1
|
Yun KM, Cohen EEW. An Era of Advances in Systemic Therapies for Advanced Thyroid Cancer. JCO Oncol Pract 2024:OP2300747. [PMID: 38452309 DOI: 10.1200/op.23.00747] [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] [Received: 11/20/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Thyroid carcinomas comprise distinct pathologic subtypes. However, advancements in characterizing the molecular tumorigenesis of thyroid cancers have changed the treatment paradigm in the past decade. Genetic profiling has become an integral component of personalizing cancer care. Oral kinase inhibitors are currently standard-of-care therapies for progressive, radioactive iodine (RAI)-refractory differentiated thyroid carcinomas (DTCs) and medullary thyroid carcinomas (MTCs). Sorafenib, lenvatinib, and cabozantinib are multikinase inhibitors approved for patients with metastatic RAI-refractory DTC, whereas vandetanib and cabozantinib are approved for patients with MTC. Management of thyroid carcinomas has evolved such that targeted therapies have become therapeutic options for patients with BRAF, RET, NTRK, ALK, and ROS1 alterations and even have reported efficacy in anaplastic thyroid carcinomas. In this article, we review the advances made over the years in the treatment of metastatic thyroid carcinoma and focus on the systemic therapies that have recently transformed the treatment landscape of advanced disease.
Collapse
Affiliation(s)
- Karen M Yun
- Division of Hematology-Oncology, Moores Cancer Center at UC San Diego Health, La Jolla, CA
| | - Ezra E W Cohen
- Division of Hematology-Oncology, Moores Cancer Center at UC San Diego Health, La Jolla, CA
| |
Collapse
|
2
|
Brahmer JR, Long GV, Hamid O, Garon EB, Herbst RS, Andre T, Armand P, Bajorin D, Bellmunt J, Burtness B, Choueiri TK, Cohen EEW, Diaz LA, Shitara K, Kulkarni G, McDermott D, Shah M, Tabernero J, Vogel A, Zinzani PL, Jafari N, Bird S, Snyder E, Gause C, Bracco OL, Pietanza MC, Gruber T, Ribas A. Safety profile of pembrolizumab monotherapy based on an aggregate safety evaluation of 8937 patients. Eur J Cancer 2024; 199:113530. [PMID: 38295556 DOI: 10.1016/j.ejca.2024.113530] [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: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Pembrolizumab has a manageable safety profile as described in its label, which was primarily based on 2799 patients who participated in clinical trials for melanoma or non-small cell lung cancer. Here, we evaluated the safety of pembrolizumab in a broader population of patients from 31 advanced cancer clinical trials across 19 cancer types. METHODS Safety was analyzed in patients who received at least one dose of pembrolizumab (200 mg every 3 weeks [Q3W], 10 mg/kg Q2W or Q3W, or 2 mg/kg Q3W). Adverse events (AEs) and immune-mediated AEs and infusion reactions were evaluated. RESULTS Safety data from 8937 patients in 31 trials of pembrolizumab monotherapy were pooled (median, seven administrations; range, 1-59). Median duration on treatment was 4.1 months (range, 0.03-40.1). AEs occurred in 96.6% of patients. Grade 3-5 AEs occurred in 50.6% of patients. AEs led to pembrolizumab discontinuation in 12.7% of patients and death in 5.9%. Immune-mediated AEs and infusion reactions occurred in 23.7% of patients (4.6% experienced multiple immune-mediated AEs/infusion reactions) and led to pembrolizumab discontinuation in 3.6% and death in 0.2%. Grade 3-5 immune-mediated AEs occurred in 6.3% of patients. Serious immune-mediated AEs and infusion reactions occurred in 6.0% of patients. Median time to immune-mediated AE onset was 85 days (range, 13-163). Of 2657 immune-mediated AEs, 22.3% were initially treated with prednisone ≥ 40 mg/day or equivalent, and 8.3% were initially treated with lower steroid doses. CONCLUSIONS This pooled analysis of 31 clinical trials showed that pembrolizumab has a consistent safety profile across indications.
Collapse
Affiliation(s)
- Julie R Brahmer
- Johns Hopkins Kimmel Cancer Center, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, 40 Rocklands Road North Sydney, Sydney, NSW 2060, Australia.
| | - Omid Hamid
- Cedars-Sinai The Angeles Clinic and Research Institute, 11800 Wilshire Blvd #300, Los Angeles, CA 90025, USA.
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
| | - Roy S Herbst
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Thierry Andre
- Sorbonne Université and Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, Paris 75012, France.
| | - Philippe Armand
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and IMIM Lab, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Barbara Burtness
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Ezra E W Cohen
- Moores Cancer Center, UC San Diego Health, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Luis A Diaz
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Kohei Shitara
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Chiba 277-8577, Japan.
| | - Girish Kulkarni
- Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON MG5 2C4, Canada.
| | - David McDermott
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02186, USA.
| | - Manish Shah
- Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA.
| | - Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Pg. de la Vall d'Hebron 119, Barcelona 08035, Spain.
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, Canada; Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada; Hannover Medical School, Hannover, Germany.
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | - Antoni Ribas
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
| |
Collapse
|
3
|
Miller AM, Koşaloğlu-Yalçın Z, Westernberg L, Montero L, Bahmanof M, Frentzen A, Lanka M, Logandha Ramamoorthy Premlal A, Seumois G, Greenbaum J, Brightman SE, Soria Zavala K, Thota RR, Naradikian MS, Makani SS, Lippman SM, Sette A, Cohen EEW, Peters B, Schoenberger SP. A functional identification platform reveals frequent, spontaneous neoantigen-specific T cell responses in patients with cancer. Sci Transl Med 2024; 16:eabj9905. [PMID: 38416845 DOI: 10.1126/scitranslmed.abj9905] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/15/2021] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
The clinical impact of tumor-specific neoantigens as both immunotherapeutic targets and biomarkers has been impeded by the lack of efficient methods for their identification and validation from routine samples. We have developed a platform that combines bioinformatic analysis of tumor exomes and transcriptional data with functional testing of autologous peripheral blood mononuclear cells (PBMCs) to simultaneously identify and validate neoantigens recognized by naturally primed CD4+ and CD8+ T cell responses across a range of tumor types and mutational burdens. The method features a human leukocyte antigen (HLA)-agnostic bioinformatic algorithm that prioritizes mutations recognized by patient PBMCs at a greater than 40% positive predictive value followed by a short-term in vitro functional assay, which allows interrogation of 50 to 75 expressed mutations from a single 50-ml blood sample. Neoantigens validated by this method include both driver and passenger mutations, and this method identified neoantigens that would not have been otherwise detected using an in silico prediction approach. These findings reveal an efficient approach to systematically validate clinically actionable neoantigens and the T cell receptors that recognize them and demonstrate that patients across a variety of human cancers have a diverse repertoire of neoantigen-specific T cells.
Collapse
Affiliation(s)
- Aaron M Miller
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Division of Hematology and Oncology, UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Zeynep Koşaloğlu-Yalçın
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Luise Westernberg
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Leslie Montero
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Milad Bahmanof
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Angela Frentzen
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Manasa Lanka
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | | | - Gregory Seumois
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Jason Greenbaum
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Spencer E Brightman
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Karla Soria Zavala
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Rukman R Thota
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Martin S Naradikian
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Samir S Makani
- Division of Hematology and Oncology, UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Scott M Lippman
- Division of Hematology and Oncology, UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Ezra E W Cohen
- Division of Hematology and Oncology, UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Bjoern Peters
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Department of Medicine, University of California, San Diego (UCSD), La Jolla, CA 92037, USA
| | - Stephen P Schoenberger
- Center for Cancer Immunotherapy, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Division of Hematology and Oncology, UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| |
Collapse
|
4
|
Hanna GJ, Villa A, Nandi SP, Shi R, ONeill A, Liu M, Quinn CT, Treister NS, Sroussi HY, Vacharotayangul P, Goguen LA, Annino DJ, Rettig EM, Jo VY, Wong KS, Lizotte P, Paweletz CP, Uppaluri R, Haddad RI, Cohen EEW, Alexandrov LB, William WN, Lippman SM, Woo SB. Nivolumab for Patients With High-Risk Oral Leukoplakia: A Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:32-41. [PMID: 37971722 PMCID: PMC10654930 DOI: 10.1001/jamaoncol.2023.4853] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/28/2023] [Accepted: 08/07/2023] [Indexed: 11/19/2023]
Abstract
Importance Proliferative verrucous leukoplakia (PVL) is an aggressive oral precancerous disease characterized by a high risk of transformation to invasive oral squamous cell carcinoma (OSCC), and no therapies have been shown to affect its natural history. A recent study of the PVL immune landscape revealed a cytotoxic T-cell-rich microenvironment, providing strong rationale to investigate immune checkpoint therapy. Objective To determine the safety and clinical activity of anti-programmed cell death 1 protein (PD-1) therapy to treat high-risk PVL. Design, Setting, and Participants This nonrandomized, open-label, phase 2 clinical trial was conducted from January 2019 to December 2021 at a single academic medical center; median (range) follow-up was 21.1 (5.4-43.6) months. Participants were a population-based sample of patients with PVL (multifocal, contiguous, or a single lesion ≥4 cm with any degree of dysplasia). Intervention Patients underwent pretreatment biopsy (1-3 sites) and then received 4 doses of nivolumab (480 mg intravenously) every 28 days, followed by rebiopsy and intraoral photographs at each visit. Main Outcomes and Measures The primary end point was the change in composite score (size and degree of dysplasia) from before to after treatment (major response [MR]: >80% decrease in score; partial response: 40%-80% decrease). Secondary analyses included immune-related adverse events, cancer-free survival (CFS), PD-1 ligand 1 (PD-L1) expression, 9p21.3 deletion, and other exploratory immunologic and genomic associations of response. Results A total of 33 patients were enrolled (median [range] age, 63 [32-80] years; 18 [55%] were female), including 8 (24%) with previously resected early-stage OSCC. Twelve patients (36%) (95% CI, 20.4%-54.8%) had a response by composite score (3 MRs [9%]), 4 had progressive disease (>10% composite score increase, or cancer). Nine patients (27%) developed OSCC during the trial, with a 2-year CFS of 73% (95% CI, 53%-86%). Two patients (6%) discontinued because of toxic effects; 7 (21%) experienced grade 3 to 4 immune-related adverse events. PD-L1 combined positive scores were not associated with response or CFS. Of 20 whole-exome sequenced patients, all 6 patients who had progression to OSCC after nivolumab treatment exhibited 9p21.3 somatic copy-number loss on pretreatment biopsy, while only 4 of the 14 patients (29%) who did not develop OSCC had 9p21.3 loss. Conclusions and Relevance This immune checkpoint therapy precancer nonrandomized clinical trial met its prespecified response end point, suggesting potential clinical activity for nivolumab in high-risk PVL. Findings identified immunogenomic associations to inform future trials in this precancerous disease with unmet medical need that has been difficult to study. Trial Registration ClinicalTrials.gov Identifier: NCT03692325.
Collapse
Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alessandro Villa
- Miami Cancer Institute and Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Shuvro P. Nandi
- Moores Cancer Center, UC San Diego, La Jolla, California
- Department of Cellular and Molecular Medicine, UC San Diego, La Jolla, California
| | - Ruichao Shi
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne ONeill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mofei Liu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charles T. Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nathaniel S. Treister
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Herve Y. Sroussi
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donald J. Annino
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eleni M. Rettig
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vickie Y. Jo
- Department of Pathology, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Kristine S. Wong
- Department of Pathology, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Patrick Lizotte
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cloud P. Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ludmil B. Alexandrov
- Moores Cancer Center, UC San Diego, La Jolla, California
- Department of Cellular and Molecular Medicine, UC San Diego, La Jolla, California
- Department of Bioengineering, UC San Diego, La Jolla, California
| | - William N. William
- Oncology Center, Hospital BP, a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Sook-bin Woo
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Harrington KJ, Cohen EEW, Soulières D, Dinis J, Licitra L, Ahn MJ, Soria A, Machiels JP, Mach N, Mehra R, Burtness B, Swaby RF, Lin J, Ge J, Lerman N, Tourneau CL. Pembrolizumab versus methotrexate, docetaxel, or cetuximab in recurrent or metastatic head and neck squamous cell carcinoma (KEYNOTE-040): Subgroup analysis by pattern of disease recurrence. Oral Oncol 2023; 147:106587. [PMID: 37925894 DOI: 10.1016/j.oraloncology.2023.106587] [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: 04/25/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In the phase 3 KEYNOTE-040 study, pembrolizumab prolonged OS versus chemotherapy in previously treated recurrent or metastatic (R/M) HNSCC. We present a post hoc subgroup analysis by disease recurrence pattern: recurrent-only, recurrent and metastatic (recurrent-metastatic), and metastatic-only HNSCC. MATERIALS AND METHODS Patients had HNSCC that progressed during or after platinum-containing treatment for R/M disease or had recurrence or progression within 3-6 months of previous platinum-containing definitive therapy for locally advanced disease. Patients were randomly assigned (1:1) to pembrolizumab 200 mg Q3W or investigator's choice of standards of care (SOC): methotrexate, docetaxel, or cetuximab. Outcomes included OS, PFS, ORR, and DOR. The data cutoff was May 15, 2017. RESULTS There were 125 patients (pembrolizumab, 53; SOC, 72) in the recurrent-only subgroup, 204 in the recurrent-metastatic subgroup (pembrolizumab, 108; SOC, 96), and 166 in the metastatic-only subgroup (pembrolizumab, 86; SOC, 80). The hazard ratio (95% CI) for death for pembrolizumab versus SOC was 0.83 (0.55-1.25) in the recurrent-only, 0.78 (0.58-1.06) in the recurrent-metastatic, and 0.74 (0.52-1.05) in the metastatic-only subgroups. PFS was similar between treatment arms in all subgroups. ORR was 22.6% for pembrolizumab versus 16.7% for SOC in the recurrent-only, 10.2% versus 6.3% in the recurrent-metastatic, and 15.1% versus 8.8% in the metastatic-only subgroups. DOR was numerically longer with pembrolizumab in all subgroups. CONCLUSION Pembrolizumab provided numerically longer OS and durable responses in all subgroups compared with SOC, suggesting that patients with previously treated R/M HNSCC benefit from pembrolizumab regardless of recurrence pattern.
