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Powers CM, Verma H, Orloff J, Piontkowski AJ, Tiersten A, Lamb A, Gulati N. Use of a topical Janus kinase inhibitor in immune checkpoint inhibitor-induced eczematous reaction: a case report. J DERMATOL TREAT 2024; 35:2336118. [PMID: 38565207 DOI: 10.1080/09546634.2024.2336118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
In this report, we describe the case of a 28-year-old female with bilateral breast cancer in the setting of a BRCA1 mutation, who presented to dermatology with an eczematous reaction, ultimately diagnosed as a cutaneous immune-related adverse event (cirAE) secondary to an immune checkpoint inhibitor (ICI), pembrolizumab. Our case report highlights a novel therapeutic option for an eczematous cirAE: the topical JAK 1/2 inhibitor, ruxolitinib. CirAEs can occur in up to 55% of patients on ICIs, a class of medications seeing rapidly increasing use in cancer therapy, and prior research has demonstrated that ICI-induced dermatitis may involve different pathways than traditionally observed in their spontaneous counterparts. Specifically, marked Th1 skewing is noted in ICI-induced dermatitis, as opposed to a predominant Th2 response which typically characterizes spontaneous atopic dermatitis. To our knowledge, this is the first case report in the literature discussing use of a topical JAK inhibitor, ruxolitinib, in the treatment of topical steroid-refractory cirAEs. Furthermore, as topical JAK inhibitors are thought to not carry the risks of systemic JAK inhibitors, including malignancy, ruxolitinib cream is a promising therapeutic option for this challenging patient population.
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Affiliation(s)
- Camille M Powers
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Verma
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeremy Orloff
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Austin J Piontkowski
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Tiersten
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angela Lamb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Bruijn TV, Geraedts A, Vlahu CA, Jaspars L, Elshot YS. IgA pemphigus as an immune checkpoint inhibitor-associated skin manifestation. JAAD Case Rep 2024; 47:41-43. [PMID: 38633887 PMCID: PMC11021218 DOI: 10.1016/j.jdcr.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Affiliation(s)
- Tristan V.M. Bruijn
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Geraedts
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Carmen A. Vlahu
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Lies.H. Jaspars
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Yannick S. Elshot
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Morita A, Ichihara E, Inoue K, Fujiwara K, Yokoyama T, Harada D, Ando C, Kano H, Oda N, Tamura T, Ochi N, Kawai H, Inoue M, Hara N, Fujimoto N, Ichikawa H, Oze I, Hotta K, Maeda Y, Kiura K. Impacts of probiotics on the efficacies of immune checkpoint inhibitors with or without chemotherapy for patients with advanced non-small-cell lung cancer. Int J Cancer 2024; 154:1607-1615. [PMID: 38196128 DOI: 10.1002/ijc.34842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
The relationships between the therapeutic effects of immune checkpoint inhibitors (ICIs) and the intestinal flora have attracted increasing attention. However, the effects of oral probiotics on the efficacies of ICIs used to treat non-small-cell lung cancer (NSCLC) remain unclear. We investigated the effects of probiotics on the efficacies of ICIs in patients treated with and without chemotherapy. We investigated patients with advanced NSCLC on ICI monotherapy or combination ICI and chemotherapy using the Okayama Lung Cancer Study Group Immunotherapy Database (OLCSG-ID) and the Okayama Lung Cancer Study Group Immunochemotherapy Database (OLCSG-ICD). In total, 927 patients (482 on ICI monotherapy, 445 on an ICI + chemotherapy) were enrolled. Most were male, of good performance status, smokers, and without epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) mutations. Probiotics were administered to 19% of patients on ICI monotherapies and 17% of those on ICIs + chemotherapy. Of the former patients, progression-free survival (PFS) and overall survival (OS) were significantly better in the probiotics group (PFS 7.9 vs. 2.9 months, hazard ratio [HR] 0.54, p < .001; OS not attained vs. 13.1 months, HR 0.45, p < .001). Among patients receiving ICI and chemotherapy, there were no significant differences in PFS between those on probiotics and not but OS was significantly better in the probiotics group (PFS 8.8 vs. 8.6 months, HR 0.89, p = .43; OS not attained vs. 22.6 months, HR 0.61, p = .03). Patients on probiotics experienced better outcomes following ICI treatment.
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Affiliation(s)
- Ayako Morita
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Eiki Ichihara
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Koji Inoue
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, NHO Okayama Medical Center, Okayama, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Daijiro Harada
- Department of Thoracic Oncology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Chihiro Ando
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Hirohisa Kano
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Naohiro Oda
- Department of Respiratory Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Tomoki Tamura
- Department of Respiratory Medicine, NHO Iwakuni Clinical Center, Iwakuni, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Haruyuki Kawai
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masaaki Inoue
- Department of Chest Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Naofumi Hara
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Nobukazu Fujimoto
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Hirohisa Ichikawa
- Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Katsuyuki Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
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Steinberg GD, Shore ND, Redorta JP, Galsky MD, Bedke J, Ku JH, Kretkowski M, Hu H, Penkov K, Vermette JJ, Tarazi JC, Randall AE, Pierce KJ, Saltzstein D, Powles TB. CREST: phase III study of sasanlimab and Bacillus Calmette-Guérin for patients with Bacillus Calmette-Guérin-naïve high-risk non-muscle-invasive bladder cancer. Future Oncol 2024; 20:891-901. [PMID: 38189180 DOI: 10.2217/fon-2023-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Bacillus Calmette-Guérin (BCG) is the standard of care for patients with high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). BCG in combination with programmed cell death-1 (PD-1) inhibitors may yield greater anti-tumor activity compared with either agent alone. CREST is a phase III study evaluating the efficacy and safety of the subcutaneous PD-1 inhibitor sasanlimab in combination with BCG for patients with BCG-naive high-risk NMIBC. Eligible participants are randomized to receive sasanlimab plus BCG (induction ± maintenance) or BCG alone for up to 25 cycles within 12 weeks of TURBT. The primary outcome is event-free survival. Secondary outcomes include additional efficacy end points and safety. The target sample size is around 1000 participants.
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Affiliation(s)
- Gary D Steinberg
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Grand Strand Urology, 823 82nd Parkway, Myrtle Beach, SC 29572, USA
| | - Joan Palou Redorta
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, C. de Cartagena 340-350, 08025 Barcelona, Spain
| | - Matthew D Galsky
- The Tisch Cancer Institute, Mount Sinai, 1190 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jens Bedke
- Department of Urology, Eberhard Karls University Tübingen, Geschwister-Scholl-Platz, 72074 Tübingen, Germany
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Michal Kretkowski
- Clinical Research Center, Spolka z Ograniczona, Feliksa Nowowiejskiego 5, 61-731 Poznań, Poland
| | - Hailong Hu
- Institute of Urology, Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Konstantin Penkov
- Private Medical Institution Euromedservice, Suvorovskiy Prospekt, 60, St Petersburg, Russia
| | | | - Jamal C Tarazi
- Pfizer Oncology, Pfizer, 10646 Science Center Drive, San Diego, CA 92121, USA
| | - Alison E Randall
- Pfizer Oncology, Pfizer, 235 East 42nd Street, New York, NY 10017, USA
| | - Kristen J Pierce
- Pfizer Oncology, Pfizer, 280 Shennecossett Road, Groton, CT 06340, USA
| | - Daniel Saltzstein
- Division of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Thomas B Powles
- Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 5PZ, UK
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Hong J, Lee J, Park S, Jung HA, Sun JM, Lee SH, Ahn JS, Sinn DH, Ahn MJ. Immune checkpoint inhibitor use and the incidence of hepatitis B virus reactivation or immune-related hepatitis in non-small cell lung cancer patients with chronic hepatitis B. Cancer 2024; 130:1693-1701. [PMID: 38165808 DOI: 10.1002/cncr.35175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/29/2023] [Accepted: 11/17/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND The safety of immune-checkpoint inhibitors (ICIs) has not been thoroughly investigated in non-small cell lung cancer (NSCLC) patients with chronic hepatitis B (CHB) or occult hepatitis B infection (OBI). The authors analyzed the incidence of hepatitis B virus (HBV) reactivation, immune-related hepatitis and jaundice in NSCLC patients in a real-world setting. METHODS A total of 1277 NSCLC patients treated with ICIs were analyzed. Among them, 52 patients were hepatitis B surface antigen (HBsAg) (+) (group A, CHB), 759 patients were HBsAg (-)/hepatitis B core antibody immunoglobulin G (anti-HBc IgG) (+) (group B, OBI), and 466 patients were HBsAg (-)/anti-HBc IgG (-) (group C). Among the 52 patients with CHB, 38 (73.1%) were receiving antiviral therapy. The primary end point was HBV reactivation, immune-related hepatitis, and jaundice. The secondary end points included other immune-related adverse events and efficacy. RESULTS HBV reactivation was observed in two patients (0.2%) who were both in group A (CHB). Among CHB patients who were not receiving antiviral therapy, HBV reactivation was observed in 14.3% (2 of 14 patients). The incidences of immune-related hepatitis and jaundice were comparable among the three groups. The incidence of ≥grade 3 other immune-related adverse events and efficacy were all comparable among the three groups (p > .05 for all comparisons). CONCLUSIONS In this large, real-world cohort study, the safety and efficacy of ICIs were comparable in patients with CHB and OBI. HBV reactivation was observed in patients with CHB without antiviral therapy indicating antiviral prophylaxis should be required for them. For patients with OBI, the risk of HBV reactivation was minimal.
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Affiliation(s)
- Joohyun Hong
- Division of Hematology-Oncology, Department of Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi, Korea
| | - Jiyun Lee
- Lung Cancer Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tominaga K, Toda E, Takeuchi K, Takakuma S, Sakamoto E, Kuno H, Kajimoto Y, Terasaki Y, Kunugi S, Mii A, Sakai Y, Terasaki M, Shimizu A. Predominant CD8 + cell infiltration and low accumulation of regulatory T cells in immune checkpoint inhibitor-induced tubulointerstitial nephritis. Pathol Int 2024. [PMID: 38634742 DOI: 10.1111/pin.13428] [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: 01/10/2024] [Revised: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Immune checkpoint inhibitors (ICIs) can provide survival benefits to cancer patients; however, they sometimes result in the development of renal immune-related adverse events (irAEs). Tubulointerstitial nephritis (TIN) is the most representative pathological feature of renal irAEs. However, the clinicopathological entity and underlying pathogenesis of ICI-induced TIN are unclear. Therefore, we compared the clinical and histological features of this condition with those of non-ICI drug-induced TIN. Age and C-reactive protein levels were significantly higher in ICI-induced TIN, but there were no significant differences in renal function. Immunophenotyping of ICI-induced TIN showed massive T cell and macrophage infiltration with fewer B cells, plasma cells, neutrophils, and eosinophils. Compared with those in non-ICI drug-induced TIN, CD4+ cell numbers were significantly lower in ICI-induced TIN but CD8+ cell numbers were not significantly different. However, CD8/CD3 and CD8/CD4 ratios were higher in ICI-induced TIN. Moreover, CD25+ and FOXP3+ cells, namely regulatory T cells, were less abundant in ICI-induced TIN. In conclusion, T cell, B cell, plasma cell, neutrophil, and eosinophil numbers proved useful for differentiating ICI-induced and non-ICI drug-induced TIN. Furthermore, the predominant distribution of CD8+ cells and low accumulation of regulatory T cells might be associated with ICI-induced TIN development.
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Affiliation(s)
- Kenta Tominaga
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Etsuko Toda
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro Takeuchi
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Shoichiro Takakuma
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Emi Sakamoto
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Hideaki Kuno
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yusuke Kajimoto
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
- Division of Pathology, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shinobu Kunugi
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akiko Mii
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Yukinao Sakai
- Department of Endocrinology, Metabolism and Nephrology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Mika Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Shiraha K, Watanabe H, Fujiwara K, Goda M, Inoue T, Fujiwara M, Matsuoka S, Takigawa Y, Mitsumune S, Kudo K, Sato A, Sato K, Shinno Y, Shibayama T. Autopsy case of meningoencephalitis induced by nivolumab and ipilimumab in a patient being treated for non-small cell lung cancer. Intern Med 2024:3457-24. [PMID: 38631854 DOI: 10.2169/internalmedicine.3457-24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
A 75-year-old woman with stage IVB (cT2bN3M1b) lung adenocarcinoma was administered nivolumab, ipilimumab, carboplatin, and paclitaxel. Fourteen days after receiving chemotherapy, she experienced an impaired consciousness and a cerebrospinal fluid analysis revealed high protein levels and pleocytosis. She was diagnosed with nivolumab- and ipilimumab-induced encephalitis and was treated with corticosteroids which were tapered to 10 mg/day, with no symptom recurrence. She died 18 weeks after the initial presentation, as the cancer worsened. An autopsy showed encephalitis and CD8+ lymphocyte infiltration around the blood vessels. Thus, immune-related adverse events should be suspected and treatment should be initiated for patients presenting with an impaired consciousness when concurrently being treated with nivolumab and ipilimumab.
