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Rached L, Laparra A, Sakkal M, Danlos FX, Barlesi F, Carbonnel F, De Martin E, Ducreux M, Even C, Le Pavec J, Michot JM, M Ribeiro J, Scotte F, Ponce Aix S, Lambotte O, Baldini C, Champiat S. Toxicity of immunotherapy combinations with chemotherapy across tumor indications: Current knowledge and practical recommendations. Cancer Treat Rev 2024; 127:102751. [PMID: 38729086 DOI: 10.1016/j.ctrv.2024.102751] [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: 02/10/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
Chemotherapy associated with Immune Checkpoint Inhibitors is currently the standard of care in several tumor indications. This combination approach improves progression free survival (PFS), overall survival (OS) and complete pathological response (pCR) in several cancer types both in the early and metastatic approaches. However, the distinct spectrum of toxicities between cytotoxic side effects and immune related adverse events (irAEs) with similar clinical presentations and different management strategies remains a challenge in daily practice for healthcare professionals. This review summarizes the most common toxicities reported in the randomized clinical trials that led to the subsequent FDA approval of these combinations, across tumor indications. We cite in particular: non-small cell lung cancer, small cell lung cancer, triple negative breast cancer, squamous cell carcinoma of the head and neck, gastric carcinoma, esophageal carcinoma, cervical carcinoma and biliary tract carcinoma. We found that the combination of chemotherapy and immunotherapy was associated with an increased incidence of all grade adverse events (RR 1.11 [1.09; 1.12]) without an excess in treatment related mortality when compared to chemotherapy alone. We report also an increase in the incidence of serious adverse events (grade ≥ 3) (RR 1.16 [1.10;1.24]); in particular: high grade diarrhea, dyspnea, fatigue, rash and elevated liver enzymes. Together with the collaboration of our institutional network of organ specialists with expertise in irAEs, we propose practical recommendations for physicians to enhance clinical care and management of patients undergoing treatment with combined ICI immunotherapy and chemotherapy.
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Affiliation(s)
- Layal Rached
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - Ariane Laparra
- Gustave Roussy, Interdisciplinary Department for the Organization of Patient Pathways, 94805 Villejuif, France
| | - Madona Sakkal
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - Fabrice Barlesi
- Paris Saclay University and Gustave Roussy, Department of Medical Oncology, 94805 Villejuif, France
| | - Franck Carbonnel
- University Hospital of Bicêtre and Université Paris-Saclay, Department of Gastroenterology, 94270 Le Kremlin Bicêtre, France
| | - Eleonora De Martin
- AP-HP Paul-Brousse Hospital, Hepato-Biliary Center, Inserm Unit 1193, Paris-Saclay University, Hepatinov FHU, Reference Center for Inflammatory Biliary Tract Diseases and Autoimmune Hepatitis, Villejuif, France
| | - Michel Ducreux
- Paris Saclay University and Gustave Roussy, Department of Medical Oncology, 94805 Villejuif, France
| | - Caroline Even
- Paris Saclay University and Gustave Roussy, Department of Medical Oncology, 94805 Villejuif, France
| | - Jerome Le Pavec
- Paris-Saclay University, Faculty of Medicine, INSERM UMR_S999, 94270 Le Kremlin-Bicêtre, France; Pneumology and Lung Transplant Department, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Jean-Marie Michot
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - Joana M Ribeiro
- Paris Saclay University and Gustave Roussy, Department of Medical Oncology, 94805 Villejuif, France
| | - Florian Scotte
- Gustave Roussy, Interdisciplinary Department for the Organization of Patient Pathways, 94805 Villejuif, France
| | - Santiago Ponce Aix
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - Olivier Lambotte
- University Paris Saclay, GHU AP-HP Paris Saclay, Department of Internal Medicine and Clinical Immunology, Bicêtre Hospital, UMR1184 CEA, Inserm, Kremlin Bicêtre, France
| | - Capucine Baldini
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy, Department of Therapeutic Innovations and Early Trials, 94805 Villejuif, France.
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2
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Brenet E, Atallah S, Guerlain J, Moya-Plana A, Verillaud B, Kania R, Bakhos D, Philouze P, Righini CA, Bozorg A, Mérol JC, Labrousse M, Vergez S, Fakhry N, Gallet P, Cullié D, Malard O, Mauvais O, Fath L, Schultz P, Dufour X, Saroul N, Evrard D, Lesnik M, Even C, Costes V, Thariat J, Taillandier de Gabory LL, Makeieff M, Dubernard X, Baujat B. Carcinomas of the external auditory canal: Management and results: A multicenter REFCOR propensity score matching study. Eur J Cancer 2024; 201:113922. [PMID: 38364629 DOI: 10.1016/j.ejca.2024.113922] [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: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyse prognostic factors and survival outcomes of malignant tumors of the external auditory canal, to investigate the role of regional surgery, and adjuvant radiotherapy in early stages and to investigate the role of surgery in operable T4 stage. SETTING A retrospective analysis was conducted on all patients prospectively included in the national database of the French Expertize Network for Rare ENT Cancers (REFCOR) from January 2000 to December 2016. PARTICIPANTS 103 patients from 19 reference centers were included. A propensity score matching analysis was applied to enable comparisons between treatments. MAIN OUTCOMES AND MEASURES Event-free survival, overall survival and factors of poor prognosis of the cohort were described. The interest of local and regional surgery and postoperative radiotherapy were evaluated. RESULTS The factors of poor prognosis on event-free survival were immunosuppression (p = 0.002), Karnofsky status less than 90% (p = 0.02), body mass index less than 19 Kg / m2 (p = 0.0009), peripheric facial palsy (p = 0.0016), and positive margin (p = 0.0006). In early stages, locoregional surgery was associated with an increase in event-free survival (p = 0.003, HR = 0.21) versus local surgery alone, while postoperative radiotherapy was not associated with an increase in event-free survival (p = 0.86, HR = 0.91) or overall (p = 0.86, HR = 0.91). In locally advanced stages, locoregional surgery followed by radiotherapy was associated with an increase in event-free survival (p = 0.03, HR = 0.39) and overall (p = 0.02, HR = 0.34) versus chemoradiotherapy alone. CONCLUSION AND RELEVANCE Regional surgery is recommended for early stages of cancers of the external auditory canal. In operable cases, locoregional surgery followed by radiotherapy is recommended.
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Affiliation(s)
- Esteban Brenet
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sarah Atallah
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 94807 Villejuif, France
| | - Joanne Guerlain
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Antoine Moya-Plana
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Benjamin Verillaud
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - Romain Kania
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - David Bakhos
- Department of ENT-Head and Neck Surgery, Bretonneau University Hospital, 37000 Tours, France
| | - Pierre Philouze
- Department of ENT-Head and Neck Surgery, La Croix Rousse University Hospital, HCL, 6900 Lyon, France
| | - Christian-Adrien Righini
- Department of ENT-Head and Neck Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France
| | - Alexis Bozorg
- Department of ENT-Head and Neck Surgery, François Mitterrand University Hospital, 21000 Dijon, France
| | - Jean-Claude Mérol
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Marc Labrousse
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sébastien Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute, 31100 Toulouse, France
| | - Nicolas Fakhry
- Department of ENT-Head and Neck Surgery, University Hospital of Marseille, APHM, 13915 Marseille, France
| | - Patrice Gallet
- Department of ENT-Head and Neck Surgery, University Hospital of Nancy, 54000 Nancy, France
| | - Dorian Cullié
- Department of ENT-Head and Neck Surgery, Lacassagne Cancer Institute, 06100 Nice, France
| | - Olivier Malard
- Department of ENT-Head and Neck Surgery, University Hospital of Nantes, 44093 Nantes, France
| | - Olivier Mauvais
- Department of ENT-Head and Neck Surgery, University Hospital of Besançon, 25000 Besançon, France
| | - Léa Fath
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Philippe Schultz
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Xavier Dufour
- Department of ENT-Head and Neck Surgery, University Hospital of Poitiers, 86021 Poitiers, France
| | - Nicolas Saroul
- Department of ENT-Head and Neck Surgery, University Hospital of Clermont-Ferrand, 63000, France
| | - Diane Evrard
- Department of ENT-Head and Neck Surgery, Bichat University Hospital, APHP, 75018 Paris, France
| | - Maria Lesnik
- Department of ENT-Head and Neck Surgery, Curie Cancer Institute, APHP, 75005 Paris, France
| | - Caroline Even
- Department of Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Valérie Costes
- Department of Pathologic Anatomy and onco-biology, University Hospital of Montpellier, France
| | - Juliette Thariat
- Department of Radiation Oncology, Cancer center Baclesse, 14076 Caen, France
| | | | - Marc Makeieff
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Xavier Dubernard
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Bertrand Baujat
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France.
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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [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: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Gasne C, Atallah S, Dauzier E, Thariat J, Fakhry N, Verillaud B, Classe M, Vergez S, Moya-Plana A, Costes-Martineau V, Righini C, de Gabory L, Digue L, Dupin C, Ferrand FR, Even C, Baujat B. Twelve years after: The french national network on rare head and neck tumours (REFCOR). Oral Oncol 2024; 151:106762. [PMID: 38513311 DOI: 10.1016/j.oraloncology.2024.106762] [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: 08/30/2023] [Revised: 01/23/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Rare cancers constitute less than 10% of head and neck cancers and lack sufficient evidence for standardized care. The French Rare Head and Neck Cancer Expert Network (REFCOR) as established a national database to collect data on these rare cancers. This study aims to describe patient and tumour characteristics in this database. METHODS Prospective data collection was conducted across multiple centers. Survival analyses were performed using Kaplan Meier method and Log Rank test. Odds ratios were used for comparing proportions. RESULTS A total of 7208 patients were included over a period of 10 years. The most frequent histologies were: Not Otherwise Specified (NOS) adenocarcinoma 13 %, adenoid cystic carcinoma 12 %, squamous cell carcinoma of rare locations 10 %, mucoepidermoid carcinoma 9 %, intestinal-type adenocarcinoma (8 %). Tumours were located in sinonasal area (38 %); salivary glands (32 %); oral cavity / oropharynx / nasopharynx (16 %); larynx / hypopharynx (3 %); ears (1 %); others (3 %). Tumours were predominantly classified as T4 (23 %), N0 (54 %), and M0 (62 %). Primary treatment approach involved tumour resection (78 %) and / or radiotherapy (63 %). Patients with salivary gland cancers exhibited better 5-year overall survival (OS) rates (p < 0.05), and lower recurrence rates compared to patients with sinonasal, laryngeal/ hypopharyngeal cancers. No significant differences were observed in the other comparisons. Acinar cell carcinoma demonstrated the best OS while mucous melanoma had the poorest prognosis. CONCLUSION Melanoma, carcinoma NOS, and sinonasal undifferenciated carcinoma still have poor prognoses. Efforts are being made, including training and guidelines, to expand network coverage (REFCOR, EURACAN), improve data collection and contribute to personalized therapies.
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Affiliation(s)
- Cassandre Gasne
- Otolaryngology-Head and Neck Surgery Department, Hopital Tenon, AP-HP, Sorbonne University, 75020 Paris, France
| | - Sarah Atallah
- Otolaryngology-Head and Neck Surgery Department, Hopital Tenon, AP-HP, Sorbonne University, 75020 Paris, France
| | - Etienne Dauzier
- Otolaryngology-Head and Neck Surgery Department, Hopital Tenon, AP-HP, Sorbonne University, 75020 Paris, France
| | - Juliette Thariat
- Radiotherapy department, Centre François Baclesse, Caen University, 14000 Caen, France
| | - Nicolas Fakhry
- Otolaryngology-Head and Neck Surgery Department, Centre Hospitalier Universitaire La Conception, APHM, Aix Marseille University, 13385 Marseille, France
| | - Benjamin Verillaud
- Otolaryngology-Head and Neck Surgery Department, Hopital Lariboisière, AP-HP, Paris University, 75010 Paris, France
| | - Marion Classe
- Pathology Department, Institut Gustave-Roussy, 94800 Villejuif, France
| | - Sebastien Vergez
- Service ORL-CCF, Hôpital Rangueil-Larrey, CHU de Toulouse, 31059 Toulouse, France
| | - Antoine Moya-Plana
- Otolaryngology-Head and Neck Surgery Department, Institut Gustave-Roussy, 94800 Villejuif, France
| | - Valerie Costes-Martineau
- Pathology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier University, 34295 Montpellier, France
| | - Christian Righini
- Otolaryngology-Head and Neck Surgery Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble University, 38043 Grenoble, France
| | - Ludovic de Gabory
- Otolaryngology-Head and Neck Surgery Department, Centre Hospitalier Universitaire F-X Michelet, Bordeaux University, 33076 Bordeaux, France
| | - Laurence Digue
- Oncology Department, Centre Hospitalier Universitaire F-X Michelet, Bordeaux University, 33076 Bordeaux, France
| | - Charles Dupin
- Pathology Department, Centre Hospitalier Universitaire F-X Michelet, Bordeaux University, 33076 Bordeaux, France
| | | | - Caroline Even
- Oncology Department, Institut Gustave-Roussy, 94800 Villejuif, France
| | - Bertrand Baujat
- Otolaryngology-Head and Neck Surgery Department, Hopital Tenon, AP-HP, Sorbonne University, 75020 Paris, France.
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Rached L, Saleh K, Casiraghi O, Even C. Salivary gland carcinoma: Towards a more personalised approach. Cancer Treat Rev 2024; 124:102697. [PMID: 38401478 DOI: 10.1016/j.ctrv.2024.102697] [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: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
Salivary Gland carcinomas (SGCs) are rare tumors accounting for less than 1% of all cancers with 21 histologically diverse subtypes. The rarity of the disease presents a challenge for clinicians to conduct large size randomized controlled trials. Surgery and radiotherapy remain the only curative treatment for localized disease, whereas treatments for recurrent and metastatic disease remain more challenging with very disappointing results for chemotherapy. The different histological subtypes harbor various genetic alterations, some pathognomonic with a diagnostic impact for pathologists in confirming a difficult diagnosis and others with therapeutic implications regardless of the histologic subtype. Current international guidelines urge pathologists to identify androgen receptor status, HER-2 expression that could be determined by immunohistochemistry, and TRK status in patients with non-adenoid cystic salivary gland carcinoma that are eligible to initiate a systemic treatment, in order to offer them available targeted therapies or refer them to clinical trials based on their mutational profile. A more advanced molecular profiling by next generation sequencing would offer a larger panel of molecular alterations with possible therapeutic implications such as NOTCH, PI3K, BRAF, MYB, and EGFR. In the following review, we present the most common genetic alterations in SGCs as well as actionable mutations with the latest available data on therapeutic options and upcoming clinical trials.
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Affiliation(s)
- Layal Rached
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Khalil Saleh
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Odile Casiraghi
- Department of Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif 94800, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif 94800, France.
