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Mourvillier B, Vlaar A, Witzenrath M, Bauer M, Heunks L, Vasquez LH, Welte T, van Paassen P, De Bruin S, Lim EHT, Tuinman PR, Saraiva JF, Marx G, Lobo SM, Boldo R, Simón Campos JA, Cornet AD, Grebenyuk A, Engelbrecht J, Habel M, Thielert C, Dickinson J, Rückinger S, Zerbib R, Neukirchen D, Pilz K, Guo R, van de Beek D, Riedemann N. LB1529. Randomized, Controlled Phase 3 Study of anti-C5a Vilobelimab's Effect on Mortality in Critically Ill COVID-19 Patients: A Therapy for Viral Pneumonia. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
SARS-CoV-2 induces endothelial damage and activates the complement system. In severe COVID-19 patients, complement split factor C5a is highly elevated leading to inflammation that contributes to multiorgan failure. The anti-C5a monoclonal antibody, Vilobelimab (Vilo), which preserves the membrane attack complex (MAC), was investigated in an adaptively designed, randomized double-blind, placebo (P)-controlled Phase 3 international multicenter study for survival in critically ill COVID-19 patients (pts).
Methods
COVID-19 pneumonia pts (N=368; Vilo n=177, P n=191), mechanically ventilated within 48 hrs before treatment, received up to 6, 800 mg infusions of Vilo or P on top of standard of care. The primary and main secondary endpoints were 28-day (d) and 60-d all-cause mortality.
Results
Pts enrolled in the study were on corticosteroids (97%) and anti-coagulants (98%) as standard of care. A smaller proportion (20%) were either continuing or had taken immunomodulators such as tocilizumab and baricitinib prior to receiving Vilo. The 28-d all-cause mortality was 31.7% with Vilo vs 41.6% with P (Kaplan-Meier estimates; Cox regression site-stratified, HR 0.73; 95% CI:0.50-1.06; P=0.094), representing a 23.8% relative mortality reduction. In predefined primary outcome analysis without site stratification, however, Vilo significantly reduced mortality at 28 (HR 0.67; 95% CI:0.48-0.96; P=0.027) and 60 days (HR 0.67; 95% CI:0.48-0.92; P=0.016). Vilo also significantly reduced 28-d mortality in more severe pts with baseline WHO ordinal scale score of 7 (n=237, HR 0.62; 95% CI:0.40-0.95; P=0.028), severe ARDS/PaO2/FiO2 ≤ 100 mmHg (n=98, HR 0.55; 95% CI:0.30-0.98; P=0.044) and eGFR < 60 mL/min/1.73m2 (n=108, HR 0.55; 95% CI:0.31-0.96; P=0.036). Treatment-emergent AEs were 90.9% Vilo vs 91.0% P. Infections were comparable: Vilo 62.9%, P 59.3%. Infection incidence per 100 Pt days were equal. No meningococcal infections were reported. Serious AEs were 58.9% Vilo, 63.5% P.
Conclusion
Vilo significantly reduced mortality at 28 and 60 days in critically ill COVID-19 pts with no increase in infections suggesting the importance of targeting C5a while preserving MAC. Vilo targets inflammation which may represent an approach to treat sepsis and ARDS caused by other respiratory viruses.
Disclosures
Alexander Vlaar, MD, PhD, InflaRx GmbH: Advisor/Consultant Maria Habel, PhD, InflaRx GmbH: Stocks/Bonds Claus Thielert, PhD, InflaRx GmbH: Stocks/Bonds James Dickinson, MSc, InflaRx GmbH: Stocks/Bonds simon Rückinger, PhD, InflaRx GmbH: Advisor/Consultant Robert Zerbib, MSc, InflaRx GmbH: Stocks/Bonds Dorothee Neukirchen, PhD, InflaRx GmbH: Stocks/Bonds Korinna Pilz, MD, MSc, InflaRx GmbH: Ownership Interest|InflaRx GmbH: Stocks/Bonds Renfeng Guo, MD, InflaRx GmbH: Board Member|InflaRx GmbH: CSO|InflaRx GmbH: Ownership Interest|InflaRx GmbH: Stocks/Bonds Diederik van de Beek, MD, PhD, InflaRx GmbH: Advisor/Consultant Niels Riedemann, MD, PhD, InflaRx GmbH: Board Member|InflaRx GmbH: CEO|InflaRx GmbH: Ownership Interest|InflaRx GmbH: Stocks/Bonds.