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Affiliation(s)
- Keisuke Shiraha
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Hiromi Watanabe
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Mayu Goda
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Tomoyoshi Inoue
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Miho Fujiwara
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Suzuka Matsuoka
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Yuki Takigawa
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Sho Mitsumune
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Kenichiro Kudo
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Akiko Sato
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Ken Sato
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
| | - Yoko Shinno
- Department of Pathology, NHO Okayama Medical Center, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
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8
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Wyss N, Berner F, Walter V, Jochum AK, Purde MT, Abdou MT, Sinnberg T, Hofmeister K, Pop OT, Hasan Ali O, Bauer J, Cheng HW, Lütge M, Klümper N, Diem S, Kosaloglu-Yalcin Z, Zhang Y, Sellmer L, Macek B, Karbach J, König D, Läubli H, Zender L, Meyer BS, Driessen C, Schürch CM, Jochum W, Amaral T, Heinzerling L, Cozzio A, Hegazy AN, Schneider T, Brutsche MH, Sette A, Lenz TL, Walz J, Rammensee HG, Früh M, Jäger E, Becher B, Tufman A, Nuñez N, Joerger M, Flatz L. Autoimmunity Against Surfactant Protein B Is Associated with Pneumonitis During Checkpoint Blockade. Am J Respir Crit Care Med 2024. [PMID: 38626354 DOI: 10.1164/rccm.202311-2136oc] [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: 11/21/2023] [Accepted: 04/16/2024] [Indexed: 04/18/2024] Open
Abstract
RATIONALE Immune checkpoint inhibitor-related pneumonitis is a serious autoimmune event affecting up to 20% of patients with non-small cell lung cancer, yet the factors underpinning its development in some patients and not others are poorly understood. OBJECTIVES To investigate the role of autoantibodies and autoreactive T cells against surfactant-related proteins in the development of pneumonitis. METHODS The study cohort consisted of non-small cell lung cancer patients who gave blood samples before and during immune checkpoint inhibitor treatment. Serum was used for proteomics analyses and to detect autoantibodies present during pneumonitis. T cell stimulation assays and single-cell RNA sequencing were performed to investigate the specificity and functionality of peripheral autoreactive T cells. The findings were confirmed in a validation cohort comprising patients with non-small cell lung cancer and patients with melanoma. MEASUREMENTS AND MAIN RESULTS Across both cohorts, patients who developed pneumonitis had higher pre-treatment levels of immunoglobulin G autoantibodies targeting surfactant protein-B. At the onset of pneumonitis, these patients also exhibited higher frequencies of CD4+ interferon-gamma-positive surfactant protein B-specific T cells, and expanding T cell clonotypes recognizing this protein, accompanied by a pro-inflammatory serum proteomic profile. CONCLUSIONS Our data suggest that the co-occurrence of surfactant protein-B-specific immunoglobulin G autoantibodies and CD4+ T cells is associated with the development of pneumonitis during ICI therapy. Pre-treatment levels of these antibodies may represent a potential biomarker for elevated risk of developing pneumonitis and on-treatment levels may provide a diagnostic aid.
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Affiliation(s)
- Nina Wyss
- Institute of Immunobiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Fiamma Berner
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Vincent Walter
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Mette T Purde
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | | | - Tobias Sinnberg
- University Hospital Tübingen, Dermatology, Tübingen, Germany
| | - Kathrin Hofmeister
- University of Tübingen, 9188, Dermatology, Tubingen, Baden-Württemberg, Germany
| | - Oltin T Pop
- Cantonal Hospital St. Gallen, Immunobiology, St. Gallen, Switzerland
| | - Omar Hasan Ali
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Jens Bauer
- University Hospital Tübingen, 27203, Tubingen, Germany
| | - Hung-Wei Cheng
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Mechthild Lütge
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Niklas Klümper
- University Hospital Bonn, 39062, Bonn, Nordrhein-Westfalen, Germany
| | - Stefan Diem
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | | | - Yizheng Zhang
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Boris Macek
- University of Tübingen, 9188, Proteome Center, Tubingen, Baden-Württemberg, Germany
| | - Julia Karbach
- Krankenhaus Nordwest, 9152, Frankfurt, Hessen, Germany
| | - David König
- University Hospital Basel, 30262, Basel, BS, Switzerland
| | - Heinz Läubli
- University Hospital Basel, 30262, Basel, BS, Switzerland
| | - Lars Zender
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | | | - Christian M Schürch
- University Hospital Tübingen Institute of Pathology and Neuropathology, 155911, Institute of Pathology, Tubingen, Baden-Württemberg, Germany
| | - Wolfram Jochum
- Cantonal Hospital St. Gallen, Pathology, St. Gallen, United States
| | - Teresa Amaral
- University Hospital Tübingen, 27203, Tubingen, Germany
| | | | - Antonio Cozzio
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Ahmed N Hegazy
- Charite University Hospital Berlin, 14903, Berlin, Germany
| | - Tino Schneider
- Cantonal Hospital St. Gallen, Division of Pneumology, St. Gallen, Switzerland
| | - Martin H Brutsche
- Cantonal Hospital St.Gallen, Division of Pulmonary Medicine, St.Gallen, Switzerland
| | - Alessandro Sette
- La Jolla Institute for Immunology, 7113, La Jolla, California, United States
| | | | - Juliane Walz
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Martin Früh
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Elke Jäger
- Krankenhaus Nordwest, 9152, Frankfurt, Hessen, Germany
| | | | | | - Nicolas Nuñez
- National University of Cordoba, 28217, Cordoba, Argentina
| | - Markus Joerger
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Lukas Flatz
- Universitätsklinikum Tübingen, 27203, Hautklinik, Tubingen, Germany;
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9
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Kovac MB, Seruga B. Potentially fatal complications of new systemic anticancer therapies: pearls and pitfalls in their initial management. Radiol Oncol 2024; 0:raon-2024-0027. [PMID: 38613842 DOI: 10.2478/raon-2024-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Various types of immunotherapy (i.e. immune checkpoint inhibitors [ICIs], chimeric antigen receptor [CAR] T-cells and bispecific T-cell engagers [BiTEs]) and antibody drug conjugates (ADCs) have been used increasingly to treat solid cancers, lymphomas and leukaemias. Patients with serious complications of these therapies can be presented to physicians of different specialties. In this narrative review we discuss potentially fatal complications of new systemic anticancer therapies and some practical considerations for their diagnosis and initial treatment. RESULTS Clinical presentation of toxicities of new anticancer therapies may be unpredictable and nonspecific. They can mimic other more common medical conditions such as infection or stroke. If not recognized and properly treated these toxicities can progress rapidly into life-threatening conditions. ICIs can cause immune-related inflammatory disorders of various organ systems (e.g. pneumonitis or colitis), and a cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) may develop after treatment with CAR T-cells or BiTEs. The cornerstones of management of these hyper-inflammatory disorders are supportive care and systemic immunosuppressive therapy. The latter should start as soon as symptoms are mild-moderate. Similarly, some severe toxicities of ADCs also require immunosuppressive therapy. A multidisciplinary team including an oncologist/haematologist and a corresponding organ-site specialist (e.g. gastroenterologist in the case of colitis) should be involved in the diagnosis and treatment of these toxicities. CONCLUSIONS Health professionals should be aware of potential serious complications of new systemic anticancer therapies. Early diagnosis and treatment with adequate supportive care and immunosuppressive therapy are crucial for the optimal outcome of patients with these complications.
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Affiliation(s)
- Milena Blaz Kovac
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bostjan Seruga
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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10
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Knisely A, Hinchcliff E, Fellman B, Mosley A, Lito K, Hull S, Westin SN, Sood AK, Schmeler KM, Taylor JS, Huang SY, Sheth RA, Lu KH, Jazaeri AA. Phase 1b study of intraperitoneal ipilimumab and nivolumab in patients with recurrent gynecologic malignancies with peritoneal carcinomatosis. Med 2024; 5:311-320.e3. [PMID: 38471508 PMCID: PMC11015975 DOI: 10.1016/j.medj.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Intravenous immune checkpoint blockade (ICB) has shown poor response rates in recurrent gynecologic malignancies. Intraperitoneal (i.p.) ICB may result in enhanced T cell activation and anti-tumor immunity. METHODS In this phase 1b study, registered at Clinical. TRIALS gov (NCT03508570), initial cohorts received i.p. nivolumab monotherapy, and subsequent cohorts received combination i.p. nivolumab every 2 weeks and i.p. ipilimumab every 6 weeks, guided by a Bayesian design. The primary objective was determination of the recommended phase 2 dose (RP2D) of the combination. Secondary outcomes included toxicity, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). FINDINGS The trial enrolled 23 patients: 18 with ovarian cancer, 2 with uterine cancer, and 3 with cervical cancer. Study evaluable patients (n = 16) received a median of 2 prior lines of therapy (range: 1-8). Partial response was observed in 2 patients (12.5%; 1 ovarian, 1 uterine), and complete response was observed in 1 patient (6.3%) with cervical cancer, for an ORR of 18.8% (95% confidence interval: 4.0%-45.6%). The median duration of response was 14.8 months (range: 4.1-20.8), with one complete response ongoing. Median PFS and OS were 2.7 months and not reached, respectively. Grade 3 or higher immune-related adverse events occurred in 2 (8.7%) patients. CONCLUSIONS i.p. administration of dual ICB is safe and demonstrated durable responses in a subset of patients with advanced gynecologic malignancy. The RP2D is 3 mg/kg i.p. nivolumab every 2 weeks plus 1 mg/kg ipilimumab every 6 weeks. FUNDING This work was funded by Bristol Myers Squibb (CA209-9C7), an MD Anderson Cancer Center Support Grant (CA016672), the Ovarian Cancer Moon Shots Program, the Emerson Collective Fund, and a T32 training grant (CA101642).
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Affiliation(s)
- Anne Knisely
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Hinchcliff
- Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Medicine, Chicago, IL, USA
| | - Bryan Fellman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann Mosley
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathryn Lito
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Hull
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amir A Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Liang Y, Maeda O, Ando Y. Biomarkers for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors. Jpn J Clin Oncol 2024; 54:365-375. [PMID: 38183211 DOI: 10.1093/jjco/hyad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
Although immune checkpoint inhibitors have greatly improved cancer therapy, they also cause immune-related adverse events, including a wide range of inflammatory side effects resulting from excessive immune activation. Types of immune-related adverse events are diverse and can occur in almost any organ, with different frequencies and severities. Furthermore, immune-related adverse events may occur within the first few weeks after treatment or even several months after treatment discontinuation. Predictive biomarkers include blood cell counts and cell surface markers, serum proteins, autoantibodies, cytokines/chemokines, germline genetic variations and gene expression profiles, human leukocyte antigen genotype, microRNAs and the gut microbiome. Given the inconsistencies in research results and limited practical utility, there is to date no established biomarker that can be used in routine clinical practice, and additional investigations are essential to demonstrate efficacy and subsequently facilitate integration into routine clinical use.
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Affiliation(s)
- Yao Liang
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Osamu Maeda
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi, Japan
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12
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Ito T, Mizuno K, Yamamoto T, Yasuda T, Yokoyama S, Yamamoto K, Imai N, Ishizu Y, Honda T, Hama M, Kataoka T, Shimokata T, Ando Y, Kawashima H. Outcomes of immune checkpoint inhibitor-induced liver toxicity managed by hepatologists in a multidisciplinary toxicity team. Hepatol Res 2024. [PMID: 38571477 DOI: 10.1111/hepr.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/24/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
AIM To detect immune-related adverse events (irAEs) early and treat them appropriately, our institute established an irAE-focused multidisciplinary toxicity team in cooperation with various departments. This study aimed to evaluate a consultation system involving a team of hepatologists in terms of its utility for the management of severe immune checkpoint inhibitor (ICI)-induced liver toxicity. METHODS To analyze the diagnosis and treatment of severe ICI-induced liver toxicity (Grade 2 requiring corticosteroid therapy and Grade 3 or higher), we examined patients' clinical courses before and after the hepatologist consultation system was established (pre-period, September 2014 to February 2019; post-period, March 2019 to March 2023). RESULTS The median follow-up period was 392 days. Of the 1247 patients with advanced malignancies treated with ICIs, 66 developed severe ICI-induced liver toxicity (n = 22 and 44 in the pre- and post-periods, respectively). In the pre-period, hepatologist consultations were sought for 15/22 patients, whereas in the post-period, 42/44 patients were referred to and treated by hepatologists. The time from the onset of liver toxicity to the consultation was significantly shorter in the post-period than in the pre-period (mean 1.9 vs. 6.5 days, respectively; p = 0.012). The number of patients with a biopsy-confirmed diagnosis of ICI-induced liver toxicity was significantly higher in the post-period than in the pre-period (n = 22 vs. n = 3, respectively; p = 0.006). Finally, there were no cases of immune-related cholangitis in the pre-period, compared to five cases in the post-period. CONCLUSION A hepatologist consultation system in an irAE-focused multidisciplinary toxicity team is useful for managing severe ICI-induced liver toxicity.