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7
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Guigay J, Ortholan C, Vansteene D, Cupissol D, Even C, Kaminsky MC, Sire C, Blot E, Debourdeau P, Bozec L, Saada-Bouzid E, Fayette J, Dalloz P, Pointreau Y, Caer HL, Falandry C, Digue L, Braccini A, Lopez S, Guillet P, Michel C, Cheurfa N, Schwob D, Bourhis J, Mertens C, Aupérin A. Cetuximab versus methotrexate in first-line treatment of older, frail patients with inoperable recurrent or metastatic head and neck cancer (ELAN UNFIT): a randomised, open-label, phase 3 trial. Lancet Healthy Longev 2024; 5:e182-e193. [PMID: 38432247 DOI: 10.1016/s2666-7568(23)00284-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND At present, there is no established standard treatment for frail older patients with recurrent or metastatic head and neck squamous cell carcinoma. We aimed to compare the efficacy and safety of cetuximab to those of methotrexate (the reference regimen) in this population. METHODS This randomised, open-label, phase 3 trial was done at 20 hospitals in France. Patients aged 70 years or older, assessed as frail by the ELAN Geriatric Evaluation, with recurrent or metastatic head and neck squamous cell carcinoma in the first-line setting and with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 were eligible for inclusion. Patients were randomly assigned (1:1) to receive cetuximab 500 mg/m2 intravenously every 2 weeks or methotrexate 40 mg/m2 intravenously every week, with minimisation by ECOG performance status, type of disease evolution, Charlson Comorbidity Index score, serum albumin concentration, and geriatrician consultation. To avoid deterministic minimisation and assure allocation concealment, patients were allocated with a probability of 0·80 to the treatment that most reduced the imbalance. Treatment was continued until disease progression or unacceptable toxicity, whichever occurred first. The primary endpoint was failure-free survival (defined as the time from randomisation to disease progression, death, discontinuation of treatment, or loss of 2 or more points on the Activities in Daily Living scale, whichever occurred first) and was analysed in the intention-to-treat population. 151 failures expected out of 164 patients were required to detect a hazard ratio (HR) of 0·625 with 0·05 alpha error, with 80% power. A futility interim analysis was planned when approximately 80 failures were observed, based on failure-free survival. Safety analyses included all patients who received at least one dose of the study drug. This study is registered on ClinicalTrials.gov (NCT01884623) and was stopped for futility after the interim analysis. FINDINGS Between Nov 7, 2013, and April 23, 2018, 82 patients were enrolled (41 to the cetuximab group and 41 to the methotrexate group); 60 (73%) were male, 37 (45%) were aged 80 years or older, 35 (43%) had an ECOG performance status of 2, and 36 (44%) had metastatic disease. Enrolment was stopped for futility at the interim analysis. At the final analysis, median follow-up was 43·3 months (IQR 30·8-52·1). At data cutoff, all 82 patients had failure; failure-free survival did not differ significantly between the groups (median 1·4 months [95% CI 1·0-2·1] in the cetuximab group vs 1·9 months [1·1-2·6] in the methotrexate group; adjusted HR 1·03 [95% CI 0·66-1·61], p=0·89). The frequency of patients who had grade 3 or worse adverse events was 63% (26 of 41) in the cetuximab group and 73% (30 of 41) in the methotrexate group. The most common grade 3-4 adverse events in the cetuximab group were fatigue (four [10%] of 41 patients), lung infection (four [10%]), and rash acneiform (four [10%]), and those in the methotrexate group were fatigue (nine [22%] of 41), increased gamma-glutamyltransferase (seven [17%]), natraemia disorder (four [10%]), anaemia (four [10%]), leukopenia (four [10%]), and neutropenia (four [10%]). The frequency of patients who had serious adverse events was 44% (18 of 41) in the cetuximab group and 39% (16 of 41) in the methotrexate group. Four patients presented with a fatal adverse event in the cetuximab group (sepsis, decreased level of consciousness, pulmonary oedema, and death of unknown cause) as did two patients in the methotrexate group (dyspnoea and death of unknown cause). INTERPRETATION The study showed no improvement in failure-free survival with cetuximab versus methotrexate. Patients with an ECOG performance status of 2 did not benefit from these systemic therapies. New treatment options including immunotherapy should be explored in frail older patients with recurrent or metastatic head and neck squamous cell carcinoma, after an initial geriatric evaluation, such as the ELAN Geriatric Evaluation. FUNDING French programme PAIR-VADS 2011 (sponsored by the National Cancer Institute, the Fondation ARC and the Ligue Contre le Cancer), GEMLUC, GEFLUC, and Merck Santé. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Joël Guigay
- Partnerships and Clinical Development - Early Assets, GORTEC, Tours, France.
| | - Cécile Ortholan
- Oncology-Radiotherapy Unit, Hospital Centre Princesse-Grace, Monaco
| | - Damien Vansteene
- Medical Oncology Unit, West Cancerology Institute, Saint Herblain, France
| | - Didier Cupissol
- Medical Oncology Unit, Cancer Institute of Montpellier, Montpellier, France
| | - Caroline Even
- Medical Oncology Unit, Gustave-Roussy Institute, Villejuif, France
| | | | - Christian Sire
- Oncology-Radiotherapy Unit, Hospital Group South Bretagne, Lorient, France
| | - Emmanuel Blot
- Medical Oncology Unit, ELSAN Group, Private Hospital Océane, Vannes, France
| | | | - Laurence Bozec
- Medical Oncology Unit, Curie Institute, Saint Cloud, France
| | - Esma Saada-Bouzid
- Medical Oncology and Research Department, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France
| | - Jérôme Fayette
- Medical Oncology Unit, Cancer Research Centre Léon Bérard, Lyon, France
| | - Pierre Dalloz
- Medical Oncology Unit, Centre Jean Perrin, Clermont-Ferrand, France
| | - Yoann Pointreau
- Radiation Oncology Unit, ILC (Inter-regional Cancerology Institute) - Jean Bernard Center & Victor Hugo Private Clinic, Sarthe Cancer Center, Le Mans, France
| | - Hervé Le Caer
- Medical Oncology Unit, Hospital Centre of Saint-Brieuc, Saint-Brieuc, France
| | - Claire Falandry
- Medical Oncology Unit, Hospital Centre of South Lyon, Pierre Bénite, France
| | - Laurence Digue
- Medical Oncology Unit, Saint André Universitary Hospital of Bordeaux, Bordeaux, France
| | - Antoine Braccini
- Medical Oncology Unit, Centre Azuréen de Cancérologie, Mougins, France
| | - Stéphane Lopez
- Medical Oncology Unit, Hospital Centre of Annecy Genevois, Pringy, France
| | - Pierre Guillet
- Medical Oncology Unit, Intercommunal Hospital Centre, La Seyne sur Mer, France
| | - Cécile Michel
- Medical Oncology and Research Department, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France
| | - Nadir Cheurfa
- Biostatistics and Epidemiology Unit, Gustave Roussy, Inserm U1018 Oncostat, Labelled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
| | - Dominique Schwob
- Biostatistics and Epidemiology Unit, Gustave Roussy, Inserm U1018 Oncostat, Labelled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
| | - Jean Bourhis
- Radiotherapy Unit, Universitary Hospital Center of Vaudois, Lausanne, Switzerland
| | - Cécile Mertens
- Oncogeriatrics Unit, Bergonié Institute, Bordeaux, France
| | - Anne Aupérin
- Biostatistics and Epidemiology Unit, Gustave Roussy, Inserm U1018 Oncostat, Labelled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
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Marret G, Temam S, Kamal M, Even C, Delord JP, Hoffmann C, Dolivet G, Malard O, Fayette J, Capitain O, Vergez S, Geoffrois L, Rolland F, Zrounba P, Laccourreye L, Saada-Bouzid E, Aide N, Bénavent V, Klijianenko J, Lamy C, Girard E, Vacher S, Masliah-Planchon J, de Koning L, Puard V, Borcoman E, Jimenez M, Bièche I, Gal J, Le Tourneau C. Randomized phase II study of preoperative afatinib in untreated head and neck cancers: predictive and pharmacodynamic biomarkers of activity. Sci Rep 2023; 13:22524. [PMID: 38110561 PMCID: PMC10728082 DOI: 10.1038/s41598-023-49887-4] [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: 07/12/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
There is no strong and reliable predictive biomarker in head and neck squamous cell carcinoma (HNSCC) for EGFR inhibitors. We aimed to identify predictive and pharmacodynamic biomarkers of efficacy of afatinib, a pan-HER tyrosine kinase inhibitor, in a window-of-opportunity trial (NCT01415674). Multi-omics analyses were carried out on pre-treatment biopsy and surgical specimen for biological assessment of afatinib activity. Sixty-one treatment-naïve and operable HNSCC patients were randomised to afatinib 40 mg/day for 21-28 days versus no treatment. Afatinib produced a high rate of metabolic response. Responders had a higher expression of pERK1/2 (P = 0.02) and lower expressions of pHER4 (P = 0.03) and pRB1 (P = 0.002) in pre-treatment biopsy compared to non-responders. At the cellular level, responders displayed an enrichment of tumor-infiltrating B cells under afatinib (P = 0.02). At the molecular level, NF-kappa B signaling was over-represented among upregulated genes in non-responders (P < 0.001; FDR = 0.01). Although exploratory, phosphoproteomics-based biomarkers deserve further investigations as predictors of afatinib efficacy.
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Affiliation(s)
- Grégoire Marret
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Maud Kamal
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Caroline Even
- Head and Neck Oncology Department, Gustave Roussy, Villejuif, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Centre Claudius Régaud, Toulouse, France
| | | | - Gilles Dolivet
- Department of Head and Neck Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - Olivier Malard
- Department of Head and Neck Surgery, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme Fayette
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Olivier Capitain
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Sébastien Vergez
- Department of Head and Neck Surgery, Institut Claudius Regaud, Toulouse, France
| | - Lionel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Frédéric Rolland
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - Philippe Zrounba
- Department of Head and Neck Surgery, Centre Léon Bérard, Lyon, France
| | - Laurent Laccourreye
- Department of Head and Neck Surgery, Centre Hospitalier Universitaire, Angers, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Nicolas Aide
- Department of Nuclear Medicine, Centre François Baclesse, Caen, France
| | | | | | - Constance Lamy
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Elodie Girard
- Bioinformatics Core Facility, INSERM U900, Mines Paris Tech, Institut Curie, Paris, France
| | | | | | - Leanne de Koning
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Vincent Puard
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Edith Borcoman
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | | | - Ivan Bièche
- Genetics Department, Institut Curie, Paris, France
| | - Jocelyn Gal
- Department of Biostatistics, Centre Antoine Lacassagne, Nice, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France.
- INSERM U900, Institut Curie, Paris-Saclay University, Paris, France.
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9
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Bredel D, Tihic E, Mouraud S, Danlos FX, Susini S, Aglave M, Alfaro A, Mohamed-Djalim C, Rouanne M, Halse H, Bigorgne A, Tselikas L, Dalle S, Hartl DM, Baudin E, Guettier C, Vibert E, Rosmorduc O, Robert C, Ferlicot S, Parier B, Albiges L, de Montpreville VT, Besse B, Mercier O, Even C, Breuskin I, Classe M, Radulescu C, Lebret T, Pautier P, Gouy S, Scoazec JY, Zitvogel L, Marabelle A, Bonvalet M. Immune checkpoints are predominantly co-expressed by clonally expanded CD4 +FoxP3 + intratumoral T-cells in primary human cancers. J Exp Clin Cancer Res 2023; 42:333. [PMID: 38057799 DOI: 10.1186/s13046-023-02897-6] [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: 07/14/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In addition to anti-PD(L)1, anti-CTLA-4 and anti-LAG-3, novel immune checkpoint proteins (ICP)-targeted antibodies have recently failed to demonstrate significant efficacy in clinical trials. In these trials, patients were enrolled without screening for drug target expression. Although these novel ICP-targeted antibodies were expected to stimulate anti-tumor CD8 + T-cells, the rationale for their target expression in human tumors relied on pre-clinical IHC stainings and transcriptomic data, which are poorly sensitive and specific techniques for assessing membrane protein expression on immune cell subsets. Our aim was to describe ICP expression on intratumoral T-cells from primary solid tumors to better design upcoming neoadjuvant cancer immunotherapy trials. METHODS We prospectively performed multiparameter flow cytometry and single-cell RNA sequencing (scRNA-Seq) paired with TCR sequencing on freshly resected human primary tumors of various histological types to precisely determine ICP expression levels within T-cell subsets. RESULTS Within a given tumor type, we found high inter-individual variability for tumor infiltrating CD45 + cells and for T-cells subsets. The proportions of CD8+ T-cells (~ 40%), CD4+ FoxP3- T-cells (~ 40%) and CD4+ FoxP3+ T-cells (~ 10%) were consistent across patients and indications. Intriguingly, both stimulatory (CD25, CD28, 4-1BB, ICOS, OX40) and inhibitory (PD-1, CTLA-4, PD-L1, CD39 and TIGIT) checkpoint proteins were predominantly co-expressed by intratumoral CD4+FoxP3+ T-cells. ScRNA-Seq paired with TCR sequencing revealed that T-cells with high clonality and high ICP expressions comprised over 80% of FoxP3+ cells among CD4+ T-cells. Unsupervised clustering of flow cytometry and scRNAseq data identified subsets of CD8+ T-cells and of CD4+ FoxP3- T-cells expressing certain checkpoints, though these expressions were generally lower than in CD4+ FoxP3+ T-cell subsets, both in terms of proportions among total T-cells and ICP expression levels. CONCLUSIONS Tumor histology alone does not reveal the complete picture of the tumor immune contexture. In clinical trials, assumptions regarding target expression should rely on more sensitive and specific techniques than conventional IHC or transcriptomics. Flow cytometry and scRNAseq accurately characterize ICP expression within immune cell subsets. Much like in hematology, flow cytometry can better describe the immune contexture of solid tumors, offering the opportunity to guide patient treatment according to drug target expression rather than tumor histological type.
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Affiliation(s)
- Delphine Bredel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
| | - Edi Tihic
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Séverine Mouraud
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France
| | - Sandrine Susini
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Marine Aglave
- Gustave Roussy, Plateforme de bioinformatique, F-94805, Villejuif, France
| | - Alexia Alfaro
- Gustave Roussy, Université Paris-Saclay, UMS 23/3655, Plateforme Imagerie Et Cytométrie, Villejuif, France
| | - Chifaou Mohamed-Djalim
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Mathieu Rouanne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Héloise Halse
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Amélie Bigorgne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Lambros Tselikas
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Stéphane Dalle
- Department of Dermatology, HCL Cancer Institute, Lyon Cancer Research Center, 69495, Lyon, France
| | - Dana M Hartl
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Eric Baudin
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Catherine Guettier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
| | - Eric Vibert
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Olivier Rosmorduc
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Caroline Robert
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U981, Gustave Roussy, 94805, Villejuif, France
| | - Sophie Ferlicot
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- Centre National de Recherche Scientifique (CNRS), Gustave Roussy, Université Paris-Saclay, UMR 9019, 94805, Villejuif, France
| | - Bastien Parier
- Service de Chirurgie Urologique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Laurence Albiges
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | | | - Benjamin Besse
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Olaf Mercier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service de Chirurgie Thoracique Et Transplantation Cardio-Pulmonaire, Hôpital Marie-Lannelongue, UMR_S 999 INSERM, Université Paris-Saclay, GHPSJ, 92350, Le Plessis-Robinson, France
| | - Caroline Even
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Ingrid Breuskin
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Marion Classe
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Camélia Radulescu
- Département de Pathologie, Hôpital Foch, UVSQ, Université Paris-Saclay, 92150, Suresnes, France
| | - Thierry Lebret
- Département d'Urologie, Hôpital Foch, UVSQ-Université Paris-Saclay, 92150, Suresnes, France
| | - Patricia Pautier
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Sébastien Gouy
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Jean-Yves Scoazec
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Aurélien Marabelle
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France.
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France.
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France.
| | - Mélodie Bonvalet
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
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Sarradin V, Digue L, Vergez S, Thariat J, Fakhry N, Chabrillac E, Bensadoun RJ, Ferrand FR, Even C. Systemic therapies for salivary gland carcinoma (excluding adenoid cystic carcinoma): REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2023:S1879-7296(23)00156-4. [PMID: 38040592 DOI: 10.1016/j.anorl.2023.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To determine the therapeutic indications for systemic medical treatment in the management of salivary gland carcinoma (excluding adenoid cystic carcinoma) according to the clinical situation. MATERIALS AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS Salivary gland carcinoma is rare and there is currently insufficient evidence to indicate chemotherapy at the localized stage. At the metastatic stage, initial management can be based on a phase of monitoring for indolent disease. Some histological subtypes (salivary duct carcinoma and adenocarcinoma) are more aggressive and require systemic treatment from the outset. To guide systemic treatment, it is recommended to perform immunohistochemistry and molecular biology analyses (overexpression of HER2 and androgen receptors, NTRK fusion, next-generation sequencing). CONCLUSION Salivary gland carcinoma is a rare tumor for which there are currently few effective medical treatments. It is therefore recommended to include patients in clinical trials.
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Affiliation(s)
- V Sarradin
- Département d'oncologie médicale, institut universitaire du cancer Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - L Digue
- Département d'oncologie médicale, hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - S Vergez
- Département de chirurgie ORL et cervico-faciale, CHU de Toulouse-Larrey, université Toulouse III Paul-Sabatier, Toulouse, France; Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, Caen, France
| | - N Fakhry
- Département d'ORL et chirurgie cervico-faciale, hôpital La Conception, AP-HM, Marseille, France
| | - E Chabrillac
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France
| | - R-J Bensadoun
- Centre de haute énergie, clinique Saint-Georges, Nice, France
| | - F-R Ferrand
- Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France; Institut de recherche biomédicale des Armées, Brétigny-sur-Orge, France
| | - C Even
- Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France
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11
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Thariat J, Ferrand FR, Fakhry N, Even C, Vergez S, Chabrillac E, Sarradin V, Digue L, Troussier I, Bensadoun RJ. Radiotherapy for salivary gland cancer: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2023:S1879-7296(23)00158-8. [PMID: 38030445 DOI: 10.1016/j.anorl.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To determine the indications for radiotherapy in salivary gland cancer and to specify the modalities and target radiation volumes. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS Postoperatively, radiotherapy to the primary tumor site±to the lymph nodes is indicated if one or more of the following adverse histoprognostic factors are present (risk>10% of locoregional recurrence): T3-T4 category, lymph node invasion, extraglandular invasion, close or positive surgical margins, high tumor grade, perineural invasion, vascular emboli, and/or bone invasion. Intensity-modulated radiation therapy (IMRT) is the gold standard. For unresectable cancers or inoperable patients, carbon ion hadrontherapy may be considered. CONCLUSION Radiotherapy in salivary gland cancer is indicated in postoperative situations in case of adverse histoprognostic factors and for inoperable tumors.
