tumor necrosis factor
- TRAC, TCR-α chain
- TRBC, TCR-β chain
- UTR, untranslated region
- tTCR, transgenic TCR
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Fernández-Barrena MG, Arechederra M, Colyn L, Berasain C, Avila MA. Epigenetics in hepatocellular carcinoma development and therapy: The tip of the iceberg. JHEP Rep 2020; 2:100167. [PMID: 33134907 PMCID: PMC7585149 DOI: 10.1016/j.jhepr.2020.100167] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a deadly tumour whose causative agents are generally well known, but whose pathogenesis remains poorly understood. Nevertheless, key genetic alterations are emerging from a heterogeneous molecular landscape, providing information on the tumorigenic process from initiation to progression. Among these molecular alterations, those that affect epigenetic processes are increasingly recognised as contributing to carcinogenesis from preneoplastic stages. The epigenetic machinery regulates gene expression through intertwined and partially characterised circuits involving chromatin remodelers, covalent DNA and histone modifications, and dedicated proteins reading these modifications. In this review, we summarise recent findings on HCC epigenetics, focusing mainly on changes in DNA and histone modifications and their carcinogenic implications. We also discuss the potential drugs that target epigenetic mechanisms for HCC treatment, either alone or in combination with current therapies, including immunotherapies.
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Key Words
- 5acC, 5-acetylcytosine
- 5fC, 5-formylcytosine
- 5hmC, 5-hydoxymethyl cytosine
- 5mC, 5-methylcytosine
- Acetyl-CoA, acetyl coenzyme A
- BER, base excision repair
- BRD, bromodomain
- CDA, cytidine deaminase
- CGI, CpG island
- CIMP, CGI methylator phenotype
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- DNMT, DNA methyltransferase
- DNMTi, DNMT inhibitor
- Epigenetics
- FAD, flavin adenine dinucleotide
- HAT, histone acetyltransferases
- HCC, hepatocellular carcinoma
- HDAC, histone deacetylase
- HDACi, HDAC inhibitor
- HDM, histone demethylase
- HMT, histone methyltransferase
- Hepatocellular carcinoma
- KMT, lysine methyltransferase
- LSD/KDM, lysine specific demethylases
- NAFLD, non-alcoholic fatty liver disease
- NK, natural killer
- NPC, nasopharyngeal carcinoma
- PD-L1, programmed cell death ligand-1
- PD1, programmed cell death protein 1
- PHD, plant homeodomain
- PTM, post-translational modification
- SAM, S-adenosyl-L-methionine
- TDG, thymidine-DNA-glycosylase
- TERT, telomerase reverse transcriptase
- TET, ten-eleven translocation
- TME, tumour microenvironment
- TSG, tumour suppressor gene
- Therapy
- UHRF1, ubiquitin like with PHD and ring finger domains 1
- VEGF, vascular endothelial growth factor
- ncRNAs, non-coding RNAs
- α-KG, α-ketoglutarate
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Affiliation(s)
- Maite G. Fernández-Barrena
- Hepatology Program CIMA, University of Navarra, Pamplona, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute), Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Arechederra
- Hepatology Program CIMA, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia Colyn
- Hepatology Program CIMA, University of Navarra, Pamplona, Spain
| | - Carmen Berasain
- Hepatology Program CIMA, University of Navarra, Pamplona, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute), Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Matias A. Avila
- Hepatology Program CIMA, University of Navarra, Pamplona, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute), Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Orbegoso C, Murali K, Banerjee S. The current status of immunotherapy for cervical cancer. Rep Pract Oncol Radiother 2018; 23:580-588. [PMID: 30534022 DOI: 10.1016/j.rpor.2018.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/13/2018] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
Immunotherapy has been proven effective in several tumours, hence diverse immune checkpoint inhibitors are currently licensed for the treatment of melanoma, kidney cancer, lung cancer and most recently, tumours with microsatellite instability. There is much enthusiasm for investigating this approach in gynaecological cancers and the possibility that immunotherapy might become part of the therapeutic landscape for gynaecological malignancies. Cervical cancer is the fourth most frequent cancer in women worldwide and represents 7.9% of all female cancers with a higher burden of the disease and mortality in low- and middle-income countries. Cervical cancer is largely a preventable disease, since the introduction of screening tests, the recognition of the human papillomavirus (HPV) as an etiological agent, and the subsequent development of primary prophylaxis against high risk HPV subtypes. Treatment for relapsed/advanced disease has improved over the last 5 years, since the introduction of antiangiogenic therapy. However, despite advances, the median overall survival for advanced cervical cancer is 16.8 months and the 5-year overall survival for all stages is 68%. There is a need to improve outcomes and immunotherapy could offer this possibility. Clinical trials aim to understand the best timing for immunotherapy, either in the adjuvant setting or recurrent disease and whether immunotherapy, alone or in combination with other agents, improves outcomes.