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Affiliation(s)
| | | | | | - Michael Bauer
- University Hospital Jena , Jena, Thuringen , Germany
| | - Leo Heunks
- Free University , Amsterdam UMC, Amsterdam, Noord-Holland , Netherlands
| | | | - Tobias Welte
- Medizinische Hochschule Hannover , Hannover, Niedersachsen , Germany
| | | | | | - Endry H T Lim
- Amsterdam UMC , Amsterdam, Noord-Holland , Netherlands
| | - Pieter R Tuinman
- Free University , Amsterdam UMC, Amsterdam, Noord-Holland , Netherlands
| | - Jose F Saraiva
- Instituto de Pesquisa Clínica de Campinas , Campinas, Sao Paulo , Brazil
| | - Gernot Marx
- Universitätsklinik RWTH Aachen , Aachen, Nordrhein-Westfalen , Germany
| | | | - Rodrigo Boldo
- Associação Educadora São Carlos AESC - Hospital Mãe de Deus - Centro de Pesquisa , Porto Alegre, Rio Grande do Sul , Brazil
| | | | - Alexander D Cornet
- Medisch Spectrum Twente - Intensive Care , Enschede, Overijssel , Netherlands
| | | | | | | | | | | | - Simon Rückinger
- Metranomia Clinical Research GmbH , Munich, Bayern , Germany
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Vlaar APJ, Witzenrath M, van Paassen P, Heunks LMA, Mourvillier B, de Bruin S, Lim EHT, Brouwer MC, Tuinman PR, Saraiva JFK, Marx G, Lobo SM, Boldo R, Simon-Campos JA, Cornet AD, Grebenyuk A, Engelbrecht JM, Mukansi M, Jorens PG, Zerbib R, Rückinger S, Pilz K, Guo R, van de Beek D, Riedemann NC, Witzenrath M, van Paassen P, Heunks LM, Mourvillier B, de Bruin S, Lim EH, Brouwer MC, Tuinman PR, Saraiva JFK, Marx G, Lobo S, Boldo R, Simon-Campos J, Cornet AD, Grebenyuk A, Engelbrecht J, Mukansi M, Jorens PG, Zerbib R, Rückinger S, Pilz K, Guo R, van de Beek D, Riedemann NC, Bulpa P, Taccone FS, Hermans G, Diltoer M, Piagnerelli M, De Neve N, Freire AT, Pizzol FD, Marinho AK, Sato VH, Arns da Cunha C, Neuville M, Dellamonica J, Annane D, Roquilly A, Diehl JL, Schneider F, Mira JP, Lascarrou JB, Desmedt L, Dupuis C, Schwebel C, Thiéry G, Gründling M, Berger M, Welte T, Bauer M, Jaschinski U, Matschke K, Mercado-Longoria R, Gomez Quintana B, Zamudio-Lerma JA, Moreno Hoyos Abril J, Aleman Marquez A, Pickkers P, Otterspoor L, Hercilla Vásquez L, Seas Ramos CR, Peña Villalobos A, Gianella Malca G, Chávez V, Filimonov V, Kulabukhov V, Acharya P, Timmermans SA, Busch MH, van Baarle FL, Koning R, ter Horst L, Chekrouni N, van Soest TM, Slim MA, van Vught LA, van Amstel RB, Olie SE, van Zeggeren IE, van de Poll MC, Thielert C, Neukirchen D. Anti-C5a antibody (vilobelimab) therapy for critically ill, invasively mechanically ventilated patients with COVID-19 (PANAMO): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Respir Med 2022; 10:1137-1146. [PMID: 36087611 PMCID: PMC9451499 DOI: 10.1016/s2213-2600(22)00297-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vilobelimab, an anti-C5a monoclonal antibody, was shown to be safe in a phase 2 trial of invasively mechanically ventilated patients with COVID-19. Here, we aimed to determine whether vilobelimab in addition to standard of care improves survival