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Affiliation(s)
- Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Mizuno
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Takafumi Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Tsukasa Yasuda
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
| | - Masayo Hama
- Department of Nursing, Nagoya University Hospital, Nagoya, Japan
| | - Tomomi Kataoka
- Department of Hospital Pharmacy, Nagoya University Hospital, Nagoya, Japan
| | - Tomoya Shimokata
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Hospital, Nagoya, Japan
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13
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Liu C, Xie J, Lin B, Tian W, Wu Y, Xin S, Hong L, Li X, Liu L, Jin Y, Tang H, Deng X, Zou Y, Zheng S, Fang W, Cheng J, Dai X, Bao X, Zhao P. Pan-Cancer Single-Cell and Spatial-Resolved Profiling Reveals the Immunosuppressive Role of APOE+ Macrophages in Immune Checkpoint Inhibitor Therapy. Adv Sci (Weinh) 2024:e2401061. [PMID: 38569519 DOI: 10.1002/advs.202401061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Indexed: 04/05/2024]
Abstract
The heterogeneity of macrophages influences the response to immune checkpoint inhibitor (ICI) therapy. However, few studies explore the impact of APOE+ macrophages on ICI therapy using single-cell RNA sequencing (scRNA-seq) and machine learning methods. The scRNA-seq and bulk RNA-seq data are Integrated to construct an M.Sig model for predicting ICI response based on the distinct molecular signatures of macrophage and machine learning algorithms. Comprehensive single-cell analysis as well as in vivo and in vitro experiments are applied to explore the potential mechanisms of the APOE+ macrophage in affecting ICI response. The M.Sig model shows clear advantages in predicting the efficacy and prognosis of ICI therapy in pan-cancer patients. The proportion of APOE+ macrophages is higher in ICI non-responders of triple-negative breast cancer compared with responders, and the interaction and longer distance between APOE+ macrophages and CD8+ exhausted T (Tex) cells affecting ICI response is confirmed by multiplex immunohistochemistry. In a 4T1 tumor-bearing mice model, the APOE inhibitor combined with ICI treatment shows the best efficacy. The M.Sig model using real-world immunotherapy data accurately predicts the ICI response of pan-cancer, which may be associated with the interaction between APOE+ macrophages and CD8+ Tex cells.
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Affiliation(s)
- Chuan Liu
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jindong Xie
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Bo Lin
- College of Computer Science and Technology, Zhejiang University, Hangzhou, 310053, China
- Innovation Centre for Information, Binjiang Institute of Zhejiang University, Hangzhou, 310053, China
| | - Weihong Tian
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, China
| | - Yifan Wu
- School of software, Zhejiang University, Ningbo, 315100, China
| | - Shan Xin
- Department of Genetics, Yale School of medicine, New Haven, CT, 06510, USA
| | - Libing Hong
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xin Li
- Department Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Lulu Liu
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yuzhi Jin
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Hailin Tang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xinpei Deng
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yutian Zou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Shaoquan Zheng
- Breast Disease Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Weijia Fang
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jinlin Cheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiaomeng Dai
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xuanwen Bao
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Peng Zhao
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
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14
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Inoue H, Inatomi O, Matsumoto H, Kimura H, Nakayama T, Nishida A, Andoh A. FOXA1/CK7-positive Esophageal Squamous Cell Carcinoma with Aggressive Liver Metastasis: A Case Report. Intern Med 2024:3300-23. [PMID: 38569907 DOI: 10.2169/internalmedicine.3300-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Cytokeratin (CK) is a specific marker of adenocarcinoma. However, cases of CK7-positive esophageal squamous cell carcinoma (ESCC) have only rarely been reported. We herein report a case of unresectable CK7-positive ESCC with aggressive liver metastasis following nivolumab treatment initiation. Nivolumab treatment was discontinued after one course because of complications. Notably, the liver metastases exhibited accelerated growth. Immunostaining of the necropsy specimens revealed diffuse positivity for forkhead box protein A1 (FOXA1)/CK7, thus indicating a potent poor immune response. The potential correlation between CK7 expression and the immune checkpoint inhibitor response may offer valuable insights into the development of effective therapeutic strategies.
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Affiliation(s)
- Hiroto Inoue
- Division of Digestive Endoscopy, Shiga University of Medical Science, Japan
| | - Osamu Inatomi
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Japan
| | - Hiroshi Matsumoto
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Japan
| | - Hidenori Kimura
- Division of Digestive Endoscopy, Shiga University of Medical Science, Japan
| | - Takahisa Nakayama
- Division of Human Pathology, Shiga University of Medical Science, Japan
| | - Atsushi Nishida
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Japan
| | - Akira Andoh
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Japan
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15
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Sun H, Bu F, Li L, Zhang X, Xin X, Yan J, Huang T. Efficacy and Safety of Immune Checkpoint Inhibitors Combined With Chemotherapy as First-line Treatment for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-analysis of Randomized Controlled Trials. Ann Pharmacother 2024; 58:349-359. [PMID: 37488978 DOI: 10.1177/10600280231188171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Different clinical trials for recurrent or metastatic nasopharyngeal carcinoma have studied different combinations of immuno-oncology in first-line treatment, but the optimal choice has not been determined. OBJECTIVE To systematically examine and compare the efficacy and safety of different immune checkpoint inhibitors (ICIs) combined with chemotherapy as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma. METHODS Several electronic databases were systematically searched up to February 2023. Articles meeting the inclusion criteria were included. RESULTS Three RCTs were eligible in the study. Compared with placebo plus gemcitabine-cisplatin (GP), toripalimab plus GP (HR = 0.59, 95% CI: 0.37-0.95) was significantly associated with a better OS. Tislelizumab plus GP generated best progression-free survival (PFS) benefit (HR = 0.50, 95% CI: 0.37-0.67), greatest improvement in 1-year PFS rate (RR = 3.00, 95% CI: 1.84-5.22), and objective response rate (ORR) (RR = 1.26, 95% CI: 1.04-1.53) over the placebo plus GP. Furthermore, tislelizumab plus GP appeared to be safer than toripalimab plus GP and camrelizumab plus GP in terms of adverse events (AEs)-grade ≥3, treatment-related AEs (TRAEs)-grade ≥3, serious AEs (SAEs), treatment-related SAEs (TRSAEs), and AEs leading to discontinuation of treatment. CONCLUSION AND RELEVANCE In recurrent or metastatic nasopharyngeal carcinoma, programmed death 1 (PD-1) inhibitors plus GP as first-line treatment have better survival outcomes than placebo plus GP with comparable toxicity. Toripalimab plus GP shows the best OS benefit over placebo plus GP, while tislelizumab plus GP generates the best PFS, 1-year PFS rate, ORR, and safety. Tislelizumab plus GP could be the best choice among the ICIs combined with chemotherapy regimens as first-line treatment in recurrent or metastatic nasopharyngeal carcinoma.
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Affiliation(s)
- Hong Sun
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Fengjiao Bu
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ling Li
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiuwen Zhang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiu Xin
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jingchao Yan
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Taomin Huang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
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16
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Ikeda G, Miyakoshi J, Yamamoto S, Kato K. Nivolumab in unresectable advanced, recurrent or metastatic esophageal squamous cell carcinoma. Future Oncol 2024; 20:665-677. [PMID: 38126175 DOI: 10.2217/fon-2022-1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Esophageal cancer (EC) is the eighth most common cancer worldwide. In view of biology and anatomical restrictions, multimodality treatment strategies have been developed for EC. However, the prognosis of patients with advanced EC remains especially poor. Immunotherapy, such as PD-1/PD-L1 and CTLA-4/B7 blockade, has emerged as a potent treatment for many types of cancer and has been approved in many countries. Based on the results of the ATTRACTION-3 trial, nivolumab, an anti-PD-1 monoclonal antibody, was approved by the US FDA for patients with platinum-resistant, unresectable, recurrent or metastatic esophageal squamous cell carcinoma. The CheckMate 648 trial demonstrated that the combination of nivolumab with platinum-based fluoropyrimidine chemotherapy and combination immunotherapy with nivolumab and ipilimumab, an anti-CTLA-4 monoclonal antibody, showed a survival benefit in patients with advanced esophageal squamous cell carcinoma compared with doublet chemotherapy. This review focuses on nivolumab-containing treatments for patients with advanced esophageal squamous cell carcinoma.
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Affiliation(s)
- Go Ikeda
- Department of Head & Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Miyakoshi
- Department of Head & Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shun Yamamoto
- Department of Head & Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ken Kato
- Department of Head & Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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17
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Hiraga T. Immunotherapy targeting PD‑1/PD‑L1: A potential approach for the treatment of cancer bone metastases (Review). Int J Oncol 2024; 64:35. [PMID: 38362963 DOI: 10.3892/ijo.2024.5623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
Immune checkpoint molecules, such as programmed cell death 1 (PD‑1) and programmed cell death ligand 1 (PD‑L1), have a critical role in regulating immune responses, including in tumor tissues. Monoclonal antibodies against these molecules, known as immune checkpoint inhibitors (ICIs), have been shown to be effective against a variety of cancers; however, significant patient populations are resistant to such treatment. Clinical studies to date have shown that ICIs are less effective in cancer patients with bone metastases. The effect of anti‑PD‑1/PD‑L1 antibodies on bone metastases, as assessed by the bone metastasis‑specific response classification criteria, was relatively low. In addition, the presence of bone metastases showed a trend toward worse progression‑free survival and overall survival in cancer patients treated with ICIs. To improve the efficacy of ICIs in bone metastases, several combination therapies are under investigation and certain studies have reported better responses. The present review summarizes the current understanding of the effects of anti‑PD‑1/PD‑L1 antibodies on bone metastases based on the reported clinical and preclinical studies.
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Affiliation(s)
- Toru Hiraga
- Department of Histology and Cell Biology, Matsumoto Dental University, Shiojiri, Nagano 399‑0781, Japan
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18
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Chabot C, Italiano A, Crombé A, Soubeyran I, Laizet Y, Khalifa E, Cousin S. Are DNA Repair Gene Alterations Associated With the Response to Platinum-Based Regimen and Immune Checkpoint Inhibitors in Patients With Solid Tumors? Oncologist 2024:oyae044. [PMID: 38558248 DOI: 10.1093/oncolo/oyae044] [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: 07/30/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
We analyzed the antitumor activity of platinum-based chemotherapies and then immune checkpoint inhibitors (ICI) in all-comers patients with solid tumors having a somatic DNA damage repair gene alteration (DDR-GA) identified through a prospective precision medicine study (NCT02534649). Each DDR-GA was classified as pathogenic (Pa), probably pathogenic (PPa), and unknown pathogenicity (UPa) according to OncoKB and ClinVAR databases. Between January 2018 and May 2020, 662 patients were screened. One hundred ninety-nine tumors with DDR-GA were found in 121 (18.3%) patients. Ninety-six patients received platinum-based chemotherapy in the advanced setting. No difference in objective response rate (ORR) under platinum regimen was observed between the 3 DDR-GA groups. The only predictor of worse progression-free survival (PFS) in Cox regression was the existence of a Pa alteration compared to the UPa group: HR = 2.11 (95% CI = 1.2-3.7), P = .009. Forty-eight patients received ICI alone or in combination. We observed a significant trend in better ORR to ICI according to the DDR-GA status: 1/11 (9%) patients in UPa, 5/17 (29.4%) patients in PPa, and 9/20 (45%) patients in Pa (P = .003, Cochran-Armitage trend test), and an increased 6-month PFS probability of 11%, 44%, and 50% in the UPa, PPa, and Pa groups, respectively (P = .37, log-rank test). Overall, somatic pathogenic DDR-GAs were not associated with ORR or PFS to platinum-based chemotherapy in patients with unselected advanced solid tumors. However, DDR-GA seemed to impact ORR and PFS to ICI, paving the way for a therapeutic combination with ICI and molecules targeting the DDR mechanisms, which are currently evaluated in ongoing clinical trials.