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Affiliation(s)
- J Thariat
- Département de radiothérapie, centre François-Baclesse, Caen, France
| | - F-R Ferrand
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France
| | - N Fakhry
- Département d'ORL et chirurgie cervico-faciale, hôpital La Conception, AP-HM, Aix-Marseille University, 147, boulevard Baille, 13005 Marseille, France.
| | - C Even
- Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France
| | - S Vergez
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France; Département de chirurgie ORL et cervico-faciale, CHU de Toulouse-Larrey, université Toulouse III Paul-Sabatier, Toulouse, France
| | - E Chabrillac
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France
| | - V Sarradin
- Département d'oncologie médicale, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France
| | - L Digue
- Département d'oncologie médicale, hôpital Saint-André, Bordeaux, France
| | - I Troussier
- Département d'oncologie radiothérapie, centre de haute énergie, Nice, France
| | - R-J Bensadoun
- Département d'oncologie radiothérapie, centre de haute énergie, Nice, France
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12
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Alouani E, Laparra A, Perret A, Sakkal M, Messayke S, Danlos FX, Ouali K, Hollebecque A, Even C, Ammari S, Baldini C, Champiat S, Besse B, Robert C, Guettier C, Samuel D, Lambotte O, De Martin E, Michot JM. Immunosuppressant mycophenolate mofetil for patients with steroid-refractory immune-related hepatitis induced by checkpoint inhibitors in oncology. Eur J Cancer 2023; 193:113313. [PMID: 37748398 DOI: 10.1016/j.ejca.2023.113313] [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: 06/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Immune-checkpoint inhibitor (ICI) hepatitis, which does not improve with steroids and requires additional immunosuppressant, is defined as steroid-refractory ICI hepatitis. The outcome of patients with steroid-refractory ICI hepatitis remains poorly determined. Herein, we investigated the incidence, clinical features, and outcome of patients treated with second-line immunosuppressant for steroid-refractory ICI hepatitis. METHODS This is a retrospective analysis of patients who presented ICI hepatitis from 1st June 2016 to 30th September 2022. Steroid-refractory ICI hepatitis was defined as no clinical and biological improvement after systemic steroid therapy ≥1 mg/kg/d. Main objectives were to assess the frequency and risk factors associated with steroid-refractory ICI hepatitis and to evaluate the efficacy of second-line immunosuppressants. RESULTS In total, 130 patients with grade ≥3 ICI hepatitis were screened, of them 60 (46.2%) were treated with systemic steroids. In total, 11/130 (8.5%) had steroid-refractory hepatitis. Statistically significant factors associated with steroid-refractory hepatitis included previous liver comorbidities (54.5% versus 11.6%; p < 0.01), hyperbilirubinemia (p < 0.001), and general symptoms (fever, jaundice, ascites, and/or encephalopathy) associated with hepatitis (72.7% versus 30.8%; p = 0.015). The 11 patients with steroid-refractory hepatitis were treated with mycophenolate mofetil. In total, resolution or return to grade ≤1 for hepatitis was observed in 81.8% (9/11) of patients. CONCLUSIONS Steroid-refractory ICI hepatitis accounted for 8.5% of patients with grade ≥3 immune-related hepatitis and was statistically associated with previous liver comorbidities, hyperbilirubinemia, and general symptoms. Mycophenolate mofetil was a suitable option of therapy for steroid-refractory ICI hepatitis.
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Affiliation(s)
- Emily Alouani
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France; Digestive Medical Oncology Department, IUCT-Rangueil, Toulouse Hospital University, Toulouse, France
| | - Ariane Laparra
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Audrey Perret
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Madonna Sakkal
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Sabine Messayke
- Pharmacovigilance Unit, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Francois-Xavier Danlos
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France; INSERM U1015 and CIC1428 BIOTHERIS, Gustave Roussy, Villejuif, France
| | - Kaissa Ouali
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Antoine Hollebecque
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Caroline Even
- Department of Medical Oncology, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Samy Ammari
- ELSAN Department of Radiology, Institut de Cancérologie Paris Nord, Sarcelles, France; Department of Radiology, Gustave Roussy Cancer Campus, Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Capucine Baldini
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Stéphane Champiat
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Caroline Robert
- Department of Medical Oncology, Gustave Roussy - Paris-Saclay University, Villejuif, France
| | - Catherine Guettier
- Department of Pathology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, UMR-S 1193, Le Kremlin Bicêtre, France
| | - Didier Samuel
- Department of Hepatology, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Centre Hépato-Biliaire, INSERM 1193, Villejuif, France
| | - Olivier Lambotte
- Internal Médecine Department, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France; IDMIT Department, IBFJ, Centre Immunology of Viral Infections and Autoimmune Diseases, INSERM, CEA, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Eleonora De Martin
- Department of Hepatology, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Centre Hépato-Biliaire, INSERM 1193, Villejuif, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy - Paris-Saclay University, Villejuif, France; INSERM U1170, Université Paris-Saclay, Gustave Roussy, Villejuif, France.
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13
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van Herpen C, Vander Poorten V, Skalova A, Terhaard C, Maroldi R, van Engen A, Baujat B, Locati LD, Jensen AD, Smeele L, Hardillo J, Costes Martineau V, Trama A, Kinloch E, Even C, Machiels JP. Corrigendum to 'Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up': [ESMO Open 7(6):100602, December 2022]. ESMO Open 2023; 8:101630. [PMID: 37625197 PMCID: PMC10470209 DOI: 10.1016/j.esmoop.2023.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Affiliation(s)
- C van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - V Vander Poorten
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Skalova
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - C Terhaard
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands
| | - R Maroldi
- Department of Radiology, ASST Spedali Civili-Bresciad University of Brescia, Brescia, Italy
| | - A van Engen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Baujat
- Department of Otorhinolaryngology, Head and Neck Surgery, Sorbonne Université Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A D Jensen
- Faculty of Medicine, Philipps-University Marburg, Marburg; Department of Radiation Oncology, University Hospitals Gießen and Marburg (UKGM) Ltd, Gießen, Germany
| | - L Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek Ziekenhuis & Amsterdam UMC, Amsterdam
| | - J Hardillo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - A Trama
- Evaluative Epidemiology, Department of Research, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Kinloch
- Salivary Gland Cancer UK, London, UK
| | - C Even
- Head and Neck Department, Gustave Roussy, Paris; French Network for Rare Head and Neck Cancers, Paris, France
| | - J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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14
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Blay JY, Chevret S, Le Cesne A, Brahmi M, Penel N, Cousin S, Bertucci F, Bompas E, Ryckewaert T, Soibinet P, Boudou-Rouquette P, Saada Bouzid E, Soulie P, Valentin T, Lotz JP, Tosi D, Neviere Z, Cancel M, Ray-Coquard I, Gambotti L, Legrand F, Lamrani-Ghaouti A, Simon C, Even C, Massard C. Pembrolizumab in patients with rare and ultra-rare sarcomas (AcSé Pembrolizumab): analysis of a subgroup from a non-randomised, open-label, phase 2, basket trial. Lancet Oncol 2023; 24:892-902. [PMID: 37429302 DOI: 10.1016/s1470-2045(23)00282-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Sarcoma is a heterogeneous group of diseases with few treatment options. Immunotherapy has shown little activity in studies including unselected sarcomas, but immune checkpoint blockers have shown activity in specific histotypes. We evaluated the activity of pembrolizumab in rare and ultra-rare sarcomas. METHODS AcSé Pembrolizumab is an ongoing phase 2, basket, multitumour study investigating the activity of pembrolizumab monotherapy in rare cancers. Here, we report the results obtained in patients with selected histotypes of rare sarcomas (incidence of less than one case per 1 000 000 people per year) recruited at 24 French hospitals. Key inclusion criteria were age 15 years or older, Eastern Cooperative Oncology Group performance status of 0-1, and advanced disease that was untreated and resistant to treatment. Patients were given pembrolizumab 200 mg intravenously on day 1 of every 21-day cycle for a maximum of 24 months. The primary endpoint was objective response rate at week 12 using Response Evaluation Criteria in Solid Tumours version 1.1, assessed by local investigators. The primary endpoint and safety were analysed in the intention-to-treat population. The AcSé Pembrolizumab study is registered with ClinicalTrials.gov, NCT03012620. FINDINGS Between Sept 4, 2017, and Dec 29, 2020, 98 patients were enrolled, of whom 97 received treatment and were included in analyses (median age 51 years [IQR 35-65]; 53 [55%] were male; 44 [45%] were female; no data were collected on race or ethnicity). 34 (35%) patients had chordomas, 14 (14%) had alveolar soft part sarcomas, 12 (12%) had SMARCA4-deficient sarcomas or malignant rhabdoid tumours, eight (8%) had desmoplastic small round cell tumours, six (6%) had epithelioid sarcomas, four (4%) had dendritic cell sarcomas, three (3%) each had clear cell sarcomas, solitary fibrous tumours, and myxoid liposarcomas, and ten (10%) had other ultra-rare histotypes. As of data cutoff (April 11, 2022), median follow-up was 13·1 months (range 0·1-52·8; IQR 4·3-19·7). At week 12, objective response rate was 6·2% (95% CI 2·3-13·0), with no complete responses and six partial responses in the 97 patients. The most common grade 3-4 adverse events were anaemia (eight [8%] of 97), alanine aminotransferase and aspartate aminotransferase increase (six [6%]), and dyspnoea (five [5%]). 86 serious adverse events were reported in 37 patients. Five deaths due to adverse events were reported, none of which were determined to be related to treatment (two due to disease progression, two due to cancer, and one due to unknown cause). INTERPRETATION Our data show the activity and manageable toxicity of pembrolizumab in some rare and ultra-rare sarcoma histotypes, and support the PD-1/PD-L1 pathway as a potential therapeutic target in selected histotypes. The completion of the basket study will provide further evidence regarding the activity and toxicity of pembrolizumab in identified rare types of cancer. FUNDING The Ligue contre le cancer, INCa, MSD. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jean-Yves Blay
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France.
| | - Sylvie Chevret
- Service de Biostatistique, Hôpital Saint Louis (AP-HP), Université Paris Cité, Paris, France
| | - Axel Le Cesne
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Mehdi Brahmi
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Emmanuelle Bompas
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes, France
| | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | - Diego Tosi
- Institut Régional du Cancer de Montpellier, Centre Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | | | | | - Caroline Even
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
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Chabrillac E, Even C, Costes-Martineau V, Fakhry N, Digue L, Moya-Plana A, Baujat B, Righini CA, De Gabory L, Verillaud B, Vergez S, Thariat J. [Rare cancers of the head and neck on behalf of the REFCOR, part 1]. Bull Cancer 2023; 110:692-699. [PMID: 37169603 DOI: 10.1016/j.bulcan.2023.04.008] [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: 02/18/2023] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
Among the 16,000 new cases of malignant tumors of the head and neck diagnosed in France each year, 10% are not conventional squamous cell carcinomas. These so-called rare cancers are distinguished by their presentation and patterns of failure, which is important to recognize in order to offer specific adapted management and maximize the chances of tumor control. These cancers can be rare by their histology, which determines their local invasiveness, and their hematogenous/nodal spread. Their diagnosis can be difficult and often requires comprehensive immunohistochemistry and genomic techniques. Expert pathology review is recommended in the cases of undifferentiated tumors, sarcomas and at the slightest diagnostic doubt. These rare cancers can also be rare by their anatomical location when arising from the paranasal sinuses, salivary glands and ear. Their location requires knowledge of their specific extension routes, and may call for a specific surgical technique (skull base endoscopic sinus surgery, extended total parotidectomy, etc.) and adapted radiotherapy to spare healthy organs surrounding the tumor. This article (part 1) discusses the diagnostic and therapeutic specificities of these rare cancers, and develops the recommendations of the French ENT Cancer Expertise Network (REFCOR) concerning rare epithelial tumors, i.e., salivary tumors, sinonasal tumors, variants of conventional squamous cell carcinomas, neuroendocrine carcinomas, malignant odontogenic tumors, and ear tumors. A second article (part 2) is focused on non-epithelial tumors (sarcomas, mucosal melanomas, lymphomas, tumors of uncertain or undetermined malignancy) and describes the organization and missions of the REFCOR.
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Affiliation(s)
- Emilien Chabrillac
- Institut universitaire du cancer Toulouse - Oncopole, département de chirurgie, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France
| | - Caroline Even
- Institut Gustave Roussy, département d'oncologie médicale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Valérie Costes-Martineau
- CHU de Montpellier, département de biopathologie, 191, avenue du doyen Gaston-Giraud, 34295 Montpellier, France
| | - Nicolas Fakhry
- Hôpital La Conception, département de chirurgie ORL et cervico-faciale, 147, boulevard Baille, 13005 Marseille, France
| | - Laurence Digue
- Hôpital Saint-André, département d'oncologie médicale, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - Antoine Moya-Plana
- Institut Gustave Roussy, département de chirurgie ORL et cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Bertrand Baujat
- Hôpital Tenon, département de chirurgie ORL et cervico-faciale, 4, rue de la Chine, 75020 Paris, France
| | - Christian-Adrien Righini
- CHU de Grenoble-Alpes, département de chirurgie ORL et cervico-faciale, 1, avenue du maquis du Grésivaudan, 38700 La Tronche, France
| | - Ludovic De Gabory
- CHU Pellegrin, département de chirurgie ORL et cervico-faciale, 1, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Benjamin Verillaud
- Hôpital Lariboisière, département de chirurgie ORL et cervico-faciale, 2, rue Ambroise Paré, 75010 Paris, France
| | - Sébastien Vergez
- CHU de Toulouse-Larrey et institut universitaire du cancer Toulouse - Oncopole, département de chirurgie ORL et cervico-faciale, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France
| | - Juliette Thariat
- Centre François-Baclesse, département de radiothérapie, 3, avenue du général-Harris, 14000 Caen, France.
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16
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Harrington KJ, Ferris RL, Gillison M, Tahara M, Argiris A, Fayette J, Schenker M, Bratland Å, Walker JWT, Grell P, Even C, Chung CH, Redman R, Coutte A, Salas S, Grant C, de Azevedo S, Soulières D, Hansen AR, Wei L, Khan TA, Miller-Moslin K, Roberts M, Haddad R. Efficacy and Safety of Nivolumab Plus Ipilimumab vs Nivolumab Alone for Treatment of Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck: The Phase 2 CheckMate 714 Randomized Clinical Trial. JAMA Oncol 2023; 9:779-789. [PMID: 37022706 PMCID: PMC10080406 DOI: 10.1001/jamaoncol.2023.0147] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/10/2022] [Indexed: 04/07/2023]
Abstract
Importance There remains an unmet need to improve clinical outcomes in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Objective To evaluate clinical benefit of first-line nivolumab plus ipilimumab vs nivolumab alone in patients with R/M SCCHN. Design, Setting, and Participants The CheckMate 714, double-blind, phase 2 randomized clinical trial was conducted at 83 sites in 21 countries between October 20, 2016, and January 23, 2019. Eligible participants were aged 18 years or older and had platinum-refractory or platinum-eligible R/M SCCHN and no prior systemic therapy for R/M disease. Data were analyzed from October 20, 2016 (first patient, first visit), to March 8, 2019 (primary database lock), and April 6, 2020 (overall survival database lock). Interventions Patients were randomized 2:1 to receive nivolumab (3 mg/kg intravenously [IV] every 2 weeks) plus ipilimumab (1 mg/kg IV every 6 weeks) or nivolumab (3 mg/kg IV every 2 weeks) plus placebo for up to 2 years or until disease progression, unacceptable toxic effects, or consent withdrawal. Main Outcomes and Measures The primary end points were objective response rate (ORR) and duration of response between treatment arms by blinded independent central review in the population with platinum-refractory R/M SCCHN. Exploratory end points included safety. Results Of 425 included patients, 241 (56.7%; median age, 59 [range, 24-82] years; 194 males [80.5%]) had platinum-refractory disease (nivolumab plus ipilimumab, n = 159; nivolumab, n = 82) and 184 (43.3%; median age, 62 [range, 33-88] years; 152 males [82.6%]) had platinum-eligible disease (nivolumab plus ipilimumab, n = 123; nivolumab, n = 61). At primary database lock, the ORR in the population with platinum-refractory disease was 13.2% (95% CI, 8.4%-19.5%) with nivolumab plus ipilimumab vs 18.3% (95% CI, 10.6%-28.4%) with nivolumab (odds ratio [OR], 0.68; 95.5% CI, 0.33-1.43; P = .29). Median duration of response for nivolumab plus ipilimumab was not reached (NR) (95% CI, 11.0 months to NR) vs 11.1 months (95% CI, 4.1 months to NR) for nivolumab. In the population with platinum-eligible disease, the ORR was 20.3% (95% CI, 13.6%-28.5%) with nivolumab plus ipilimumab vs 29.5% (95% CI, 18.5%-42.6%) with nivolumab. The rates of grade 3 or 4 treatment-related adverse events with nivolumab plus ipilimumab vs nivolumab were 15.8% (25 of 158) vs 14.6% (12 of 82) in the population with platinum-refractory disease and 24.6% (30 of 122) vs 13.1% (8 of 61) in the population with platinum-eligible disease. Conclusions and Relevance The CheckMate 714 randomized clinical trial did not meet its primary end point of ORR benefit with first-line nivolumab plus ipilimumab vs nivolumab alone in platinum-refractory R/M SCCHN. Nivolumab plus ipilimumab was associated with an acceptable safety profile. Research to identify patient subpopulations in R/M SCCHN that would benefit from nivolumab plus ipilimumab over nivolumab monotherapy is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02823574.
