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Maarup S, Skadborg S, Draghi A, Borch A, Hasselbalch B, Yde C, Svane I, Hadrup S, Christensen I, Law I, Skjoeth-Rasmussen J, Scheie D, Skovgaard Poulsen H, Lassen U. PL02.3.A Survival and T-cell tumor reactivity in patients treated with nivolumab and bevacizumab for recurrent glioblastoma in the clinical trial CA209-9UP. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is an aggressive brain tumor with a median survival of 14.6 months. We have no standard treatment for relapse and current treatment options have limited effect. Novel treatments are necessary to improve survival and quality of life.
Material and Methods
We present data from; a phase II open label, two-armed clinical trial studying nivolumab and bevacizumab in treatment of recurrent GBM, with progression after Stupp’s regime. Patients were included in two arms depending on the possibility of salvage neurosurgical resection. All patients had biopsies for genome sequencing at primary tumor and recurrence. Both arms received nivolumab and bevacizumab administrated every second week and the surgical arm also received neoadjuvant nivolumab 7 days prior to surgery. Fresh tissue samples were collected for tumor digest, TILs (tumor infiltrating lymphocytes) for phenotype exploration and intracellular staining to test reactivity. Patients were treated until progression, death, or intolerable side effects. Toxicity screens were reported, and follow-up ended in Marts 2022.
Results
Forty-four patients were included from November 2018 to January 2022; 20 in each arm (four screen-failures). Treatment was overall well tolerated. Median (m) age at inclusion was 57,5 years (arm A) and 50,5 years (arm B), and the groups had an even distribution. The surgical and non-surgical arm had an mPFS of 5.95 and 3.83 months respectively, while the mOS was 13.96 months and 6.77 months, respectively. Multivariate analysis was performed by variables such us steroid, MGMT, gender, age at diagnosis, resection extent and arm. Steroid at inclusion was a significant negative predictor of outcome (p = 0.0378). Controls from our GBM registry (N=140), which were treated with neurosurgical resection and then bevazicumab and irinotecan in recurrent setting had an mOS of 8.64 months (log-rank p=0.0181).Furthermore, reactive tumor infiltrating lymphocytes (TIL) were detected in four of the patients who presented with a longer mOS and mPFS of 16.75 months and 9.18 months, while the 16 patients without TIL reactivity had mOS and mPFS of 12.63 months and 5.13 months, respectively (not significant).
Conclusion
We found an increased mOS in patients treated with nivolumab and bevacizumab at recurrence, compared to our controls: 13.96 months and 8.64 months, respectively. Four patients with T-cell reactivity towards tumor cells showed an even longer mPFS and mOS. Though not significant, these results warrant further research evaluation in larger patient cohorts. We are currently investigating proteomics and sequencing data to identify predictive biomarkers.
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Affiliation(s)
- S Maarup
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - S Skadborg
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - A Draghi
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - A Borch
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - B Hasselbalch
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - C Yde
- Center of Genomic Medicine, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - I Svane
- National Center for Cancer Immune Therapy, Copenhagen University Hospital , Herlev , Denmark
| | - S Hadrup
- Department of Health Technology, Kemitorvet, Building 204, room 154 , Kongens Lyngby , Denmark
| | - I Christensen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
| | - I Law
- Department of Clinical Physiology, Nuclear Medicine and pet, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - J Skjoeth-Rasmussen
- Neurosurgery Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - D Scheie
- Pathology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - H Skovgaard Poulsen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9 , Copenhagen , Denmark
| | - U Lassen
- dccc Brain Tumor Center, Oncology Department, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen , Copenhagen , Denmark
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Kumar A, Abbas W, Colin L, Khan KA, Bouchat S, Varin A, Larbi A, Gatot JS, Kabeya K, Vanhulle C, Delacourt N, Pasquereau S, Coquard L, Borch A, König R, Clumeck N, De Wit S, Rohr O, Rouzioux C, Fulop T, Van Lint C, Herbein G. Tuning of AKT-pathway by Nef and its blockade by protease inhibitors results in limited recovery in latently HIV infected T-cell line. Sci Rep 2016; 6:24090. [PMID: 27076174 PMCID: PMC4831010 DOI: 10.1038/srep24090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
Akt signaling plays a central role in many biological processes, which are key players in human immunodeficiency virus 1 (HIV-1) pathogenesis. We found that Akt interacts with HIV-1 Nef protein. In primary T cells treated with exogenous Nef or acutely infected with Nef-expressing HIV-1 in vitro, Akt became phosphorylated on serine473 and threonine308. In vitro, Akt activation mediated by Nef in T-cells was blocked by HIV protease inhibitors (PI), but not by reverse transcriptase inhibitors (RTI). Ex vivo, we found that the Akt pathway is hyperactivated in peripheral blood lymphocytes (PBLs) from cART naïve HIV-1-infected patients. PBLs isolated from PI-treated patients, but not from RTI-treated patients, exhibited decreased Akt activation, T-cell proliferation and IL-2 production. We found that PI but not RTI can block HIV-1 reactivation in latently infected J-Lat lymphoid cells stimulated with various stimuli. Using luciferase measurement, we further confirmed that Nef-mediated reactivation of HIV-1 from latency in 1G5 cells was blocked by PI parallel to decreased Akt activation. Our results indicate that PI-mediated blockade of Akt activation could impact the HIV-1 reservoir and support the need to further assess the therapeutic use of HIV-1 PI in order to curtail latently infected cells in HIV-1-infected patients.