Collapse
Affiliation(s)
- K J Harrington
- 105 Cotswold Road, Division of Radiotherapy and Imaging, The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust National Institute of Health Research Biomedical Research Centre, London SM2 5NG, United Kingdom.
| | - E E W Cohen
- 3855 Health Sciences Dr, Department of Medical Oncology, Moores Cancer Center, UC San Diego Health, La Jolla, CA 92093, United States.
| | - D Soulières
- 1560, rue Sherbrooke estx, Department of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2L 4MN, Canada.
| | - J Dinis
- R Dr. Antonio Bernardino de Almeida Medicina Oncologica Unidade de Investigacao Clinica, Department of Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, 4200-072 Porto, Portugal.
| | - L Licitra
- Via Giacomo Venezian, 1, Department of Head and Neck Cancer, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, 20133 Milan, Italy
| | - M-J Ahn
- 81 Irwon-Ro Gangnam, Department of Hematology & Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - A Soria
- Ctra. de Colmenar Viejo km. 9,100, Department of Medical Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - J-P Machiels
- Avenue Hippocrate 10, Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium
| | - N Mach
- Rue Gabrielle-Perret-Gentil 4, Clinical Research Unit, Department of Oncology, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - R Mehra
- 22 South Greene Street, Department of Head and Neck Medical Oncology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, United States
| | - B Burtness
- 25 York Street PO Box 208028, Yale Cancer Center and Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - R F Swaby
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - J Lin
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - J Ge
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - N Lerman
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - C Le Tourneau
- 26 rue d'Ulm, Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, 75005 Paris, France
| |
Collapse
|
6
|
Flanagan KC, Earls J, Schillebeeckx I, Hiken J, Wellinghoff RL, LaFranzo NA, Bradley ZS, Babbitt J, Westra WH, Hsu R, Nadauld L, Mcleod H, Firth SD, Sharp B, Fuller J, Vavinskaya V, Sutton L, Deichaite I, Bailey SD, Sandulache VC, Rendo MJ, Macdonald OK, Welaya K, Wade JL, Pippas AW, Slim J, Bank B, Saccaro SJ, Sui X, Akhtar A, Balaraman S, Kossman SE, Sonnier SA, Shenkenberg TD, Alexander WL, Price KA, Bane CL, Ley J, Messina DN, Glasscock JI, Cohen EEW, Adkins DR, Duncavage EJ. Multidimensional biomarker predicts disease control in response to immunotherapy in recurrent or metastatic head and neck squamous-cell carcinoma. J Cancer Res Clin Oncol 2023; 149:14125-14136. [PMID: 37552307 PMCID: PMC10590294 DOI: 10.1007/s00432-023-05205-z] [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] [Received: 06/26/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Anti-PD-1 therapy provides clinical benefit in 40-50% of patients with relapsed and/or metastatic head and neck squamous cell carcinoma (RM-HNSCC). Selection of anti- PD-1 therapy is typically based on patient PD-L1 immunohistochemistry (IHC) which has low specificity for predicting disease control. Therefore, there is a critical need for a clinical biomarker that will predict clinical benefit to anti-PD-1 treatment with high specificity. METHODS Clinical treatment and outcomes data for 103 RM-HNSCC patients were paired with RNA-sequencing data from formalin-fixed patient samples. Using logistic regression methods, we developed a novel biomarker classifier based on expression patterns in the tumor immune microenvironment to predict disease control with monotherapy PD-1 inhibitors (pembrolizumab and nivolumab). The performance of the biomarker was internally validated using out-of-bag methods. RESULTS The biomarker significantly predicted disease control (65% in predicted non-progressors vs. 17% in predicted progressors, p < 0.001) and was significantly correlated with overall survival (OS; p = 0.004). In addition, the biomarker outperformed PD-L1 IHC across numerous metrics including sensitivity (0.79 vs 0.64, respectively; p = 0.005) and specificity (0.70 vs 0.61, respectively; p = 0.009). CONCLUSION This novel assay uses tumor immune microenvironment expression data to predict disease control and OS with high sensitivity and specificity in patients with RM-HNSCC treated with anti-PD-1 monotherapy.
Collapse
Affiliation(s)
- Kevin C Flanagan
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA.
| | - Jon Earls
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | - Ian Schillebeeckx
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | - Jeffrey Hiken
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | | | | | - Zachary S Bradley
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | - Joey Babbitt
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Josh Fuller
- Intermountain Healthcare, St. George, UT, USA
| | - Vera Vavinskaya
- Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA, USA
| | - Leisa Sutton
- Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA, USA
| | - Ida Deichaite
- Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA, USA
| | | | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew J Rendo
- Hematology and Oncology, Brooke Army Medical Center, San Antonio, TX, USA
| | | | - Karim Welaya
- CoxHealth Medical Oncology, Springfield, MO, USA
| | | | - Andrew W Pippas
- John B Amos Cancer Center, Columbus Regional Research Institute, Centricity Research, Columbus, GA, USA
| | - Jennifer Slim
- Multicare Institute for Research and Innovation, Tacoma, WA, USA
| | - Bruce Bank
- Northwest Oncology and Hematology, Elk Grove Village, IL, USA
| | | | - Xingwei Sui
- Providence Regional Cancer System, Lacey, WA, USA
| | - Adil Akhtar
- Revive Research Institute, Sterling Heights, MI, USA
| | | | | | | | | | - Warren L Alexander
- William Beaumont Army Medical Center and The Geneva Foundation, Fort Bliss, TX, USA
| | | | - Charles L Bane
- Dayton Physicians Network/Precision Cancer Research, Dayton, OH, USA
| | - Jessica Ley
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - David N Messina
- Cofactor Genomics, Inc., 4044 Clayton Ave, St. Louis, MO, 63110, USA
| | | | - Ezra E W Cohen
- Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA, USA
| | - Douglas R Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric J Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
7
|
Madan S, Sinha S, Chang T, Gutkind JS, Cohen EEW, Schäffer AA, Ruppin E. Pan-Cancer Analysis of Patient Tumor Single-Cell Transcriptomes Identifies Promising Selective and Safe Chimeric Antigen Receptor Targets in Head and Neck Cancer. Cancers (Basel) 2023; 15:4885. [PMID: 37835579 PMCID: PMC10571718 DOI: 10.3390/cancers15194885] [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: 08/23/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapies have yielded transformative clinical successes for patients with blood tumors, but their full potential remains to be unleashed against solid tumors. One challenge is finding selective targets, which we define intuitively to be cell surface proteins that are expressed widely by cancer cells but minimally by healthy cells in the tumor microenvironment and other normal tissues. Analyzing patient tumor single-cell transcriptomics data, we first defined and quantified selectivity and safety scores of existing CAR targets for indications in which they are in clinical trials or approved. We then sought new candidate cell surface CAR targets that have better selectivity and safety scores than those currently being tested. Remarkably, in almost all cancer types, we could not find such better targets, testifying to the near optimality of the current target space. However, in human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSC), for which there is currently a dearth of existing CAR targets, we identified a total of twenty candidate novel CAR targets, five of which have both superior selectivity and safety scores. These newly identified cell surface targets lay a basis for future investigations that may lead to better CAR treatments in HNSC.
Collapse
Affiliation(s)
- Sanna Madan
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (S.M.); (S.S.); (T.C.)
- Department of Computer Science, University of Maryland, College Park, MD 20742, USA
| | - Sanju Sinha
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (S.M.); (S.S.); (T.C.)
| | - Tiangen Chang
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (S.M.); (S.S.); (T.C.)
| | - J. Silvio Gutkind
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (J.S.G.); (E.E.W.C.)
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92093, USA
| | - Ezra E. W. Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (J.S.G.); (E.E.W.C.)
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Alejandro A. Schäffer
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (S.M.); (S.S.); (T.C.)
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (S.M.); (S.S.); (T.C.)
| |
Collapse
|
8
|
Dolina JS, Lee J, Brightman SE, McArdle S, Hall SM, Thota RR, Zavala KS, Lanka M, Ramamoorthy Premlal AL, Greenbaum JA, Cohen EEW, Peters B, Schoenberger SP. Linked CD4+/CD8+ T cell neoantigen vaccination overcomes immune checkpoint blockade resistance and enables tumor regression. J Clin Invest 2023; 133:e164258. [PMID: 37655661 PMCID: PMC10471175 DOI: 10.1172/jci164258] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
Therapeutic benefit to immune checkpoint blockade (ICB) is currently limited to the subset of cancers thought to possess a sufficient tumor mutational burden (TMB) to allow for the spontaneous recognition of neoantigens (NeoAg) by autologous T cells. We explored whether the response to ICB of an aggressive low-TMB squamous cell tumor could be improved through combination immunotherapy using functionally defined NeoAg as targets for endogenous CD4+ and CD8+ T cells. We found that, whereas vaccination with CD4+ or CD8+ NeoAg alone did not offer prophylactic or therapeutic immunity, vaccines containing NeoAg recognized by both subsets overcame ICB resistance and led to the eradication of large established tumors that contained a subset of PD-L1+ tumor-initiating cancer stem cells (tCSC), provided the relevant epitopes were physically linked. Therapeutic CD4+/CD8+ T cell NeoAg vaccination produced a modified tumor microenvironment (TME) with increased numbers of NeoAg-specific CD8+ T cells existing in progenitor and intermediate exhausted states enabled by combination ICB-mediated intermolecular epitope spreading. We believe that the concepts explored herein should be exploited for the development of more potent personalized cancer vaccines that can expand the range of tumors treatable with ICB.
Collapse
Affiliation(s)
- Joseph S. Dolina
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
- Cancer Immunology Discovery, Pfizer, San Diego, California, USA
| | - Joey Lee
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Spencer E. Brightman
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
| | | | - Samantha M. Hall
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Rukman R. Thota
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Karla S. Zavala
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Manasa Lanka
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, California, USA
| | | | - Jason A. Greenbaum
- Bioinformatics Core, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Ezra E. W. Cohen
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Bjoern Peters
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Stephen P. Schoenberger
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, California, USA
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| |
Collapse
|
9
|
Brightman SE, Becker A, Thota RR, Naradikian MS, Chihab L, Zavala KS, Ramamoorthy Premlal AL, Griswold RQ, Dolina JS, Cohen EEW, Miller AM, Peters B, Schoenberger SP. Neoantigen-specific stem cell memory-like CD4 + T cells mediate CD8 + T cell-dependent immunotherapy of MHC class II-negative solid tumors. Nat Immunol 2023; 24:1345-1357. [PMID: 37400675 PMCID: PMC10382322 DOI: 10.1038/s41590-023-01543-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
CD4+ T cells play key roles in a range of immune responses, either as direct effectors or through accessory cells, including CD8+ T lymphocytes. In cancer, neoantigen (NeoAg)-specific CD8+ T cells capable of direct tumor recognition have been extensively studied, whereas the role of NeoAg-specific CD4+ T cells is less well understood. We have characterized the murine CD4+ T cell response against a validated NeoAg (CLTCH129>Q) expressed by the MHC-II-deficient squamous cell carcinoma tumor model (SCC VII) at the level of single T cell receptor (TCR) clonotypes and in the setting of adoptive immunotherapy. We find that the natural CLTCH129>Q-specific repertoire is diverse and contains TCRs with distinct avidities as measured by tetramer-binding assays and CD4 dependence. Despite these differences, CD4+ T cells expressing high or moderate avidity TCRs undergo comparable in vivo proliferation to cross-presented antigen from growing tumors and drive similar levels of therapeutic immunity that is dependent on CD8+ T cells and CD40L signaling. Adoptive cellular therapy (ACT) with NeoAg-specific CD4+ T cells is most effective when TCR-engineered cells are differentiated ex vivo with IL-7 and IL-15 rather than IL-2 and this was associated with both increased expansion as well as the acquisition and stable maintenance of a T stem cell memory (TSCM)-like phenotype in tumor-draining lymph nodes (tdLNs). ACT with TSCM-like CD4+ T cells results in lower PD-1 expression by CD8+ T cells in the tumor microenvironment and an increased frequency of PD-1+CD8+ T cells in tdLNs. These findings illuminate the role of NeoAg-specific CD4+ T cells in mediating antitumor immunity via providing help to CD8+ T cells and highlight their therapeutic potential in ACT.
Collapse
Affiliation(s)
- Spencer E Brightman
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Biomedical Sciences Program, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Angelica Becker
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Rukman R Thota
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Martin S Naradikian
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Leila Chihab
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Karla Soria Zavala
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Ryan Q Griswold
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Biomedical Sciences Program, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph S Dolina
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Ezra E W Cohen
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
| | - Aaron M Miller
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
| | - Bjoern Peters
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Stephen P Schoenberger
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA.
| |
Collapse
|
10
|
Rosenberg AJ, Liao CY, Karrison T, de Souza JA, Worden FP, Libao B, Krzyzanowska MK, Hayes DN, Winquist E, Saloura V, Prescott K, Villaflor VM, Seiwert TY, Schechter RB, Stadler WM, Cohen EEW, Vokes EE. A multicenter, open-label, randomized, phase II study of cediranib with or without lenalidomide in iodine 131-refractory differentiated thyroid cancer. Ann Oncol 2023; 34:714-722. [PMID: 37182801 PMCID: PMC10696593 DOI: 10.1016/j.annonc.2023.05.002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Multitargeted tyrosine kinase inhibitors (TKIs) of the vascular endothelial growth factor receptor (VEGFR) pathway have activity in differentiated thyroid cancer (DTC). Lenalidomide demonstrated preliminary efficacy in DTC, but its safety and efficacy in combination with VEGFR-targeted TKIs is unknown. We sought to determine the safety and efficacy of cediranib, a VEGFR-targeted TKI, with or without lenalidomide, in the treatment of iodine 131-refractory DTC. PATIENTS AND METHODS In this multicenter, open-label, randomized, phase II clinical trial, 110 patients were enrolled and randomized to cediranib alone or cediranib with lenalidomide. The primary endpoint was progression-free survival (PFS). Secondary endpoints included response rate, duration of response, toxicity, and overall survival (OS). Patients (≥18 years of age) with DTC who were refractory to further surgical or radioactive iodine (RAI) therapy as reviewed at a multispecialty tumor board conference, and evidence of disease progression within the previous 12 months and no more than one prior line of systemic therapy were eligible. RESULTS Of the 110 patients, 108 started therapy and were assessable for efficacy. The median PFS was 14.8 months [95% confidence interval (CI) 8.5-23.8 months] in the cediranib arm and 11.3 months (95% CI 8.7-18.9 months) in the cediranib with lenalidomide arm (P = 0.36). The 2-year OS was 64.8% (95% CI 43.3% to 86.4%) and 75.3% (95% CI 59.4% to 91.0%), respectively (P = 0.80). The serious adverse event rate was 41% in the cediranib arm and 46% in the cediranib with lenalidomide arm. CONCLUSIONS Single-agent therapy with cediranib showed promising efficacy in RAI-refractory DTC similar to other VEGFR-targeted TKIs, while the addition of lenalidomide did not result in clinically meaningful improvements in outcomes.