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Affiliation(s)
- Kevin J. Harrington
- Royal Marsden Hospital/The Institute of Cancer Research National Institute for Health and Care Research Biomedical Research Centre, London, United Kingdom
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Athanasios Argiris
- Hygeia Hospital, Marousi, Greece
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jérôme Fayette
- Centre Léon Bérard, Lyon, France
- Hôpital Saint-André, Bordeaux, France
| | | | | | | | - Peter Grell
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Rebecca Redman
- University of Louisville, Brown Cancer Center, Louisville, Kentucky
| | | | - Sébastien Salas
- Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | | | | | | | - Aaron R. Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Li Wei
- Bristol Myers Squibb, Princeton, New Jersey
| | | | | | | | - Robert Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Chabrillac E, Even C, Costes-Martineau V, Fakhry N, Digue L, Moya-Plana A, Baujat B, Righini CA, De Gabory L, Verillaud B, Vergez S, Thariat J. [Rare cancers of the head and neck on behalf of the REFCOR, part 2]. Bull Cancer 2023:S0007-4551(23)00202-3. [PMID: 37169602 DOI: 10.1016/j.bulcan.2023.04.007] [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: 02/18/2023] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
Among the 16,000 new cases of malignant tumors of the head and neck diagnosed in France each year, 10% are not conventional squamous cell carcinomas. These so-called rare cancers are distinguished by their presentation and patterns of failure, which is important to recognize in order to offer specific adapted management and maximize the chances of tumor control. These cancers can be rare by their histology as well as their anatomical location when arising from the paranasal sinuses, salivary glands and ear. The management of these heterogeneous rare diseases of complex treatment has considerably been structured over the last 15 years, in particular via the French ENT Cancer Expertise Network (REFCOR) and international networks and registries (EURACAN, etc.). Structuration also favors research with identification of new entities and setting up of specific therapeutic trials. A first article (part 1) discusses the diagnostic and therapeutic specificities of these rare cancers, and develops the recommendations of the REFCOR concerning rare epithelial tumors, i.e., salivary tumors, sinonasal tumors, variants of conventional squamous cell carcinomas, neuroendocrine carcinomas, malignant odontogenic tumors, and ear tumors. This second article (part 2) is focused on non-epithelial tumors (sarcomas, mucosal melanomas, lymphomas, tumors of uncertain or undetermined malignancy) and describes the organization and missions of the REFCOR.
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Affiliation(s)
- Emilien Chabrillac
- Institut universitaire du cancer Toulouse-oncopole, département de chirurgie, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Caroline Even
- Institut Gustave Roussy, département d'oncologie médicale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Valérie Costes-Martineau
- CHU de Montpellier, département de biopathologie, 191, avenue du Doyen Gaston-Giraud, 34295 Montpellier, France
| | - Nicolas Fakhry
- Hôpital La Conception, département de chirurgie ORL et cervico-faciale, 147, boulevard Baille, 13005 Marseille, France
| | - Laurence Digue
- Hôpital Saint-André, département d'oncologie médicale, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - Antoine Moya-Plana
- Institut Gustave-Roussy, département de chirurgie ORL et cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Bertrand Baujat
- Hôpital Tenon, département de chirurgie ORL et cervico-faciale, 4, rue de la Chine, 75020 Paris, France
| | - Christian-Adrien Righini
- CHU de Grenoble-Alpes, département de chirurgie ORL et cervico-faciale, 1, avenue du Maquis du Grésivaudan, 38700 La Tronche, France
| | - Ludovic De Gabory
- CHU de Pellegrin, département de chirurgie ORL et cervico-faciale, 1, Place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Benjamin Verillaud
- Hôpital Lariboisière, département de chirurgie ORL et cervico-faciale, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse-Larrey, département de chirurgie ORL et cervico-faciale, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Juliette Thariat
- Centre François-Baclesse, département de radiothérapie, 3, avenue du Général-Harris, 14000 Caen, France.
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Tang E, Schwartz B, Limkin E, Even C, Blanchard P, Haddy N, Gorphe P, Ferrand FR, Tao Y, Nguyen TVF. Locoregional treatment of primary tumor in synchronous metastatic head and neck squamous cell carcinomas. Acta Oncol 2023:1-8. [PMID: 37151099 DOI: 10.1080/0284186x.2023.2209266] [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] [Indexed: 05/09/2023]
Abstract
PURPOSE Patients with synchronous metastatic head and neck squamous cell carcinomas (mHNSCC) are at risk of locoregional progression associated with significant morbidity and mortality. The aim of this study is to assess whether the addition of aggressive locoregional treatment to systemic therapy could be associated with an improved overall survival (OS) compared to systemic therapy alone in upfront mHNSCC patients. MATERIAL AND METHODS This retrospective study included patients presenting with previously untreated mHNSCC who underwent first-line systemic therapy at a single institution between 1998 and 2018. Locoregional treatment was defined as either exclusive locoregional radiotherapy (RT) or surgery with or without adjuvant RT. RESULTS One hundred forty-eight patients were included. Eighty patients were treated with systemic therapy alone and 68 patients were treated with a combination of locoregional treatment and systemic therapy. Median overall survival (OS) was 13 months [10.7-15] and median progression free survival (PFS) was 7.7 month [6.5-8.9]. The addition of a locoregional treatment to systemic therapy compared to systemic therapy alone was associated with improved survival (1-year OS, 65.8% vs. 41.1%, p < .001, and 1-year PFS, 42.5% vs. 18.5%, p < .001). Moreover, RT dose equal to 70 Gy was associated with even longer OS compared to a RT dose below 70 Gy and to no locoregional treatment (23.4 vs. 12.7 vs 7.5 months respectively). In a subgroup analysis on 75 patients presenting with a responding or stable metastatic disease after first-line systemic therapy, oropharyngeal primary tumor site and the addition of a locoregional treatment, especially a high radiation dose of 70 Gy, were evidenced as independent prognostic factors for improved OS. CONCLUSION The addition of a high-dose RT locoregional treatment to systemic therapy is associated with prolonged OS in patients with synchronous mHNSCC and should be discussed for patients who respond to or have a stable disease after first-line systemic therapy.
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Affiliation(s)
- Eliane Tang
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Boris Schwartz
- Department of Radiation Epidemiology, Unité 1018 INSERM, Gustave Roussy, Villejuif, France
| | - Elaine Limkin
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Nadia Haddy
- Department of Radiation Epidemiology, Unité 1018 INSERM, Gustave Roussy, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | | | - Yungan Tao
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
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Haddad RI, Harrington K, Tahara M, Ferris RL, Gillison M, Fayette J, Daste A, Koralewski P, Zurawski B, Taberna M, Saba NF, Mak M, Kawecki A, Girotto G, Alvarez Avitia MA, Even C, Toledo JGR, Guminski A, Müller-Richter U, Kiyota N, Roberts M, Khan TA, Miller-Moslin K, Wei L, Argiris A. Nivolumab Plus Ipilimumab Versus EXTREME Regimen as First-Line Treatment for Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: The Final Results of CheckMate 651. J Clin Oncol 2023; 41:2166-2180. [PMID: 36473143 PMCID: PMC10115555 DOI: 10.1200/jco.22.00332] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/17/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE CheckMate 651 (ClinicalTrials.gov identifier: NCT02741570) evaluated first-line nivolumab plus ipilimumab versus EXTREME (cetuximab plus cisplatin/carboplatin plus fluorouracil ≤ six cycles, then cetuximab maintenance) in recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). METHODS Patients without prior systemic therapy for R/M SCCHN were randomly assigned 1:1 to nivolumab plus ipilimumab or EXTREME. Primary end points were overall survival (OS) in the all randomly assigned and programmed death-ligand 1 combined positive score (CPS) ≥ 20 populations. Secondary end points included OS in the programmed death-ligand 1 CPS ≥ 1 population, and progression-free survival, objective response rate, and duration of response in the all randomly assigned and CPS ≥ 20 populations. RESULTS Among 947 patients randomly assigned, 38.3% had CPS ≥ 20. There were no statistically significant differences in OS with nivolumab plus ipilimumab versus EXTREME in the all randomly assigned (median: 13.9 v 13.5 months; hazard ratio [HR], 0.95; 97.9% CI, 0.80 to 1.13; P = .4951) and CPS ≥ 20 (median: 17.6 v 14.6 months; HR, 0.78; 97.51% CI, 0.59 to 1.03; P = .0469) populations. In patients with CPS ≥ 1, the median OS was 15.7 versus 13.2 months (HR, 0.82; 95% CI, 0.69 to 0.97). Among patients with CPS ≥ 20, the median progression-free survival was 5.4 months (nivolumab plus ipilimumab) versus 7.0 months (EXTREME), objective response rate was 34.1% versus 36.0%, and median duration of response was 32.6 versus 7.0 months. Grade 3/4 treatment-related adverse events occurred in 28.2% of patients treated with nivolumab plus ipilimumab versus 70.7% treated with EXTREME. CONCLUSION CheckMate 651 did not meet its primary end points of OS in the all randomly assigned or CPS ≥ 20 populations. Nivolumab plus ipilimumab showed a favorable safety profile compared with EXTREME. There continues to be a need for new therapies in patients with R/M SCCHN.
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Affiliation(s)
- Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kevin Harrington
- Royal Marsden Hospital/The Institute of Cancer Research NIHR Biomedical Research Centre, London, United Kingdom
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Piotr Koralewski
- Wojewodzki Szpital Specjalistyczny im. Ludwika Rydygiera w Krakowie, Krakow, Poland
| | | | - Miren Taberna
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Milena Mak
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andrzej Kawecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Gustavo Girotto
- Hospital de Base de Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
| | | | | | | | | | - Urs Müller-Richter
- University Hospital Würzburg, Bavarian Cancer Research Center (BZKF), Würzburg, Germany
| | | | | | | | | | - Li Wei
- Bristol Myers Squibb, Princeton, NJ
| | - Athanassios Argiris
- Hygeia Hospital, Marousi, Greece
- Thomas Jefferson University, Philadelphia, PA
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20
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Chatelet F, Ferrand FR, Atallah S, Thariat J, Mouawad F, Fakhry N, Malard O, Even C, de Monès E, Uro-Coste E, Benzerdjeb N, Hans S, Testelin S, Mauvais O, Evrard D, Bastit V, Salas S, Espitalier F, Classe M, Digue L, Doré M, Wong S, Dupin C, Nguyen F, Bettoni J, Lapierre A, Colin E, Philouze P, Vergez S, Baujat B, Herman P, Verillaud B. Survival outcomes, prognostic factors, and effect of adjuvant radiotherapy and prophylactic neck dissection in salivary acinic cell carcinoma: A prospective multicenter REFCOR study of 187 patients. Eur J Cancer 2023; 185:11-27. [PMID: 36947928 DOI: 10.1016/j.ejca.2023.02.020] [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: 12/27/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Acinic cell carcinomas (AciCCs) are malignant tumours of the salivary glands. The aim of this work was to analyse data from the national REFCOR multicenter cohort (i) to investigate the prognostic factors influencing survival outcomes in AciCC, (ii) to assess the impact on survival of postoperative radiotherapy (RT) in patients treated for AciCC without high-grade transformation and (iii) to explore the prognostic impact of prophylactic neck dissection (ND) in patients treated for AciCC of the major salivary glands. PATIENTS AND METHODS Data from all the patients treated for salivary AciCC between 2009 and 2020 were extracted from the REFCOR database. Survival outcomes and prognostic factors influencing Disease-Free Survival (DFS) and Overall Survival (OS) were investigated using univariate and multivariate analyses. Propensity score matching was used to assess the impact of postoperative RT and prophylactic ND on DFS. RESULTS A total of 187 patients were included. After a median follow-up of 53 months, their 5-year OS and DFS rates were 92.8% and 76.2%, respectively. In multivariate analysis, male sex, older age, higher T and N status, and high grade were independently associated with a worse DFS. In the subpopulation analysed after propensity score matching, patients with cN0 AciCC without high-grade transformation who were treated by surgery and RT did not have an improved DFS compared to patients who were treated by surgery alone (hazard ratio (HR) = 0.87, p = 0.8). Factors associated with nodal invasion were T3-T4 status and intermediate/high histological grade. After propensity score matching, prophylactic ND was associated with a trend toward a better DFS (HR = 0.46, p = 0.16). CONCLUSIONS These results suggest that (i) long-term follow-up (>5 years) should be considered in patients with AciCC, (ii) treatment by surgery alone could be an option in selected cN0 patients with AciCC without high-grade transformation and (iii) prophylactic ND may be considered preferentially in patients with T3-T4 status and/or intermediate/high histological grade.
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Affiliation(s)
- Florian Chatelet
- Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France.
| | - François Régis Ferrand
- French Armed Forces Biomedical Research Institute, F-91220 Brétigny sur Orge, France; Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France
| | - Sarah Atallah
- Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, F-75020 Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 16 Avenue Paul Vaillant Couturier, F-94807 Villejuif, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre Francois Baclesse, F-14000 Caen, France; ARCHADE Research Community, F-14000 Caen, France; Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534-Normandie Université, F-14000 Caen, France
| | - François Mouawad
- Department of ENT-Head and Neck Surgery, Université de Lille, Hôpital Huriez, CHU de Lille, Rue Michel Polonovski, 59000 Lille, France; Inserm U 908, Université des Sciences et Technologies de Lille, UFR de Biologie - SN3, 59655 Villeneuve d'Ascq, France
| | - Nicolas Fakhry
- Department of ENT-Head and Neck Surgery, CHU La Conception, AP-HM. Aix-Marseille Univ (AMU), Marseille, France
| | - Olivier Malard
- Service d'ORL et de chirurgie cervico-faciale CHU 1, INSERM U1229-RMeS, Place A. Ricordeau Hôtel-Dieu, F-44093 Nantes Cedex, France
| | - Caroline Even
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France
| | | | - Emmanuelle Uro-Coste
- Department of Pathological Anatomy and Histology-Cytology, Rangueil Hospital, Toulouse, France
| | - Nazim Benzerdjeb
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Sylvie Testelin
- EA 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, Amiens-Picardy University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Olivier Mauvais
- Department of ENT-Head and Neck Surgery, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Diane Evrard
- Université de Paris, Department of ENT-Head and Neck Surgery, Hôpital Bichat, AP-HP, 46 Rue Henri Huchard, F-75018 Paris, France
| | - Vianney Bastit
- Department of ENT-Head and Neck Surgery, François Baclesse Centre, 3 rue du Général Harris, 14000, Caen, France
| | - Sébastien Salas
- Medical Oncology Department, Centre Hospitalier (CHU) La Timone, F-13000, Marseille, France
| | - Florent Espitalier
- Department of Otolaryngology-Head and Neck Surgery, CHU de Nantes, F-44093 Nantes, France
| | - Marion Classe
- Pathology Department, Gustave Roussy Cancer Campus, France
| | | | - Mélanie Doré
- Institut de cancérologie de l'Ouest Nantes, 2 boulevard Jacques Monod, F-44805 Saint Herblain, France
| | - Stéphanie Wong
- Radiation Oncology Department, Hôpital Timone Adultes, 264 Rue Saint-Pierre, F-13005 Marseille, France
| | - Charles Dupin
- Department of Radiation Therapy, Hôpital de Haut Lévèque, Bordeaux University Hospital-CHU, F-33000 Bordeaux, France
| | - France Nguyen
- Onco-radiotherapy Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France
| | - Jeremie Bettoni
- EA 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, Amiens-Picardy University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Ariane Lapierre
- Claude Bernard University, Lyon 1, France; Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chem. du Grand Revoyet, F-69310 Pierre-Bénite, France
| | - Emilien Colin
- EA 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, Amiens-Picardy University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Pierre Philouze
- Claude Bernard University, Lyon 1, France; Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Vergez
- Department of Surgery, University Cancer Institute Toulouse - Oncopôle, University Hospital of Toulouse, F-31100 Toulouse, France
| | - Bertrand Baujat
- Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, F-75020 Paris, France
| | - Philippe Herman
- Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France; Université de Paris, INSERM U1141, Unité"NeuroDiderot", Université de Paris, F-75006 Paris, France
| | - Benjamin Verillaud
- Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France; Université de Paris, INSERM U1141, Unité"NeuroDiderot", Université de Paris, F-75006 Paris, France
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Bossi P, Chan AT, Even C, Machiels JP. ESMO-EURACAN Clinical Practice Guideline update for nasopharyngeal carcinoma: adjuvant therapy and first-line treatment of recurrent/metastatic disease. Ann Oncol 2023; 34:247-250. [PMID: 36529446 DOI: 10.1016/j.annonc.2022.11.011] [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: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - A T Chan
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China
| | - C Even
- Head and Neck Department, Gustave Roussy, Paris
| | - J-P Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc, Brussels; Institut de Recherche Clinique et Expérimentale (POLE MIRO), Université Catholique de Louvain, Brussels, Belgium
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22
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Tran BTT, Gelin A, Durand S, Texier M, Daste A, Toullec C, Benihoud K, Breuskin I, Gorphe P, Garic F, Brenner C, Le Tourneau C, Fayette J, Niki T, David M, Busson P, Even C. Plasma galectins and metabolites in advanced head and neck carcinomas: evidence of distinct immune characteristics linked to hypopharyngeal tumors. Oncoimmunology 2022; 12:2150472. [PMID: 36545254 PMCID: PMC9762837 DOI: 10.1080/2162402x.2022.2150472] [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] [Indexed: 12/23/2022] Open
Abstract
Extra-cellular galectins 1, 3 and 9 (gal-1, -3 and -9) are known to act as soluble immunosuppressive agents in various malignancies. Previous publications have suggested that their expression is dependent on the metabolic status of producing cells and reciprocally that they can influence metabolic pathways in their target cells. Very little is known about the status of gal-1, -3 and -9 in patients bearing head and neck squamous cell carcinomas (HNSCC) and about their relationships with the systemic metabolic condition. This study was conducted in plasma samples from a prospective cohort of 83 HNSCC patients with advanced disease. These samples were used to explore the distribution of gal-1, -3 and -9 and simultaneously to profile a series of 87 metabolites assessed by mass spectrometry. We identified galectin and metabolic patterns within five disease categories defined according to the primary site and human papillomavirus (HPV) status (HPV-positive and -negative oropharyngeal carcinomas, carcinomas of the oral cavity, hypopharynx and larynx carcinomas). Remarkably, samples related to hypopharyngeal carcinomas displayed the highest average concentration of gal-9 (p = .017) and a trend toward higher concentrations of kynurenine, a potential factor of tumor growth and immune suppression. In contrast, there was a tendency toward higher concentrations of fatty acids in samples related to oral cavity. These observations emphasize the diversity of HPV-negative HNSCCs. Depending on their primary site, they evolve into distinct types of immune and metabolic landscapes that seem to be congruent with specific oncogenic mechanisms.