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Affiliation(s)
- Clément Chabot
- Early Phase Trials Department, Institut Bergonié, Bordeaux, France
| | - Antoine Italiano
- Early Phase Trials Department, Institut Bergonié, Bordeaux, France
| | - Amandine Crombé
- Department of Radiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Yech'an Laizet
- Department of Bioinformatics, Institut Bergonié, Bordeaux, France
| | - Emmanuel Khalifa
- Department of Molecular Biology, Institut Bergonié, Bordeaux, France
| | - Sophie Cousin
- Early Phase Trials Department, Institut Bergonié, Bordeaux, France
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19
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Pan CX, Liu M, Lau CB, Lau WC, Kim DY, Saberi SA, Rowley R, Kanwar R, Giobbie-Hurder A, LeBoeuf NR, Nambudiri VE. Histopathological predictors of immune-related adverse events among patients with melanoma treated with immune checkpoint inhibitors. J Am Acad Dermatol 2024; 90:826-829. [PMID: 38040339 DOI: 10.1016/j.jaad.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Catherina X Pan
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mofei Liu
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charles B Lau
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Boston University, Boston, Massachusetts
| | - William C Lau
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Daniel Y Kim
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shahin A Saberi
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachael Rowley
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ruhi Kanwar
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole R LeBoeuf
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Center for Cutaneous Oncology, Boston, Massachusetts
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Center for Cutaneous Oncology, Boston, Massachusetts.
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20
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Nishimura T, Fujimoto H, Fujiwara T, Ito K, Fujiwara A, Yuda H, Itani H, Naito M, Kodama S, Furuhashi K, Yagi A, Saiki H, Yasuma T, Okano T, Tomaru A, Tanigawa M, Yoshida M, Hataji O, Ibata H, D'Alessandro‐Gabazza CN, Gabazza EC, Kobayashi T. Impact of immune-related adverse events on survival outcomes in extensive-stage small cell lung cancer patients treated with immune checkpoint inhibitors. Cancer Med 2024; 13:e7188. [PMID: 38629295 PMCID: PMC11022147 DOI: 10.1002/cam4.7188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/27/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have recently become the standard of care in the first-line treatment of extensive-stage small cell lung cancer. Although immune-related adverse events have been reported to influence prognosis in non-small cell lung cancer patients, few studies have investigated the prognostic value of immune-related adverse events in small cell lung cancer patients. In this study, we evaluated the prognosis of patients who developed immune-related adverse events after first-line treatment with immune checkpoint inhibitor-based chemotherapy for extensive-stage small cell lung cancer. METHODS We enrolled 90 patients with extensive-stage small cell lung cancer who received immune checkpoint inhibitor-based chemotherapy as first-line treatment from September 2019 to December 2022 in six hospitals in Japan. The patients were categorized into groups with and without immune-related adverse events. RESULTS There were 23 patients with and 67 without immune-related adverse events. Seventeen patients had grade 1-2 immune-related adverse events, and nine (including overlapping cases) had grade ≥3. The most frequent immune-related adverse event was a skin rash. The median survival time was 22 months in patients with immune-related adverse events and 9.3 months in patients without immune-related adverse events. The hazard ratio was 0.40 (95% confidence interval: 0.19-0.83, p = 0.013). CONCLUSIONS The results of this study show that immune-related adverse events are associated with improved survival outcomes in patients with extensive-stage small cell lung cancer.
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Affiliation(s)
- Tadashi Nishimura
- Department of Pulmonary MedicineMie Chuo Medical CenterTsuJapan
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Hajime Fujimoto
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Takumi Fujiwara
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
- Department of Genomic MedicineMie University HospitalTsuJapan
| | - Kentaro Ito
- Respiratory CenterMatsusaka Municipal HospitalMatsusakaJapan
| | - Atsushi Fujiwara
- Department of Pulmonary MedicineMie Prefectural General Medical CenterYokkaichiJapan
| | - Hisamichi Yuda
- Department of Pulmonary MedicineKuwana City Medical CenterKuwanaJapan
| | - Hidetoshi Itani
- Department of Respiratory MedicineIse Red Cross HospitalIseJapan
| | - Masahiro Naito
- Department of Pulmonary MedicineMie Chuo Medical CenterTsuJapan
| | - Shuji Kodama
- Department of Pulmonary MedicineMie Prefectural General Medical CenterYokkaichiJapan
| | - Kazuki Furuhashi
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Akihiko Yagi
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Haruko Saiki
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Taro Yasuma
- Department of ImmunologyMie University Faculty and Graduate School of MedicineTsuJapan
| | - Tomohito Okano
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Atsushi Tomaru
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
| | - Motoaki Tanigawa
- Department of Respiratory MedicineIse Red Cross HospitalIseJapan
| | - Masamichi Yoshida
- Department of Pulmonary MedicineMie Prefectural General Medical CenterYokkaichiJapan
| | - Osamu Hataji
- Respiratory CenterMatsusaka Municipal HospitalMatsusakaJapan
| | - Hidenori Ibata
- Department of Pulmonary MedicineMie Chuo Medical CenterTsuJapan
| | | | - Esteban C. Gabazza
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
- Department of ImmunologyMie University Faculty and Graduate School of MedicineTsuJapan
| | - Tetsu Kobayashi
- Department of Pulmonary and Critical Care MedicineMie University Faculty and Graduate School of MedicineTsuJapan
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21
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Euvrard R, Robert M, Mainbourg S, Dalle S, Lega JC. Association between immune-related adverse events and prognosis in patients treated with immune checkpoint inhibitors in melanoma: A surrogacy analysis. Fundam Clin Pharmacol 2024; 38:369-379. [PMID: 38012082 DOI: 10.1111/fcp.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/10/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) represent a breakthrough in oncology in terms of prognosis and safety. They now constitute a cornerstone in the management of metastatic melanoma. However, a new kind of adverse event called immune-related adverse events (irAE) has emerged. These irAE could be conceptually considered as an indicator of the antitumoral immune response, but the association between irAE and prognosis is still a matter of debate. OBJECTIVE The purpose of this study was to investigate the association between the overall survival (OS) and the prevalence of irAE in melanoma. METHODS MEDLINE/PubMed, WebofScience, ClinicalTrials, and WHOTrials databases were searched to identify phase 3 randomized controlled trials (RCT) assessing ICI in melanoma and published up to April 2021. A weighted regression was performed to estimate this association according to standard method of surrogacy analysis. RESULTS A total of 14 RCT including 7646 patients (median age: 59.3 years) with melanoma were included. All types of ICI were represented (ipilimumab, tremelimumab, pembrolizumab, nivolumab, atezolizumab, as well as ipilimumab and nivolumab combination). irAE were frequent but rarely fatal. The combination of ICI caused more irAE than anti-PD1 (or PDL1) and anti-CTLA4 monotherapies. No relationship was found between the occurrence of irAE and OS (beta coefficient 0.078, R2 3%, p = 0.52), nor between cutaneous irAE and OS (beta coefficient 0.080, R2 6%, p = 0.33). CONCLUSION Although limited by the heterogeneity of ICI included in the regression and the low number of included RCT, the present study suggests an absence of association between irAE and prognosis in melanoma.
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Affiliation(s)
- Romain Euvrard
- Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, France
| | - Marie Robert
- Service de Médecine Interne et d'immunologie clinique, Université de Lyon 1, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sabine Mainbourg
- Equipe Évaluation et Modélisations des Effets Thérapeutiques, UMR CRNS 5558, Université Claude Bernard Lyon 1, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, France
| | - Stéphane Dalle
- Service de Dermatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, France
| | - Jean-Christophe Lega
- Equipe Évaluation et Modélisations des Effets Thérapeutiques, UMR CRNS 5558, Université Claude Bernard Lyon 1, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, France
- Service de Rhumatologie, Hôpital Lyon Sud, Hospices Civils de lyon, France
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22
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Li J, Zhu JX, Zhang YX, Li SQ. Effectiveness of immune checkpoint inhibitors in combination with tyrosine kinase inhibitors in patients with advanced or metastatic colorectal carcinoma with either mismatch repair proficient or metastatic microsatellite stable disease: A systematic review and meta‑analysis. Oncol Lett 2024; 27:153. [PMID: 38406596 PMCID: PMC10884996 DOI: 10.3892/ol.2024.14286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) have limited efficacy in mismatch repair proficient (pMMR) or metastatic microsatellite stable (MSS) advanced or metastatic colorectal cancer (mCRC). ICIs, in conjunction with tyrosine kinase inhibitors (TKIs) possessing anti-angiogenic properties, serve as a potential strategy for circumventing the resistance exhibited by MSS or pMMR mCRC to immunotherapeutic interventions. The present study aimed to evaluate efficacy and safety of ICIs + TKIs and provide a reference for the treatment of CRC. The present systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane, Web of Science and ClinicalTrials.gov databases were screened from January 1, 2003 to July 28, 2023. A total of 14 studies were included in qualitative and quantitative analyses, with a total of 819 patients enrolled. The Newcastle-Ottawa scale scores of the 14 cohort studies included were ≥7, indicating they were of a high quality. The objective response rate (ORR) of ICIs + TKIs was 14% [95% confidence interval (CI), 0.08-0.24; P=0.132] in patients with advanced or metastatic MSS/pMMR CRC. The disease control rate (DCR) was 65% (95% CI, 0.58-0.74; P<0.0001). The overall incidence of adverse events of varying severity linked to combination of ICIs and TKIs in patients with advanced or metastatic MSS/pMMR CRC was 64% (95% CI, 0.52-0.78; P<0.0001). The incidence of grade ≥3 adverse reactions was 24% (95% CI, 0.14-0.4; P<0.0001). The sensitivity analysis indicated that the exclusion of individual studies did not yield statistically significant variations in combined analysis results. Based on the examination of publication bias, ORR and DCR, Begg's and Egger's tests had P-values of 0.114 and 0.395, respectively. Overall publication bias overall was absent in the Begg's funnel plot, as there was no apparent asymmetry. Nonetheless, the P-values of the Egger's and Begg's tests for adverse reactions and adverse reactions grade ≥3 were P=0.008 and P=0.048, respectively. The asymmetry of the Begg's funnel plots was evident, suggesting the presence of potential publication bias regarding adverse event results. In conclusion, the combination of ICIs and TKIs demonstrates a favorable effectiveness and notable safety profile in the management of patients with advanced or metastatic MSS/pMMR CRC.
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Affiliation(s)
- Ji Li
- Department of General Surgery, Chongqing Western Hospital, Chongqing 400051, P.R. China
| | - Jin-Xian Zhu
- Department of General Surgery, Chongqing Western Hospital, Chongqing 400051, P.R. China
| | - Yu-Xin Zhang
- Department of General Surgery, Chongqing Western Hospital, Chongqing 400051, P.R. China
| | - Shi-Qiang Li
- Department of General Surgery, Chongqing Western Hospital, Chongqing 400051, P.R. China
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23
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Otto F, Seiberl M, Lara B, Moser T, Kleindienst W, Walter WE, Peter K, Wipfler P, Harrer A. Beyond T cell toxicity-Intrathecal chemokine C-X-C motif ligand indicating B cell involvement in immune-related adverse events following checkpoint inhibition: A two-case series and literature review. Eur J Neurol 2024:e16279. [PMID: 38556899 DOI: 10.1111/ene.16279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to raise awareness of a role of B cells in immune checkpoint inhibitor (ICI)-associated neurological immune-related adverse events (nirAE). METHODS A systematic literature review was made, with case observations of a melanoma and a non-small cell lung cancer (NSCLC) patient who developed ICI-associated nirAE with cerebrospinal fluid (CSF) findings indicating B cell involvement. RESULTS Two patients receiving ipilimumab/nivolumab for melanoma and chemotherapy/pembrolizumab for NSCLC developed nirAE in the form of myocarditis/myositis/myasthenia gravis overlap syndrome (triple M) and cerebellitis plus longitudinal transverse myelitis (c-LETM), respectively. Intrathecal inflammation with chemokine C-X-C motif ligand (CXCL13) elevation was present in both patients; the triple M case had acetylcholine receptor antibodies, antititin reactivity, altered CD4/CD8 T cell ratio in blood, and depressed programmed death-1 (PD-1) expression on CSF T cells; the c-LETM case showed intrathecal antibody production and plasma cells. Both patients insufficiently responded to first-line treatment. The NSCLC case improved upon administration of B cell-depleting therapy with rituximab, whereas the melanoma patient died before escalation therapy was initiated. Literature research revealed one additional ICI-associated LETM case with intrathecal CXCL13 elevation, three cases with ICI-associated aquaporin-4 antibody neuromyelitis spectrum disorder, and evidence of B cell-mediated toxicity based on antibody-mediated immune pathologies in ICI-associated immune-related adverse events. CONCLUSIONS The case observations highlight the plethora of uncertainties in diagnosis and treatment of ICI-associated nirAE, exemplify the heterogeneity of immune mechanisms involved, and suggest a role of B cells, which may be underdiagnosed. Intrathecal CXCL13 may serve as a biomarker of B cell involvement in nirAE, supported by intrathecal immunoglobulin synthesis, presence of plasma cells, and/or recruitment of cognate immune cells.