Collapse
Affiliation(s)
- A J Rosenberg
- Department of Medicine, University of Chicago, Chicago, USA; University of Chicago Comprehensive Cancer Center, Chicago, USA.
| | - C-Y Liao
- Department of Medicine, University of Chicago, Chicago, USA; University of Chicago Comprehensive Cancer Center, Chicago, USA
| | - T Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | | | - F P Worden
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - B Libao
- Department of Medicine, University of Chicago, Chicago, USA
| | | | - D N Hayes
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - E Winquist
- Department of Oncology, University of Western Ontario and London Health Sciences Centre, London, Canada
| | - V Saloura
- National Cancer Institute, Bethesda, USA
| | - K Prescott
- University of Illinois Chicago, Chicago, USA
| | - V M Villaflor
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | - T Y Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA
| | - R B Schechter
- Department of Medicine, University of Chicago, Chicago, USA
| | - W M Stadler
- Department of Medicine, University of Chicago, Chicago, USA; University of Chicago Comprehensive Cancer Center, Chicago, USA
| | - E E W Cohen
- Moores Cancer Center at UC San Diego, La Jolla, USA
| | - E E Vokes
- Department of Medicine, University of Chicago, Chicago, USA; University of Chicago Comprehensive Cancer Center, Chicago, USA
| |
Collapse
|
11
|
Brightman SE, Becker A, Thota RR, Naradikian MS, Chihab L, Zavala KS, Ramamoorthy Premlal AL, Griswold RQ, Dolina JS, Cohen EEW, Miller AM, Peters B, Schoenberger SP. Author Correction: Neoantigen-specific stem cell memory-like CD4 + T cells mediate CD8 + T cell-dependent immunotherapy of MHC class II-negative solid tumors. Nat Immunol 2023; 24:1391. [PMID: 37464051 PMCID: PMC10382305 DOI: 10.1038/s41590-023-01591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Spencer E Brightman
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Biomedical Sciences Program, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Angelica Becker
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Rukman R Thota
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Martin S Naradikian
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Leila Chihab
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Karla Soria Zavala
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Ryan Q Griswold
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Biomedical Sciences Program, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph S Dolina
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Ezra E W Cohen
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
| | - Aaron M Miller
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
| | - Bjoern Peters
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, UCSD, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Stephen P Schoenberger
- Division of Developmental Immunology, La Jolla Institute for Immunology, La Jolla, CA, USA.
| |
Collapse
|
12
|
Hong DS, Postow M, Chmielowski B, Sullivan R, Patnaik A, Cohen EEW, Shapiro G, Steuer C, Gutierrez M, Yeckes-Rodin H, Ilaria R, O’Connell B, Peng J, Peng G, Zizlsperger N, Tolcher A, Wolchok JD. Eganelisib, a First-in-Class PI3Kγ Inhibitor, in Patients with Advanced Solid Tumors: Results of the Phase 1/1b MARIO-1 Trial. Clin Cancer Res 2023; 29:2210-2219. [PMID: 37000164 PMCID: PMC10388696 DOI: 10.1158/1078-0432.ccr-22-3313] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/13/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Eganelisib (IPI-549) is a first-in-class, orally administered, highly selective PI3Kγ inhibitor with antitumor activity alone and in combination with programmed cell death protein 1/ligand 1 (PD-1/PD-L1) inhibitors in preclinical studies. This phase 1/1b first-in-human, MAcrophage Reprogramming in Immuno-Oncology-1 (NCT02637531) study evaluated the safety and tolerability of once-daily eganelisib as monotherapy and in combination with nivolumab in patients with solid tumors. PATIENTS AND METHODS Dose-escalation cohorts received eganelisib 10-60 mg as monotherapy (n = 39) and 20-40 mg when combined with nivolumab (n = 180). Primary endpoints included incidence of dose-limiting toxicities (DLT) and adverse events (AE). RESULTS The most common treatment-related grade ≥3 toxicities with monotherapy were increased alanine aminotransferase (ALT; 18%), aspartate aminotransferase (AST; 18%), and alkaline phosphatase (5%). No DLTs occurred in the first 28 days; however, toxicities meeting DLT criteria (mostly grade 3 reversible hepatic enzyme elevations) occurred with eganelisib 60 mg in later treatment cycles. In combination, the most common treatment-related grade ≥3 toxicities were increased AST (13%) and increased ALT and rash (10%). Treatment-related serious AEs occurred in 5% of monotherapy patients (grade 4 bilirubin and hepatic enzyme increases in one patient each) and 13% in combination (pyrexia, rash, cytokine release syndrome, and infusion-related reaction in ≥2 patients each). Antitumor activity was observed in combination, including patients who had progressed on PD-1/PD-L1 inhibitors. CONCLUSIONS On the basis of the observed safety profile, eganelisib doses of 30 and 40 mg once daily in combination with PD-1/PD-L1 inhibitors were chosen for phase 2 study.
Collapse
Affiliation(s)
| | - Michael Postow
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA
| | | | - Amita Patnaik
- South Texas Accelerated Research Therapeutics (START), San Antonio, TX
| | | | | | - Conor Steuer
- Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Joanna Peng
- Infinity Pharmaceuticals, Inc., Cambridge, MA
| | | | | | | | | |
Collapse
|
13
|
Ahrens ET, Helfer BM, O'Hanlon CF, Lister DR, Bykowski JL, Messer K, Leach BI, Chen J, Xu H, Daniels GA, Cohen EEW. Method for estimation of apoptotic cell fraction of cytotherapy using in vivo fluorine-19 magnetic resonance: pilot study in a patient with head and neck carcinoma receiving tumor-infiltrating lymphocytes labeled with perfluorocarbon nanoemulsion. J Immunother Cancer 2023; 11:e007015. [PMID: 37339797 PMCID: PMC10314637 DOI: 10.1136/jitc-2023-007015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Adoptive transfer of T cells is a burgeoning cancer therapeutic approach. However, the fate of the cells, once transferred, is most often unknown. We describe the first clinical experience with a non-invasive biomarker to assay the apoptotic cell fraction (ACF) after cell therapy infusion, tested in the setting of head and neck squamous cell carcinoma (HNSCC). A patient with HNSCC received autologous tumor-infiltrating lymphocytes (TILs) labeled with a perfluorocarbon (PFC) nanoemulsion cell tracer. Nanoemulsion, released from apoptotic cells, clears through the reticuloendothelial system, particularly the Kupffer cells of the liver, and fluorine-19 (19F) magnetic resonance spectroscopy (MRS) of the liver was used to non-invasively infer the ACF. METHODS Autologous TILs were isolated from a patient in their late 50s with relapsed, refractory human papillomavirus-mediated squamous cell carcinoma of the right tonsil, metastatic to the lung. A lung metastasis was resected for T cell harvest and expansion using a rapid expansion protocol. The expanded TILs were intracellularly labeled with PFC nanoemulsion tracer by coincubation in the final 24 hours of culture, followed by a wash step. At 22 days after intravenous infusion of TILs, quantitative single-voxel liver 19F MRS was performed in vivo using a 3T MRI system. From these data, we model the apparent ACF of the initial cell inoculant. RESULTS We show that it is feasible to PFC-label ~70×1010 TILs (F-TILs) in a single batch in a clinical cell processing facility, while maintaining >90% cell viability and standard flow cytometry-based release criteria for phenotype and function. Based on quantitative in vivo 19F MRS measurements in the liver, we estimate that ~30% cell equivalents of adoptively transferred F-TILs have become apoptotic by 22 days post-transfer. CONCLUSIONS Survival of the primary cell therapy product is likely to vary per patient. A non-invasive assay of ACF over time could potentially provide insight into the mechanisms of response and non-response, informing future clinical studies. This information may be useful to developers of cytotherapies and clinicians as it opens an avenue to quantify cellular product survival and engraftment.
Collapse
Affiliation(s)
- Eric T Ahrens
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | | | | | - Deanne R Lister
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Julie L Bykowski
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Karen Messer
- Division of Biostatistics, University of California San Diego, La Jolla, California, USA
| | - Benjamin I Leach
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Jiawen Chen
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California, USA
| | - Hongyan Xu
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Gregory A Daniels
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ezra E W Cohen
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
14
|
Faraji F, Cohen EEW, Guo TW. Evolving treatment paradigms in recurrent and metastatic head and neck squamous cell carcinoma: the emergence of immunotherapy. Transl Cancer Res 2023; 12:1353-1358. [PMID: 37304550 PMCID: PMC10248584 DOI: 10.21037/tcr-23-1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, Gleiberman Head and Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
| | - Ezra E. W. Cohen
- Division of Hematology-Oncology, Department of Internal Medicine, Gleiberman Head and Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
| | - Theresa W. Guo
- Department of Otolaryngology-Head and Neck Surgery, Gleiberman Head and Neck Cancer Center, Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
| |
Collapse
|
15
|
Miyauchi S, Kim SS, Jones RN, Zhang L, Guram K, Sharma S, Schoenberger SP, Cohen EEW, Califano JA, Sharabi AB. Human papillomavirus E5 suppresses immunity via inhibition of the immunoproteasome and STING pathway. Cell Rep 2023; 42:112508. [PMID: 37171962 PMCID: PMC10789500 DOI: 10.1016/j.celrep.2023.112508] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 05/14/2023] Open
Abstract
The role that human papillomavirus (HPV) oncogenes play in suppressing responses to immunotherapy in cancer deserves further investigation. In particular, the effects of HPV E5 remain poorly understood relative to E6 and E7. Here, we demonstrate that HPV E5 is a negative regulator of anti-viral interferon (IFN) response pathways, antigen processing, and antigen presentation. Using head and neck cancer as a model, we identify that E5 decreases expression and function of the immunoproteasome and that the immunoproteasome, but not the constitutive proteasome, is associated with improved overall survival in patients. Moreover, immunopeptidome analysis reveals that HPV E5 restricts the repertoire of antigens presented on the cell surface, likely contributing to immune escape. Mechanistically, we discover a direct interaction between E5 and stimulator of interferon genes (STING), which suppresses downstream IFN signaling. Taken together, these findings identify a powerful molecular mechanism by which HPV E5 limits immune detection and mediates resistance to immunotherapy.
Collapse
Affiliation(s)
- Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Riley N Jones
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Lin Zhang
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Kripa Guram
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Sonia Sharma
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | | | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Joseph A Califano
- Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA 92037, USA
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA 92037, USA; Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA.
| |
Collapse
|
16
|
Dolina JS, Lee J, Brightman SE, McArdle S, Hall SM, Thota RR, Lanka M, Premlal ALR, Greenbaum JA, Cohen EEW, Peters B, Schoenberger SP. Linked CD4 + /CD8 + T cell neoantigen vaccination overcomes immune checkpoint blockade resistance and enables tumor regression. bioRxiv 2023:2023.05.06.539290. [PMID: 37205330 PMCID: PMC10187312 DOI: 10.1101/2023.05.06.539290] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Therapeutic benefit to immune checkpoint blockade (ICB) is currently limited to the subset of cancers thought to possess a sufficient tumor mutational burden (TMB) to allow for the spontaneous recognition of neoantigens (NeoAg) by autologous T cells. We explored whether the response of an aggressive low TMB squamous cell tumor to ICB could be improved through combination immunotherapy using functionally defined NeoAg as targets for endogenous CD4 + and CD8 + T cells. We found that, whereas vaccination with CD4 + or CD8 + NeoAg alone did not offer prophylactic or therapeutic immunity, vaccines containing NeoAg recognized by both subsets overcame ICB resistance and led to the eradication of large established tumors that contained a subset of PD-L1 + tumor-initiating cancer stem cells (tCSC), provided the relevant epitopes were physically linked. Therapeutic CD4 + /CD8 + T cell NeoAg vaccination produced a modified tumor microenvironment (TME) with increased numbers of NeoAg-specific CD8 + T cells existing in progenitor and intermediate exhausted states enabled by combination ICB-mediated intermolecular epitope spreading. The concepts explored herein should be exploited for the development of more potent personalized cancer vaccines that can expand the range of tumors treatable with ICB.
Collapse
|
17
|
Nathan CAO, Hayes DN, Karrison T, Harismendy O, Flores JM, Moore-Medlin T, Vokes EE, Gutkind JS, Neupane P, Mills G, Sargi Z, Seiwert T, Grilley-Olson J, Day T, Gillison M, Wade JL, Feldman L, Jha G, Kozloff M, O’ Leary M, Worden FP, Cohen EEW. A Randomized Multi-institutional Phase II Trial of Everolimus as Adjuvant Therapy in Patients with Locally Advanced Squamous Cell Cancer of the Head and Neck. Clin Cancer Res 2022; 28:5040-5048. [PMID: 36194164 PMCID: PMC9722644 DOI: 10.1158/1078-0432.ccr-21-4290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Investigate whether adjuvant everolimus, an mTOR inhibitor, improves progression-free survival (PFS) in advanced-stage head and neck squamous cell carcinoma (HNSCC) and provide outcomes related to correlative biological factors associated with disease control. PATIENTS AND METHODS This was a prospective, randomized, double-blind phase II trial of patients with advanced-stage HNSCC from 13 institutions who were confirmed disease-free post-definitive therapy and enrolled between December 2010 and March 2015. Patients received adjuvant everolimus or placebo daily (10 mg, oral) for a maximum of 1 year. p16 IHC as a surrogate marker for human papillomavirus infection and whole-exome sequencing were performed. Cox proportional hazard models estimated hazard rates. Log-rank tests evaluated differences in survival. The primary endpoint was PFS. Secondary endpoints and objectives included overall survival (OS) and toxicity assessment. RESULTS 52 patients [median (range) age, 58 (37-76) years; 43 men (83%), 9 women (17%)] were randomized to placebo (n = 24) or everolimus (n = 28). PFS favored everolimus, but was not significant [log-rank P = 0.093; HR = 0.44; 95% confidence interval (CI), 0.17-1.17]. There was no difference in OS (P = 0.29; HR = 0.57; 95% CI, 0.20-16.2). Everolimus resulted in significant improvement in PFS for p16-negative patients (n = 31; P = 0.031; HR = 0.26; 95% CI, 0.07-0.97), although subgroup analysis showed no difference for p16-positive patients (n = 21; P = 0.93). Further, PFS was significantly higher in TP53-mutated (TP53mut) patients treated with everolimus compared with placebo (log-rank P = 0.027; HR = 0.24; 95% CI, 0.06-0.95). No treatment difference was seen in patients with TP53 wild-type tumors (P = 0.79). CONCLUSIONS p16-negative and TP53mut patients may benefit from adjuvant treatment with everolimus.
Collapse
Affiliation(s)
- Cherie-Ann O. Nathan
- Department of Otolaryngology-Head and Neck Surgery, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport., Shreveport, LA
| | - D Neil Hayes
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Theodore Karrison
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Olivier Harismendy
- Division of Biomedical Informatics, Department of Medicine, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - José M. Flores
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tara Moore-Medlin
- Department of Otolaryngology-Head and Neck Surgery, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport., Shreveport, LA
| | | | - J. Silvio Gutkind
- Department of Pharmacology, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Glenn Mills
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport, Shreveport, LA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami, Miami, FL
| | - Tanguy Seiwert
- Department of Medicine, The University of Chicago, Chicago, IL
| | | | - Terry Day
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Maura Gillison
- Viral Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James L. Wade
- Department of Medicine, Decatur Memorial Hospital, Decatur, IL
| | - Lawrence Feldman
- Department of Medicine, University of Illinois Cancer Center, Chicago, IL
| | - Gautam Jha
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Mark Kozloff
- Department of Medicine, Ingalls Cancer Research Center, Chicago, IL
| | - Miriam O’ Leary
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
| | - Francis P. Worden
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
18
|
Abstract
In the recent years, the prevalence of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased significantly. Currently, nearly 80-90% of all oropharynx tumors are HPV-positive. In addition, it is now recognized that HPV-positive tumor status is associated with good prognosis and improved response to chemoradiation. However, within this setting, there are still patients with HPV-positive OPSCC who will experience recurrence. With the increasing incidence of HPV-mediated OPSCC, recurrent HPV disease is also becoming more prevalent and there is an increasing need to understand the unique presentation and treatment of recurrent HPV-mediated disease. In this review, we will discuss epidemiology of recurrent HPV-positive OPSCC, role of surgical salvage, re-irradiation, and the role of upcoming novel treatments and immunotherapy. Historically, recurrent oropharyngeal disease has been associated with poor prognosis and high morbidity. However, recent advances have transformed the landscape for salvage treatment of HPV-mediated OPSCC. Liquid biomarkers offer potential for early detection of recurrence, robotic techniques may reduce morbidity of surgical salvage, improvements in re-irradiation approaches reduce toxicities, and novel immune based therapies on the horizon are offering promising results. These advances combined with the improved prognosis of HPV-positive disease offer to transform our approach to recurrent disease of the oropharynx.
Collapse
Affiliation(s)
- Theresa Guo
- Department of Otolaryngology-Head and Neck Cancer, Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
- *Correspondence: Theresa Guo,
| | - Stephen Y. Kang
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, United States
| | - Ezra E. W. Cohen
- Division of Medical Oncology, Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
19
|
Saddawi-Konefka R, O'Farrell A, Faraji F, Clubb L, Allevato MM, Jensen SM, Yung BS, Wang Z, Wu VH, Anang NA, Msari RA, Schokrpur S, Pietryga IF, Molinolo AA, Mesirov JP, Simon AB, Fox BA, Bui JD, Sharabi A, Cohen EEW, Califano JA, Gutkind JS. Lymphatic-preserving treatment sequencing with immune checkpoint inhibition unleashes cDC1-dependent antitumor immunity in HNSCC. Nat Commun 2022; 13:4298. [PMID: 35879302 PMCID: PMC9314425 DOI: 10.1038/s41467-022-31941-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [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: 02/18/2022] [Accepted: 07/11/2022] [Indexed: 12/30/2022] Open
Abstract
Despite the promise of immune checkpoint inhibition (ICI), therapeutic responses remain limited. This raises the possibility that standard of care treatments delivered in concert may compromise the tumor response. To address this, we employ tobacco-signature head and neck squamous cell carcinoma murine models in which we map tumor-draining lymphatics and develop models for regional lymphablation with surgery or radiation. We find that lymphablation eliminates the tumor ICI response, worsening overall survival and repolarizing the tumor- and peripheral-immune compartments. Mechanistically, within tumor-draining lymphatics, we observe an upregulation of conventional type I dendritic cells and type I interferon signaling and show that both are necessary for the ICI response and lost with lymphablation. Ultimately, we provide a mechanistic understanding of how standard oncologic therapies targeting regional lymphatics impact the tumor response to immune-oncology therapy in order to define rational, lymphatic-preserving treatment sequences that mobilize systemic antitumor immunity, achieve optimal tumor responses, control regional metastatic disease, and confer durable antitumor immunity.