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Affiliation(s)
- Bao-Tram Thi Tran
- CNRS UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Aurore Gelin
- CNRS UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Sylvère Durand
- Plateforme de Métabolomique/UMR 1138, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Matthieu Texier
- Service d’Epidémiologie et de Biostatistiques, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint André, Bordeaux, France
| | - Clémence Toullec
- GI and Liver/Head and Neck unit, Institut du Cancer-Avignon Provence, Avignon, France
| | - Karim Benihoud
- CNRS UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Ingrid Breuskin
- Service de Cancérologie Cervico-Faciale, Gustave Roussy, Villejuif, France
| | - Philippe Gorphe
- Service de Cancérologie Cervico-Faciale, Gustave Roussy, Villejuif, France
| | | | - Catherine Brenner
- CNRS UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie and Paris-Saclay University, Paris, France
| | - Jérôme Fayette
- Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286 & Department of Medical Oncology, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Toshiro Niki
- Department of Immunology, Kagawa University, Kita-gun, Japan
| | - Muriel David
- HiFiBiO Therapeutics, Pépinière Paris Santé Cochin, Paris, France
| | - Pierre Busson
- CNRS UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France,CONTACT Pierre Busson CNRS UMR 9018-METSY, Gustave Roussy, 39, Rue Camile Desmoulins, F-94805Villejuif, France
| | - Caroline Even
- Service de Cancérologie Cervico-Faciale, Gustave Roussy, Villejuif, France
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23
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van Herpen C, Vander Poorten V, Skalova A, Terhaard C, Maroldi R, van Engen A, Baujat B, Locati LD, Jensen AD, Smeele L, Hardillo J, Martineau VC, Trama A, Kinloch E, Even C, Machiels JP. Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Open 2022; 7:100602. [PMID: 36567082 PMCID: PMC9808465 DOI: 10.1016/j.esmoop.2022.100602] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
•This ESMO–EURACAN Clinical Practice Guideline provides key recommendations for managing salivary gland cancer. •The guideline covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-up. •Treatment algorithms for parotid, submandibular, sublingual and minor salivary gland cancer are provided. •The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe. •Recommendations are based on available scientific data and the authors’ collective expert opinion.
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Affiliation(s)
- C van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Multidisciplinary Salivary Gland Society, Geneva, Switzerland. https://twitter.com/myESMO
| | - V Vander Poorten
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Skalova
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - C Terhaard
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland; Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands
| | - R Maroldi
- Department of Radiology, ASST Spedali Civili Brescia-University of Brescia, Brescia, Italy
| | - A van Engen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Baujat
- Department of Otorhinolaryngology, Head and Neck Surgery, Sorbonne Université Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A D Jensen
- Faculty of Medicine, Philipps-University Marburg, Marburg; Department of Radiation Oncology, University Hospitals Gießen and Marburg (UKGM) Ltd, Gießen, Germany
| | - L Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek Ziekenhuis & Amsterdam UMC, Amsterdam
| | - J Hardillo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - A Trama
- Evaluative Epidemiology, Department of Research, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Kinloch
- Salivary Gland Cancer UK, London, UK
| | - C Even
- Head and Neck Department, Gustave Roussy, Paris; French Network for Rare Head and Neck Cancers, Paris, France
| | - J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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24
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Hwang M, Chia YL, Zheng Y, Chen CCK, He J, Song X, Zhou D, Goldberg SB, Siu LL, Planchard D, Peters S, Mann H, Krug L, Even C. Population pharmacokinetic modelling of tremelimumab in patients with advanced solid tumours and the impact of disease status on time-varying clearance. Br J Clin Pharmacol 2022; 89:1601-1616. [PMID: 36454221 DOI: 10.1111/bcp.15622] [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: 07/01/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Tremelimumab, a cytotoxic T-lymphocyte-associated protein 4 human monoclonal antibody of the immunoglobulin G2 κ isotype, has been studied in oncology clinical trials as both monotherapy and in combination with durvalumab. This study characterized the pharmacokinetics of tremelimumab as monotherapy and in combination with durvalumab and evaluated the impact of patient covariates on pharmacokinetics. METHODS A pooled-analysis population pharmacokinetics model was built using NONMEM methodology. Pharmacokinetic data from 5 studies spanning different tumour types and therapy regimens were pooled for model development (956 patients). A dataset pooled from 4 additional studies was used for external validation (554 patients). Demographic and relevant clinical covariates were explored during model development. RESULTS Tremelimumab exhibited linear pharmacokinetics, well described by a 2-compartment model, with time-varying clearance (0.276 L/day at baseline) associated primarily with therapy regimen and linked with changes in disease status. As monotherapy and combination therapy, tremelimumab clearance over 1 year increased by ~16% and decreased by ~17%, respectively. Pharmacokinetic behaviour was consistent across patient demographics and cancer subtypes. Patients with higher bodyweight and lower albumin levels at baseline had significantly higher clearance; however, no dosage adjustments are warranted. A flat dose (75 mg) was projected to provide comparable exposure to weight-based dosing (1 mg/kg) in adults. CONCLUSION Tremelimumab exhibited linear pharmacokinetics but consistently opposite trends of time-varying clearance as monotherapy and in combination with durvalumab. Baseline bodyweight and albumin were significant covariates, but conversion from weight-based dosing at 1 mg/kg to flat dosing at 75 mg had no clinically relevant impact.
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Affiliation(s)
- Michael Hwang
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Yen Lin Chia
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Yanan Zheng
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Cecil Chi-Keung Chen
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Jimmy He
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Xuyang Song
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Diansong Zhou
- Clinical Pharmacology and Quantitative Pharmacology, Biopharmaceuticals R&D, AstraZeneca, Boston, MA, USA
| | - Sarah B Goldberg
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, CT, USA
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Planchard
- Department of Medical Oncology, Thoracic Unit, Institut Gustave-Roussy, Villejuif, France
| | - Solange Peters
- Department of Oncology CHUV-UNIL, University Hospital Lausanne, Lausanne, Switzerland
| | - Helen Mann
- Oncology Biometrics, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Lee Krug
- Late Development Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Caroline Even
- Head and Neck Department, Institut Gustave-Roussy, Villejuif, France
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25
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Vozy A, Roussel-Simonin C, Houessinon A, Bayle A, Blanc-Durand F, Ferrand F, Fouilloux A, Iacob M, Khalife N, Ponce S, Loriot Y, Baldini C, Italiano A, Even C. 129P Molecular screening and early phase trial inclusion for head and neck squamous cell carcinoma patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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26
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Gorphe P, Blanchard P, Garcia GCTE, Classe M, Even C, Temam S, Breuskin I. 2011-2021 rising prevalence of HPV infection among oropharyngeal carcinoma in France. BMC Cancer 2022; 22:1000. [PMID: 36127667 PMCID: PMC9490895 DOI: 10.1186/s12885-022-10091-8] [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: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background The objective of our study was to investigate changes over the past decade in patient age and the prevalence of HPV in the population of patients with oropharyngeal carcinoma (OPC) treated at our center. Methods We performed a retrospective cohort study of patients treated at our cancer center for OPC between 2011 and 2021. Tissue biopsies were assessed for HPV status based on p16 staining for all patients. Results There were 1,365 treated patients. The proportion of p16-positive patients increased from 43% in 2011 to 57.3% in 2021 (p = 0.01). The sex ratio was 3.6 M/1F for p16-positive and 3.7 M/1F for p16-negative patients (p = 0.94). The mean age increased from 60.2 y in 2011 to 63.6 y in 2021. The mean ages were 61.9 y for p16-positive and 61.7 y for p16-negative patients (p = 0.71), but there was a broader age distribution for the p16-positive patients (p = 0.03). The proportion of patients older than 70 y increased from 11% in 2011 to 28.2% in 2021, and this aging was similar between p16-positive (30.7% in 2021) and p16-negative (26.3% in 2021) patients. The 2-year and 5-year OS rates were 73.7% and 56.5% for the entire cohort. p16-positive patients had 2-year and 5-year OS rates of 86.8% and 77.4%, respectively, whereas p16-negative patients had 2-year and 5-year OS rates of 63.9% and 40.5%. Conclusions Assessment of the change over the past decade in the population of patients with OPC at our center showed that HPV-positive OPC now appear to have overtaken HPV-negative cases in France, with 57.3% in 2021, and showed significant aging, with almost thirty percent of patients now older than 70 years. Those combined changes emphasize some of the challenges to be addressed in future OPC management.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris Saclay, 114 rue Edouard Vaillant, 94800, Villejuif, France.
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Gabriel C T E Garcia
- Department of Radiology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Marion Classe
- Department of Pathology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy, University Paris Saclay, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy, University Paris Saclay, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy, University Paris Saclay, 114 rue Edouard Vaillant, 94800, Villejuif, France
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27
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Le Tourneau C, Salas S, Pointreau Y, Ceruse P, Babin E, Rondeau V, Guigay J, Rotarski M, Chehimi M, Toullec C, Marie G, Sire C, Darut Jouve A, Theron A, Calderon B, Houessinon A, Cotté FE, Lavignon M, Even C, Fayette J. 695P Effectiveness and quality-of-life (QoL) data from real-world study (ProNiHN) in patients (pts) with recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHN) treated with nivolumab (nivo) in France. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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28
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Chatelet F, Fakhry N, Garrel R, de Monès E, Saroul N, Mouawad F, Thariat J, Even C, Costes Martineau V, Herman P, Chevret S, Verillaud B. 694P Prognostic impact of facial nerve resection in patients treated for a primary parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric study of the REFCOR group with propensity score matching analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Peyraud F, Guegan JP, Bodet D, Nafia I, Fontan L, Auzanneau C, Cousin S, Roubaud G, Cabart M, Chomy F, Le Loarer F, Chaput N, Danlos FX, Planchard D, Even C, Khettab M, Tselikas L, Besse B, Barlesi F, Soria JC, Marabelle A, Bessede A, Italiano A. Circulating L-Arginine predicts the survival of cancer patients treated with immune checkpoint inhibitors. Ann Oncol 2022; 33:1041-1051. [PMID: 35850444 DOI: 10.1016/j.annonc.2022.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 04/17/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The discovery of immune checkpoint inhibitors (ICIs) has revolutionized the systemic approach to cancer treatment. However, most patients receiving ICIs do not derive benefits. Therefore, it is crucial to identify reliable predictive biomarkers of response to ICIs. One important pathway in regulating immune cell reactivity is L-arginine (ARG) metabolism, essential to T-cell activation. We therefore aimed to evaluate the association between baseline plasma ARG levels and the clinical benefit of ICIs. PATIENTS AND METHODS The correlation between ARG levels and clinical ICI activity was assessed by analyzing plasma samples obtained before treatment onset in two independent cohorts of patients with advanced cancer included in two institutional molecular profiling programs (BIP, NCT02534649, n = 77; PREMIS, NCT03984318, n = 296) and from patients in a phase 1 first-in-human study of budigalimab monotherapy (NCT03000257). Additionally, the correlation between ARG levels and ICI efficacy in preclinical settings was evaluated using a syngeneic mouse model of colorectal cancer responsive to ICIs. Using matched PBMC plasma samples, we analyzed the correlation between ARG levels and PBMC features through multiplexed flow cytometry analysis. RESULTS In both discovery and validation cohorts, low ARG levels at baseline (<42 μM) were significantly and independently associated with a worse clinical benefit rate, progression-free survival, and overall survival. Moreover, at the preclinical level, the tumor rejection rate was significantly higher in mice with high baseline ARG levels than in those with low ARG levels (85.7% versus 23.8%; P = 0.004). Finally, PBMC immunophenotyping showed that low ARG levels were significantly associated with increased PD-L1 expression in several immune cell subsets from the myeloid lineage. CONCLUSION We demonstrate that baseline ARG levels predict ICI response. Plasma ARG quantification may therefore represent an attractive biomarker to tailor novel therapeutic regimens targeting the ARG pathway in combination with ICIs.
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Affiliation(s)
- F Peyraud
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France; Department of Medicine, Institut Bergonié, Bordeaux, France; Explicyte Immuno-Oncology, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - J-P Guegan
- Explicyte Immuno-Oncology, Bordeaux, France
| | - D Bodet
- Explicyte Immuno-Oncology, Bordeaux, France
| | - I Nafia
- Explicyte Immuno-Oncology, Bordeaux, France
| | - L Fontan
- Explicyte Immuno-Oncology, Bordeaux, France
| | - C Auzanneau
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - S Cousin
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Cabart
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - F Chomy
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - F Le Loarer
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - N Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay, UFR pharmacy, Chatenay-Malabry F-92290, France
| | - F-X Danlos
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - D Planchard
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - C Even
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Khettab
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - L Tselikas
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
| | - B Besse
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - F Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - J-C Soria
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - A Marabelle
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France; Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - A Bessede
- Explicyte Immuno-Oncology, Bordeaux, France
| | - A Italiano
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France; Department of Medicine, Institut Bergonié, Bordeaux, France; University of Bordeaux, Bordeaux, France.
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30
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Even C, Delord JP, Price KA, Nakagawa K, Oh DY, Burge M, Chung HC, Doi T, Fakih M, Takahashi S, Yao L, Jin F, Norwood K, Hansen AR. Evaluation of pembrolizumab monotherapy in patients with previously treated advanced salivary gland carcinoma in the phase 2 KEYNOTE-158 study. Eur J Cancer 2022; 171:259-268. [PMID: 35777186 DOI: 10.1016/j.ejca.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 01/02/2023]
Abstract
AIM We evaluated pembrolizumab monotherapy in patients with advanced salivary gland carcinoma on the phase 2 KEYNOTE-158 study (NCT02628067). METHODS Eligible patients had histologically/cytologically confirmed advanced salivary gland carcinoma with prior failure or intolerance to standard therapy, measurable disease per Response Evaluation Criteria in Solid Tumours (RECIST) v1.1., and ECOG performance status 0-1. Patients were enrolled irrespective of tumour PD-L1 expression. Patients received pembrolizumab 200 mg Q3W for up to 35 cycles (∼2 years). Radiographic imaging occurred every 9 weeks through month 12, then every 12 weeks. PD-L1 positivity was defined as combined positive score ≥1 (evaluated using PD-L1 IHC 22C3 pharmDx). The primary endpoint was objective response rate per RECIST v1.1. RESULTS In total, 109 patients were enrolled (PD-L1-positive, 25.7%). At the data cutoff (October 5, 2020), median follow-up was 53.3 (range, 50.8-56.3) months. Objective response rate was 4.6% (95% CI, 1.5-10.4%) among all patients (complete response, n = 1; partial response, n = 4) and was 10.7% (95% CI, 2.3-28.2%) in patients with PD-L1-positive disease and 2.6% (95% CI, 0.3-9.1%) in patients with PD-L1-negative disease. Duration of response was ≥24 months for all 5 responders; median duration of response was not reached (range, 25.1-49.8+ months). Median progression-free survival and overall survival were 4.0 (95% CI, 2.6-4.2) and 21.1 (95% CI, 15.9-25.5) months, respectively. Treatment-related adverse events occurred in 75.2% (grade 3-4, 15.6%; grade 5, 0%) of patients. Immune-mediated adverse events occurred in 22.0% of patients (grade 3, 5.5%; grade 4-5, 0). CONCLUSIONS A small subset of patients with advanced salivary gland carcinoma treated with pembrolizumab had a response; all had response duration ≥2 years. The safety profile of pembrolizumab was manageable.