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Key Words
- APC, antigen-presenting cell
- Adoptive T cell therapy
- CAR, chimeric antigen receptor
- CD4, -8, -80, cluster of differentiation 4, -8, -80
- CTL, cytotoxic-T lymphocyte
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- Cervical cancer
- DC, dendritic cell
- DFS, disease free survival
- DNA, deoxyribonucleic acid
- FIGO, International Federation of Gynecology and Obstetrics
- HLA, human leucocyte antigen
- HPV, human papilloma virus
- Human papillomavirus
- IL-2, interleukin 2
- ILT's, Ig-like transcripts
- Immune checkpoints inhibitors
- LLO, listerolysin O
- Lm, Listeria monocytogenes
- MAGE-A3, melanoma-associated antigen 3
- MCH, major histocompatibility complex
- ORR, objective response rate
- OS, overall survival
- PD-1, programmed cell death protein 1
- PD-L1, programmed death-ligand 1
- PFS, progression free survival
- RNA, ribonucleic acid
- SLP, synthetic long-peptide
- TCR, T-cell receptor
- TGFβ, transforming growth factor beta
- TILs, tumor-infiltrating lymphocytes
- TRAEs, treatment related adverse events
- Therapeutic vaccines
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Affiliation(s)
- Cecilia Orbegoso
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Krithika Murali
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Susana Banerjee
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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9
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Birnbaum MR, Ma MW, Fleisig S, Packer S, Amin BD, Jacobson M, McLellan BN. Nivolumab-related cutaneous sarcoidosis in a patient with lung adenocarcinoma. JAAD Case Rep 2017; 3:208-211. [PMID: 28443311 PMCID: PMC5394200 DOI: 10.1016/j.jdcr.2017.02.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mathew R. Birnbaum
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Michelle W. Ma
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Sarah Fleisig
- Department of Medicine, Division of Hematology/Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Stuart Packer
- Department of Medicine, Division of Hematology/Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Bijal D. Amin
- Department of Pathology, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Mark Jacobson
- Department of Pathology, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Beth N. McLellan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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10
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Eckert F, Gaipl U, Niedermann G, Hettich M, Schilbach K, Huber S, Zips D. Beyond checkpoint inhibition - Immunotherapeutical strategies in combination with radiation. Clin Transl Radiat Oncol 2017; 2:29-35. [PMID: 29657997 PMCID: PMC5893529 DOI: 10.1016/j.ctro.2016.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/20/2022] Open
Abstract
The revival of cancer immunotherapy has taken place with the clinical success of immune checkpoint inhibition. However, the spectrum of immunotherapeutic approaches is much broader encompassing T cell engaging strategies, tumour-specific vaccination, antibodies or immunocytokines. This review focuses on the immunological effects of irradiation and the evidence available on combination strategies with immunotherapy. The available data suggest great potential of combined treatments, yet also poses questions about dose, fractionation, timing and most promising multimodal strategies.