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Affiliation(s)
- Amit Kumar
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Wasim Abbas
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Laurence Colin
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Kashif Aziz Khan
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Sophie Bouchat
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Audrey Varin
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Anis Larbi
- Department of Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Jean-Stéphane Gatot
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Kabamba Kabeya
- Department of Infectious Diseases, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Caroline Vanhulle
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Nadège Delacourt
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Sébastien Pasquereau
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Laurie Coquard
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
| | - Alexandra Borch
- Research Group "Host-Pathogen Interactions", Paul-Ehrlich-Institute, Langen, Germany
| | - Renate König
- Research Group "Host-Pathogen Interactions", Paul-Ehrlich-Institute, Langen, Germany.,Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Research Institute, La Jolla, CA; German Center for Infection Research (DZIF), Langen, Germany
| | - Nathan Clumeck
- Department of Infectious Diseases, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Stephane De Wit
- Department of Infectious Diseases, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Olivier Rohr
- Institut de Parasitologie et Pathologie Tropicale, University of Strasbourg, Strasbourg, France
| | - Christine Rouzioux
- Department of Virology, Paris University, EA7327 Paris Descartes, APHP Necker Hospital, Paris, France
| | - Tamas Fulop
- Department of Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Carine Van Lint
- Laboratory of Molecular Virology, Institut de Biologie et de Médecine Moléculaires (IBMM), Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Georges Herbein
- Department of Virology, Pathogens &Inflammation Laboratory, University of Franche-Comté and COMUE Bourgogne Franche-Comté University, UPRES EA4266, SFR FED 4234, CHRU Besançon, Besançon, France
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Hansen M, Podenphant J, Florescu A, Stoltenberg M, Borch A, Kluger E, Sørensen SF, Hansen TM. A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects. Ann Rheum Dis 1999; 58:713-8. [PMID: 10531077 PMCID: PMC1752793 DOI: 10.1136/ard.58.11.713] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study benefits and skeletal side effects of carefully monitored prednisolone treatment in patients with active rheumatoid arthritis. METHODS One hundred and two patients with active rheumatoid arthritis were randomly allocated to treatment with disease modifying anti-inflammatory drug (DMARD) alone or DMARD and prednisolone in a one year follow up study. Prednisolone was given in a dose regimen adapted to the disease activity of the individual patient. The mean dose was 6 mg and the mean cumulated dose was 2160 mg. Patients were followed up with disease activity parameters, radiograph of the hands (Larsen score), and bone mineral density (BMD) of the lumbar spine, distal forearm and hand. At one year 26 patients had withdrawn from the investigation leaving 76 patients for evaluation. RESULTS The results showed that disease activity in the prednisolone treated group was reduced within two weeks. In the DMARD alone group disease activity was gradually reduced over months. At six months there was no difference between the groups as evaluated by an improvement score using a number of ACR criteria. Prednisolone in the present set up was not able to protect significantly against radiological disease progression, although there was a trend towards less progression in Larsen score in the prednisolone group, a matter that was further underlined in an intention to treat analysis. BMD data revealed a significant reduction in spinal BMD in the prednisolone group, whereas prednisolone seemed to have a protective effect against bone loss in the hand and distal forearm. CONCLUSIONS This study does not allow any firm conclusions for or against the treatment of rheumatoid arthritis with prednisolone. The data suggest that the beneficial effects of prednisolone are not as clear cut in established rheumatoid arthritis as in early disease. Furthermore the data indicate that treatment in the chosen relatively low dose does not provide sufficient control of disease. On the other hand the spinal bone loss observed in the prednisolone group does invite considerations about using higher doses.
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Affiliation(s)
- M Hansen
- Department of Rheumatology, Hvidovre Hospital, University of Copenhagen, Denmark
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