Collapse
Affiliation(s)
- Robert Saddawi-Konefka
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, USA.
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA.
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA.
| | - Aoife O'Farrell
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, USA
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Lauren Clubb
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Shawn M Jensen
- Earle A Chiles Research Institute, Robert W Franz Cancer Research Center, Providence Portland Medical Center, Portland, OR, USA
| | - Bryan S Yung
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Zhiyong Wang
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Victoria H Wu
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | | | - Shiruyeh Schokrpur
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Medicine, Division of Hematology-Oncology, UC San Diego School of Medicine, San Diego, CA, USA
| | | | | | - Jill P Mesirov
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron B Simon
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Radiation Oncology, UC Irvine School of Medicine, Irvine, CA, USA
| | - Bernard A Fox
- Earle A Chiles Research Institute, Robert W Franz Cancer Research Center, Providence Portland Medical Center, Portland, OR, USA
- Department of Molecular Microbiology and Immunology, Oregon Health Science University, Portland, OR, USA
| | - Jack D Bui
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Pathology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Andrew Sharabi
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, San Diego, CA, USA
| | - Ezra E W Cohen
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Medicine, Division of Hematology-Oncology, UC San Diego School of Medicine, San Diego, CA, USA
| | - Joseph A Califano
- Department of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, USA
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA
| | - J Silvio Gutkind
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA.
- Gleiberman Head and Neck Cancer Center, UC San Diego, La Jolla, CA, USA.
- Department of Pharmacology, UC San Diego, La Jolla, CA, USA.
| |
Collapse
|
20
|
Hingorani DV, Allevato MM, Camargo MF, Lesperance J, Quraishi MA, Aguilera J, Franiak-Pietryga I, Scanderbeg DJ, Wang Z, Molinolo AA, Alvarado D, Sharabi AB, Bui JD, Cohen EEW, Adams SR, Gutkind JS, Advani SJ. Monomethyl auristatin antibody and peptide drug conjugates for trimodal cancer chemo-radio-immunotherapy. Nat Commun 2022; 13:3869. [PMID: 35790753 PMCID: PMC9256669 DOI: 10.1038/s41467-022-31601-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/24/2022] [Indexed: 12/20/2022] Open
Abstract
Locally advanced cancers remain therapeutically challenging to eradicate. The most successful treatments continue to combine decades old non-targeted chemotherapies with radiotherapy that unfortunately increase normal tissue damage in the irradiated field and have systemic toxicities precluding further treatment intensification. Therefore, alternative molecularly guided systemic therapies are needed to improve patient outcomes when applied with radiotherapy. In this work, we report a trimodal precision cytotoxic chemo-radio-immunotherapy paradigm using spatially targeted auristatin warheads. Tumor-directed antibodies and peptides conjugated to radiosensitizing monomethyl auristatin E (MMAE) specifically produce CD8 T cell dependent durable tumor control of irradiated tumors and immunologic memory. In combination with ionizing radiation, MMAE sculpts the tumor immune infiltrate to potentiate immune checkpoint inhibition. Here, we report therapeutic synergies of targeted cytotoxic auristatin radiosensitization to stimulate anti-tumor immune responses providing a rationale for clinical translational of auristatin antibody drug conjugates with radio-immunotherapy combinations to improve tumor control.
Collapse
Affiliation(s)
- Dina V Hingorani
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Michael M Allevato
- Department of Pharmacology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Maria F Camargo
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jacqueline Lesperance
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Maryam A Quraishi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Joseph Aguilera
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ida Franiak-Pietryga
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Daniel J Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Zhiyong Wang
- Department of Pharmacology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Alfredo A Molinolo
- Department of Pathology, University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA
| | | | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA
| | - Jack D Bui
- Department of Pathology, University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA
| | - Ezra E W Cohen
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA
- Department of Medicine, Division of Hematology and Oncology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Stephen R Adams
- Department of Pharmacology, University of California San Diego, La Jolla, CA, 92093, USA
| | - J Silvio Gutkind
- Department of Pharmacology, University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA
| | - Sunil J Advani
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.
- UC San Diego, Moores Cancer Center, La Jolla, CA, 92093, USA.
| |
Collapse
|
21
|
Levy DA, Patel JJ, Nguyen SA, Nicholas Jungbauer W, Neskey DM, Cohen EEW, Paulos CM, Kaczmar JA, Knochelmann HM, Day TA. Programmed death 1 (PD‐1) and ligand (PD‐L1) inhibitors in head and neck squamous cell carcinoma: A meta‐analysis. World J Otorhinolaryngol Head Neck Surg 2022; 8:177-186. [PMID: 36159902 PMCID: PMC9479482 DOI: 10.1002/wjo2.15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background PD‐1 and PD‐L1 inhibitors have emerged as promising treatments for patients with head and neck squamous cell carcinoma (HNSCC). Methods Systematic review and meta‐analysis of PD‐1 and PD‐L1 inhibitors in HNSCC. Outcomes: median overall survival (mOS), median progression‐free survival (mPFS), Response Evaluation Criteria in Solid Tumors (RECIST) and treatment‐related adverse events (TRAEs). Results Eleven trials reported data on 1088 patients (mean age: 59.9 years, range: 18–90). The total mOS was 7.97 months (range: 6.0–16.5). Mean mPFS for all studies was 2.84 months (range: 1.9–6.5). PD‐1 inhibitors had a lower rate of RECIST Progressive Disease than PD‐L1 inhibitors (42.61%, 95% confidence interval [CI]: 36.29–49.06 vs. 56.79%, 95% CI: 49.18–64.19, P < 0.001). The rate of TRAEs of any grade (62.7%, 95% CI: 59.8–65.6) did not differ. Conclusions Meta‐analysis shows the efficacy of PD‐1 and PD‐L1 inhibitors in HNSCC and suggests a possible difference in certain RECIST criterion between PD‐1 and PD‐L1 inhibitors. Future work to investigate the clinical significance of these findings is warranted. Significant Findings of this Study: 11 studies were analyzed in this meta‐analysis of PD‐1 and PD‐L1 inhibitor use in head and neck squamous cell carcinoma. Data showed that PD‐1 inhibitors had a significantly lower rate of RECIST progressive disease when compared to PD‐L1 inhibitors. What this study adds: Our meta‐analysis describes the efficacy of PD‐1 and PD‐L1 inhibitors in HNSCC and suggests a possible difference in certain RECIST criterion between PD‐1 and PD‐L1 inhibitors. This lays foundation for future work to guide clinical treatment of HNSCC.
Collapse
Affiliation(s)
- Dylan A. Levy
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Jaimin J. Patel
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Shaun A. Nguyen
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - W. Nicholas Jungbauer
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - David M. Neskey
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Department of Cell and Molecular Pharmacology and Developmental Therapeutics Medical University of South Carolina Charleston South Carolina USA
| | - Ezra E. W. Cohen
- Department of Medicine, Division of Hematology‐Oncology University of California, San Diego La Jolla California USA
| | - Chrystal M. Paulos
- Department of Microbiology and Immunology Medical University of South Carolina Charleston South Carolina USA
- Department of Dermatology and Dermatologic Surgery Medical University of South Carolina Charleston South Carolina USA
| | - John A. Kaczmar
- Division of Hematology & Oncology Medical University of South Carolina Charleston South Carolina USA
| | - Hannah M. Knochelmann
- Department of Microbiology and Immunology Medical University of South Carolina Charleston South Carolina USA
- Department of Dermatology and Dermatologic Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Terry A. Day
- Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| |
Collapse
|
22
|
Jeong AR, Forbes K, Orosco RK, Cohen EEW. Hereditary oral squamous cell carcinoma associated with CDKN2A germline mutation: a case report. J Otolaryngol Head Neck Surg 2022; 51:5. [PMID: 35123577 PMCID: PMC8818223 DOI: 10.1186/s40463-022-00556-y] [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: 08/01/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germline CDKN2A mutations are a well-known cause of familial atypical multiple mole melanoma (OMIM #155601) and melanoma-pancreatic cancer syndrome (OMIM #606719). Increased risk of head and neck squamous cell carcinoma (HNSCC), particularly oral squamous cell carcinoma (OSCC) in those with germline CDKN2A mutations, has been described. However, screening for HNSCC is not a routine practice in patients with CDKN2A germline mutations and these mutations are not a conventional test for HNSCC patients without obvious risk factors. CASE PRESENTATION We describe a female with no smoking history who developed oral squamous cell carcinoma at age 39 and had a complex clinical course of recurrent multifocal squamous cell carcinoma (SCC) and carcinoma in situ of the oral cavity and oropharynx. Detailed family history demonstrated that her mother was diagnosed with OSCC and melanoma in her 40 s, and her maternal grandfather was diagnosed with metastatic melanoma in his 40 s. Genetic testing of the patient and her mother revealed CDKN2A c.301G>T mutation. She was referred to genetic counseling as well as to dermatology, gastroenterology, and neurology for cancer surveillance. She was treated with resections and has no evidence of disease 3 years after diagnosis. CONCLUSIONS We report a family with a CDKN2A c.301 G>T mutation who also have significant history of OSCC, adding to the growing body of literature suggesting increased risk of HNSCC, particularly OSCC, in CDKN2A germline mutation carriers. It is important to consider CDKN2A mutation testing in familial HNSCC and young patients without obvious risk factors. Moreover, surveillance for HNSCC should be routine practice in those with a CDKN2A germline mutation.
Collapse
Affiliation(s)
- Ah-Reum Jeong
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA
| | - Kimberly Forbes
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA
| | - Ryan K Orosco
- Division of Otolaryngology, Department of Surgery, University of California San Diego, La Jolla, CA, 92093, USA.,Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ezra E W Cohen
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA. .,Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
| |
Collapse
|
23
|
Sacco AG, Cohen EEW. Inevitable Progress-Relying on the Immune System, Not Chance. Clin Cancer Res 2021; 28:435-437. [PMID: 34848533 DOI: 10.1158/1078-0432.ccr-21-3739] [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] [Received: 11/05/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
Locoregional recurrence of head and neck cancer after curative therapy portends a poor prognosis even when resectable. Immunotherapy has opened the door to novel strategic approaches in the curative treatment paradigm. Potentially improving outcomes for patients with recurrent, resectable disease through combination immune modulators highlights a new frontier. See related article by Hanna et al., p. XXXX.
Collapse
Affiliation(s)
- Assuntina G Sacco
- University of California, San Diego Health Moores Cancer Center, La Jolla, California
| | - Ezra E W Cohen
- Division of Hematology-Oncology, University of California, San Diego Health Moores Cancer Center, La Jolla, California.
| |
Collapse
|
24
|
Saddawi-Konefka R, Simon AB, Sumner W, Sharabi A, Mell LK, Cohen EEW. Defining the Role of Immunotherapy in the Curative Treatment of Locoregionally Advanced Head and Neck Cancer: Promises, Challenges, and Opportunities. Front Oncol 2021; 11:738626. [PMID: 34621678 PMCID: PMC8490924 DOI: 10.3389/fonc.2021.738626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 12/30/2022] Open
Abstract
Recent advancements in the development of immunotherapies have raised the hope for patients with locally-advanced HNSCC (LA-HNSCC) to achieve improved oncologic outcomes without the heavy burden of treatment-related morbidity. While there are several ongoing late phase clinical trials that seek to determine whether immunotherapy can be effectively employed in the definitive setting, initial results from concurrent immuno-radiotherapy therapy trials have not shown strong evidence of benefit. Encouragingly, evidence from preclinical studies and early-phase neoadjuvant studies have begun to show potential pathways forward, with therapeutic combinations and sequences that intentionally spare tumor draining lymphatics in order to maximize the synergy between definitive local therapy and immunotherapy. The intent of this review is to summarize the scientific rationale and current clinical evidence for employing immunotherapy for LA-HNSCC as well as the ongoing efforts and challenges to determine how to optimally deliver and sequence immunotherapy alongside traditional therapeutics. In both the preclinical and clinical settings, we will discuss the application of immunotherapies to both surgical and radiotherapeutic management of HNSCC.
Collapse
Affiliation(s)
- Robert Saddawi-Konefka
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, United States
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
| | - Aaron B. Simon
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
- Department of Radiation Oncology, UC Irvine School of Medicine, Irvine, CA, United States
| | - Whitney Sumner
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, San Diego, CA, United States
| | - Andrew Sharabi
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, San Diego, CA, United States
| | - Loren K. Mell
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, San Diego, CA, United States
| | - Ezra E. W. Cohen
- Moores Cancer Center, UC San Diego, La Jolla, CA, United States
- Department of Medicine, Division of Hematology-Oncology, UC San Diego School of Medicine, San Diego, CA, United States
| |
Collapse
|
25
|
Kim SS, Sumner WA, Miyauchi S, Cohen EEW, Califano JA, Sharabi AB. Role of B Cells in Responses to Checkpoint Blockade Immunotherapy and Overall Survival of Cancer Patients. Clin Cancer Res 2021; 27:6075-6082. [PMID: 34230025 DOI: 10.1158/1078-0432.ccr-21-0697] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
The role of B cells in the tumor microenvironment and B-cell-mediated antitumor immune responses remains relatively understudied. Recent seminal studies have discovered that B cells and associated tertiary lymphoid structures correlate with responses to checkpoint blockade immunotherapy and are prognostic for overall survival of cancer patients. B-cell subsets have remarkable functional diversity and include professional antigen-presenting cells, regulatory cells, memory populations, and antibody-producing plasma cells. Importantly, secreted antibodies can independently activate innate immune responses and induce the cancer immunity cycle. Thus, B cells and B-cell-mediated antibody responses comprise the largely underappreciated second arm of the adaptive immune system and certainly deserve further attention in the field of oncology. Here, we review the known functions of B cells in the tumor microenvironment, the contribution of B cells to the antitumor activity of immunotherapies, and the role of B cells in the overall survival of cancer patients.
Collapse
Affiliation(s)
- Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, California
| | - Whitney A Sumner
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, California
| | - Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, California
| | - Ezra E W Cohen
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, California
| | - Joseph A Califano
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, California.,Department of Surgery, Division of Otolaryngology, University of California, San Diego, California
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, California.
| |
Collapse
|
26
|
Kato S, Cohen EEW. Did Everolimus Break the Rules? Clin Cancer Res 2021; 27:3807-3808. [PMID: 33986025 DOI: 10.1158/1078-0432.ccr-21-1508] [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] [Received: 04/23/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
A phase II study with everolimus (mTORC1 inhibitor) among advanced solid tumors patients with TSC1/TSC2 or MTOR alterations was recently published. Although efficacy was limited, the study provided the future groundwork to advance the targeted therapy approach.See related article by Adib et al., p. 3845.