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Key Words
- Bispecific antibodies
- CAR, chimeric antigen receptor
- CAR-T-cells
- CDN, cyclic dinucleotides
- CTL, cytotoxic T lymphocyte
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- GM-CSF, granulocyte-monocyte colony stimulating factor
- IR, irradiation
- Immunocytokines
- Immunotherapy
- PD-1, Programmed cell death protein 1 receptor
- PD-L1, PD-1 ligand
- Radiotherapy
- TCR, T cell receptor
- Treg, regulatory T cells
- Vaccination
- bsAb, bispecific antibody
- scFv, single chain variable fragment
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Affiliation(s)
- F. Eckert
- Department of Radiation Oncology, Universitaetsklinikum Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - U.S. Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - G. Niedermann
- Department of Radiation Oncology, Medical Center – University of Freiburg, Freiburg, Germany
| | - M. Hettich
- Department of Radiation Oncology, Medical Center – University of Freiburg, Freiburg, Germany
| | - K. Schilbach
- Department of General Pediatrics/Pediatric Oncology, Universitaetsklinikum Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - S.M. Huber
- Department of Radiation Oncology, Universitaetsklinikum Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - D. Zips
- Department of Radiation Oncology, Universitaetsklinikum Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
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11
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Zynda ER, Grimm MJ, Yuan M, Zhong L, Mace TA, Capitano M, Ostberg JR, Lee KP, Pralle A, Repasky EA. A role for the thermal environment in defining co-stimulation requirements for CD4(+) T cell activation. Cell Cycle 2016; 14:2340-54. [PMID: 26131730 DOI: 10.1080/15384101.2015.1049782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Maintenance of normal core body temperature is vigorously defended by long conserved, neurovascular homeostatic mechanisms that assist in heat dissipation during prolonged, heat generating exercise or exposure to warm environments. Moreover, during febrile episodes, body temperature can be significantly elevated for at least several hours at a time. Thus, as blood cells circulate throughout the body, physiologically relevant variations in surrounding tissue temperature can occur; moreover, shifts in core temperature occur during daily circadian cycles. This study has addressed the fundamental question of whether the threshold of stimulation needed to activate lymphocytes is influenced by temperature increases associated with physiologically relevant increases in temperature. We report that the need for co-stimulation of CD4+ T cells via CD28 ligation for the production of IL-2 is significantly reduced when cells are exposed to fever-range temperature. Moreover, even in the presence of sufficient CD28 ligation, provision of extra heat further increases IL-2 production. Additional in vivo and in vitro data (using both thermal and chemical modulation of membrane fluidity) support the hypothesis that the mechanism by which temperature modulates co-stimulation is linked to increases in membrane fluidity and membrane macromolecular clustering in the plasma membrane. Thermally-regulated changes in plasma membrane organization in response to physiological increases in temperature may assist in the geographical control of lymphocyte activation, i.e., stimulating activation in lymph nodes rather than in cooler surface regions, and further, may temporarily and reversibly enable CD4+ T cells to become more quickly and easily activated during times of infection during fever.
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Key Words
- APC, antigen-presenting cell
- CD28, cluster of differentiation 28
- CD3, cluster of differentiation 3
- CD4, cluster of differentiation 4
- CD8, cluster of differentiation 8
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- CTxB, cholera toxin B subunit
- Ct, cycle threshold
- ELISA, enzyme-linked immunosorbant assay
- EtOH, ethanol
- FITC, fluoroisothiocyanate
- GM1, monosialotetrahexosylganglioside
- IDEAS, imagestream data exploration and analysis software
- IL-2, interleukin 2
- LA, latrunculin A
- MβCD, methyl-β-cyclodextrin
- PD-1, Programmed cell death-1
- PMA, phorbol 12-myristate 13-acetate
- T cell activation
- T cell co-stimulation
- TCR, T cell receptor
- TDI, time delay integration
- TMA-DPH, trimethylammonium diphenylhexatriene
- WBH, whole body hyperthermia.