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Affiliation(s)
| | | | | | | | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Matthew Burge
- Royal Brisbane and Women's Hospital and University of Queensland, Herston, QLD, Australia
| | - Hyun C Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Toshihiko Doi
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Marwan Fakih
- City of Hope National Medical Center, Duarte, CA, USA
| | - Shunji Takahashi
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Lili Yao
- Merck & Co., Inc., Rahway, NJ, USA
| | - Fan Jin
- Merck & Co., Inc., Rahway, NJ, USA
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Marret G, Kamal M, Gal J, Temam S, Klijianenko J, Delord JP, Hoffmann C, Dolivet G, Malard O, Fayette J, Capitain O, Even C, Vergez S, Geoffrois L, Rolland F, Zrounba P, Laccourreye L, Guigay J, Aide N, Bénavent V, Lamy C, Girard E, Jimenez M, Bièche I, Tourneau CL. Abstract 1237: Randomized phase II trial of pre-operative afatinib in non-metastatic head and neck squamous cell carcinoma patients: Identification of predictive biomarkers of response. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Epidermal growth factor receptor (EGFR) inhibitors, including monoclonal antibodies and tyrosine kinase inhibitors, have limited efficacy in head and neck squamous cell carcinoma (HNSCC) patients. In the randomized phase II PREDICTOR trial, we aimed at identifying predictive and pharmacodynamics biomarkers of 2-4 weeks afatinib (an irreversible pan-HER inhibitor) versus no treatment in the pre-operative setting (NCT01415674). We previously reported a 59% metabolic response rate on PET imaging in the afatinib arm. We report here the evaluation of predictive genomic and transcriptomic biomarkers of afatinib efficacy.
Patients and Methods: All patients (41 in the afatinib arm and 20 in the no treatment arm) underwent a pre-treatment biopsy. We performed targeted DNA sequencing using an in-house NGS panel of 571 genes on baseline biopsies from 56 patients, and RNA-sequencing (RNAseq) in 54 patients. In the afatinib arm, 26 patients had paired pre- and post-treatment tumor samples. DNA and RNA alterations were correlated with metabolic response to afatinib using PET imaging, as well as overall survival (OS).
Results: Most frequent molecular alterations, including known activating mutations and/or focal amplifications for oncogenes or homozygous deletions and inactivating mutations for tumor suppressor genes, involved genome integrity (TP53 [70%]), cell cycle (CCND1 [38%], CDKN2A [32%], CDKN2B [14%]), senescence (TERT [23%]), Wnt signaling (NOTCH1 [16%]), and the PI3K pathway (PIK3CA [14%]). In the afatinib arm, metabolic response was observed in 1 out of 7 patients (14%) and in 19 out of 28 patients (68%) in the Wnt altered and unaltered groups (p = 0.03, fisher exact test), respectively. In the whole cohort of patients, homozygous deletions of both CDKN2A and CDKN2B correlated with shorter OS, with 6-year survival of 22% in the CDKN2A/B altered group and 70% in the CDKN2A/B wild-type group (p = 0.004; log-rank test). In the afatinib treated patients, using a generalized linear mixed model with a patient as random effect and a quasi-binomial family, the ratio of B cells expression levels in the post-treated versus pre-treated samples was significantly higher in responder as compared to non-responder patients (p = 0.001).
Conclusions: Wnt signaling pathway alterations and treatment-related dynamic changes in B cells proportions were identified as predictive and pharmacodynamics biomarkers of afatinib efficacy. CDKN2A/B homozygous deletions were associated with a poor prognosis in HNSCC patients treated with upfront surgery.
Citation Format: Grégoire Marret, Maud Kamal, Jocelyn Gal, Stéphane Temam, Jerzy Klijianenko, Jean-Pierre Delord, Caroline Hoffmann, Gilles Dolivet, Olivier Malard, Jerôme Fayette, Olivier Capitain, Caroline Even, Sébastien Vergez, Lionel Geoffrois, Frédéric Rolland, Philippe Zrounba, Laurent Laccourreye, Joël Guigay, Nicolas Aide, Valérie Bénavent, Constance Lamy, Elodie Girard, Marta Jimenez, Ivan Bièche, Christophe Le Tourneau. Randomized phase II trial of pre-operative afatinib in non-metastatic head and neck squamous cell carcinoma patients: Identification of predictive biomarkers of response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1237.
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Affiliation(s)
- Grégoire Marret
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
| | - Maud Kamal
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Constance Lamy
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
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Guegan JP, Peyraud F, Marabelle A, Chaput N, Bodet D, Fontan L, Gaultier A, NAFIA I, Danlos FX, Planchard D, Robert C, Even C, Khettab M, Tselikas L, Friboulet L, Soria JC, Andre F, Barlesi F, Bessede A, Italiano A. Abstract 1251: Low plasma Arginine level is associated with resistance to immune checkpoint blockers in patients with advanced cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The discovery of immune checkpoint blockers (ICB) has revolutionized the systemic approach of the treatment of cancer. However, most patients receiving ICB do not derive benefit. Therefore, there is a crucial need to identify reliable predictive biomarkers of response to anti-PD-1/PD-L1 agents, both to develop precision medicine in cancer immunotherapy and to better understand mechanisms of sensitivity and resistance. One pathway that plays an important role in the regulation of immune cell reactivity is L-Arginine (Arg) metabolism, which is essential to T-cell activation. We therefore aimed at evaluating the association of baseline plasmatic level of Arg - serving as a surrogate of Arginase (Arg1) activity - and clinical benefit to ICB.
Methods: Correlation with Arg levels and efficacy of ICB in the pre-clinical setting was assessed by using a syngeneic mouse model of colorectal cancer (MC38) known to be responsive to ICB. Correlation of Arg levels and clinical activity of ICB was assessed by analyzing the plasma samples obtained before treatment onset in two independent cohorts of patient with advanced cancer and included in two institutional molecular profiling programs (discovery cohort: BIP, NCT02534649, n=77; validation cohort: PREMIS, n=295, NCT03984318). In addition, using matched PBMCs-plasma samples, we analyzed the correlation between Arg level and features of PBMCs that were captured through multiplexed-flow cytometry analysis.
Results: As expected, treatment of MC38-tumor bearing mice with anti-PD(L)1 antibodies demonstrated a strong anti-tumor effect with tumor rejection observed for app. 40% of mice (11 out of 28). The tumor rejection rate was significantly higher in mice with high baseline Arg level than in mice with low Arg level: 85.7% versus 23.8%, p=0.004. In both discovery and validation cohorts, low Arg level at baseline (42 <µmol/L) was significantly associated with worse clinical benefit rate, progression-free survival (PFS) and overall survival (OS). Multivariate analysis showed that low baseline Arg level isd an independent prognostic factor for both PFS and OS. Finally, PBMCs immunophenotyping showed that low Arg level was significantly associated with increased PDL1 expression in several immune cell subsets from the myeloid lineage.
Conclusions: Altogether, our results demonstrate that baseline Arg levels are highly predictive of ICB efficacy. Increase in PDL1 expression in myeloid cells upon Arg deprivation could partly underly its suppressive activity. Plasmatic Arg quantification can therefore represent an attractive biomarker to tailor novel therapeutic regimens targeting the Arginase pathway in combination with ICB.
Citation Format: Jean-Philippe Guegan, Florent Peyraud, Aurelien Marabelle, Nathalie Chaput, Dominique Bodet, Laure Fontan, Anthony Gaultier, Imane NAFIA, Francois-Xavier Danlos, David Planchard, Caroline Robert, Caroline Even, Mohamed Khettab, Lambros Tselikas, Luc Friboulet, Jean-Charles Soria, Fabrice Andre, Fabrice Barlesi, Alban Bessede, Antoine Italiano. Low plasma Arginine level is associated with resistance to immune checkpoint blockers in patients with advanced cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1251.
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Saleh K, Vinches M, Safta I, Guiard E, Marret G, Vion R, Guigay J, Ferrand FR, Clatot F, Le Tourneau C, Rambeau A, Saada-Bouzid E, Daste A, Even C. Taxanes plus cetuximab with or without platinum chemotherapy after progression on immune checkpoint inhibitors in patients with squamous cell carcinoma of the head and neck. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6036 Background: Salvage chemotherapy after progression on immune checkpoint inhibitors (ICIs) was associated with an objective response rate (ORR) of 30% in patients (pts) with recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). We aimed to investigate the efficacy of taxanes + cetuximab (TC) +/- platinum chemotherapy in pts with R/M SCCHN who failed ICIs in palliative setting. Methods: A retrospective study was conducted at 7 French university hospitals. Eligibility criteria were pts treated with ICI for R/M SCCHN, who progressed after treatment with ICI and received TC +/- platinum salvage chemotherapy between August 2017 and December 2021. Clinical and radiological data and outcome were collected from review of medical records. Results: Ninety-nine pts met eligibility criteria: 63 pts received TC and 36 pts received triplet regimen (TR). The median age was 61 years (range 24-78) and 79% of pts were male. Forty-two pts (42%) had platinum-refractory disease (PRD) after multimodal treatment, 13 pts received prior taxanes and 24 pts received prior cetuximab. The median PS at salvage chemotherapy was 1 (range 0-3). ICIs were given as first-line treatment in 70% of pts including those with PRD. The ORR of the entire cohort was 62% (61/99) including 5 complete responses (CR) and the disease control rate was 79% (78/99). The median progression-free survival of the entire cohort was 4.4 months and the median overall survival (OS) was 7.5 months. The 5 pts who had CR as best response are still in remission after a median follow-up of 24 months (range 8-58). The ORR of TC subgroup was 57% (36/63) and the ORR of TR subgroup was 69% (25/36). Furthermore, the ORR in the PRD subgroup of pts was 54% (39/72), and the ORR in the subgroup of pts who were not chemo naïve was 54% (39/72). The ORR in pts who previously received cetuximab was 50% (12/24) vs 75% (49/75) in those who did not. The ORR in pts who previsouly received taxanes was 38% (5/13) vs 65% in those who did not. Finally, the ORR in PRD pts and treated with TR was 50% (7/14) and the ORR in pts who previously received platinum-based treatment or PRD and treated with TR was 55% (11/20). Conclusions: TC +/- platinum chemotherapy was highly effective in pts R/M SCCHN who progressed on ICIs with an ORR of 62% and DCR of 79%. Further investigations are warranted.
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Affiliation(s)
- Khalil Saleh
- Departemnt of Hematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marie Vinches
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - Inga Safta
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - Gregoire Marret
- Department of Drug Development and Innovation, Institut Curie, Paris-Saclay University, Paris, France
| | - Roman Vion
- Department of Medical Oncology, Centre Henri Becquerel,, Rouen, France
| | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU OncoAge, Université Côte d'Azur, Nice, France
| | | | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | | | - Audrey Rambeau
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, University of Bordeaux-CHU, Bordeaux, France
| | - Caroline Even
- Head and Neck Department, Gustave Roussy, Villejuif, France
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Ray-Coquard IL, Penel N, Bompas E, Coquan E, Soulie P, Cousin S, Bertucci F, Tosi D, Heudel PE, Abdeddaim C, Pautier P, Kalbacher E, Selle F, Floquet A, Gambotti L, Simon C, Lamrani-Ghaouti A, Chevret S, Even C. Potential clinical activity of pembrolizumab monotherapy in ovarian sex cords, rare epithelial carcinoma, and other rare ovarian tumor histotypes: The French AcSé pembrolizumab study from Unicancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5572 Background: AcSé Pembrolizumab is a Phase 2, non-randomized parallel arms, multicentric basket trial investigating the efficacy and safety of pembrolizumab monotherapy in different cohorts of patients with rare cancers (NCT03012620). Here we report the results in the rare ovarian tumors cohort. Methods: Selected histotypes were all rare ovarian cancers (incidence < 6/100,000/year). Main inclusion criteria were age > 18, ECOG PS≤1, resistant disease to platinum based chemotherapy, and systematic histological central review by expert pathologist from TMRG network. Patients (pts) received pembrolizumab 200 mg IV on Day 1 of every 21-day cycle for a maximum of 2 years. The primary endpoint was the confirmed objective response rate according to RECIST v1.1 at 12 weeks. Secondary endpoints included best response rate, duration of response, progression-free survival (PFS), overall survival (OS), and safety. The 7 subgroups of pts analyzed were carcinosarcoma (CS), clear cell carcinoma (CCC), low grade serous carcinoma (LGSC), mucinous carcinoma (MEOC), sex cord tumors (SCT), germ cell tumor (GCT), and smarcA4 deficient hypercalcemic ovarian tumor (SCHOCCT). Results: 62 pts from 22 centers, were included from 08/2017 to 12/2020. Median Age was 53.5 years old [36-64]. Median number of previous lines of chemotherapy was 2 (range 1-4). The median number of cycles was 8 (range, 1-35) with 44 pts (70.9%) who discontinued the trial after a mean number of 6.8 cycles. There were 2 pts (3.2%) with partial response (PR) at 12 weeks. The best response in ITT was complete response (CR) in 1 patient (1%), PR in 3 (14.3%), and stable disease (SD) in 21 (33.8%). The occurrence of best response depended on the histotype with 1 CR (33%) in GCT (cancerized teratoma), 2 PR (20%) in CCC, and 1 PR (4%) in LGSC. 4/4 pts (100%) reported PD as best response in SCOOHT (Table 1). Median duration of response or stabilized disease was 7.8 months [IQR, 4.1 to 9.0]. At the data cut off, 6-month PFS was 29% [19.7-42.8] and 6-month OS was 77.8% [67.7-89.3] on the overall population. Outcomes differed according to subgroups and will be presented. There were a total of 62 adverse events (AEs) reported in 28 pts. For 5 pts (8%) AEs lead to drug discontinuation. AEs were of grade 1 (n = 9), grade 2 (n = 8), or grade ≥ 3 (n = 45: 42 grade 3, 2 grade 4, and 1 grade 5). Conclusions: Pembrolizumab is safe and well tolerate in this population of rare ovarian cancer pts. AcSé study reports prolonged responses in very selected subtypes of rare ovarian tumor (CCC, cancerized teratoma, and LGCS). Acknowledgements: TMRG (national cancer network dedicated to rare gynecological tumors), GINECO group for partnership, La Ligue Nationale contre le Cancer, INCa and MSD. Clinical trial information: NCT03012620. [Table: see text]
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Affiliation(s)
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | | | | | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Diego Tosi
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
| | - Elsa Kalbacher
- Groupe d’Investigateurs Nationaux pour l’Etute des Cancers Ovariens and CHRU Jean Minjoz, Besançon, France
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | | | | | | | - Caroline Even
- Head and Neck Department, Gustave Roussy, Villejuif, France
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Gillison ML, Blumenschein G, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington KJ, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Jayaprakash V, Wei L, Ferris RL. Long-term Outcomes with Nivolumab as First-line Treatment in Recurrent or Metastatic Head and Neck Cancer: Subgroup Analysis of CheckMate 141. Oncologist 2022; 27:e194-e198. [PMID: 35641218 PMCID: PMC8895496 DOI: 10.1093/oncolo/oyab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022] Open
Abstract
In the randomized, phase 3 CheckMate 141 trial, nivolumab significantly improved overall survival (OS) versus investigator's choice (IC) of chemotherapy at primary analysis among 361 patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) post-platinum therapy. Nivolumab versus IC as first-line treatment also improved OS among patients with R/M SCCHN who progressed on platinum therapy for locally advanced disease in the adjuvant or primary setting at 1-year follow-up. In the present long-term follow-up analysis of patients receiving first-line treatment, OS benefit with nivolumab (n = 50) versus IC (n = 26) was maintained (median: 7.7 months versus 3.3 months; hazard ratio: 0.56; 95% confidence interval, 0.34-0.94) at 2 years. No new safety signals were identified. In summary, this long-term 2-year analysis of CheckMate 141 supports the use of nivolumab as a first-line treatment for patients with platinum-refractory R/M SCCHN.