Collapse
Affiliation(s)
- Shumei Kato
- Division of Hematology-Oncology, Department of Internal Medicine, University of California, San Diego, Moores Cancer Center, La Jolla, California
| | - Ezra E W Cohen
- Division of Hematology-Oncology, Department of Internal Medicine, University of California, San Diego, Moores Cancer Center, La Jolla, California.
| |
Collapse
|
27
|
Sacco AG, Chen R, Worden FP, Wong DJL, Adkins D, Swiecicki P, Chai-Ho W, Oppelt P, Ghosh D, Bykowski J, Molinolo A, Pittman E, Estrada MV, Gold K, Daniels G, Lippman SM, Natsuhara A, Messer K, Cohen EEW. Pembrolizumab plus cetuximab in patients with recurrent or metastatic head and neck squamous cell carcinoma: an open-label, multi-arm, non-randomised, multicentre, phase 2 trial. Lancet Oncol 2021; 22:883-892. [PMID: 33989559 DOI: 10.1016/s1470-2045(21)00136-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pembrolizumab (PD-1 inhibitor) and cetuximab (EGFR inhibitor) are active as single agents and in combination with cytotoxic chemotherapy for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). Given each drug's single agent activity and unique mechanism of action, we aimed to evaluate the anti-tumour activity of PD-1 blockade with EGFR inhibition in recurrent or metastatic HNSCC. METHODS This study is an open-label, non-randomised, multi-arm, phase 2 trial done at four academic centres in the USA. Participants were required to have platinum-resistant or platinum-ineligible, recurrent or metastatic HNSCC, be at least 18 years old, have an Eastern Cooperative Oncology Group performance status 0-1, have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and to have received no previous immunotherapy or EGFR inhibition. All participants received pembrolizumab 200 mg intravenously every 3 weeks, combined with an initial loading dose of cetuximab 400 mg/m2 intravenously followed by 250 mg/m2 intravenously weekly (21 day cycle). The primary endpoint was overall response rate defined as the proportion of participants with a partial or complete responses (per RECIST version 1.1) by 6 months in the intention-to-treat population. The safety population included all participants who received at least one dose of pembrolizumab. Herein, the final analysis of cohort 1 (no previous PD-1, PD-L1, or EGFR inhibition for recurrent or metastatic HNSCC) is reported. Three additional cohorts (two for participants with a previous response to immunotherapy followed by relapse or progression, with or without previous cetuximab exposure, and one for cutaneous HNSCC) will be reported separately once fully accrued. This study is registered with ClinicalTrials.gov, NCT03082534, and remains open as the three additional cohorts are actively accruing participants. FINDINGS Between March 22, 2017, and July 16, 2019, 33 participants were enrolled to cohort 1. All 33 participants received at least one dose of pembrolizumab. Median follow-up duration was 7·3 months (IQR 3·9-10·9). By 6 months, the overall response rate was 45% (95% CI 28-62), with 15 of 33 participants achieving a partial response. The most common grade 3-4 treatment-related adverse event was oral mucositis (three [9%] of 33 participants), and serious treatment-related adverse events occurred in five (15%) participants. No treatment-related deaths occurred. INTERPRETATION Pembrolizumab combined with cetuximab shows promising clinical activity for recurrent or metastatic HNSCC, and merits further investigation. FUNDING Merck Sharp & Dohme.
Collapse
Affiliation(s)
- Assuntina G Sacco
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA.
| | - Ruifeng Chen
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA; Division of Biostatistics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Francis P Worden
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Deborah J L Wong
- Los Angeles Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Douglas Adkins
- Siteman Comprehensive Cancer Center, Washington University, St Louis, MO, USA
| | - Paul Swiecicki
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Wanxing Chai-Ho
- Los Angeles Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peter Oppelt
- Siteman Comprehensive Cancer Center, Washington University, St Louis, MO, USA
| | - Debanjali Ghosh
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Julie Bykowski
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alfredo Molinolo
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Emily Pittman
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - M Valeria Estrada
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Kathryn Gold
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Gregory Daniels
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Scott M Lippman
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Amanda Natsuhara
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Karen Messer
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA; Division of Biostatistics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Ezra E W Cohen
- Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
28
|
Wang Z, Goto Y, Allevato MM, Wu VH, Saddawi-Konefka R, Gilardi M, Alvarado D, Yung BS, O'Farrell A, Molinolo AA, Duvvuri U, Grandis JR, Califano JA, Cohen EEW, Gutkind JS. Disruption of the HER3-PI3K-mTOR oncogenic signaling axis and PD-1 blockade as a multimodal precision immunotherapy in head and neck cancer. Nat Commun 2021; 12:2383. [PMID: 33888713 PMCID: PMC8062674 DOI: 10.1038/s41467-021-22619-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 06/01/2020] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
Immune checkpoint blockade (ICB) therapy has revolutionized head and neck squamous cell carcinoma (HNSCC) treatment, but <20% of patients achieve durable responses. Persistent activation of the PI3K/AKT/mTOR signaling circuitry represents a key oncogenic driver in HNSCC; however, the potential immunosuppressive effects of PI3K/AKT/mTOR inhibitors may limit the benefit of their combination with ICB. Here we employ an unbiased kinome-wide siRNA screen to reveal that HER3, is essential for the proliferation of most HNSCC cells that do not harbor PIK3CA mutations. Indeed, we find that persistent tyrosine phosphorylation of HER3 and PI3K recruitment underlies aberrant PI3K/AKT/mTOR signaling in PIK3CA wild type HNSCCs. Remarkably, antibody-mediated HER3 blockade exerts a potent anti-tumor effect by suppressing HER3-PI3K-AKT-mTOR oncogenic signaling and concomitantly reversing the immune suppressive tumor microenvironment. Ultimately, we show that HER3 inhibition and PD-1 blockade may provide a multimodal precision immunotherapeutic approach for PIK3CA wild type HNSCC, aimed at achieving durable cancer remission.
Collapse
Affiliation(s)
- Zhiyong Wang
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Yusuke Goto
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Michael M Allevato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Victoria H Wu
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Robert Saddawi-Konefka
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, USA.
| | - Mara Gilardi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | - Bryan S Yung
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Aoife O'Farrell
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Alfredo A Molinolo
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer R Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joseph A Califano
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA, USA
| | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - J Silvio Gutkind
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
29
|
Harrington KJ, Soulières D, Le Tourneau C, Dinis J, Licitra LF, Ahn MJ, Soria A, Machiels JPH, Mach N, Mehra R, Burtness B, Ellison MC, Cheng JD, Chirovsky DR, Swaby RF, Cohen EEW. Quality of Life With Pembrolizumab for Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma: KEYNOTE-040. J Natl Cancer Inst 2021; 113:171-181. [PMID: 32407532 PMCID: PMC7850527 DOI: 10.1093/jnci/djaa063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/28/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) affects health-related quality of life (HRQoL); few treatments have demonstrated clinically meaningful HRQoL benefit. KEYNOTE-040 evaluated pembrolizumab vs standard of care (SOC) in patients with recurrent and/or metastatic HNSCC whose disease recurred or progressed after platinum-containing regimen. METHODS Patients received pembrolizumab 200 mg or SOC (methotrexate, docetaxel, or cetuximab). Exploratory HRQoL analyses used European Organisation for Research and Treatment of Cancer (EORTC) 30 quality-of-life, EORTC 35-question quality-of-life head and neck cancer-specific module, and EuroQoL 5-dimensions questionnaires. RESULTS The HRQoL population comprised 469 patients (pembrolizumab = 241, SOC = 228). HRQoL compliance for patients in the study at week 15 was 75.3% (116 of 154) for pembrolizumab and 74.6% (85 of 114) for SOC. The median time to deterioration in global health status (GHS) and QoL scores were 4.8 months with pembrolizumab and 2.8 months with SOC (hazard ratio = 0.79, 95% confidence interval [CI] = 0.59 to 1.05). At week 15, GHS / QoL scores were stable for pembrolizumab (least squares mean [LSM] = 0.39, 95% CI = -3.00 to 3.78) but worsened for SOC (LSM = -5.86, 95% CI = -9.68 to -2.04); the LSM between-group difference was 6.25 points (95% CI = 1.32 to 11.18; nominal 2-sided P = .01). A greater difference in the LSM for GHS / QoL score occurred with pembrolizumab vs docetaxel (10.23, 95% CI = 3.15 to 17.30) compared with pembrolizumab vs methotrexate (6.21, 95% CI = -4.57 to 16.99) or pembrolizumab vs cetuximab (-1.44, 95% CI = -11.43 to 8.56). Pembrolizumab-treated patients had stable functioning and symptoms at week 15, with no notable differences from SOC. CONCLUSIONS GHS / QoL scores were stable with pembrolizumab but declined with SOC in patients at week 15, supporting the clinically meaningful benefit of pembrolizumab in recurrent and/or metastatic HNSCC.
Collapse
Affiliation(s)
- Kevin J Harrington
- The Institute of Cancer Research/The Royal Marsden National Institute for Health Research Biomedical Research Centre, London, UK
| | | | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, France
- INSERM U900 Research Unit, Saint-Cloud, France
- Paris-Saclay University, Paris, France
| | - Jose Dinis
- Instituto Português Oncologia, Porto, Portugal
| | - Lisa F Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ainara Soria
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nicolas Mach
- HUG - Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Ezra E W Cohen
- Moores Cancer Center at UC San Diego Health, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
30
|
Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [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: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
Collapse
Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
| | | | | |
Collapse
|
31
|
Jou J, Harrington KJ, Zocca MB, Ehrnrooth E, Cohen EEW. The Changing Landscape of Therapeutic Cancer Vaccines-Novel Platforms and Neoantigen Identification. Clin Cancer Res 2020; 27:689-703. [PMID: 33122346 DOI: 10.1158/1078-0432.ccr-20-0245] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/12/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022]
Abstract
Therapeutic cancer vaccines, an exciting development in cancer immunotherapy, share the goal of creating and amplifying tumor-specific T-cell responses, but significant obstacles still remain to their success. Here, we briefly outline the principles underlying cancer vaccine therapy with a focus on novel vaccine platforms and antigens, underscoring the renewed optimism. Numerous strategies have been investigated to overcome immunosuppressive mechanisms of the tumor microenvironment (TME) and counteract tumor escape, including improving antigen selection, refining delivery platforms, and use of combination therapies. Several new cancer vaccine platforms and antigen targets are under development. In an effort to amplify tumor-specific T-cell responses, a heterologous prime-boost antigen delivery strategy is increasingly used for virus-based vaccines. Viruses have also been engineered to express targeted antigens and immunomodulatory molecules simultaneously, to favorably modify the TME. Nanoparticle systems have shown promise as delivery vectors for cancer vaccines in preclinical research. T-win is another platform targeting both tumor cells and the TME, using peptide-based vaccines that engage and activate T cells to target immunoregulatory molecules expressed on immunosuppressive and malignant cells. With the availability of next-generation sequencing, algorithms for neoantigen selection are emerging, and several bioinformatic platforms are available to select therapeutically relevant neoantigen targets for developing personalized therapies. However, more research is needed before the use of neoepitope prediction and personalized immunotherapy becomes commonplace. Taken together, the field of therapeutic cancer vaccines is fast evolving, with the promise of potential synergy with existing immunotherapies for long-term cancer treatment.
Collapse
Affiliation(s)
- Jessica Jou
- Moores Cancer Center, University of California, San Diego Health, La Jolla, California
| | - Kevin J Harrington
- The Institute of Cancer Research/Royal Marsden National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego Health, La Jolla, California.
| |
Collapse
|
32
|
Hanna GJ, Guenette JP, Chau NG, Sayehli CM, Wilhelm C, Metcalf R, Wong DJ, Brose M, Razaq M, Pérez-Ruiz E, Cohen EEW, Aggarwal R, Scholz C, Gualberto A, Ho AL. Tipifarnib in recurrent, metastatic HRAS-mutant salivary gland cancer. Cancer 2020; 126:3972-3981. [PMID: 32557577 PMCID: PMC8266417 DOI: 10.1002/cncr.33036] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To the authors' knowledge, there are no approved therapies for recurrent, metastatic (R/M) salivary gland carcinoma (SGC), but molecularly targeted therapies warrant ongoing investigation. In the current study, the authors have reported on the efficacy of tipifarnib in patients with aggressive HRAS-mutant, R/M SGC. METHODS The current prospective, nonrandomized, multicenter, international cohort study involved 8 centers and was conducted from May 2015 to June 2019. The median follow-up was 22 months (range, 6-55 months). Subjects with HRAS-mutant R/M SGC (any histology) and disease progression within the last 6 months were enrolled. Tipifarnib was dosed orally twice daily. The authors determined the objective response rate using Response Evaluation Criteria in Solid Tumors (version 1.1), duration of response, and molecular predictors of response. RESULTS A total of 13 patients with R/M SGC were enrolled; all had received prior systemic therapy (1-3 regimens). One objective response was observed; an additional 7 of 12 evaluable patients (58%) had stable disease as their best response with a median duration of 9 months (range, 3-14 months). Five of 7 patients had >10% tumor regression and 6 of 7 had stable disease lasting >6 months. Q61R was the most frequent activating HRAS mutation noted (7 of 13 patients; 54%), but gene variant and allele frequency did not correlate with outcomes. The median progression-free survival was 7 months (95% confidence interval, 5.9-10.1 months), and the median overall survival was 18 months (95% confidence interval, 9.6-22.4 months) with approximately 58.6% of patients alive at 1 year. Survival was similar regardless of HRAS mutant variant or co-occurring PIK3CA alterations. No participant discontinued treatment because of toxicity. CONCLUSIONS Tipifarnib resulted in modest clinical activity with a promising disease control rate among patients with HRAS-mutant, R/M SGC who developed disease progression within the last 6 months.
Collapse
Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole G. Chau
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada
| | - Cyrus M. Sayehli
- Department of Internal Medicine II, Early Clinical Trial Unit, University Hospital Wurzburg, Wurzburg, Germany
| | - Christian Wilhelm
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius Maximilian University of Wuerzburg, Wuerzburg, Germany
| | - Robert Metcalf
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Deborah J. Wong
- Division of Hematology and Oncology, Department of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, Los Angeles, California
| | - Marcia Brose
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohammad Razaq
- Department of Hematology/Oncology, Stephenson Cancer Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Elisabeth Pérez-Ruiz
- Department of Medical Oncology, Institute of Biomedical Research of Malaga, Costa del Sol Health Agency, Marbella, Spain
| | - Ezra E. W. Cohen
- Division of Hematology-Oncology, Moores Cancer Center, University of California at San Diego Health, San Diego, California
| | - Rahul Aggarwal
- Division of Hematology/Oncology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | | | - Alan L. Ho
- Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
- Department of Medicine, Weill Cornell Medical College, New York City, New York
| |
Collapse
|
33
|
Harrington KJ, Kong A, Mach N, Chesney JA, Fernandez BC, Rischin D, Cohen EEW, Radcliffe HS, Gumuscu B, Cheng J, Snyder W, Siu LL. Talimogene Laherparepvec and Pembrolizumab in Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck (MASTERKEY-232): A Multicenter, Phase 1b Study. Clin Cancer Res 2020; 26:5153-5161. [PMID: 32669371 DOI: 10.1158/1078-0432.ccr-20-1170] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The prognosis for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is poor, and only a minority of patients benefit from checkpoint immunotherapy. Talimogene laherparepvec (T-VEC), an oncolytic immunotherapy approved for advanced melanoma, in combination with pembrolizumab may yield enhanced antitumor activity over either agent alone. PATIENTS AND METHODS This was a phase Ib/III, multicenter trial testing intratumoral T-VEC combined with intravenous pembrolizumab in R/M HNSCC refractory to platinum-based chemotherapy. For phase Ib, primary endpoint was incidence of dose-limiting toxicity (DLT). Key secondary endpoints included objective response rate and progression-free survival per irRECIST, overall survival, and safety. RESULTS Thirty-six patients were enrolled into the phase Ib study. The data cut-off date was August 28, 2018. Median follow-up was 5.8 months (range, 0.3-24.2). One DLT of T-VEC-related fatal arterial hemorrhage was reported. Twenty (55.6%) and 21 (58.3%) patients experienced adverse events (AE) related to T-VEC and pembrolizumab, respectively. Besides the DLT, there were no treatment-related fatal AEs. A confirmed partial response was observed in 5 (13.9%) patients. Ten (27.8%) patients were unevaluable for response due to early death. Median PFS and OS were 3.0 months [95% confidence interval (Cl), 2.0-5.8] and 5.8 months (95% Cl, 2.9-11.4), respectively. CONCLUSIONS The combination of T-VEC and pembrolizumab demonstrated a tolerable safety profile in R/M HNSCC. The efficacy with the combination was similar to that with pembrolizumab monotherapy in historical HNSCC studies. Phase III part of this study was not further pursued (ClinicalTrials.gov Identifier: NCT02626000).