- fever
- hyperthermia
- immune response
- membrane fluidity
- pMHC, peptide-major histocompatibility complexes
- qRT-PCR, quantitative reverse transcription polymerase chain reaction
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Affiliation(s)
- Evan R Zynda
- a Department of Cell Stress Biology ; Roswell Park Cancer Institute ; Buffalo , NY USA
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12
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Wyluda EJ, Cheng J, Schell TD, Haley JS, Mallon C, Neves RI, Robertson G, Sivik J, Mackley H, Talamo G, Drabick JJ. Durable complete responses off all treatment in patients with metastatic malignant melanoma after sequential immunotherapy followed by a finite course of BRAF inhibitor therapy. Cancer Biol Ther 2016; 16:662-70. [PMID: 25806780 PMCID: PMC4622667 DOI: 10.1080/15384047.2015.1026507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report 3 cases of durable complete response (CR) in patients with BRAF-mutated metastatic melanoma who were initially treated unsuccessfully with sequential immunotherapies (high dose interleukin 2 followed by ipilimumab with or without concurrent radiation therapy). After progression during or post immunotherapy, these patients were given BRAF inhibitor therapy and developed rapid CRs. Based on the concomitant presence of autoimmune manifestations (including vitiligo and hypophysitis), we postulated that there was a synergistic effect between the prior immune therapy and the BRAF targeting agents. Accordingly, the inhibitors were gradually weaned off beginning at 3 months and were stopped completely at 9-12 months. The three patients remain well and in CR off of all therapy at up to 15 months radiographic follow-up. The institution of the BRAF therapy was associated with development of severe rheumatoid-like arthritis in 2 patients which persisted for months after discontinuation of therapy, suggesting it was not merely a known toxicity of BRAF inhibitors (arthralgias). On immunologic analysis, these patients had high levels of non-T-regulatory, CD4 positive effector phenotype T-cells, which persisted after completion of therapy. Of note, we had previously reported a similar phenomenon in patients with metastatic melanoma who failed high dose interleukin-2 and were then placed on a finite course of temozolomide with rapid complete responses that have remained durable for many years after discontinuation of temozolomide. We postulate that a finite course of cytotoxic or targeted therapy specific for melanoma given after apparent failure of prior immunotherapy can result in complete and durable remissions that may persist long after the specific cytotoxic or targeted agents have been discontinued suggesting the existence of sequence specific synergism between immunotherapy and these agents. Here, we discuss these cases in the context of the literature on synergy between conventional or targeted cytotoxic therapy and immunotherapy in cancer treatment.
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Key Words
- BRAF inhibitor
- CBC, complete blood count
- CR, complete response
- CRP, c-reactive protein
- CT, computed tomography
- CTL, cytotoxic lymphocyte
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- GrzB, granzyme B
- HD, high dose
- IFN, interferon
- IL-2, interleukin 2
- LDH, lactate dehydrogenase
- M6P, manose 6 phosphate
- MAPK, mitogen-activated protein kinase pathway
- PD-1, programmed death 1
- PDL-1, programmed death ligand 1
- PDL-2, programmed death ligand 2
- PET, positron emission tomography
- PR, partial response
- RT, radiation therapy
- SLE, systemic lupus erythematosus
- WBC, white blood cell count
- cytotoxic therapy, immunotherapy, treatment of melanoma
- interleukin-2
- ipilimumab
- metastatic melanoma
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Affiliation(s)
- Edward J Wyluda
- a Division of Hematology Oncology; Penn State Milton S Hershey Medical Center ; Hershey , PA , USA
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13
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Leone RD, Lo YC, Powell JD. A2aR antagonists: Next generation checkpoint blockade for cancer immunotherapy. Comput Struct Biotechnol J 2015; 13:265-72. [PMID: 25941561 PMCID: PMC4415113 DOI: 10.1016/j.csbj.2015.03.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/26/2015] [Accepted: 03/31/2015] [Indexed: 12/11/2022] Open
Abstract
The last several years have witnessed exciting progress in the development of immunotherapy for the treatment of cancer. This has been due in great part to the development of so-called checkpoint blockade. That is, antibodies that block inhibitory receptors such as CTLA-4 and PD-1 and thus unleash antigen-specific immune responses against tumors. It is clear that tumors evade the immune response by usurping pathways that play a role in negatively regulating normal immune responses. In this regard, adenosine in the immune microenvironment leading to the activation of the A2a receptor has been shown to represent one such negative feedback loop. Indeed, the tumor microenvironment has relatively high concentrations of adenosine. To this end, blocking A2a receptor activation has the potential to markedly enhance anti-tumor immunity in mouse models. This review will present data demonstrating the ability of A2a receptor blockade to enhance tumor vaccines, checkpoint blockade and adoptive T cell therapy. Also, as several recent studies have demonstrated that under certain conditions A2a receptor blockade can enhance tumor progression, we will also explore the complexities of adenosine signaling in the immune response. Despite important nuances to the A2a receptor pathway that require further elucidation, studies to date strongly support the development of A2a receptor antagonists (some of which have already been tested in phase III clinical trials for Parkinson Disease) as novel modalities in the immunotherapy armamentarium.