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Affiliation(s)
- Maura L Gillison
- Department of Thoracic-Head & Neck Med Onc, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - George Blumenschein
- Department of Thoracic-Head & Neck Med Onc, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Jerome Fayette
- Radiation Oncology Department, Centre Leon Berard, Lyon, France
| | - Joel Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, FHU OncoAge, Université Côte d’Azur, Nice, France
| | - A Dimitrios Colevas
- Department of Medicine - Med/Oncology, Stanford University, Stanford, CA, USA
| | - Lisa Licitra
- Medical Oncology Head and Neck Cancer Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Kevin J Harrington
- Division of Radiotherapy and Imaging, Royal Marsden NHS Foundation Trust/The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital, Essen, Germany
| | - Everett E Vokes
- Department of Medicine, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Caroline Even
- Head and Neck Medical Oncology, Gustave Roussy, Villejuif Cedex, France
| | - Francis Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Robert Haddad
- Division of Head and Neck Oncology, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Tamara Rordorf
- Clinic for Medical Oncology and Hematology, Universitätsspital Zurich, Zurich, Switzerland
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Li Wei
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Robert L Ferris
- Department of Otolaryngology, of Immunology, and of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
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Wildsmith S, Ye J, Franks A, Melillo G, Armstrong J, Whiteley J, Schnittker K, Lian F, Roland B, Sabalos C, Ahmadi P, Fayette J, Even C, Mesía R, Siu LL, Zandberg DP, Walker J. Association of PD-L1 Expression on Tumor and Immune Cells with Survival in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma and Assay Validation. Cancer Res Commun 2022; 2:39-48. [PMID: 36860696 PMCID: PMC9973403 DOI: 10.1158/2767-9764.crc-21-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 06/18/2023]
Abstract
UNLABELLED Programmed cell death ligand-1 (PD-L1), expressed on both tumor cells (TC) and tumor-associated immune cells (IC), has been shown to be a useful biomarker and predictive of response to anti-PD-L1 agents in certain tumor types. In recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), there is a growing interest in the role of PD-L1 expression on ICs, as well as TCs, for predicting response to immune checkpoint inhibitors. Using pooled data from the phase II HAWK and CONDOR studies, we investigated the association of baseline PD-L1 expression with durvalumab efficacy in patients with R/M HNSCC. To determine an optimal PD-L1 cut-off point for predicting survival, we assessed PD-L1 expression levels at different TC and IC cut-off points in patients treated with durvalumab. Longer survival was associated with higher TC membrane PD-L1 expression and IC staining. When the combined TC/IC algorithm was applied, a cut-off point for PD-L1 expression of ≥50% on TCs or ≥25% on ICs (TC ≥ 50%/IC ≥ 25%) showed a higher objective response rate (17.2% vs. 8.8%), longer median progression-free survival (2.8 vs. 1.9 months), and longer median overall survival (8.4 vs. 5.4 months) in the PD-L1-high versus PD-L1-low/negative patient populations, respectively. A scoring algorithm combining PD-L1 expression on TCs and ICs using the cut-off point TC ≥ 50%/IC ≥ 25% was optimal for identifying patients with HNSCC most likely to benefit from durvalumab treatment. The new algorithm is robust and can be reproducibly scored by trained pathologists. SIGNIFICANCE A novel algorithm for PD-L1 expression using the cut-off point TC ≥ 50%/IC ≥ 25% is robust for identifying patients with HNSCC most likely to benefit from durvalumab treatment and can be reproducibly scored by trained pathologists.
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Affiliation(s)
- Sophie Wildsmith
- Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Jiabu Ye
- Statistics, AstraZeneca, Gaithersburg, Maryland
| | - April Franks
- Global Medical Affairs, AstraZeneca, Gaithersburg, Maryland
| | | | - Jon Armstrong
- Statistics, AstraZeneca, Macclesfield, United Kingdom
| | - Jessica Whiteley
- Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Karina Schnittker
- Companion Diagnostics Development, Ventana Medical Systems, Tucson, Arizona
| | - Fangru Lian
- Companion Diagnostics Pathology, Ventana Medical Systems, Tucson, Arizona
| | - Bryan Roland
- Companion Diagnostics Project Lead, Ventana Medical Systems, Tucson, Arizona
| | - Constantine Sabalos
- Regulatory Affairs, Companion Diagnostics, Ventana Medical Systems, Tucson, Arizona
| | - Payam Ahmadi
- Biometrics, Ventana Medical Systems, Tucson, Arizona
| | - Jerome Fayette
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Caroline Even
- Head and Neck Oncology Department, CLCC Institut Gustave Roussy, Paris, France
| | - Ricard Mesía
- Medical Oncology Department, Institut Català d'Oncologia Badalona, B-ARGO group, IGTP, Barcelona, Catalonia, Spain
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dan P. Zandberg
- Department of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jill Walker
- Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, United Kingdom
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Gorphe P, Classe M, Ammari S, Garcia G, Even C, Casiraghi O, Breuskin I, Tao Y, Temam S, Blanchard P, Moya-Plana A. Patterns of disease events and causes of death in patients with HPV-positive versus HPV-negative oropharyngeal carcinoma. Radiother Oncol 2022; 168:40-45. [DOI: 10.1016/j.radonc.2022.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 01/27/2023]
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Even C, Goldberg S, Siu L, Planchard D, Hwang M, Chen CK, He J, Song X, Zhou D, Doake R, Krug L, Peters S. 162P Population pharmacokinetic modeling of tremelimumab in patients (pts) with advanced solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hollebecque A, Brana I, Iglesias L, Even C, Shumei K, García MD, Bover M, Martin-Romano P, Garcia-Carbonero R, Argilés G, Tabernero J, Khanna R, Stalbovskaya V, van Bueren JL, Bol K, Bekradda M, Joe A, Wasserman E, Cohen EE. Abstract P185: Preliminary antitumor activity of MCLA-158, an IgG1 bispecific antibody targeting EGFR and LGR5, in advanced head and neck squamous cell carcinoma. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In the expansion part of an ongoing phase 1 study, MCLA-158 is being investigated at the recommended phase 2 dose (RP2D) in patients (pts) with advanced solid tumors, including head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor (EGFR) and WNT signaling are known oncogenic and mitogenic drivers in several cancers, including HNSCC. MCLA-158 is a human common light chain IgG1 bispecific antibody with enhanced antibody-dependent cellular cytotoxicity (ADCC) activity. It targets EGFR and the leucine-rich, repeat-containing, G-protein coupled receptor 5 (LGR5), a transmembrane receptor associated with tumor initiating cells, particularly cancer stem cells. Potent antitumor activity was seen with MCLA-158 in pt-derived HNSCC xenograft models. The RP2D of MCLA-158 was determined to be 1500 mg every 2 weeks (q2w), with 4-week cycles, during the dose escalation part of the study, based on safety, PK and receptor occupancy prediction. A maximum tolerated dose was not reached. The primary objective of the expansion part is to characterize the safety and tolerability of single-agent MCLA-158 and confirm the RP2D. Secondary objectives include assessment of antitumor activity (investigator-assessed overall response rate [ORR] per RECIST 1.1 and duration of response). Key eligibility criteria include prior exposure to standard therapy, ECOG performance status (PS) 0-1, measurable disease (RECIST 1.1), and availability of a baseline tumor biopsy. At the interim data cutoff date of 15 June 2021, 7 pts with advanced recurrent/metastatic HNSCC were enrolled and treated in the expansion phase. Median age was 63 years (range 50-74), ECOG PS 0/1: 2/5. Primary tumor locations were oropharynx (2 pts), hypopharynx (1 pts), larynx (3 pts), and unknown primary (1 pt). All pts had a histology of squamous cell carcinoma. Prior treatment included platinum-based chemotherapy in all pts, and anti-PD-1/PD-L1 in 6 pts. No pts received prior cetuximab. A median of 3 treatment cycles (range 1-8) were administered to the 7 pts, 4 of whom were continuing with therapy at the cutoff. Of the 5 pts who had a postbaseline assessment, 2 had confirmed partial responses (5+ and 8 cycles initiated), and 2 pts had stable disease (reduction in the sum of target lesions of 7% and 17%; 4+ and 5 cycles initiated, respectively). Scheduled first postbaseline tumor assessments for 2 pts occurred after the data cutoff date. Among 26 pts who were treated at the RP2D in the dose escalation and expansion cohorts, the most frequent adverse events regardless of causality (all grades/grade 3) were infusion-related reactions (73%/8%), rash (39%/0%), asthenia (35%/4%), decreased appetite (27%/4%), nausea (27%/4%), and acneiform dermatitis (23%/4%). There were no treatment-related grade 4 or 5 adverse events. In conclusion, MCLA-158 shows promising signs of antitumor activity in pretreated HNSCC, and a well-tolerated and favorable safety profile.
Citation Format: Antoine Hollebecque, Irene Brana, Lara Iglesias, Caroline Even, Kato Shumei, Marc Díez García, Mateo Bover, Patricia Martin-Romano, Rocio Garcia-Carbonero, Guillen Argilés, Josep Tabernero, Rajan Khanna, Viktoriya Stalbovskaya, Jeroen Lammerts van Bueren, Kees Bol, Mohamed Bekradda, Andrew Joe, Ernesto Wasserman, Ezra E.W. Cohen. Preliminary antitumor activity of MCLA-158, an IgG1 bispecific antibody targeting EGFR and LGR5, in advanced head and neck squamous cell carcinoma [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P185.
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Affiliation(s)
| | - Irene Brana
- 2Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain,
| | - Lara Iglesias
- 3Hospital Universitario 12 de Octubre, Imas12, Madrid, Spain,
| | | | | | | | - Mateo Bover
- 5Hospital Universitario 12 de Octubre, imas12, Madrid, Spain,
| | | | | | - Guillen Argilés
- 7Vall d'Hebron Institute of Oncology (VHIO), Barcelona, France,
| | - Josep Tabernero
- 2Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain,
| | | | | | | | - Kees Bol
- 8Merus NV, Utrecht, Netherlands,
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Guiard E, Clatot F, Even C, Perréard M, Abdeddaim C, Johnson A, Vauléon E, Rambeau A. Impact of previous nivolumab treatment on the response to taxanes in patients with recurrent/metastatic head and neck squamous cell carcinoma. Eur J Cancer 2021; 159:125-132. [PMID: 34743067 DOI: 10.1016/j.ejca.2021.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/23/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors are widely used in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). We aimed to describe response rates to taxanes after progression on nivolumab in R/M HNSCC patients. METHODS In this multicentric retrospective comparative study, we included patients treated with taxane monotherapy from 2014 to 2020. Patients were divided into two groups depending on whether they received nivolumab before taxanes (post-nivolumab group) or not (control group). The primary end-point was objective response rate (ORR) comparison between the two groups. The secondary end-points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and PFS ratio (PFSr=PFS associated with taxanes divided by PFS associated with the previous line of treatment), a survival marker used for comparison of different treatment lines. RESULTS Between July 2014 and August 2020, 185 patients were included (114 in the control group and 71 in the post-nivolumab group). ORR was significantly higher in the post-nivolumab group (39.4% versus 26.3%, p = 0.03) as was DCR (69% versus 50%, P = 0.06). The median OS (7.5 months) and PFS (3.5 months) were not significantly different in the two groups, whereas PFSr was significantly improved in the post-nivolumab group (1.63 versus 1.11, P = 0.004). CONCLUSION Response and DCRs with taxanes are improved after prior exposure to nivolumab. Thus, taxane monotherapy could be a good choice as third-line therapy after nivolumab following a platinum-based first line. These results currently apply to patients without access to or potential benefit from first-line pembrolizumab.
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Affiliation(s)
- Emeline Guiard
- Medical Oncology Department, Centre François Baclesse, Caen, France.
| | - Florian Clatot
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France
| | - Caroline Even
- Head and Neck Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Marion Perréard
- Head and Neck Surgery Department, University Hospital, Caen, France
| | - Cyril Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Alison Johnson
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Elodie Vauléon
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - Audrey Rambeau
- Medical Oncology Department, Centre François Baclesse, Caen, France
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Meng R, Even C, Licitra L, Yen CJ, Ahn MJ, Abbadessa G, Menas FZ, Zang M, Blumenschein G. 435 Pegasus HNSCC, a platform study of SAR444245 (THOR-707, a pegylated recombinant non-alpha IL-2) with anti-cancer agents in patients with recurrent/metastatic head and neck squamous cell carcinoma. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundSAR444245 (THOR-707) is a recombinant human IL-2 molecule that includes a PEG moiety irreversibly bound to a novel amino acid via click chemistry to block the alpha-binding domain while retaining near-native affinity for the beta/gamma subunits. In animal models, SAR444245 showed anti-tumor benefits, but with no severe side effects, both as single agent and when combined with anti-PD1 comparing with historical data from aldeslukin. Preclinical study demonstrated SAR444245 enhances ADCC function of cetuximab. The HAMMER trial, which is the FIH study shows preliminary encouraging clinical results: initial efficacy and safety profile with SAR444245 monotherapy and in combination with pembrolizumab or with cetuximab support a non-alpha preferential activity, validating preclinical models. The Pegasus Head and Neck Ph 2 study will evaluate the clinical benefit of SAR444245 in combination with other anticancer therapies for the treatment of patients with R/M HNSCC.MethodsThe Pegasus Head and Neck will enroll approximately 272 patients in 4 separate cohorts concurrently. In cohorts A1 & A2, 1L R/M HNSCC patients will receive SAR444245 + pembrolizumab, or SAR444245+ pembrolizumab+ cetuximab respectively. In cohort B1 & B2 patients with 2/3L R/M HNSCC failed a checkpoint based regimen & a platinum containing regimen will receive SAR444245 + pembrolizumab, or SAR444245 + cetuximab. Patients to be enrolled in cohort B2 need to be cetuximab-naïve in R/M setting. SAR444245 is administered intravenously IV at a dose of 24 ug/kg Q3W until disease progression (PD) or completion of 35 cycles. Pembrolizumab is administered at a dose of 200 mg Q3W until PD or completion of 35 cycles. Cetuximab is administered at a dose of 400/250 mg/m2 QW until PD. The study primary objective is to determine the antitumor activity of SAR444245 in combination with other anticancer therapies. Secondary objectives include confirmation of dose and safety profile, assess other indicators of antitumor activity, and assess the pharmacokinetic profile and immunogenicity of SAR444245. The study will be conducted in the US, Canada, France, Germany, Italy, Netherlands, Poland, South Korea, Spain and Taiwan.AcknowledgementsThe Pegasus Head and Neck study is sponsored by Sanofi.
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Galot R, Le Tourneau C, Saada-Bouzid E, Daste A, Even C, Debruyne P, Henry S, Zanetta S, Rutten A, Licitra L, Canon JL, Kaminsky MC, Specenier P, Rottey S, Guigay J, Kong A, Tinhofer I, Borcoman E, Dirix L, Raveloarivahy T, Fortpied C, Vanlancker M, Morfouace M, Govaerts AS, Machiels JP. A phase II study of monalizumab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck: The I1 cohort of the EORTC-HNCG-1559 UPSTREAM trial. Eur J Cancer 2021; 158:17-26. [PMID: 34638090 DOI: 10.1016/j.ejca.2021.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 07/24/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Monalizumab is a monoclonal antibody targeting the inhibitory natural killer group 2A (NKG2A) receptor localised on natural killer (NK) and T cells. Its ligand, the human leukocyte antigen E (HLA-E), is overexpressed in squamous cell carcinoma of the head and neck (SCCHN). By targeting the HLA-E-NKG2A pathway, monalizumab may enhance NK and T cell activity. EXPERIMENTAL DESIGN The UPSTREAM trial is a biomarker-driven umbrella trial studying targeted therapies and immunotherapies in patients with recurrent/metastatic (R/M) SCCHN progressing after platinum therapy. The immunotherapy 1 (I1) cohort was a phase II, single-arm substudy evaluating monalizumab (10 mg/kg intravenously on day 1 of a 14-day cycle). The primary end-point was the objective response (OR) rate (Response Evaluation Criteria in Solid Tumours 1.1) over the first 16 weeks. A two-stage Simon design was used (H1 15%, H0 3%, α 8%, power 90%) with pre-planned interruption of accrual if no OR was observed after the first 25 patients. RESULTS Twenty-six eligible patients were enrolled. Seventeen (65%) patients had received ≥2 previous lines of systemic treatment, and 15 (58%) patients were PD(-L)1 inhibitor pretreated. No OR was observed. Stable disease was observed in 6 patients (23%) with a median duration of 3.8 months (95% confidence interval [CI]: 2.7-NE). The median progression-free survival and overall survival were 1.7 months (95% CI: 1.5-1.8) and 6.7 months (95% CI: 3.0-9.6), respectively. The most frequent treatment-related adverse event was grade I/II fatigue (19%). CONCLUSIONS Monalizumab monotherapy has limited activity in R/M SCCHN. The I1 cohort did not meet its primary objective. Monalizumab combined with durvalumab is under investigation within UPSTREAM.
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Affiliation(s)
- Rachel Galot
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris, Saint-Cloud, France; INSERM U900 Research Unit, Saint-Cloud, France; Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France.
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France.
| | - Amaury Daste
- Département d'Oncologie Médicale, Hôpital Saint André, CHU de Bordeaux, 1 Rue Jean Burguet, 33075, Bordeaux Cedex, France.
| | - Caroline Even
- Head and Neck Department, Gustave Roussy, Villejuif, France.
| | - Philip Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium; School of Life Sciences, Anglia Ruskin University, Cambridge, UK.
| | - Stéphanie Henry
- Université Catholique de Louvain, CHU UCL Namur, Département d'oncologie Médicale, Site Ste Elisabeth, Place Louise Godin 15, B5000, Namur, Belgium.
| | - Sylvie Zanetta
- Département d'oncologie Médicale, Centre GF Leclerc, 1 Rue Du Pr Marion, 21000 DIJON, France.
| | | | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS "Istituto Nazionale Dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Italy.
| | - Jean-Luc Canon
- Grand Hôpital de Charleroi, Pôle Cancer et Maladies Du Sang, Site Notre Dame, Grand Rue 3, 6000 Charleroi, Belgium.
| | - Marie-Christine Kaminsky
- Institut de Cancérologie de Lorraine - Alexis Vautrin, 6 Avenue de Bourgogne - CS 30519, 54519 Vandoeuvre-les-Nancy Cedex, France.
| | - Pol Specenier
- Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, 2610 Edegem, Belgium.
| | - Sylvie Rottey
- Drug Research Unit Ghent and Department Medical Oncology, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000 Gent, Belgium.
| | - Joël Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France.
| | - Anthony Kong
- Comprehensive Cancer Centre, King's College London, Guy's Campus, Room 2.36b New Hunt's House, London SE1 1UL, UK.
| | - Inge Tinhofer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Radiooncology and Radiotherapy, Charitéplatz 1, 10117, Berlin, Germany.
| | - Edith Borcoman
- Department of Drug Development and Innovation, Institut Curie, Paris, Saint-Cloud, France.
| | - Lieve Dirix
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Tiana Raveloarivahy
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Catherine Fortpied
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Maureen Vanlancker
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Marie Morfouace
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Anne-Sophie Govaerts
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Jean-Pascal Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium.