outcomes in this patient population. METHODS This randomised, double-blind, placebo-controlled, multicentre phase 3 trial was performed at 46 hospitals in the Netherlands, Germany, France, Belgium, Russia, Brazil, Peru, Mexico, and South Africa. Participants aged 18 years or older who were receiving invasive mechanical ventilation, but not more than 48 h after intubation at time of first infusion, had a PaO2/FiO2 ratio of 60-200 mm Hg, and a confirmed SARS-CoV-2 infection with any variant in the past 14 days were eligible for this study. Eligible patients were randomly assigned (1:1) to receive standard of care and vilobelimab at a dose of 800 mg intravenously for a maximum of six doses (days 1, 2, 4, 8, 15, and 22) or standard of care and a matching placebo using permuted block randomisation. Treatment was not continued after hospital discharge. Participants, caregivers, and assessors were masked to group assignment. The primary outcome was defined as all-cause mortality at 28 days in the full analysis set (defined as all randomly assigned participants regardless of whether a patient started treatment, excluding patients randomly assigned in error) and measured using Kaplan-Meier analysis. Safety analyses included all patients who had received at least one infusion of either vilobelimab or placebo. This study is registered with ClinicalTrials.gov, NCT04333420. FINDINGS From Oct 1, 2020, to Oct 4, 2021, we included 368 patients in the ITT analysis (full analysis set; 177 in the vilobelimab group and 191 in the placebo group). One patient in the vilobelimab group was excluded from the primary analysis due to random assignment in error without treatment. At least one dose of study treatment was given to 364 (99%) patients (safety analysis set). 54 patients (31%) of 177 in the vilobelimab group and 77 patients (40%) of 191 in the placebo group died in the first 28 days. The all-cause mortality rate at 28 days was 32% (95% CI 25-39) in the vilobelimab group and 42% (35-49) in the placebo group (hazard ratio 0·73, 95% CI 0·50-1·06; p=0·094). In the predefined analysis without site-stratification, vilobelimab significantly reduced all-cause mortality at 28 days (HR 0·67, 95% CI 0·48-0·96; p=0·027). The most common TEAEs were acute kidney injury (35 [20%] of 175 in the vilobelimab group vs 40 [21%] of 189 in the placebo), pneumonia (38 [22%] vs 26 [14%]), and septic shock (24 [14%] vs 31 [16%]). Serious treatment-emergent adverse events were reported in 103 (59%) of 175 patients in the vilobelimab group versus 120 (63%) of 189 in the placebo group. INTERPRETATION In addition to standard of care, vilobelimab improves survival of invasive mechanically ventilated patients with COVID-19 and leads to a significant decrease in mortality. Vilobelimab could be considered as an additional therapy for patients in this setting and further research is needed on the role of vilobelimab and C5a in other acute respiratory distress syndrome-causing viral infections. FUNDING InflaRx and the German Federal Government.