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Affiliation(s)
- Ferdinand Otto
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Michael Seiberl
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Bieler Lara
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Tobias Moser
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Waltraud Kleindienst
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Wallner-Essl Walter
- Department of Neuroradiology, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Koelblinger Peter
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Peter Wipfler
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
| | - Andrea Harrer
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
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Taghizadeh H, Dong Y, Gruenberger T, Prager GW. Perioperative and palliative systemic treatments for biliary tract cancer. Ther Adv Med Oncol 2024; 16:17588359241230756. [PMID: 38559612 PMCID: PMC10981863 DOI: 10.1177/17588359241230756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
Due to the fact biliary tract cancer (BTC) is often diagnosed at an advanced stage, thus, not eligible for resection, and due to the aggressive tumor biology, it is considered as one of the cancer types with the worst prognosis. Advances in diagnosis, surgical techniques, and molecular characterization have led to an improvement of the prognosis of BTC patients, recently. Although neoadjuvant therapy is expected to improve surgical outcomes by reducing tumor size, its routine is not well established. The application of neoadjuvant therapy in locally advanced disease may be indicated, the routine use of systemic therapy prior to surgery for cholangiocarcinoma patients with an upfront resectable disease is less well established, but discussed and performed in selected cases. In advanced disease, only combination chemotherapy regimens have been demonstrated to achieve disease control in untreated patients. Molecular profiling of the tumor has demonstrated that many BTC might bear actionable targets, which might be addressed by biological treatments, thus improving the prognosis of the patients. Furthermore, the addition of the immunotherapy to standard chemotherapy might improve the prognosis in a subset of patients. This review seeks to give a comprehensive overview about the role of neoadjuvant as well as palliative systemic treatment approaches and an outlook about novel systemic treatment concept in BTC.
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Affiliation(s)
- Hossein Taghizadeh
- Division of Oncology, Department of Internal Medicine I, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner Institute for Oncology and Nephrology, St. Pölten, Austria
- Medical University of Vienna, Center for Cancer Research, Vienna, Austria
- Medical University of Vienna, Department of Medicine I, Vienna, Austria
| | - Yawen Dong
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten, Vienna, Austria
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten, Vienna, Austria
| | - Gerald W. Prager
- Department of Medicine I, Medical University of Vienna, Comprehensive Cancer Center Vienna, Spitalgasse 23, Vienna AT1090, Austria
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25
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Mahadevia H, Ponvilawan B, Al-Obaidi A, Buckley J, Subramanian J, Bansal D. Exceptional synergistic response of PARP inhibitor and immune checkpoint inhibitor in esophageal adenocarcinoma with a germline BRCA2 mutation: a case report. Ther Adv Med Oncol 2024; 16:17588359241242406. [PMID: 38559611 PMCID: PMC10981852 DOI: 10.1177/17588359241242406] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase (PARP) inhibitors have shown efficacy in various tumors. A significant therapeutic challenge with either ICIs or PARP inhibitors as monotherapy is treatment failure from intrinsic primary resistance or the development of secondarily acquired resistance after a period of responsiveness. The combination of PARP inhibitors and ICIs could mitigate this by potentiating treatment response. We describe an 83-year-old male patient who initially presented with abdominal pain, and weight loss along with alternating constipation and diarrhea. Imaging and biopsy revealed metastatic esophageal adenocarcinoma. Genomic testing revealed germline BRCA2 mutation. The patient initially underwent a few cycles of chemoimmunotherapy. However, due to intolerance to chemotherapy, the patient's case was discussed at a multidisciplinary molecular tumor board. He was switched to PARP inhibitor olaparib and ICI nivolumab. This combination led to a durable complete response. A combination of poly-ADP ribose polymerase inhibitor (PARPi) plus ICI may work in synergy through various mechanisms including enhanced neoantigen expression, release of immune-activating cytokines, and increased programmed death-ligand 1 expression. This may culminate in accentuated efficacy outcomes with a manageable safety profile. This exceptional response with ICI and PARPi in our case is consistent with the synergistic value of this combination, and prospective studies are warranted to definitively characterize clinical utility.
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Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ben Ponvilawan
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ammar Al-Obaidi
- Department of Hematology and Oncology, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Jennifer Buckley
- Department of Radiology, Saint Luke’s Hospital, Kansas City, MO, USA
| | | | - Dhruv Bansal
- Department of Hematology and Oncology, Saint Luke’s Cancer Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
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26
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Fujimoto K, Ikeda S, Tabata E, Kaneko T, Sagawa S, Yamada C, Kumagai K, Fukushima T, Haga S, Watanabe M, Muraoka T, Sekine A, Baba T, Ogura T. KRASG12C Inhibitor as a Treatment Option for Non-Small-Cell Lung Cancer with Comorbid Interstitial Pneumonia. Cancers (Basel) 2024; 16:1327. [PMID: 38611005 PMCID: PMC11010978 DOI: 10.3390/cancers16071327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Non-small-cell lung cancer (NSCLC) with comorbid interstitial pneumonia (IP) is a population with limited treatment options and a poor prognosis. Patients with comorbid IP are at high risk of developing fatal drug-induced pneumonitis, and data on the safety and efficacy of molecularly targeted therapies are lacking. KRAS mutations have been frequently detected in patients with NSCLC with comorbid IP. However, the low detection rate of common driver gene mutations, such as epidermal growth factor receptor and anaplastic lymphoma kinase, in patients with comorbid IP frequently results in inadequate screening for driver mutations, and KRAS mutations may be overlooked. Recently, sotorasib and adagrasib were approved as treatment options for advanced NSCLC with KRASG12C mutations. Although patients with comorbid IP were not excluded from clinical trials of these KRASG12C inhibitors, the incidence of drug-induced pneumonitis was low. Therefore, KRASG12C inhibitors may be a safe and effective treatment option for NSCLC with comorbid IP. This review article discusses the promise and prospects of molecular-targeted therapies, especially KRASG12C inhibitors, for NSCLC with comorbid IP, along with our own clinical experience.
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Affiliation(s)
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohoma 236-0051, Japan; (K.F.); (E.T.); (T.K.); (S.S.); (C.Y.); (K.K.); (T.F.); (S.H.); (M.W.); (T.M.); (A.S.); (T.B.); (T.O.)
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27
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Chang MS, Lee SW, Kim S, Lee CS, Byeon SH, Kim SS, Kim YJ. Incident non-infectious uveitis risk after immune checkpoint inhibitor treatment. Ophthalmology 2024:S0161-6420(24)00198-2. [PMID: 38522600 DOI: 10.1016/j.ophtha.2024.03.017] [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: 01/21/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Abstract
Our findings suggest that, while incident uveitis is rare in patients with cancer treated with anti-PD-1/PD-L1 inhibitors, there is an increased risk in those with skin melanoma, warranting vigilant monitoring for uveitis in this subgroup.
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Affiliation(s)
- Myung Soo Chang
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Sunyeup Kim
- Department of Medical AI, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Joon Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
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28
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Cartwright E, Slater S, Saffery C, Tran A, Turkes F, Smith G, Aresu M, Kohoutova D, Terlizzo M, Zhitkov O, Rana I, Johnston EW, Sanna I, Smyth E, Mansoor W, Fribbens C, Rao S, Chau I, Starling N, Cunningham D. Phase II trial of domatinostat (4SC-202) in combination with avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal adenocarcinoma: EMERGE. ESMO Open 2024; 9:102971. [PMID: 38518549 DOI: 10.1016/j.esmoop.2024.102971] [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: 12/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Most oesophagogastric adenocarcinomas (OGAs) and colorectal cancers (CRCs) are mismatch repair proficient (MMRp), responding poorly to immune checkpoint inhibition. We evaluated the safety and efficacy of domatinostat (histone deacetylase inhibitor) plus avelumab (anti-PD-L1 antibody) in patients with previously treated inoperable, advanced/metastatic MMRp OGA and CRC. PATIENTS AND METHODS Eligible patients were evaluated in a multicentre, open-label dose escalation/dose expansion phase II trial. In the escalation phase, patients received escalating doses of domatinostat [100 mg once daily (OD), 200 mg OD, 200 mg twice daily (BD)] orally for 14 days followed by continuous dosing plus avelumab 10 mg/kg administered intravenously 2-weekly (2qw) to determine the recommended phase II dose (RP2D). The trial expansion phase evaluated the best objective response rate (ORR) during 6 months by RECIST version 1.1 using a Simon two-stage optimal design with 2/9 and 1/10 responses required to proceed to stage 2 in the OGA and CRC cohorts, respectively. RESULTS Patients (n = 40) were registered between February 2019 and October 2021. Patients in the dose escalation phase (n = 12) were evaluated to confirm the RP2D of domatinostat 200 mg BD plus avelumab 10 mg/kg. No dose-limiting toxicities were observed. Twenty-one patients were treated at the RP2D, 19 (9 OGA and 10 CRC) were assessable for the best ORR; 2 patients with CRC did not receive combination treatment and were not assessable for the primary endpoint analysis. Six patients were evaluated in the dose escalation and expansion phases. In the OGA cohort, the best ORR was 22.2% (95% one-sided confidence interval lower bound 4.1) and the median duration of disease control was 11.3 months (range 9.9-12.7 months). No responses were observed in the CRC cohort. No treatment-related grade 3-4 adverse events were reported at the RP2D. CONCLUSIONS Responses in the OGA cohort met the criteria to expand to stage 2 of recruitment with an acceptable safety profile. There was insufficient signal in the CRC cohort to progress to stage 2. TRIAL REGISTRATION NCT03812796 (registered 23rd January 2019).
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Affiliation(s)
- E Cartwright
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Slater
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - C Saffery
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - A Tran
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - F Turkes
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - G Smith
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Aresu
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Kohoutova
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Terlizzo
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - O Zhitkov
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Rana
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E W Johnston
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Sanna
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E Smyth
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - W Mansoor
- Oesophago-Gastric Cancer Services, The Christie NHS Foundation Trust, Manchester, UK
| | - C Fribbens
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Rao
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - N Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London.
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Sood S, Bagit A, Taghaddos D, King A, Maliyar K, Sachdeva M, Mufti A, Yeung J. Characteristics and management of sclerosing skin diseases during immune checkpoint inhibitor therapy: An evidence-based review. J Am Acad Dermatol 2024:S0190-9622(24)00507-3. [PMID: 38518957 DOI: 10.1016/j.jaad.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/20/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Taghaddos
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada; Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.