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Saleh K, Auperin A, Martin N, Borcoman E, Torossian N, Iacob M, Ferrand FR, Khalife N, Baste N, Guigay J, Le Tourneau C, Daste A, Saada-Bouzid E, Even C. Efficacy and safety of immune checkpoint inhibitors in elderly patients (≥70 years) with squamous cell carcinoma of the head and neck. Eur J Cancer 2021; 157:190-197. [PMID: 34536943 DOI: 10.1016/j.ejca.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent meta-analysis showed that immune checkpoint inhibitors (ICIs) have comparable activity between younger and older patients. However, little is known about efficacy and safety of ICI in elderly patients with relapsed/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). The aim of this study is to compare the efficacy of ICI for patients aged ≥70 y to that for younger patients, while taking into account potential confounding factors. METHODS A retrospective study was conducted at four hospitals in France. Patients treated with ICI for R/M SCCHN between September 2014 and December 2018 were eligible. Patients' charts were reviewed for clinical and radiological data as well as oncologic outcomes. RESULTS We included 226 patients, of whom 67 were aged ≥70 years. Objective response rate (ORR), median overall survival (OS) and median progression-free survival (PFS) were 23%, 9.7 months and 2.7 months, respectively, for elderly patients, compared to 13%, 8.7 months and 1.9 months for younger patients (respective p-values: 0.071, 0.87 and 0.21). After adjustment for performance status, site of progression, number of ICI drugs, time between initial diagnosis and ICI start and number of previous lines, age ≥70 years was significantly associated with a better PFS (hazard ratio [HR], 0.66; p = 0.021) but not OS (HR, 0.91; p = 0.59). Grade 3-5 adverse events (AEs) occurred in 15% of patients aged ≥70 years and in 8% of younger patients (p = 0.13). CONCLUSION Patients aged ≥70 years with R/M SCCHN may respond to ICI similarly as younger patients in terms of ORR, OS and PFS, while maintaining comparable rate of AEs.
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Affiliation(s)
- Khalil Saleh
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Anne Auperin
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nicolas Martin
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Edith Borcoman
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Nouritza Torossian
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Mariana Iacob
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Nadine Khalife
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Neus Baste
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Joel Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris & Saint-Cloud, France; INSERM U900 Research Unit, Saint-Cloud, France; Paris-Saclay University, Paris, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital-CHU Bordeaux, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France; Université Côte d'Azur, Nice, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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Muratori L, Texier M, Mayache-Badis L, Bidault F, Iacob M, Daste A, Fayette J, Lefebvre G, Saada-Bouzid E, Zanetta S, Toullec C, Cupissol D, Salas S, Kaminsky-Forrett MC, Johnson A, Ferrand F, Aupérin A, Guigay J, Raynard B, Even C. 916P Impact of sarcopenia (S) on efficacy and toxicity of nivolumab (N) in patients (pts) with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) in TOPNIVO (T) study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lasserre M, Muratori L, Esma S, Marret G, Salas S, Borel C, Delord JP, Le Nagat S, Clatot F, Evrard C, Rolland F, Even C, Le Tourneau C, Daste A. 896P Long-responders to ICI in R/M-HNSCC: A retrospective multicentric French cohort. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bourhis J, Tao Y, Sun X, Sire C, Martin L, Liem X, Coutte A, Pointreau Y, Thariat J, Miroir J, Rolland F, Kaminsky MC, Borel C, Maillard A, Sinigaglia L, Guigay J, Saada-Bouzid E, Even C, Aupérin A. LBA35 Avelumab-cetuximab-radiotherapy versus standards of care in patients with locally advanced squamous cell carcinoma of head and neck (LA-SCCHN): Randomized phase III GORTEC-REACH trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Even C, Wang HM, Li SH, Ngan RKC, Dechaphunkul A, Zhang L, Yen CJ, Chan PC, Chakrabandhu S, Ma BBY, Tanasanvimon S, Lee VHF, Lou PJ, Li Z, Spira AI, Sukari A, Guigay J, McCune S, Gonzalez-Maffe J, Szpakowski S, Yao Y, Liang H, Mataraza J, Séchaud R, Manenti L, Lim DWT. Phase II, Randomized Study of Spartalizumab (PDR001), an Anti-PD-1 Antibody, versus Chemotherapy in Patients with Recurrent/Metastatic Nasopharyngeal Cancer. Clin Cancer Res 2021; 27:6413-6423. [PMID: 34433653 DOI: 10.1158/1078-0432.ccr-21-0822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND No standard treatment exists for platinum-refractory, recurrent/metastatic nasopharyngeal cancer (NPC). This phase II study (NCT02605967) evaluated progression-free survival (PFS) of spartalizumab, an antiprogrammed cell death protein-1 (PD-1) monoclonal antibody, versus chemotherapy, in NPC. PATIENTS AND METHODS Patients with nonkeratinizing recurrent/metastatic NPC who progressed on/after platinum-based chemotherapy were enrolled. Spartalizumab was dosed 400 mg once every 4 weeks, and chemotherapy was received per investigator's choice. RESULTS Patients were randomized to receive either spartalizumab (82 patients) or chemotherapy (40 patients). The most common spartalizumab treatment-related adverse events were fatigue (10.3%) and pruritus (9.3%). Median PFS in the spartalizumab arm was 1.9 months versus 6.6 months in the chemotherapy arm (P = 0.915). The overall response rate in the spartalizumab arm was 17.1% versus 35.0% in the chemotherapy arm. Median duration of response was 10.2 versus 5.7 months in the spartalizumab versus chemotherapy arms, respectively. Median overall survival was 25.2 and 15.5 months in the spartalizumab and chemotherapy arms, respectively. Tumor RNA sequencing showed a correlation between response to spartalizumab and IFNγ, LAG-3, and TIM-3 gene expression. CONCLUSIONS Spartalizumab demonstrated a safety profile consistent with other anti-PD-1 antibodies. The primary endpoint of median PFS was not met; however, median overall survival and median duration of response were longer with spartalizumab compared with chemotherapy.
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Affiliation(s)
| | - Hung-Ming Wang
- Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Roger K-C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | | | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chia-Jui Yen
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Po Chung Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Suebpong Tanasanvimon
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Victor H F Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Zujun Li
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | | | - Ammar Sukari
- Department of Oncology, Karmanos Cancer Institute, Detroit, Michigan
| | - Joël Guigay
- Medical Oncology Department, Centre Antoine Lacassagne, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Steven McCune
- Medical Oncology, Wellstar Health System, Marietta, Georgia
| | | | - Sebastian Szpakowski
- Oncology Translational Research, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Yao Yao
- Translational Clinical Oncology, Novartis Institutes for BioMedical Research, Shanghai, China
| | - Hongzi Liang
- Translational Clinical Oncology, Novartis Institutes for BioMedical Research, Shanghai, China
| | - Jennifer Mataraza
- Oncology Translational Research, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Romain Séchaud
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Luigi Manenti
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Darren W-T Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
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Cabanié C, Ammari S, Hans S, Pobel C, Laparra A, Danlos FX, Chanson N, Dolidon S, Seban R, Voisin AL, Pautier P, Romano-Martin P, Even C, Baldini C, Besse B, Albiges L, Boutros C, Routier E, Balleyguier C, De Montpreville VT, Champiat S, Massard C, Robert C, Marabelle A, Mateus C, Lambotte O, Le Pavec J, Michot JM. Outcomes of patients with cancer and sarcoid-like granulomatosis associated with immune checkpoint inhibitors: A case-control study. Eur J Cancer 2021; 156:46-59. [PMID: 34425404 DOI: 10.1016/j.ejca.2021.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/30/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Sarcoid-like granulomatosis (SLG) reaction caused by immunotherapy remains poorly understood. This study aims to investigate the outcome of patients with cancer and SLG associated with immunotherapy. PATIENTS AND METHODS Between April 2016 and June 2020, 434 patients with immunological adverse events were screened from the ImmunoTOX assessment board of Gustave Roussy, an academic cancer centre in France. Among them, 28 patients had SLG associated with immunotherapy (SLG cohort) and 406 patients had other immunological adverse events (control cohort). Clinical characteristics and outcome of patients were compared from SLG and control cohort. RESULTS The SLG cohort consisted of 28 patients, 14 women and 14 men, with the median (range) age of 56.5 (28.7-75.3) years. Patients in the SLG cohort with sarcoidosis were asymptomatic (only radiographical finding) in 13 (46.4%) cases; otherwise, the most frequent symptoms were dyspnoea in 8 (28.6%) patients and cough in 5 (17.8%) patients. The computerised tomography scan found sarcoidosis localisations in mediastinal or peri-hilar thoracic lymph nodes in 26 (92.9%) patients, and lung parenchymal involvement was found in 14 (50.0%) patients. The radiographic Scadding stages for sarcoidosis classification were distributed in stages 0, I, II, III and IV in 2 patients (7.1%), 13 patients (46.4%), 11 patients (39.3%), 1 patient (3.6%) and 1 patient (3.6%), respectively. Compared with patients with other immunological toxicities (cohort control), patients with sarcoidosis presented most frequently with melanoma (75.0% versus 21.9% of patients; p < 0.001) and more often received combined therapies of anti-programmed cell death 1 plus anti-cytotoxic T-lymphocyte antigen 4 protein (46.4% versus 12.6% of patients; p = 0.002). Patients with sarcoidosis had an improved overall survival (OS); the median OS was not reached in the SLG cohort and 40.4 months in the control cohort, hazard ratio = 0.232 (95% confidence interval: 0.086-0.630) (p = 0.002). CONCLUSION Sarcoidosis-like reactions in patients receiving immunotherapy were reported as non-severe immunological reactions in most cases and were correlated with improved OS. SLG should not be misdiagnosed as tumour progression in patients receiving immunotherapy treatment for cancer.
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Affiliation(s)
- Charlotte Cabanié
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Samy Ammari
- Department of Radiology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France; Université Paris-Saclay, BIOMAPS, UMR1281, INSERM, CEA, CNRS, Paris, France
| | - Sophie Hans
- Department of Radiology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Cedric Pobel
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Ariane Laparra
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Francois-Xavier Danlos
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Noémie Chanson
- Department of Internal Medicine, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Kremlin Bicêtre, 94270, France
| | - Samuel Dolidon
- Department of Pneumology, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, 92350, France
| | - Romain Seban
- Department of Radiology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Anne-Laure Voisin
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Patricia Pautier
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Patricia Romano-Martin
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Caroline Even
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Capucine Baldini
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Benjamin Besse
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Laurence Albiges
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Celine Boutros
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Emilie Routier
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Corinne Balleyguier
- Department of Radiology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France; Université Paris-Saclay, BIOMAPS, UMR1281, INSERM, CEA, CNRS, Paris, France
| | | | - Stéphane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Caroline Robert
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Aurélien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Christina Mateus
- Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Olivier Lambotte
- Department of Internal Medicine, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Kremlin Bicêtre, 94270, France; Université Paris-Saclay, INSERM, CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France
| | - Jérôme Le Pavec
- Department of Thoracic Surgery, Vascular Surgery, and Cardiopulmonary Transplantation, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France; Université Paris-Sud, Faculty of Medicine, Université Paris-Saclay, Le Kremlin Bicêtre, France; UMRS 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France.
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Loriot Y, Marabelle A, Guégan JP, Danlos FX, Besse B, Chaput N, Massard C, Planchard D, Robert C, Even C, Khettab M, Tselikas L, Friboulet L, André F, Nafia I, Le Loarer F, Soria JC, Bessede A, Italiano A. Plasma proteomics identifies leukemia inhibitory factor (LIF) as a novel predictive biomarker of immune-checkpoint blockade resistance. Ann Oncol 2021; 32:1381-1390. [PMID: 34416362 DOI: 10.1016/j.annonc.2021.08.1748] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 06/08/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune checkpoint blockers (ICBs) are now widely used in oncology. Most patients, however, do not derive benefit from these agents. Therefore, there is a crucial need to identify novel and reliable biomarkers of resistance to such treatments in order to prescribe potentially toxic and costly treatments only to patients with expected therapeutic benefits. In the wake of genomics, the study of proteins is now emerging as the new frontier for understanding real-time human biology. PATIENTS AND METHODS We analyzed the proteome of plasma samples, collected before treatment onset, from two independent prospective cohorts of cancer patients treated with ICB (discovery cohort n = 95, validation cohort n = 292). We then investigated the correlation between protein plasma levels, clinical benefit rate, progression-free survival and overall survival by Cox proportional hazards models. RESULTS By using an unbiased proteomics approach, we show that, in both discovery and validation cohorts, elevated baseline serum level of leukemia inhibitory factor (LIF) is associated with a poor clinical outcome in cancer patients treated with ICB, independently of other prognostic factors. We also demonstrated that the circulating level of LIF is inversely correlated with the presence of tertiary lymphoid structures in the tumor microenvironment. CONCLUSION This novel clinical dataset brings strong evidence for the role of LIF as a potential suppressor of antitumor immunity and suggests that targeting LIF or its pathway may represent a promising approach to improve efficacy of cancer immunotherapy in combination with ICB.
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Affiliation(s)
- Y Loriot
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - A Marabelle
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - F X Danlos
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - B Besse
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Faculty of Medicine, University Paris-Saclay, Le Kremlin Bicêtre, France
| | - N Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy Cancer Campus, CNRS-UMS 3655 and INSERM-US23, Villejuif, France; Faculty of Pharmacy, University Paris-Saclay, Chatenay-Malabry, France; Laboratory of Genetic Instability and Oncogenesis, UMR CNRS 8200, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Massard
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - D Planchard
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Robert
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Even
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - M Khettab
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - L Tselikas
- Interventional Radiology, Gustave Roussy, Villejuif, France
| | - L Friboulet
- Université Paris-Saclay, Institut Gustave Roussy, Inserm U981, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | - F André
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Faculty of Medicine, University Paris-Saclay, Le Kremlin Bicêtre, France
| | | | - F Le Loarer
- Department of Pathology, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - J C Soria
- Cancer Medicine Department, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - A Italiano
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France; Department of Medicine, Institut Bergonié, Bordeaux, France.
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Hachicha H, Pirozhkova I, Gelin A, Bidault F, Rouffiac V, Dayris T, Ragot T, Breuskin I, Even C, Gorphe P, Busson P. Abstract 2656: Muscle wasting in head and neck carcinomas: Investigations on the underlying transcriptional reprogrammation. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Cancer cachexia is a multifactorial syndrome associated with a skeletal muscle atrophy that affects at least 55% of patients bearing Head and Neck Squamous Cell Carcinomas (HNSCCs). To our knowledge, molecular mechanisms of muscle alterations have never been investigated on clinical muscle specimens from HNSCC patients. The aim of this study was to perform transcriptome profiling by bulk RNAseq on muscle fragments from HNSCC patients with and without cachexia and from nude mice bearing human HNSCC xenografts.
Methods:
Our study was made in three parts: 1) In Vitro investigations on human myoblasts co-cultivated with HNSCC cells. 2) In Situ investigations on muscles collected from nude mice xenografted with HNSSCs cells (FADU). 3) Exploration of clinical muscle samples collected from HNSCC patients. RNA sequencing was used to assess gene expression changes and gene function enrichment related to cachexia, in myoblasts co-cultivated with malignant cells as well as skeletal muscle samples collected from mice xenografted with HNSCC cells (FADU) or HNSCC patients.
Results:
In vitro experimentations showed significant impact of malignant cells on myoblast proliferation and differentiation. In nude mice, FADU xenografts resulted in distant loss of muscle mass at various anatomic locations. RNA sequencing of muscle samples from cachectic patients showed significant differences in gene expression compared with control muscles samples from tumor-free donors. Commonly modified pathways included immune and inflammatory response, mitochondrial metabolism and striated muscle differentiation. The most remarkable finding was the up-regulation of the BIRC3 transcript which encodes the anti-apoptotic protein c-IAP2. This alteration was observed both in human cachectic muscles and murine muscle fragments from tumor-bearing mice.
Conclusions:
Although the mechanism of BIRC3 up-regulation in cachectic muscle cells is not well understood, this finding is likely to be important for patient management in a context of promising therapeutic results obtained using Smac mimetics. Because these compounds are inhibitors of the c-IAP protein family, it will be important in the future to monitor their positive or negative effects on muscle alterations in cachectic HNSCC patients.
Citation Format: Héla Hachicha, Iryna Pirozhkova, Aurore Gelin, François Bidault, Valérie Rouffiac, Thibault Dayris, Thierry Ragot, Ingrid Breuskin, Caroline Even, Philippe Gorphe, Pierre Busson. Muscle wasting in head and neck carcinomas: Investigations on the underlying transcriptional reprogrammation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2656.
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