Collapse
Affiliation(s)
- Kevin J Harrington
- The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom.
| | - Anthony Kong
- Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, United Kingdom.,Comprehensive Cancer Centre, King's College London, United Kingdom
| | - Nicolas Mach
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Jason A Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | | | | | - Ezra E W Cohen
- Moores Cancer Center UC San Diego Health, La Jolla, California
| | | | | | | | | | - Lillian L Siu
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Powell SF, Gold KA, Gitau MM, Sumey CJ, Lohr MM, McGraw SC, Nowak RK, Jensen AW, Blanchard MJ, Fischer CD, Bykowski J, Ellison CA, Black LJ, Thompson PA, Callejas-Valera JL, Lee JH, Cohen EEW, Spanos WC. Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. J Clin Oncol 2020; 38:2427-2437. [PMID: 32479189 DOI: 10.1200/jco.19.03156] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Pembrolizumab is a humanized monoclonal antibody that blocks interaction between programmed death receptor-1 (PD-1) and its ligands (PD-L1, PD-L2). Although pembrolizumab is approved for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), its role in the management of locally advanced (LA) disease is not defined. We report a phase IB study evaluating the safety and efficacy of adding pembrolizumab to cisplatin-based chemoradiotherapy in patients with LA HNSCC. PATIENTS AND METHODS Eligible patients included those with oral cavity (excluding lip), oropharyngeal, hypopharyngeal, or laryngeal stage III to IVB HNSCC (according to American Joint Committee on Cancer, 7th edition, staging system) eligible for cisplatin-based, standard-dose (70 Gy) chemoradiotherapy. Pembrolizumab was administered concurrently with and after chemoradiotherapy with weekly cisplatin. Safety was the primary end point and was determined by incidence of chemoradiotherapy adverse events (AEs) and immune-related AEs (irAEs). Efficacy was defined as complete response (CR) rate on end-of-treatment (EOT) imaging or with pathologic confirmation at 100 days postradiotherapy completion. Key secondary end points included overall (OS) and progression-free survival (PFS). RESULTS The study accrued 59 patients (human papillomavirus [HPV] positive, n = 34; HPV negative, n = 25) from November 2015 to October 2018. Five patients (8.8%) required discontinuation of pembrolizumab because of irAEs, all of which occurred during concurrent chemoradiotherapy; 98.3% of patients completed the full planned treatment dose (70 Gy) of radiotherapy without any delays ≥ 5 days; 88.1% of patients completed the goal cisplatin dose of ≥ 200 mg/m2. EOT CR rates were 85.3% and 78.3% for those with HPV-positive and -negative HNSCC, respectively. CONCLUSION Pembrolizumab in combination with weekly cisplatin-based chemoradiotherapy is safe and does not impair delivery of curative radiotherapy or chemotherapy in HNSCC. Early efficacy data support further investigation of this approach.
Collapse
Affiliation(s)
| | - Kathryn A Gold
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Mark M Gitau
- Roger Maris Cancer Center, Sanford Health, Fargo, ND
| | | | | | | | - Ryan K Nowak
- Sanford Cancer Center, Sanford Health, Sioux Falls, SD
| | | | | | | | - Julie Bykowski
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Lora J Black
- Sanford Research, Sanford Health, Sioux Falls, SD
| | | | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | |
Collapse
|
35
|
Haddad R, Cohen EEW, Venkatachalam M, Young K, Singh P, Shaw JW, Korytowsky B, Abraham P, Harrington KJ. Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States. J Med Econ 2020; 23:442-447. [PMID: 31928375 DOI: 10.1080/13696998.2020.1715414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim: To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US.Methods: We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death). Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period. Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state. A scenario analysis was conducted assuming increased uptake of subsequent immunotherapies. A one-way deterministic sensitivity analysis assessed the impact of variation in multiple parameters. A probabilistic sensitivity analysis in which probabilistic distributions were applied to each input during 1,000 model iterations was also conducted.Results: Total costs incurred were higher with nivolumab ($101,552) than with IC ($38,067). Nivolumab was associated with a higher number of life-years (LY; 1.21) and quality-adjusted life-years (QALYs; 0.89), compared with IC (0.68 and 0.42, respectively). The incremental cost-effectiveness ratio for nivolumab compared with IC was $134,438 per QALY, and this remained qualitatively similar when increased uptake of subsequent immunotherapies was assumed ($129,603 per QALY). Sensitivity analyses supported these findings.Conclusions: These results suggest that, at a willingness-to-pay threshold of $150,000 per QALY, nivolumab is a cost-effective option for therapy of SCCHN in the US.
Collapse
Affiliation(s)
| | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | - Kevin J Harrington
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK
| |
Collapse
|
36
|
Kim SS, Shen S, Miyauchi S, Sanders PD, Franiak-Pietryga I, Mell L, Gutkind JS, Cohen EEW, Califano JA, Sharabi AB. B Cells Improve Overall Survival in HPV-Associated Squamous Cell Carcinomas and Are Activated by Radiation and PD-1 Blockade. Clin Cancer Res 2020; 26:3345-3359. [PMID: 32193227 DOI: 10.1158/1078-0432.ccr-19-3211] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/22/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To characterize the role of B cells on human papilloma virus (HPV)-associated cancer patient outcomes and determine the effects of radiation and PD-1 blockade on B-cell populations. EXPERIMENTAL DESIGN Tumor RNA-sequencing data from over 800 patients with head and neck squamous cell carcinoma (HNSCC) and cervical cancer, including a prospective validation cohort, was analyzed to study the impact of B-cell gene expression on overall survival (OS). A novel murine model of HPV+ HNSCC was used to study the effects of PD-1 blockade and radiotherapy on B-cell activation, differentiation, and clonality including analysis by single-cell RNA-sequencing and B-cell receptor (BCR)-sequencing. Human protein microarray was then used to quantify B-cell-mediated IgG and IgM antibodies to over 16,000 proteins in the serum of patients treated on a clinical trial with PD-1 blockade. RESULTS RNA-sequencing identified CD19 and IGJ as novel B-cell prognostic biomarkers for 3-year OS (HR, 0.545; P < 0.001). PD-1 blockade and radiotherapy enhance development of memory B cells, plasma cells, and antigen-specific B cells. BCR-sequencing found that radiotherapy enhances B-cell clonality, decreases CDR3 length, and induces B-cell somatic hypermutation. Single-cell RNA-sequencing identified dramatic increases in B-cell germinal center formation after PD-1 blockade and radiotherapy. Human proteome array revealed enhanced IgG and IgM antibody responses in patients who derived clinical benefit but not those with progressive disease after treatment with PD-1 blockade. CONCLUSIONS These findings establish a key role for B cells in patient outcomes and responses to PD-1 blockade in HPV-associated squamous cell carcinomas and demonstrate the need for additional diagnostics and therapeutics targeting B cells.
Collapse
Affiliation(s)
- Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California.,School of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Sarek Shen
- School of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Surgery, Division of Otolaryngology, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - P Dominick Sanders
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Ida Franiak-Pietryga
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Loren Mell
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - J Silvio Gutkind
- Department of Pharmacology, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Ezra E W Cohen
- Department of Medicine, Division of Hematology-Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Joseph A Califano
- Department of Surgery, Division of Otolaryngology, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California.
| |
Collapse
|
37
|
Porter A, Natsuhara M, Daniels GA, Patel SP, Sacco AG, Bykowski J, Banks KC, Cohen EEW. Next generation sequencing of cell free circulating tumor DNA in blood samples of recurrent and metastatic head and neck cancer patients. Transl Cancer Res 2020; 9:203-209. [PMID: 35117174 PMCID: PMC8798156 DOI: 10.21037/tcr.2019.12.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/04/2019] [Indexed: 11/06/2022]
Abstract
Background Effective targeted therapy is lacking in head and neck cancer (HNC). The use of next generation sequencing (NGS) has been suggested as a way to potentially expand therapeutic options and improve outcomes. This study was performed in order to further characterize blood sample cell-free circulating tumor DNA (ctDNA) in advanced HNC patients, to determine its ability to identify actionable mutations, and to elucidate its potential role in patient management. Methods Retrospective analysis of 60 patients with recurrent and metastatic (R/M) HNCs who underwent molecular profiling of blood samples utilizing Guardant360, a 70-gene ctDNA NGS platform. ctDNA sequencing data was compared to tumor NGS data, when available. Best response to therapy was assessed using RECIST measures. Results The most common tumor type was oropharyngeal squamous cell carcinoma (n=21). Other cancer types included salivary gland (n=8) and thyroid (n=4). The most common mutations identified by blood analysis were TP53 (68% of patients), PIK3CA (34% of patients), NOTCH1 (20% of patients), and ARID1A (15% of patients). These findings were consistent with results from tumor sequencing data (n=30) where TP53 (48%) and PIK3CA (24%) were also the most common. Seventy-three percent (n=22) of patients had alterations identified in blood that were not present in tumor specimens. In patients with squamous cell carcinoma, 66% had an off-label option identified and 90% had a trial option identified, while 50% of patients with salivary primaries had off-label option identified and 75% had trial options identified. All patients (n=3, 100%) with thyroid primaries had off-label and clinical trial options identified. Of patients with actionable mutations, 13% (n=8) received matched targeted therapy (MTT). Three patients had stable disease (37.5%), 3 had progressive disease (37.5%), and 2 (25%) were not evaluated at the time of follow up. Of those who did not receive targeted therapy (n=21), 11 patients had stable disease (52.4%), 9 had progressive disease (42.9%), and 1 had a complete response (4.8%). Conclusions Alterations identified by ctDNA may help inform management decisions in advanced HNC. The majority of patients had unique mutations identified on ctDNA. The role of NGS of ctDNA should be explored in future studies.
Collapse
Affiliation(s)
- Ashleigh Porter
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mandy Natsuhara
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | - Gregory A Daniels
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | | | | | - Julie Bykowski
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | - Kimberly C Banks
- Department of Medical Affairs, Guardant Health, Inc., Redwood City, CA, USA
| | - Ezra E W Cohen
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| |
Collapse
|
38
|
Pai SI, Cohen EEW, Lin D, Fountzilas G, Kim ES, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Wang H, Twumasi-Ankrah P, Wildsmith S, Khaliq A, Melillo G, Shire N. SUPREME-HN: a retrospective biomarker study assessing the prognostic value of PD-L1 expression in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. J Transl Med 2019; 17:429. [PMID: 31878938 PMCID: PMC6933901 DOI: 10.1186/s12967-019-02182-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Programmed cell death ligand-1 (PD-L1) expression on tumor cells (TCs) is associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy, although its role as a prognostic factor is controversial. This study investigates whether tumoral expression of PD-L1 is a prognostic marker in patients with recurrent and/or metastatic (R/M) HNSCC treated with standard chemotherapy. Methods This retrospective, multicenter, noninterventional study assessed PD-L1 expression on archival R/M HNSCC tissue samples using the VENTANA PD-L1 (SP263) Assay. PD-L1 high was defined as PD-L1 staining of ≥ 25% TC, with exploratory scoring at TC ≥ 10% and TC ≥ 50%. The primary objective of this study was to estimate the prognostic value of PD-L1 status in terms of overall survival (OS) in patients with R/M HNSCC. Results 412 patients (median age, 62.0 years; 79.9% male; 88.2% Caucasian) were included from 19 sites in seven countries. 132 patients (32.0%) had TC ≥ 25% PD-L1 expression; 199 patients (48.3%) and 85 patients (20.6%) had TC ≥ 10% and ≥ 50%, respectively. OS did not differ significantly across PD-L1 expression (at TC ≥ 25% cutoff median OS: 8.2 months vs TC < 25%, 10.1 months, P = 0.55) or the ≥ 10% and ≥ 50% cutoffs (at TC ≥ 10%, median OS: 9.6 months vs TC < 10%, 9.4 months, P = 0.32, and at TC ≥ 50%, median OS 7.9 vs TC < 50%, 10.0 months, P = 0.39, respectively). Conclusions PD-L1 expression, assessed using the VENTANA PD-L1 (SP263) Assay, was not prognostic of OS in patients with R/M HNSCC treated with standard of care chemotherapies. Trial registration ClinicalTrials.gov, NCT02543476. Registered September 4, 2015.
Collapse
Affiliation(s)
- Sara I Pai
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.
| | - Ezra E W Cohen
- UC San Diego Health System, Moores Cancer Center, La Jolla, CA, USA
| | - Derrick Lin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.,Massachusetts Eye and Ear, Boston, MA, USA
| | | | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Holger Mehlhorn
- Universitaetsklinikum Leipzig, Klinik und Poliklinik fur HNO-Heilkunde, Leipzig, Germany
| | - Neus Baste
- Department of Oncology, Hospital Universitari Vall d'Hebron & Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Loren Lipworth
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nawar Shara
- MedStar Health Research Institute, Hyattsville, MD, USA
| | | | - Jun Zhang
- Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Miyauchi S, Sanders PD, Guram K, Kim SS, Paolini F, Venuti A, Cohen EEW, Gutkind JS, Califano JA, Sharabi AB. HPV16 E5 Mediates Resistance to PD-L1 Blockade and Can Be Targeted with Rimantadine in Head and Neck Cancer. Cancer Res 2019; 80:732-746. [PMID: 31848196 DOI: 10.1158/0008-5472.can-19-1771] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/19/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
There is a critical need to understand mechanisms of resistance and to develop combinatorial strategies to improve responses to checkpoint blockade immunotherapy (CBI). Here, we uncover a novel mechanism by which the human papillomavirus (HPV) inhibits the activity of CBI in head and neck squamous cell carcinoma (HNSCC). Using orthotopic HNSCC models, we show that radiation combined with anti-PD-L1 immunotherapy significantly enhanced local control, CD8+ memory T cells, and induced preferential T-cell homing via modulation of vascular endothelial cells. However, the HPV E5 oncoprotein suppressed immune responses by downregulating expression of major histocompatibility complex and interfering with antigen presentation in murine models and patient tumors. Furthermore, tumors expressing HPV E5 were rendered entirely resistant to anti-PD-L1 immunotherapy, and patients with high expression of HPV16 E5 had worse survival. The antiviral E5 inhibitor rimantadine demonstrated remarkable single-agent antitumor activity. This is the first report that describes HPV E5 as a mediator of resistance to anti-PD-1/PD-L1 immunotherapy and demonstrates the antitumor activity of rimantadine. These results have broad clinical relevance beyond HNSCC to other HPV-associated malignancies and reveal a powerful mechanism of HPV-mediated immunosuppression, which can be exploited to improve response rates to checkpoint blockade. SIGNIFICANCE: This study identifies a novel mechanism of resistance to anti-PD-1/PD-L1 immunotherapy mediated by HPV E5, which can be exploited using the HPV E5 inhibitor rimantadine to improve outcomes for head and neck cancer patients. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/4/732/F1.large.jpg.