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Vasbinder A, Anderson E, Catalan T, Ismail A, Banerjee M, Pizzo I, Machado K, Blakely P, Salem JE, Hayek SS. Incidence of Immune Checkpoint Inhibitor-Induced Myocarditis During the COVID-19 Pandemic. J Am Heart Assoc 2024; 13:e032667. [PMID: 38497479 PMCID: PMC11010026 DOI: 10.1161/jaha.123.032667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/23/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Alexi Vasbinder
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Elizabeth Anderson
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Tonimarie Catalan
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Anis Ismail
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health University of Michigan Ann Arbor MI USA
| | - Ian Pizzo
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Kristen Machado
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Pennelope Blakely
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
| | - Joe-Elie Salem
- Department of Pharmacology Sorbonne Université, INSERM, AP-HP, CIC-1901, Pitié-Salpêtrière Hospital Paris France
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology University of Michigan Ann Arbor MI USA
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Nakayama Y, Sawa N, Suwabe T, Yamanouchi M, Ikuma D, Mizuno H, Hasegawa E, Sekine A, Oba Y, Ishiwata K, Wake A, Hatano M, Kitajima I, Kono K, Kinowaki K, Takazawa Y, Takemura T, Ubara Y. Histologically Proven Recurrent Synovitis after Nivolumab Treatment. Intern Med 2024; 63:867-871. [PMID: 37495530 PMCID: PMC11009007 DOI: 10.2169/internalmedicine.2221-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
A 58-year-old woman with rheumatoid arthritis was diagnosed with methotrexate-associated Hodgkin lymphoma. After receiving several chemotherapy regimens, she started nivolumab treatment. Two weeks later, she was hospitalized with worsening finger, wrist, and elbow joint pain. A synovial biopsy of the wrist joint showed villous synovial proliferation and linear infiltration of CD68-/CD3-positive T cells (with more CD8 than CD4 T cells) but no CD20-positive B cells or CD138-positive macrophages. These findings corresponded to synovitis associated with immune-related adverse events, which are induced mainly by T cells and are different from typical rheumatoid arthritis (RA), in which B cells play a central role.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Japan
| | - Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital Kajigaya, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | | | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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Kim JW, Lee HJ, Lee JY, Park SR, Kim YJ, Hwang IG, Kyun Bae W, Byun JH, Kim JS, Kang EJ, Lee J, Shin SJ, Chang WJ, Kim EO, Sa JK, Park KH. Phase II study of nivolumab in patients with genetic alterations in DNA damage repair and response who progressed after standard treatment for metastatic solid cancers (KM-06). J Immunother Cancer 2024; 12:e008638. [PMID: 38485184 PMCID: PMC10941126 DOI: 10.1136/jitc-2023-008638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Immune-modulating antibodies targeting programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) have demonstrated promising antitumor efficacy in various types of cancers, especially highly mutated ones. Genetic alterations in DNA damage response and repair (DDR) genes can lead to genetic instability, often accompanied by a high tumor mutation burden (TMB). However, few studies have validated the aberration of DDR genes as a predictive biomarker for response to immune-modulating antibodies. METHODS The KM-06 open-label, multicenter, single-arm, phase II trial evaluated the safety and efficacy of nivolumab in refractory solid cancers with DDR gene mutations assessed by clinically targeted sequencing. Nivolumab (3 mg/kg) was administered every 2 weeks until disease progression, unacceptable toxicity, or for 24 months. The primary endpoint was the objective response rate (ORR) as per RECIST V.1.1 criteria. RESULTS A total of 48 patients were enrolled in the study (median age 61, 58.3% male). The most common cancer type was colorectal cancer (41.7%), followed by prostate and biliary tract cancer (8.3% each). Eight patients achieved a partial response as their best overall response, resulting in an ORR of 17.8%. The disease control rate was 60.0%. The median progression-free survival was 2.9 months. Treatment-related adverse events of any grade and grade ≥3 occurred in 44 (91.7%) and 4 (8.3%) patients, respectively. Clinically targeted sequencing data inferred both TMB and microsatellite instability (MSI). Using a TMB cut-off of 12 mut/Mb, there were significant differences in overall survival (p=0.00035), progression-free survival (p=0.0061), and the best overall response (p=0.05). In the RNA sequencing analysis, nivolumab responders showed activation of the interleukin signaling pathway. Patients who experienced early progression presented high epithelial-mesenchymal transition signaling pathway activation. The responders exhibited a marked increase in PD-1-/Ki67+CD8 T cells at the early stage of treatment (C3D1) compared with non-responders (p=0.03). CONCLUSIONS In this phase II trial, nivolumab demonstrated moderate efficacy and manageable toxicity in patients with solid cancer harboring DDR gene mutations. A high TMB (>12 mut/Mb) and MSI score (>2.5) determined through clinically target sequencing presented significant discriminatory power for the nivolumab response. TRIAL REGISTRATION NUMBER NCT04761744.
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Affiliation(s)
- Ju Won Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ji Yoon Lee
- Department of Biomedical Informatics and Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine and Graduate School of Medicine, Dongjak-gu, Republic of Korea
| | - Woo Kyun Bae
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Republic of Korea
| | - Jae Ho Byun
- Division of Oncology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jung Sun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Eun Joo Kang
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jeeyun Lee
- Division of Hemato-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
| | - Won Jin Chang
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eun-Ok Kim
- Medical Science Research Center, College of Medicine, Korea University, Seongbuk-gu, Republic of Korea
| | - Jason K Sa
- Department of Biomedical Informatics and Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyong Hwa Park
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Nishizawa A, Kawakami M, Kitahara Y. Case report: A case of metastatic BRAFV600-mutated melanoma with heart failure treated with immune checkpoint inhibitors and BRAF/MEK inhibitors. Front Oncol 2024; 14:1366532. [PMID: 38529375 PMCID: PMC10961452 DOI: 10.3389/fonc.2024.1366532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
Background Novel therapies, immune checkpoint inhibitors (ICIs), and BRAF/MEK inhibitors (BRAFi/MEKi) provide unprecedented survival benefits for patients with advanced melanoma. However, the management of drug-induced adverse events is problematic for both agents and, although rare, can cause serious cardiac dysfunction. Case report A 42-year-old male patient with no significant medical history noticed a fading dark brown patch on his left anterior chest, which had been there for 20 years, after his second coronavirus disease 2019 (COVID-19) vaccination. The left axillary lymph node became swollen one week after a third booster vaccination. Thinking of it as an adverse reaction to the vaccine, but the swelling increased, so he visited a hospital. The patient presented with a brown macule with depigmentation on the left anterior chest and a 13 cm left axillary mass. A biopsy of the axillary mass showed a metastatic malignant melanoma. Positron emission tomography (PET) showed an accumulation only in the axillary lymph nodes. One month after the initial diagnosis, the axillary mass had further enlarged. In addition, pleural effusion, ascites, difficulty breathing, and systemic edema appeared, and he was diagnosed with heart failure (NYHA class III). Echocardiography showed an ejection fraction of 52% and electrocardiogram (ECG) showed no abnormal findings. Though it was (a life-threatening instead of the life-threatening) the life-threatening condition, we determined that the symptoms were associated with the current disease. Then nivolumab (nivo) plus ipilimumab (ipi) was initiated after explaining the risk of cardiac dysfunction associated with drug use to the patient. After initiation of ICIs, treatment was switched to BRAFi/MEKi (encorafenib/vinimetinib) after the patient tested positive for BRAF V600E. After one month of treatment, the tumor shrank significantly and achieved a complete remission after four months. Furthermore, as the tumor shrank, the patient's heart failure improved, and he was able to continue treatment without serious drug-induced cardiotoxicity. Conclusion Both ICI and BRAFi/MEKi carry a risk of cardiac dysfunction. However, without any underlying cardiac disease or severe cardiac dysfunction, their administration should not necessarily be excluded if careful follow-up is provided.
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Affiliation(s)
- Aya Nishizawa
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Misaki Kawakami
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasuyuki Kitahara
- Department of Cardiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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Taguchi S, Kawai T, Nakagawa T, Kume H. Latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the era of immune checkpoint inhibitors: a narrative review. Jpn J Clin Oncol 2024; 54:254-264. [PMID: 38109484 DOI: 10.1093/jjco/hyad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023] Open
Abstract
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Ikezawa K, Urabe M, Kai Y, Takada R, Akita H, Nagata S, Ohkawa K. Comprehensive review of pancreatic acinar cell carcinoma: epidemiology, diagnosis, molecular features and treatment. Jpn J Clin Oncol 2024; 54:271-281. [PMID: 38109477 PMCID: PMC10925851 DOI: 10.1093/jjco/hyad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023] Open
Abstract
Pancreatic acinar cell carcinoma is a rare form (0.2-4.3%) of pancreatic neoplasm with unique clinical and molecular characteristics, which largely differ from pancreatic ductal adenocarcinoma. Pancreatic acinar cell carcinoma occurs more frequently in males and can occur in children. Serum lipase is elevated in 24-58% of patients with pancreatic acinar cell carcinoma. Pancreatic acinar cell carcinomas tend to be large at diagnosis (median tumour size: ~5 cm) and are frequently located in the pancreas head. Radiologically, pancreatic acinar cell carcinoma generally exhibits a solid appearance; however, necrosis, cystic changes and intratumoral haemorrhage can occur in larger lesions. Immunostaining is essential for the definitive diagnosis of pancreatic acinar cell carcinoma. Compared with pancreatic ductal adenocarcinoma, pancreatic acinar cell carcinoma has a more favourable prognosis. Although radical surgery is recommended for patients with pancreatic acinar cell carcinoma who do not have distant metastases, the recurrence rate is high. The effectiveness of adjuvant therapy for pancreatic acinar cell carcinoma is unclear. The response to FOLFIRINOX is generally favourable, and some patients achieve a complete response. Pancreatic acinar cell carcinoma has a different genomic profile compared with pancreatic ductal adenocarcinoma. Although genomic analyses have shown that pancreatic acinar cell carcinoma rarely has KRAS, TP53 and CDKN2A mutations, it has a higher prevalence of homologous recombination-related genes, including BRCA1/2 and ATM, than pancreatic ductal adenocarcinoma, suggesting high sensitivity to platinum-containing regimens and PARP inhibitors. Targeted therapies for genomic alternations are beneficial. Therefore, genetic testing is important for patients with pancreatic acinar cell carcinoma to choose the optimal therapeutic strategy.
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Affiliation(s)
- Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Makiko Urabe
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yugo Kai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
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Miao X, Dong S, Tao Y, Yang X, Shen S. Second primary malignancy post immunotherapy: A case report of 2 cases. Medicine (Baltimore) 2024; 103:e37434. [PMID: 38457542 PMCID: PMC10919459 DOI: 10.1097/md.0000000000037434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Immune checkpoint inhibitors have shown high efficacies as the first-line treatment of various advanced malignancies. Yet, the effect and practice patterns of immune checkpoint inhibitors on the second primary tumors are still unclear. Second primary malignancy post immunotherapy, there is paucity in such cases being reported. PATIENT CONCERNS We report 2 cases of a 57-year-old woman with nonsmall cell lung cancer and a 69-year-old man with metastatic clear cell renal carcinoma treated with immunotherapy who developed second primary malignancies during the therapy. DIAGNOSIS Second primary malignancy during the therapy. INTERVENTIONS In addition to the treatments of the second primary malignancies, maintenance immunotherapy was continued for the patients. OUTCOMES Overall survival in both patients was longer than 12 months, and the treatments were well tolerated. The adverse reactions mainly included depigmentation of hair and facial and limb skin in patient 1 and diarrhea in patient 2. LESSONS It is necessary to recognize that the second primary malignancy may occur during the immunotherapy, and more clinical studies and practices are still needed for the adjustment of the regimens of immunotherapy. Full diagnosis, timely treatment, and long-term regular follow-up have important significance for patients with malignancies.
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Affiliation(s)
- Xian Miao
- Department of Oncology, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, Nantong, China
| | - Shu Dong
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuhua Tao
- Department of Oncology, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, Nantong, China
| | - Xiaohui Yang
- Department of Oncology, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, Nantong, China
| | - Shuijie Shen
- Department of Oncology, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, Nantong, China
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Iwamoto Y, Tatsumi F, Ohnishi M, Katakura Y, Kimura T, Shimoda M, Nakanishi S, Mune T, Kaneto H. A case of Empty Sella syndrome with adrenal insufficiency masked by prednisolone after administration of immune checkpoint inhibitors. Medicine (Baltimore) 2024; 103:e37204. [PMID: 38457550 PMCID: PMC10919508 DOI: 10.1097/md.0000000000037204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/18/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION The use of immune checkpoint inhibitors (ICIs) is gradually increasing; ICIs produce a variety of immune-related adverse events (irAEs), especially ICI-induced hypoadrenocorticism, which can be a lethal complication if treatment is delayed. PATIENT CONCERNS A 63-year-old man received chemotherapy with pembrolizumab for nonsmall cell lung cancer. He developed drug-induced interstitial pneumonia 366 days after receiving pembrolizumab and was treated with prednisolone. Five hundred thirty-seven days later, he developed drug-induced eosinophilic enteritis, and pembrolizumab was discontinued and prednisolone was continued. After discontinuation of prednisolone, general malaise and edema of the lower extremities appeared, and adrenal insufficiency was suspected. DIAGNOSIS In blood tests on admission adrenocorticotropic hormone (ACTH) was 2.2 pg/mL and cortisol was 15 μg/dL, with no apparent cortisol deficiency. However, the cortisol circadian rhythm disappeared and remained low throughout the day; a corticotropin-releasing hormone stimulation test showed decreased reactive secretion of ACTH. Pituitary magnetic resonance imaging showed pituitary emptying, suggesting Empty Sella syndrome. INTERVENTIONS AND OUTCOMES We started hydrocortisone and his symptoms were improved. CONCLUSIONS The administration of high-dose steroids after ICI administration may mask the symptoms of hypoadrenocorticism as irAEs. Therefore, we should bear in mind the possibility of hypoadrenocorticism when we stop steroid therapy in patients who are treated with steroids after ICI administration.