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Key Words
- A2a adenosine receptor
- A2aR, adenosine A2a receptor
- APC, antigen presenting cell
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- DLBCL, diffuse large B-cell lymphoma
- Hif1-alpha, hypoxia inducible factor-1 alpha
- Immune checkpoint
- Immunotherapy
- LAG-3, lymphocyte-activation gene 3
- NSCLC, non-small cell lung cancer
- ORR, overall response rate
- OS, overall survival
- PD-1
- PD-1, programmed cell death 1
- PD-L1, programmed cell death ligand 1
- T cell
- TFS, tumor free survival
- TIM-3, T-cell immunoglobulin domain and mucin domain 3
- Treg, regulatory T cell
- Tumor
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Affiliation(s)
- Robert D Leone
- Sidney Kimmel Comprehensive Cancer Research Center, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ying-Chun Lo
- Sidney Kimmel Comprehensive Cancer Research Center, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jonathan D Powell
- Sidney Kimmel Comprehensive Cancer Research Center, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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14
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Abstract
Melanoma is the most serious form of skin cancer. Metastatic melanoma historically carries a poor prognosis and until recently there have been few effective agents available to treat widely disseminated disease. Recognition of the immunogenic nature of melanoma has resulted in the development of various immunotherapeutic approaches, especially with regards to the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1). Antibodies targeting the PD-1 axis have shown enormous potential in the treatment of metastatic melanoma. Here, we will review the immune basis for the disease and discuss approved immunotherapeutic options for advanced melanoma, as well as the current state of development of PD-1 and PD-L1 antibodies and their importance in shaping the future of melanoma treatment.
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Key Words
- AE, adverse event
- APC, antigen presenting cell
- ASCO, American Society of Clinical Oncology
- BMS-936559
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- FDA, Food and Drug Administration
- ITIM , immunoreceptor tyrosine-based inhibitory motif
- ITSM, immunoreceptor tyrosine-based switch motif
- Ig, immunoglobulin
- MAPK, mitogen-activated protein kinase
- MHC, major histocompatibility complex
- MPDL3280A
- NK, natural killer
- ORR, objective response rate
- OS, overall survival
- PD, progressive disease
- PD-1
- PD-1, programmed cell death 1
- PD-L1
- PD-L1, programmed cell death ligand 1
- PD-L2
- PFS, progression free survival
- TCR, T cell receptor
- TIL, tumor infiltrating lymphocyte
- gp100, glycoprotein 100 vaccine
- immunotherapy
- melanoma
- nivolumab
- pembrolizumab
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Affiliation(s)
- Katy K Tsai
- University of California San Francisco; San Francisco, CA USA
| | - Inés Zarzoso
- University of California San Francisco; San Francisco, CA USA
| | - Adil I Daud
- University of California San Francisco; San Francisco, CA USA
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