Collapse
Affiliation(s)
- Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - P Dominick Sanders
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Kripa Guram
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California.,School of Medicine, University of California, San Diego, La Jolla, California
| | - Francesca Paolini
- HPV-Unit, UOSD Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Venuti
- HPV-Unit, UOSD Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, La Jolla, California
| | - J Silvio Gutkind
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Pharmacology, University of California, San Diego, La Jolla, California
| | - Joseph A Califano
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Surgery, Division of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California. .,Moores Cancer Center, University of California, San Diego, La Jolla, California
| |
Collapse
|
40
|
Wang Z, Wu VH, Allevato MM, Gilardi M, He Y, Luis Callejas-Valera J, Vitale-Cross L, Martin D, Amornphimoltham P, Mcdermott J, Yung BS, Goto Y, Molinolo AA, Sharabi AB, Cohen EEW, Chen Q, Lyons JG, Alexandrov LB, Gutkind JS. Syngeneic animal models of tobacco-associated oral cancer reveal the activity of in situ anti-CTLA-4. Nat Commun 2019; 10:5546. [PMID: 31804466 PMCID: PMC6895221 DOI: 10.1038/s41467-019-13471-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [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: 05/24/2019] [Accepted: 11/08/2019] [Indexed: 02/05/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Tobacco use is the main risk factor for HNSCC, and tobacco-associated HNSCCs have poor prognosis and response to available treatments. Recently approved anti-PD-1 immune checkpoint inhibitors showed limited activity (≤20%) in HNSCC, highlighting the need to identify new therapeutic options. For this, mouse models that accurately mimic the complexity of the HNSCC mutational landscape and tumor immune environment are urgently needed. Here, we report a mouse HNSCC model system that recapitulates the human tobacco-related HNSCC mutanome, in which tumors grow when implanted in the tongue of immunocompetent mice. These HNSCC lesions have similar immune infiltration and response rates to anti-PD-1 (≤20%) immunotherapy as human HNSCCs. Remarkably, we find that >70% of HNSCC lesions respond to intratumoral anti-CTLA-4. This syngeneic HNSCC mouse model provides a platform to accelerate the development of immunotherapeutic options for HNSCC.
Collapse
Affiliation(s)
- Zhiyong Wang
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
| | - Victoria H Wu
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Michael M Allevato
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Mara Gilardi
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
| | - Yudou He
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Lynn Vitale-Cross
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Martin
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | | | - James Mcdermott
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
| | - Bryan S Yung
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Yusuke Goto
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
| | - Alfredo A Molinolo
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
| | - Andrew B Sharabi
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, La Jolla, CA, USA
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Guy Lyons
- Dermatology, Bosch Institute, University of Sydney, Camperdown, NSW, 2050, Australia
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Centenary Institute, Camperdown, NSW, 2050, Australia
| | - Ludmil B Alexandrov
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - J Silvio Gutkind
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, USA.
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
41
|
Cohen EEW, Pishvaian MJ, Shepard DR, Wang D, Weiss J, Johnson ML, Chung CH, Chen Y, Huang B, Davis CB, Toffalorio F, Thall A, Powell SF. A phase Ib study of utomilumab (PF-05082566) in combination with mogamulizumab in patients with advanced solid tumors. J Immunother Cancer 2019; 7:342. [PMID: 31801624 PMCID: PMC6894203 DOI: 10.1186/s40425-019-0815-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 09/06/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed on activated T and natural killer cells, 4-1BB/CD137 is a costimulatory receptor that signals a series of events resulting in cytokine secretion and enhanced effector function. Targeting 4-1BB/CD137 with agonist antibodies has been associated with tumor reduction and antitumor immunity. C-C chemokine receptor 4 (CCR4) is highly expressed in various solid tumor indications and associated with poor prognosis. This phase Ib, open-label study in patients with advanced solid tumors assessed the safety, efficacy, pharmacokinetics, and pharmacodynamics of utomilumab (PF-05082566), a human monoclonal antibody (mAb) agonist of the T-cell costimulatory receptor 4-1BB/CD137, in combination with mogamulizumab, a humanized mAb targeting CCR4 reported to deplete subsets of regulatory T cells (Tregs). METHODS Utomilumab 1.2-5 mg/kg or 100 mg flat dose every 4 weeks plus mogamulizumab 1 mg/kg (weekly in Cycle 1 followed by biweekly in Cycles ≥2) was administered intravenously to 24 adults with solid tumors. Blood was collected pre- and post-dose for assessment of drug pharmacokinetics, immunogenicity, and pharmacodynamic markers. Baseline tumor biopsies from a subset of patients were also analyzed for the presence of programmed cell death-ligand 1 (PD-L1), CD8, FoxP3, and 4-1BB/CD137. Radiologic tumor assessments were conducted at baseline and on treatment every 8 weeks. RESULTS No dose-limiting toxicities occurred and the maximum tolerated dose was determined to be at least 2.4 mg/kg per the time-to-event continual reassessment method. No serious adverse events related to either treatment were observed; anemia was the only grade 3 non-serious adverse event related to both treatments. Utomilumab systemic exposure appeared to increase with dose. One patient with PD-L1-refractory squamous lung cancer achieved a best overall response of partial response and 9 patients had a best overall response of stable disease. No patients achieved complete response. Objective response rate was 4.2% (95% confidence interval: 0.1-21.1%) per RECIST 1.1. Depletion of Tregs in peripheral blood was accompanied by evidence of T-cell expansion as assessed by T-cell receptor sequence analysis. CONCLUSIONS The combination of utomilumab/mogamulizumab was safe and tolerable, and may be suitable for evaluation in settings where CCR4-expressing Tregs are suppressing anticancer immunity. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02444793.
Collapse
Affiliation(s)
- Ezra E W Cohen
- UC San Diego Health, Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA.
| | | | | | - Ding Wang
- Henry Ford Hospital, Detroit, MI, USA
| | - Jared Weiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Guo Y, Ahn MJ, Chan A, Wang CH, Kang JH, Kim SB, Bello M, Arora RS, Zhang Q, He X, Li P, Dechaphunkul A, Kumar V, Kamble K, Li W, Kandil A, Cohen EEW, Geng Y, Zografos E, Tang PZ. Afatinib versus methotrexate as second-line treatment in Asian patients with recurrent or metastatic squamous cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 3): an open-label, randomised phase III trial. Ann Oncol 2019; 30:1831-1839. [PMID: 31501887 PMCID: PMC6927323 DOI: 10.1093/annonc/mdz388] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment options are limited for patients with recurrent or metastatic squamous cell carcinoma of the head and neck (HNSCC) following progression after first-line platinum-based therapy, particularly in Asian countries. PATIENTS AND METHODS In this randomised, open-label, phase III trial, we enrolled Asian patients aged ≥18 years, with histologically or cytologically confirmed recurrent/metastatic HNSCC following first-line platinum-based therapy who were not amenable for salvage surgery or radiotherapy, and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0/1. Patients were randomised (2 : 1) to receive oral afatinib (40 mg/day) or intravenous methotrexate (40 mg/m2/week), stratified by ECOG performance status and prior EGFR-targeted antibody therapy. The primary end point was progression-free survival (PFS) assessed by an independent central review committee blinded to treatment allocation. RESULTS A total of 340 patients were randomised (228 afatinib; 112 methotrexate). After a median follow-up of 6.4 months, afatinib significantly decreased the risk of progression/death by 37% versus methotrexate (hazard ratio 0.63; 95% confidence interval 0.48-0.82; P = 0.0005; median 2.9 versus 2.6 months; landmark analysis at 12 and 24 weeks, 58% versus 41%, 21% versus 9%). Improved PFS was complemented by quality of life benefits. Objective response rate was 28% with afatinib and 13% with methotrexate. There was no significant difference in overall survival. The most common grade ≥3 drug-related adverse events were rash/acne (4% with afatinib versus 0% with methotrexate), diarrhoea (4% versus 0%), fatigue (1% versus 5%), anaemia (<1% versus 5%) and leukopenia (0% versus 5%). CONCLUSIONS Consistent with the phase III LUX-Head & Neck 1 trial, afatinib significantly improved PFS versus methotrexate, with a manageable safety profile. These results demonstrate the efficacy and feasibility of afatinib as a second-line treatment option for certain patients with recurrent or metastatic HNSCC. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01856478.
Collapse
Affiliation(s)
- Y Guo
- Department of Medical Oncology, Shanghai East Hospital, Tongji University, Shanghai, China.
| | - M-J Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - A Chan
- State Key Laboratory in Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - C-H Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - J-H Kang
- The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul
| | - S-B Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - M Bello
- Department of Oncology, St Luke's Medical Center, Quezon City, Philippines
| | - R S Arora
- Department Oncology, Sujan Surgical Cancer Hospital and Amravati Cancer Foundation, Amravati, India
| | - Q Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - X He
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Science, Beijing
| | - P Li
- West China Hospital, Sichuan University, Chengdu, China
| | - A Dechaphunkul
- Division of Medical Oncology, Prince of Songkla University, Songkhla, Thailand
| | - V Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow
| | - K Kamble
- Department of Medicine, Government Medical College and Hospital, Nagpur, India
| | - W Li
- Department of Hematology and Oncology, First Hospital Affiliated to Jilin University, Jilin, China
| | - A Kandil
- Internal Medicine, Alexandria University Hospital, Alexandria, Egypt
| | - E E W Cohen
- Department of Medicine, University of California, San Diego, USA
| | - Y Geng
- Biostatistics, Boehringer Ingelheim (China) Investment Co., Ltd, China
| | - E Zografos
- Clinical Development and Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, Berkshire, UK
| | - P Z Tang
- Department of Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
43
|
Cohen EEW, Soulières D, Swaby RF, Harrington KJ. p16 status and choice of chemotherapy in the KEYNOTE-040 study - Authors' reply. Lancet 2019; 394:1323. [PMID: 31609223 DOI: 10.1016/s0140-6736(19)31264-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ezra E W Cohen
- Moores Cancer Center at University of California, San Diego, CA 92093, USA.
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Kevin J Harrington
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, National Institute of Health Research Biomedical Research Centre, London, UK
| |
Collapse
|
44
|
Hingorani DV, Doan MK, Camargo MF, Aguilera J, Song SM, Pizzo D, Scanderbeg DJ, Cohen EEW, Lowy AM, Adams SR, Advani SJ. Precision Chemoradiotherapy for HER2 Tumors Using Antibody Conjugates of an Auristatin Derivative with Reduced Cell Permeability. Mol Cancer Ther 2019; 19:157-167. [PMID: 31597712 DOI: 10.1158/1535-7163.mct-18-1302] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/21/2018] [Revised: 06/07/2019] [Accepted: 09/30/2019] [Indexed: 01/30/2023]
Abstract
The most successful therapeutic strategies for locally advanced cancers continue to combine decades-old classical radiosensitizing chemotherapies with radiotherapy. Molecular targeted radiosensitizers offer the potential to improve the therapeutic ratio by increasing tumor-specific kill while minimizing drug delivery and toxicity to surrounding normal tissue. Auristatins are a potent class of anti-tubulins that sensitize cells to ionizing radiation damage and are chemically amenable to antibody conjugation. To achieve tumor-selective radiosensitization, we synthesized and tested anti-HER2 antibody-drug conjugates of two auristatin derivatives with ionizing radiation. Monomethyl auristatin E (MMAE) and monomethyl auristatin F (MMAF) were attached to the anti-HER2 antibodies trastuzumab and pertuzumab through a cleavable linker. While MMAE is cell permeable, MMAF has limited cell permeability as free drug resulting in diminished cytotoxicity and radiosensitization. However, when attached to trastuzumab or pertuzumab, MMAF was as efficacious as MMAE in blocking HER2-expressing tumor cells in G2-M. Moreover, MMAF anti-HER2 conjugates selectively killed and radiosensitized HER2-rich tumor cells. Importantly, when conjugated to targeting antibody, MMAF had the advantage of decreased bystander and off-target effects compared with MMAE. In murine xenograft models, MMAF anti-HER2 antibody conjugates had less drug accumulated in the normal tissue surrounding tumors compared with MMAE. Therapeutically, systemically injected MMAF anti-HER2 conjugates combined with focal ionizing radiation increased tumor control and improved survival of mice with HER2-rich tumor xenografts. In summary, our results demonstrate the potential of cell-impermeable radiosensitizing warheads to improve the therapeutic ratio of radiotherapy by leveraging antibody-drug conjugate technology.
Collapse
Affiliation(s)
- Dina V Hingorani
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Matthew K Doan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Maria F Camargo
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Joseph Aguilera
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Seung M Song
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Donald Pizzo
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Daniel J Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ezra E W Cohen
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, La Jolla, California
- University of California San Diego, Moores Cancer Center, La Jolla, California
| | - Andrew M Lowy
- University of California San Diego, Moores Cancer Center, La Jolla, California
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, California
| | - Stephen R Adams
- Department of Pharmacology, University of California San Diego, La Jolla, California
| | - Sunil J Advani
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
- University of California San Diego, Moores Cancer Center, La Jolla, California
| |
Collapse
|
45
|
Ferris RL, Saba NF, Gitlitz BJ, Haddad R, Sukari A, Neupane P, Morris JC, Misiukiewicz K, Bauman JE, Fenton M, Jimeno A, Adkins DR, Schneider CJ, Sacco AG, Shirai K, Bowles DW, Gibson M, Nwizu T, Gottardo R, Manjarrez KL, Dietsch GN, Bryan JK, Hershberg RM, Cohen EEW. Effect of Adding Motolimod to Standard Combination Chemotherapy and Cetuximab Treatment of Patients With Squamous Cell Carcinoma of the Head and Neck: The Active8 Randomized Clinical Trial. JAMA Oncol 2019; 4:1583-1588. [PMID: 29931076 DOI: 10.1001/jamaoncol.2018.1888] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Immunotherapy for recurrent and/or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) is promising. The toll-like receptor 8 (TLR8) agonist motolimod may stimulate innate and adaptive immunity. Objective To determine whether motolimod improves outcomes for R/M SCCHN when combined with standard therapy. Design, Setting, and Participants The Active8 study was a multicenter, randomized, double-blind, placebo-controlled clinical trial enrolling adult patients (age ≥18 years) with histologically confirmed R/M SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx between October 2013 and August 2015. Follow-up ended September 2016. Analysis for the present report was conducted between June 2016 and December 2017. Interventions Combination treatment with platinum (carboplatin or cisplatin), fluorouracil, cetuximab (the EXTREME regimen), and either placebo or motolimod, each administered intravenously every 3 weeks. Patients received a maximum of 6 chemotherapy cycles, after which patients received weekly cetuximab with either placebo or motolimod every 4 weeks. Main Outcomes and Measures Progression-free survival (PFS) as determined by independent central review using immune-related RECIST (Response Evaluation Criteria in Solid Tumors). Key secondary end points included overall survival (OS) and safety. Results Of 195 patients enrolled, 85% were men (n = 166); 82% were white (n = 159); median age was 58 years (range 23-81 years). Median PFS was 6.1 vs 5.9 months (hazard ratio [HR], 0.99; 1-sided 90% CI, 0.00-1.22; P = .47), and median OS was 13.5 vs 11.3 months (HR, 0.95; 1-sided 90% CI, 0.00-1.22; P = .40) for motolimod vs placebo. Increased incidence of injection site reactions, pyrexia, chills, anemia, and acneiform rash were noted with motolimod. Of 83 cases oropharyngeal cancer, 52 (63%) were human papillomavirus (HPV) positive. In a prespecified subgroup analysis of HPV-positive participants, motolimod vs placebo resulted in significantly longer PFS (7.8 vs 5.9 months; HR, 0.58; 1-sided 90% CI, 0.00-0.90; P = .046) and OS (15.2 vs 12.6 months; HR, 0.41; 1-sided 90% CI, 0.00-0.77; P = .03). In an exploratory analysis, patients with injection site reactions had longer PFS and OS (median PFS, 7.1 vs 5.9 months; HR, 0.69; 1-sided 90% CI, 0.00-0.93; P = .06; and median OS, 18.7 vs 12.6; HR, 0.56; 1-sided 90% CI, 0.00-0.81; P = .02). Conclusions and Relevance Adding motolimod to the EXTREME regimen was well tolerated but did not improve PFS or OS in the intent-to-treat population. Significant benefit was observed in HPV-positive patients and those with injection site reactions, suggesting that TLR8 stimulation may benefit subset- and biomarker-selected patients. Trial Registration ClinicalTrials.gov identifier: NCT01836029.