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Affiliation(s)
- Yuichiro Iwamoto
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Fuminori Tatsumi
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Mana Ohnishi
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Yukino Katakura
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Tomohiko Kimura
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Masashi Shimoda
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Tomoatsu Mune
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki-city, Okayama, Japan
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Deng D, Hao T, Lu L, Yang M, Zeng Z, Lovell JF, Liu Y, Jin H. Applications of Intravital Imaging in Cancer Immunotherapy. Bioengineering (Basel) 2024; 11:264. [PMID: 38534538 DOI: 10.3390/bioengineering11030264] [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: 12/20/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Currently, immunotherapy is one of the most effective treatment strategies for cancer. However, the efficacy of any specific anti-tumor immunotherapy can vary based on the dynamic characteristics of immune cells, such as their rate of migration and cell-to-cell interactions. Therefore, understanding the dynamics among cells involved in the immune response can inform the optimization and improvement of existing immunotherapy strategies. In vivo imaging technologies use optical microscopy techniques to visualize the movement and behavior of cells in vivo, including cells involved in the immune response, thereby showing great potential for application in the field of cancer immunotherapy. In this review, we briefly introduce the technical aspects required for in vivo imaging, such as fluorescent protein labeling, the construction of transgenic mice, and various window chamber models. Then, we discuss the elucidation of new phenomena and mechanisms relating to tumor immunotherapy that has been made possible by the application of in vivo imaging technology. Specifically, in vivo imaging has supported the characterization of the movement of T cells during immune checkpoint inhibitor therapy and the kinetic analysis of dendritic cell migration in tumor vaccine therapy. Finally, we provide a perspective on the challenges and future research directions for the use of in vivo imaging technology in cancer immunotherapy.
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Affiliation(s)
- Deqiang Deng
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Tianli Hao
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Lisen Lu
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Muyang Yang
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Zhen Zeng
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Jonathan F Lovell
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY 14260, USA
| | - Yushuai Liu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Honglin Jin
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
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Nara K, Taguchi S, Buti S, Kawai T, Uemura Y, Yamamoto T, Kume H, Takada T. Associations of concomitant medications with immune-related adverse events and survival in advanced cancers treated with immune checkpoint inhibitors: a comprehensive pan-cancer analysis. J Immunother Cancer 2024; 12:e008806. [PMID: 38458634 PMCID: PMC10921543 DOI: 10.1136/jitc-2024-008806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND While concomitant medications can affect the efficacy of immune checkpoint inhibitors (ICIs), few studies have assessed associations of concomitant medications with the occurrence and profile of immune-related adverse events (irAEs). METHODS This study assessed associations of concomitant medication (antibiotics/proton pump inhibitors (PPIs)/corticosteroids)-based risk model termed the "drug score" with survival and the occurrence and profile of irAEs in 851 patients with advanced cancer treated with ICIs (with or without other agents). The study also assessed the survival impact of the occurrence of irAEs, using a landmark analysis to minimize immortal time bias. Multivariable Cox proportional hazard analyses were conducted for progression-free survival (PFS) and overall survival (OS). RESULTS The drug score classified patients into three risk groups, with significantly different PFS and OS. Notably, the score's predictive capability was better in patients treated with ICIs only than in those treated with ICIs plus other agents. The landmark analysis showed that patients who developed irAEs had significantly longer PFS and OS than those without irAEs. Generally, concomitant medications were negatively associated with the occurrence of irAEs, especially endocrine irAEs, whereas PPI use was positively associated with gastrointestinal irAEs, as an exception. CONCLUSIONS Using a large pan-cancer cohort, the prognostic ability of the drug score was validated, as well as that of the occurrence of irAEs. The negative association between concomitant medications and irAE occurrence could be an indirect measure of the detrimental effect on the immune system induced by one or more concomitant drugs.
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Affiliation(s)
- Katsuhiko Nara
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sebastiano Buti
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tappei Takada
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
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Sun J, Yao H, Ren X, Cui L, Liu L, Wang G, Tang Z. Radiation-Activated Resiquimod Prodrug Nanomaterials for Enhancing Immune Checkpoint Inhibitor Therapy. Nano Lett 2024; 24:2921-2930. [PMID: 38411094 DOI: 10.1021/acs.nanolett.4c00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Immune checkpoint inhibitor (ICI) therapy is effectively employed in treating various malignancies. However, the response rate is constrained to 5-30%, which is attributed to differences in immune responses across different tumors. Overcoming all obstacles of multistep immune activation with monotherapy is difficult. Here, maleimide-modified resiquimod (R848) prodrug nanoparticles (MAL-NPs) are reported and combined with radiotherapy (RT) and anti-PD1 to enhance ICI therapy. MAL-NPs can promote antigen endocytosis by dendritic cells and are radio-reduced to produce R848. When combined with RT, MAL-NPs can augment the concentration of nanoparticles at tumor sites and be selectively radio-reduced within the tumor, thereby triggering a potent antitumor immune response. The systemic immune response and long-term memory efficacy induced by MAL-NPs + RT + anti-PD1 significantly inhibit the abscopal tumor growth and prevent tumor recurrence. This strategy can achieve systemic therapy through selective training of the tumor immune microenvironment, offering a new approach to overcome the obstacles of ICI therapy.
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Affiliation(s)
- Jiali Sun
- Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Science, Jilin University, Changchun, 130021 Jilin, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022 Jilin, China
| | - Haochen Yao
- Hepatobiliary and Pancreatic Surgery Department, General Surgery Center, First Hospital of Jilin University, Changchun, 130021 Jilin, China
| | - Xitong Ren
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022 Jilin, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026 Anhui, China
| | - Linjie Cui
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022 Jilin, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026 Anhui, China
| | - Linlin Liu
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033 Jilin, China
| | - Guoqing Wang
- Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Science, Jilin University, Changchun, 130021 Jilin, China
| | - Zhaohui Tang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022 Jilin, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, 230026 Anhui, China
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Liang X, Guan Y, Wang B, Liu X, Wang J. Histological sarcomatoid transformation in a lung adenocarcinoma patient following immune checkpoint blockade. Ther Adv Med Oncol 2024; 16:17588359241236450. [PMID: 38455710 PMCID: PMC10919128 DOI: 10.1177/17588359241236450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
Histological transformation is a phenomenon that is well described as one of the causes of tyrosine kinase inhibitor resistance in oncogene-driven non-small-cell lung cancer (NSCLC). The use of immune checkpoint inhibitors (ICIs) as a potential mechanism of acquired resistance to immunotherapy in NSCLC to small-cell lung cancer was also recently found. Here, we report the histological transformation of sarcomatoid carcinoma and metastasis in a lung adenocarcinoma patient without targetable genetic alterations who experienced long-term disease remission after nivolumab therapy. The patient subsequently developed rapid progression in the mediastinal and retroperitoneal lymph nodes, bones, and small intestine. Surgical resection of the small intestine lesion due to acute small intestine bleeding revealed the transformation of NSCLC to sarcomatoid carcinoma. The patient died 3 months after sarcomatoid carcinoma transformation and extensive disease progression, although he was rechallenged with immunotherapy. Genomic and immunohistochemical analyses revealed a comparable abundance of gene mutations and a limited number of immune cells in the tumor microenvironment, with low infiltration of CD8+ T cells, CD4+ T cells, regulatory T cells, and PD-L1+ macrophages in metastatic tumors, revealing a noninflamed immune microenvironment for ICI-resistant tumors.
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Affiliation(s)
- Xiuju Liang
- Department of Oncology, 960th Hospital of the People’s Liberation Army, Jinan, China
| | - Yaping Guan
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Lung Cancer Institute, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Baocheng Wang
- Department of Oncology, 960th Hospital of the People’s Liberation Army, Jinan, China
| | - Xiaohong Liu
- Department of Pathology, 960th Hospital of the People’s Liberation Army, No. 25, Shifan Road, Jinan 250031, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan 250014, China
- Shandong Lung Cancer Institute, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
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Gupta S, Costantino H, Ike C, Gupta S, Bhanegaonkar A, Su C, Thakkar S, Mackie DS, Devgan G, Katzenstein HM, Liu FX. Evaluating Oncologists' Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study. Oncologist 2024; 29:244-253. [PMID: 37846191 PMCID: PMC10911905 DOI: 10.1093/oncolo/oyad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. MATERIALS AND METHODS US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. RESULTS Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists' 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). CONCLUSION OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians' decision-making in the real-world setting for la/mUC.
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Affiliation(s)
- Shilpa Gupta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Chiemeka Ike
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA
| | - Shaloo Gupta
- Cerner Enviza, an Oracle company, Kansas City, MO, USA
| | | | - Cathy Su
- Cerner Enviza, an Oracle company, Kansas City, MO, USA
| | | | | | | | | | - Frank X Liu
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA
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Yoshida Y, Toriyabe S, Imai H, Sasaki K, Kasahara Y, Ouchi K, Saijo K, Onodera K, Ishioka C. Nivolumab-induced Thrombotic Thrombocytopenic Purpura in Patients with Gastric Tube Cancer. Intern Med 2024:2931-23. [PMID: 38432967 DOI: 10.2169/internalmedicine.2931-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Recently, immune checkpoint inhibitors (ICIs) have been used to treat several cancer types. ICIs have been reported to cause a wide variety of immune-related adverse events, including endocrine, neurologic, gastrointestinal, and cutaneous disorders. Thrombotic thrombocytopenic purpura (TTP) is an autoimmune hematologic disorder characterized by the presence of autoantibodies against a disintegrin and metalloprotease with thrombospondin-1, member 13. Several previous cases of TTP were thought to have been caused by ICI treatment. We herein report a rare case of TTP that developed after long-term treatment with an ICI (nivolumab) for gastric tube cancer.
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Affiliation(s)
- Yuya Yoshida
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Sakura Toriyabe
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Keiju Sasaki
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Yuki Kasahara
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Kota Ouchi
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Ken Saijo
- Department of Medical Oncology, Tohoku University Hospital, Japan
| | - Koichi Onodera
- Department of Hematology, Tohoku University Hospital, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Japan
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Xu X, Shi X, Zhou D, Cao D. The Association Between Modified Albumin-Bilirubin (mALBI) and Survival in Advanced Non-small Cell Lung Cancer Patients Treated With Immunotherapy. Cureus 2024; 16:e56074. [PMID: 38618479 PMCID: PMC11009909 DOI: 10.7759/cureus.56074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE This study aimed to assess the clinical value of the modified albumin-bilirubin (mALBI) grade in predicting the survival of patients with advanced non-small cell lung cancer (NSCLC) treated with immunotherapy. METHODS We conducted a retrospective cohort study of patients with advanced NSCLC who received immune checkpoint inhibitors (ICIs) from January 2020 to May 2022. The primary endpoints were overall survival (OS), treatment response, and the association between different mALBI grades and survival. RESULTS In these 67 patients, 85.1% (57/67) were male, and the median age was 63 years. The patients with mALBI grades 1 and 2a at baseline had a median OS of 12.83 months (95% CI: 9.4 to 16.27 months), whereas it was 3.2 months (95% CI: NA to 11.59 months) for patients with mALBI grades 2b and 3. The OS for patients with dynamic mALBI grades 1 and 2a was 13.27 months (95% CI: 8.72 to 17.81 months), significantly longer than five months (95% CI: 2.47 to 7.53 months) for dynamic mALBI grades 2b and 3 patients (p<0.01). Conclusion: In conclusion, mALBI grade may be a potential dynamic biomarker for predicting the prognosis in advanced NSCLC patients treated with immunotherapy.