Collapse
Affiliation(s)
- Robert L Ferris
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Barbara J Gitlitz
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | | | | | - John C Morris
- University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | | | - Julie E Bauman
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Moon Fenton
- West Cancer Center, University of Tennessee, Memphis
| | | | | | | | | | | | | | - Michael Gibson
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla
| |
Collapse
|
46
|
Haddad R, Guigay J, Keilholz U, Clement PM, Fayette J, de Souza Viana L, Rolland F, Cupissol D, Geoffrois L, Kornek G, Licitra L, Melichar B, Ribaldo Nicolau U, Rauch D, Zanetta-Devauges S, Cohen EEW, Machiels JP, Tahara M, Vermorken J, Geng Y, Zografos E, Gauler T. Afatinib as second-line treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck: Subgroup analyses of treatment adherence, safety and mode of afatinib administration in the LUX-Head and Neck 1 trial. Oral Oncol 2019; 97:82-91. [PMID: 31450171 DOI: 10.1016/j.oraloncology.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with head and neck squamous cell carcinoma (HNSCC) can experience severe symptom burden and/or difficulty swallowing, leading to problems with treatment adherence/administration. In LUX-Head and Neck 1 (LH&N1; NCT01345682), second-line afatinib improved progression-free survival (PFS) versus methotrexate in patients with recurrent/metastatic HNSCC. We report adherence and safety across pre-specified and additional subgroups potentially linked to afatinib PFS benefit in LH&N1 (p16 status, smoking history), and afatinib adherence, safety and efficacy by administration (oral versus feeding tube; post-hoc analysis). METHODS Patients were randomized (2:1) to afatinib (40 mg/day) or intravenous methotrexate (40 mg/m2/week). RESULTS Among 320 afatinib-treated and 160 methotrexate-treated patients, 83-92% and 76-92% (of patients with data available) across all subgroups took ≥80% of treatment. Across p16 status and smoking history subgroups, the most common treatment-related adverse events (AEs) were diarrhea (70-91%), rash/acne (72-84%), stomatitis (34-73%) with afatinib; and included stomatitis (39-100%), fatigue (22-50%), nausea (19-36%) with methotrexate. Dose reduction decreased AE incidence/severity. Baseline characteristics were generally similar between oral/feeding tube (n = 276/n = 46) groups. 89%/89% (of patients with data available) took ≥80% of assigned afatinib. Median PFS was 2.6 versus 2.7 months (hazard ratio: 0.997; 95% confidence interval: 0.72-1.38). The most common afatinib-related AEs were: rash/acne (74% versus 74%), diarrhea (73% versus 65%), stomatitis (40% versus 30%). CONCLUSION Subgroup analyses of LH&N1 demonstrate that afatinib has predictable and manageable safety across patient subgroups, with high treatment adherence, and is effective via oral and feeding tube administration.
Collapse
Affiliation(s)
- Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Joel Guigay
- Centre Antoine Lacassagne, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Ulrich Keilholz
- Medical Department, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Paul M Clement
- Department of Oncology, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Luciano de Souza Viana
- Department of Medical Oncology, Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
| | - Frédéric Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Didier Cupissol
- Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Gabriela Kornek
- Klinische Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Vienna, Austria
| | - Lisa Licitra
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, and University of Milan, Milan, Italy
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School, Olomouc, Czech Republic
| | | | - Daniel Rauch
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Yuan Geng
- Boehringer Ingelheim (China) Investment Co., Ltd., Shanghai, China
| | | | - Thomas Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
| |
Collapse
|
47
|
Burtness B, Haddad R, Dinis J, Trigo J, Yokota T, de Souza Viana L, Romanov I, Vermorken J, Bourhis J, Tahara M, Martins Segalla JG, Psyrri A, Vasilevskaya I, Nangia CS, Chaves-Conde M, Kiyota N, Homma A, Holeckova P, Del Campo JM, Asarawala N, Nicolau UR, Rauch D, Even C, Wang B, Gibson N, Ehrnrooth E, Harrington K, Cohen EEW. Afatinib vs Placebo as Adjuvant Therapy After Chemoradiotherapy in Squamous Cell Carcinoma of the Head and Neck: A Randomized Clinical Trial. JAMA Oncol 2019; 5:1170-1180. [PMID: 31194247 DOI: 10.1001/jamaoncol.2019.1146] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Locoregionally advanced head and neck squamous cell cancer (HNSCC) is treated curatively; however, risk of recurrence remains high among some patients. The ERBB family blocker afatinib has shown efficacy in recurrent or metastatic HNSCC. Objective To assess whether afatinib therapy after definitive chemoradiotherapy (CRT) improves disease-free survival (DFS) in patients with HNSCC. Design, Setting, and Participants This multicenter, phase 3, double-blind randomized clinical trial (LUX-Head & Neck 2) studied 617 patients from November 2, 2011, to July 4, 2016. Patients who had complete response after CRT, comprising radiotherapy with cisplatin or carboplatin, with or without resection of residual disease, for locoregionally advanced high- or intermediate-risk HNSCC of the oral cavity, hypopharynx, larynx, or oropharynx were included in the study. Data analysis was of the intention-to-treat population. Interventions Patients were randomized (2:1) to treatment with afatinib (40 mg/d) or placebo, stratified by nodal status (N0-2a or N2b-3) and Eastern Cooperative Oncology Group performance status (0 or 1). Treatment continued for 18 months or until disease recurrence, unacceptable adverse events, or patient withdrawal. Main Outcomes and Measures The primary end point was DFS, defined as time from the date of randomization to the date of tumor recurrence or secondary primary tumor or death from any cause. Secondary end points were DFS at 2 years, overall survival (defined as time from the date of randomization to death), and health-related quality of life. Results A total of 617 patients were studied (mean [SD] age, 58 [8.4] years; 528 male [85.6%]). Recruitment was stopped after a preplanned interim futility analysis on July 4, 2016, on recommendation from an independent data monitoring committee. Treatment was discontinued. Median DFS was 43.4 months (95% CI, 37.4 months to not estimable) in the afatinib group and not estimable (95% CI, 40.1 months to not estimable) in the placebo group (hazard ratio, 1.13; 95% CI, 0.81-1.57; stratified log-rank test P = .48). The most common grade 3 and 4 drug-related adverse effects were acneiform rash (61 [14.8%] of 411 patients in the afatinib group vs 1 [0.5%] of 206 patients in the placebo group), stomatitis (55 [13.4%] in the afatinib group vs 1 [0.5%] in the placebo group), and diarrhea (32 [7.8%] in the afatinib group vs 1 [0.5%] in the placebo group). Conclusions and Relevance This study's findings indicate that treatment with afatinib after CRT did not improve DFS and was associated with more adverse events than placebo in patients with primary, unresected, clinically high- to intermediate-risk HNSCC. The use of adjuvant afatinib after CRT is not recommended. Trial Registration ClinicalTrials.gov identifier: NCT01345669.
Collapse
Affiliation(s)
- Barbara Burtness
- Department of Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - José Dinis
- Instituto Português de Oncologia, Porto, Portugal
| | - José Trigo
- Department of Medical Oncology, Hospital Virgen de la Victoria, IBIMA, Malaga, Spain
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Centre, Shizuoka, Japan
| | | | - Ilya Romanov
- Russian Oncological Research Centre, Moscow, Russia
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jean Bourhis
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Centre Hospital East, Kashiwa, Japan
| | | | - Amanda Psyrri
- Department of Internal Medicine, National Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | | | | | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Akihiro Homma
- Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Petra Holeckova
- Department of Oncology and Radiotherapy, Hospital Na Bulovce and 1st Medical Faculty of Charles University, Prague, Czech Republic
| | | | - Nirav Asarawala
- Shree Krishna Hospital and Medical Research Centre, Gujarat, India
| | | | - Daniel Rauch
- Inselspital, University Hospital Bern, Bern, Switzerland
| | - Caroline Even
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - Bushi Wang
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | | | - Kevin Harrington
- Division of Radiotherapy and Imaging, The Royal Marsden Hospital/The Institute of Cancer Research, National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | - Ezra E W Cohen
- Department of Translational Science, Moores Cancer Centre, University of California at San Diego, La Jolla
| | | |
Collapse
|
48
|
Cohen EEW, Bell RB, Bifulco CB, Burtness B, Gillison ML, Harrington KJ, Le QT, Lee NY, Leidner R, Lewis RL, Licitra L, Mehanna H, Mell LK, Raben A, Sikora AG, Uppaluri R, Whitworth F, Zandberg DP, Ferris RL. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). J Immunother Cancer 2019; 7:184. [PMID: 31307547 PMCID: PMC6632213 DOI: 10.1186/s40425-019-0662-5] [Citation(s) in RCA: 366] [Impact Index Per Article: 73.2] [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: 01/24/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancers, including those of the lip and oral cavity, nasal cavity, paranasal sinuses, oropharynx, larynx and nasopharynx represent nearly 700,000 new cases and 380,000 deaths worldwide per annum, and account for over 10,000 annual deaths in the United States alone. Improvement in outcomes are needed for patients with recurrent and or metastatic squamous cell carcinoma of the head and neck (HNSCC). In 2016, the US Food and Drug Administration (FDA) granted the first immunotherapeutic approvals - the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab - for the treatment of patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) that is refractory to platinum-based regimens. The European Commission followed in 2017 with approval of nivolumab for treatment of the same patient population, and shortly thereafter with approval of pembrolizumab monotherapy for the treatment of recurrent or metastatic HNSCC in adults whose tumors express PD-L1 with a ≥ 50% tumor proportion score and have progressed on or after platinum-containing chemotherapy. Then in 2019, the FDA granted approval for PD-1 inhibition as first-line treatment for patients with metastatic or unresectable, recurrent HNSCC, approving pembrolizumab in combination with platinum and fluorouracil for all patients with HNSCC and pembrolizumab as a single agent for patients with HNSCC whose tumors express a PD-L1 combined positive score ≥ 1. These approvals marked the first new therapies for these patients since 2006, as well as the first immunotherapeutic approvals in this disease. In light of the introduction of these novel therapies for the treatment of patients with head and neck cancer, The Society for Immunotherapy of Cancer (SITC) formed an expert committee tasked with generating consensus recommendations for emerging immunotherapies, including appropriate patient selection, therapy sequence, response monitoring, adverse event management, and biomarker testing. These consensus guidelines serve as a foundation to assist clinicians' understanding of the role of immunotherapies in this disease setting, and to standardize utilization across the field for patient benefit. Due to country-specific variances in approvals, availability and regulations regarding the discussed agents, this panel focused solely on FDA-approved drugs for the treatment of patients in the U.S.
Collapse
Affiliation(s)
- Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - R Bryan Bell
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | - Carlo B Bifulco
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Maura L Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Nancy Y Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rom Leidner
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | | | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori Milan and University of Milan, Milan, Italy
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Loren K Mell
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Adam Raben
- Helen F. Graham Cancer Center, Newark, DE, USA
| | | | - Ravindra Uppaluri
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | |
Collapse
|
49
|
Guram K, Kim SS, Wu V, Sanders PD, Patel S, Schoenberger SP, Cohen EEW, Chen SY, Sharabi AB. A Threshold Model for T-Cell Activation in the Era of Checkpoint Blockade Immunotherapy. Front Immunol 2019; 10:491. [PMID: 30936880 PMCID: PMC6431643 DOI: 10.3389/fimmu.2019.00491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Continued discoveries of negative regulators of inflammatory signaling provide detailed molecular insights into peripheral tolerance and anti-tumor immunity. Accumulating evidence indicates that peripheral tolerance is maintained at multiple levels of immune responses by negative regulators of proinflammatory signaling, soluble anti-inflammatory factors, inhibitory surface receptors & ligands, and regulatory cell subsets. This review provides a global overview of these regulatory machineries that work in concert to maintain peripheral tolerance at cellular and host levels, focusing on the direct and indirect regulation of T cells. The recent success of checkpoint blockade immunotherapy (CBI) has initiated a dramatic shift in the paradigm of cancer treatment. Unprecedented responses to CBI have highlighted the central role of T cells in both anti-tumor immunity and peripheral tolerance and underscored the importance of T cell exhaustion in cancer. We discuss the therapeutic implications of modulating the negative regulators of T cell function for tumor immunotherapy with an emphasis on inhibitory surface receptors & ligands—central players in T cell exhaustion and targets of checkpoint blockade immunotherapies. We then introduce a Threshold Model for Immune Activation—the concept that these regulatory mechanisms contribute to defining a set threshold of immunogenic (proinflammatory) signaling required to elicit an anti-tumor or autoimmune response. We demonstrate the value of the Threshold Model in understanding clinical responses and immune related adverse events in the context of peripheral tolerance, tumor immunity, and the era of Checkpoint Blockade Immunotherapy.
Collapse
Affiliation(s)
- Kripa Guram
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Victoria Wu
- Moores Comprehensive Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - P Dominick Sanders
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Sandip Patel
- Division of Hematology and Oncology, Center for Personalized Cancer Therapy, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Stephen P Schoenberger
- Division of Hematology and Oncology, Center for Personalized Cancer Therapy, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States.,Laboratory of Cellular Immunology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, United States
| | - Ezra E W Cohen
- Moores Comprehensive Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Si-Yi Chen
- Department of Molecular Microbiology and Immunology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, San Diego, San Diego, CA, United States.,Moores Comprehensive Cancer Center, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
50
|
Miyauchi S, Kim SS, Pang J, Gold KA, Gutkind JS, Califano JA, Mell LK, Cohen EEW, Sharabi AB. Immune Modulation of Head and Neck Squamous Cell Carcinoma and the Tumor Microenvironment by Conventional Therapeutics. Clin Cancer Res 2019; 25:4211-4223. [PMID: 30814108 DOI: 10.1158/1078-0432.ccr-18-0871] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/18/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) accounts for more than 600,000 cases and 380,000 deaths annually worldwide. Although human papillomavirus (HPV)-associated HNSCCs have better overall survival compared with HPV-negative HNSCC, loco-regional recurrence remains a significant cause of mortality and additional combinatorial strategies are needed to improve outcomes. The primary conventional therapies to treat HNSCC are surgery, radiation, and chemotherapies; however, multiple other targeted systemic options are used and being tested including cetuximab, bevacizumab, mTOR inhibitors, and metformin. In 2016, the first checkpoint blockade immunotherapy was approved for recurrent or metastatic HNSCC refractory to platinum-based chemotherapy. This immunotherapy approval confirmed the critical importance of the immune system and immunomodulation in HNSCC pathogenesis, response to treatment, and disease control. However, although immuno-oncology agents are rapidly expanding, the role that the immune system plays in the mechanism of action and clinical efficacy of standard conventional therapies is likely underappreciated. In this article, we focus on how conventional and targeted therapies may directly modulate the immune system and the tumor microenvironment to better understand the effects and combinatorial potential of these therapies in the context and era of immunotherapy.
Collapse
Affiliation(s)
- Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - John Pang
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California
| | - Kathryn A Gold
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, La Jolla, California
| | - J Silvio Gutkind
- Department of Pharmacology, University of California, San Diego, La Jolla, California
| | - Joseph A Califano
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California.,Department of Surgery, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Ezra E W Cohen
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California. .,Moores Cancer Center, University of California, San Diego, La Jolla, California
| |
Collapse
|