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Affiliation(s)
- Xiaoya Xu
- Oncology, People's Hospital of Macheng City, Macheng, CHN
| | - Xiangru Shi
- Oncology, People's Hospital of Macheng City, Macheng, CHN
| | - Dingjie Zhou
- Oncology, Renmin Hospital of Wuhan University, Wuhan, CHN
| | - Dedong Cao
- Oncology, Renmin Hospital of Wuhan University, Wuhan, CHN
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Sarkar A, Nagappa M, Dey S, Mondal S, Babu GS, Choudhury SP, Akhil P, Debnath M. Synergistic effects of immune checkpoints and checkpoint inhibitors in inflammatory neuropathies: Implications and mechanisms. J Peripher Nerv Syst 2024; 29:6-16. [PMID: 37988274 DOI: 10.1111/jns.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/23/2023]
Abstract
Immune checkpoint molecules play pivotal roles in the regulation of immune homeostasis. Disruption of the immune checkpoints causes autoimmune/inflammatory as well as malignant disorders. Over the past few years, the immune checkpoint molecules with inhibitory function emerged as potential therapeutic targets in oncological conditions. The inhibition of the function of these molecules by using immune checkpoint inhibitors (ICIs) has brought paradigmatic changes in cancer therapy due to their remarkable clinical benefits, not only in improving the quality of life but also in prolonging the survival time of cancer patients. Unfortunately, the ICIs soon turned out to be a "double-edged sword" as the use of ICIs caused multiple immune-related adverse effects (irAEs). The development of inflammatory neuropathies such as Guillain-Barré syndrome (GBS) and Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) as the secondary effects of immunotherapy appeared very challenging as these conditions result in significant and often permanent disability. The underlying mechanism(s) through which ICIs trigger inflammatory neuropathies are currently not known. Compelling evidence suggests autoimmune reaction and/or inflammation as the independent risk mechanism of inflammatory neuropathies. There is a lack of understanding as to whether prior exposure to the risk factors of inflammatory neuropathies, the presence of germline genetic variants in immune function-related genes, genetic variations within immune checkpoint molecules, the existence of autoantibodies, and activated/memory T cells act as determining factors for ICI-induced inflammatory neuropathies. Herein, we highlight the available pieces of evidence, discuss the mechanistic basis, and propose a few testable hypotheses on inflammatory neuropathies as irAEs of immunotherapy.
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Affiliation(s)
- Aritrani Sarkar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Saikat Dey
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sandipan Mondal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Gopika Suresh Babu
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Saptamita Pal Choudhury
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pokala Akhil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Liu J, Yang T, Luo Y, Ma Z, Yu Z, Zhang L, Liu G, Wen J, Lu G, Zhang G, Zhao Y, Luo W, Li Y, Yang N, Zhou J, Lu Y, Chen S, Zeng X. DEAD-box helicase 1 inhibited CD8 + T cell antitumor activity by inducing PD-L1 expression in hepatocellular carcinoma. Cancer Sci 2024; 115:763-776. [PMID: 38243657 PMCID: PMC10921000 DOI: 10.1111/cas.16076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/21/2024] Open
Abstract
Hepatocellular carcinoma (HCC) does not respond well to current treatments, even immune checkpoint inhibitors. PD-L1 (programmed cell death ligand 1 or CD274 molecule)-mediated immune escape of tumor cells may be a key factor affecting the efficacy of immune checkpoint inhibitor (ICI) therapy. However, the regulatory mechanisms of PD-L1 expression and immune escape require further exploration. Here, we observed that DDX1 (DEAD-box helicase 1) was overexpressed in HCC tissues and associated with poor prognosis in patients with HCC. Additionally, DDX1 expression correlated negatively with CD8+ T cell frequency. DDX1 overexpression significantly increased interferon gamma (IFN-γ)-mediated PD-L1 expression in HCC cell lines. DDX1 overexpression decreased IFN-γ and granzyme B production in CD8+ T cells and inhibited CD8+ T cell cytotoxic function in vitro and in vivo. In conclusion, DDX1 plays an essential role in developing the immune escape microenvironment, rendering it a potential predictor of ICI therapy efficacy in HCC.
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Affiliation(s)
- Junhao Liu
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Ti Yang
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yurong Luo
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zengxin Ma
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhitao Yu
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Lei Zhang
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Gai Liu
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Jianfan Wen
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Guankun Lu
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Guowei Zhang
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Yujun Zhao
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Wang Luo
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Yanan Li
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina
| | - Nengjia Yang
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Affiliated Guangdong Second Provincial General Hospital of Jinan UniversityGuangzhouGuangdongChina
| | - Jiawei Zhou
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Affiliated Guangdong Second Provincial General Hospital of Jinan UniversityGuangzhouGuangdongChina
| | - Yuhui Lu
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
- The Affiliated Guangdong Second Provincial General Hospital of Jinan UniversityGuangzhouGuangdongChina
| | - Siliang Chen
- Department of Interventional RadiologyGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
| | - Xiancheng Zeng
- Department of Hepatobiliary‐Pancreatic & Hernia SurgeryGuangdong Second Provincial General HospitalGuangzhouGuangdongChina
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47
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Liu K, Zhu Y, Zhu H, Zeng M. Combination tumor-treating fields treatment for patients with metastatic non-small cell lung cancer: A cost-effectiveness analysis. Cancer Med 2024; 13:e7070. [PMID: 38468503 DOI: 10.1002/cam4.7070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Tumor-treating field (TTFields) was a novel antitumor therapy that provided significant survival for previously treated metastatic non-small cell lung cancer (mNSCLC). The consistency of the cost of the new treatment regimen with its efficacy was the main objective of the study. METHODS The primary parameters, derived from the Phase 3 LUNAR study, were collected to evaluate the cost and efficacy of TTFields plus standard-of-care (SOC) (immune checkpoint inhibitors [ICIs] and docetaxel [DTX]) or SOC in patients with mNSCLC by establishing a three-state Markov model over a 15-year time horizon. Primary outcome measures for this study included costs, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed. RESULTS The total costs of TTFields plus SOC, TTFields plus ICI, and TTFields plus DTX were $319,358, $338,688, and $298,477, generating 1.23 QALYs, 1.58 QALYs, and 0.89 QALYs, respectively. The ICERs of TTFields plus SOC versus SOC, TTFields plus ICI versus ICI, and TTFields plus DTX versus DTX were $613,379/QALY, $387,542/QALY, and $1,359,559/QALY, respectively. At willingness-to-pay (WTP) thresholds of $150,000/QALY, the probability of combination TTFields being cost-effective was 0%. In addition, TTFields plus SOC exhibited similar efficacy (1.12 QALYs and 1.14 QALYs) and costs ($309,822 and $312,531) in the treatment of squamous cell carcinoma (SCC) and non-squamous cell carcinoma (NSCC) populations. CONCLUSIONS In the United States, TTFields plus SOC as second-line treatment was not a more cost-effective strategy for patients with mNSCLC. Of the analyzed regimens, TTFields plus ICI was associated with most significant health benefits.
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Affiliation(s)
- Kun Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Youwen Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Manting Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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48
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Hirose S, Mashima T, Yuan X, Yamashita M, Kitano S, Torii S, Migita T, Seimiya H. Interleukin-4 induced 1-mediated resistance to an immune checkpoint inhibitor through suppression of CD8 + T cell infiltration in melanoma. Cancer Sci 2024; 115:791-803. [PMID: 38258342 PMCID: PMC10921010 DOI: 10.1111/cas.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Cancer cells adopt multiple strategies to escape tumor surveillance by the host immune system and aberrant amino acid metabolism in the tumor microenvironment suppresses the immune system. Among the amino acid-metabolizing enzymes is an L-amino-acid oxidase called interleukin-4 induced 1 (IL4I1), which depletes essential amino acids in immune cells and is associated with a poor prognosis in various cancer types. Although IL4I1 is involved in immune metabolism abnormalities, its effect on the therapeutic efficacy of immune checkpoint inhibitors is unknown. In this study, we established murine melanoma cells overexpressing IL4I1 and investigated their effects on the intratumor immune microenvironment and the antitumor efficacy of anti-programmed death-ligand 1 (PD-L1) antibodies (Abs) in a syngeneic mouse model. As a result, we found that IL4I1-overexpressing B16-F10-derived tumors showed resistance to anti-PD-L1 Ab therapy. Transcriptome analysis revealed that immunosuppressive genes were globally upregulated in the IL4I1-overexpressing tumors. Consistently, we showed that IL4I1-overexpressing tumors exhibited an altered subset of lymphoid cells and particularly significant suppression of cytotoxic T cell infiltration compared to mock-infected B16-F10-derived tumors. After treatment with anti-PD-L1 Abs, we also found a more prominent elevation of tumor-associated macrophage (TAM) marker, CD68, in the IL4I1-overexpressing tumors than in the mock tumors. Consistently, we confirmed an enhanced TAM infiltration in the IL4I1-overexpressing tumors and a functional involvement of TAMs in the tumor growth. These observations indicate that IL4I1 reprograms the tumor microenvironment into an immunosuppressive state and thereby confers resistance to anti-PD-L1 Abs.
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Affiliation(s)
- Shiho Hirose
- Division of Molecular Biotherapy, Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier SciencesUniversity of TokyoTokyoJapan
| | - Tetsuo Mashima
- Division of Molecular Biotherapy, Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Xunmei Yuan
- Division of Molecular Biotherapy, Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Makiko Yamashita
- Division of Cancer Immunotherapy Development, Department of Advanced Medical DevelopmentThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Shigehisa Kitano
- Division of Cancer Immunotherapy Development, Department of Advanced Medical DevelopmentThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Shinichi Torii
- Division of Neuropathology and Neuroscience, Graduate School of Pharmaceutical SciencesUniversity of TokyoTokyoJapan
- Vermilion Therapeutics Inc.TokyoJapan
| | - Toshiro Migita
- Division of Cancer Cell BiologyInstitute of Medical Science, University of TokyoTokyoJapan
| | - Hiroyuki Seimiya
- Division of Molecular Biotherapy, Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier SciencesUniversity of TokyoTokyoJapan
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49
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Chick RC, Ruff SM, Pawlik TM. Neoadjuvant systemic therapy for hepatocellular carcinoma. Front Immunol 2024; 15:1355812. [PMID: 38495884 PMCID: PMC10940409 DOI: 10.3389/fimmu.2024.1355812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Surgical resection and liver transplant remain the only curative therapies for most patients with hepatocellular carcinoma (HCC). Systemic therapy options have typically been ineffective, but recent advances, such as the combination of immune checkpoint inhibitors and targeted therapies, have shown great promise. Neoadjuvant systemic therapy in resectable or locally advanced HCC is under active investigation with encouraging results in small, early-phase trials. Many of these completed and ongoing trials include combinations of systemic therapy (e.g. immune checkpoint inhibitors, tyrosine kinase inhibitors), transarterial therapies, and radiation. Despite early successes, larger trials with evaluation of long-term oncologic outcomes are needed to determine the role of neoadjuvant systemic therapy in patients with HCC who may be eligible for curative intent surgery or transplant.
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Affiliation(s)
| | | | - Timothy M. Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
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50
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Yeo SK, Haas M, Manupati K, Hao M, Yang F, Chen S, Guan JL. AZI2 mediates TBK1 activation at unresolved selective autophagy cargo receptor complexes with implications for CD8 T-cell infiltration in breast cancer. Autophagy 2024; 20:525-540. [PMID: 37733921 PMCID: PMC10936636 DOI: 10.1080/15548627.2023.2259775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Most breast cancers do not respond to immune checkpoint inhibitors and there is an urgent need to identify novel sensitization strategies. Herein, we uncovered that activation of the TBK-IFN pathway that is mediated by the TBK1 adapter protein AZI2 is a potent strategy for this purpose. Our initial observations showed that RB1CC1 depletion leads to accumulation of AZI2, in puncta along with selective macroautophagy/autophagy cargo receptors, which are both required for TBK1 activation. Specifically, disrupting the selective autophagy function of RB1CC1 was sufficient to sustain AZI2 puncta accumulation and TBK1 activation. AZI2 then mediates downstream activation of DDX3X, increasing its interaction with IRF3 for transcription of pro-inflammatory chemokines. Consequently, we performed a screen to identify inhibitors that can induce the AZI2-TBK1 pathway, and this revealed Lys05 as a pharmacological agent that induced pro-inflammatory chemokine expression and CD8+ T cell infiltration into tumors. Overall, we have identified a distinct AZI2-TBK1-IFN signaling pathway that is responsive to selective autophagy blockade and can be activated to make breast cancers more immunogenic.Abbreviations: AZI2/NAP1: 5-azacytidine induced 2; CALCOCO2: calcium binding and coiled-coil domain 2; DDX3X: DEAD-box helicase 3 X-linked; FCCP: carbonyl cyanide p-triflouromethoxyphenylhydrazone; a protonophore that depolarizes the mitochondrial inner membrane; ICI: immune checkpoint inhibitor; IFN: interferon; NBR1: NBR1 autophagy cargo receptor; OPTN: optineurin; RB1CC1/FIP200: RB1 inducible coiled-coil 1; SQSTM1/p62: sequestosome 1; TAX1BP1: Tax1 binding protein 1; TBK1: TANK binding kinase 1.
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Affiliation(s)
- Syn Kok Yeo
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Haas
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kanakaraju Manupati
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mingang Hao
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Fuchun Yang
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Song Chen
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Translational Research Institute, Henan Provincial People’s Hospital, Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jun-Lin Guan
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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