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Affiliation(s)
- Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands,Prof Alexander P J Vlaar, Department of Intensive Care, University of Amsterdam, Amsterdam UMC, 1100DD Amsterdam, Netherlands
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, German Center for Lung Research, Berlin, Germany
| | | | - Leo M A Heunks
- Department of Intensive Care, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Bruno Mourvillier
- Medical Intensive Care Unit, University Hospital of Reims, Reims, France
| | - Sanne de Bruin
- Department of Intensive Care, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Endry H T Lim
- Department of Intensive Care, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | | | - Gernot Marx
- Uniklinik RWTH Aachen, Klinik für Operative Intensivmedizin und Intermediate Care, Aachen, Germany
| | | | - Rodrigo Boldo
- Associação Educadora São Carlos, Hospital Mãe de Deus, Centro de Pesquisa, Porto Alegre, Brazil
| | | | | | | | | | - Murimisi Mukansi
- Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | - Diederik van de Beek
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
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Cohen RB, Bauman JR, Salas S, Colevas AD, Even C, Cupissol D, Posner MR, Lefebvre G, Saada-Bouzid E, Bernadach M, Seiwert TY, Pearson AT, Calmels F, Zerbib R, Andre P, Rotolo F, Boyer-chammard A, Fayette J. Combination of monalizumab and cetuximab in recurrent or metastatic head and neck cancer patients previously treated with platinum-based chemotherapy and PD-(L)1 inhibitors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6516] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6516 Background: Monalizumab is a first-in-class immune checkpoint inhibitor targeting Natural Killer Group 2A (NKG2A), which is expressed on subsets of Natural Killer (NK), gd T and tumor-infiltrating CD8+T cells. NKG2A blockade promotes innate anti-tumor immunity mediated by NK and CD8+T cells and enhances NK cell antibody-dependent cell-mediated cytotoxicity induced by cetuximab. In a Phase I study, the combination of monalizumab and cetuximab was well tolerated. In an initial expansion cohort 1 of 40 patients (pts) who had progressed after platinum-based therapy, we reported an overall response rate (ORR) of 27.5%, a 4.5 month median PFS and an 8.5 month median OS. In a subset of patients (n=18) previously treated with PD-(L)1 inhibitors (IO), corresponding results were 17%, 5.1, and 14.1 months, respectively (ESMO 2019). Here we present data from a second expansion cohort 2 (n=40) conducted specifically in the post-IO setting to independently confirm the cohort 1 results. Methods: Eligible patients had R/M SCCHN previously treated with platinum and a PD-(L)1 inhibitor. Pts received monalizumab 750 mg q2weeks and cetuximab according to the label until progression or toxicity. Cohort 2 was designed as a confirmatory multicenter single arm phase II study, with a pre-planned total of 40 patients. The primary endpoint was ORR assessed per RECIST 1.1. Results: As of January 31, 2020, 40 pts have been treated in cohort 2. Median follow-up is 7.3 months (range, 1.9-13.6+). Eight (8) pts have a confirmed partial response (PR); ORR is 20% [95% confidence interval: 11-35]. Median time to response is 1.6 months [1.6-5.3]. At the time of data analysis, 3 pts were still in PR and 3 pts had stable disease continue on treatment. PFS and OS are still immature. Conclusions: In pts previously treated with platinum and PD-(L)1 inhibitors, the combination of monalizumab and cetuximab demonstrated promising activity. The second extension cohort confirmed prospectively the ORR reported in cohort 1. A randomized phase III trial of monalizumab and cetuximab is planned in this platinum and IO-pretreated SCCHN population. Clinical trial information: NCT02643550 .
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Affiliation(s)
- Roger B. Cohen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Sebastien Salas
- CEPCM Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | | | | | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Alexander T. Pearson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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van Hall T, André P, Horowitz A, Ruan DF, Borst L, Zerbib R, Narni-Mancinelli E, van der Burg SH, Vivier E. Monalizumab: inhibiting the novel immune checkpoint NKG2A. J Immunother Cancer 2019; 7:263. [PMID: 31623687 PMCID: PMC6798508 DOI: 10.1186/s40425-019-0761-3] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [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: 05/31/2019] [Accepted: 09/26/2019] [Indexed: 02/08/2023] Open
Abstract
The implementation of immune checkpoint inhibitors to the oncology clinic signified a new era in cancer treatment. After the first indication of melanoma, an increasing list of additional cancer types are now treated with immune system targeting antibodies to PD-1, PD-L1 and CTLA-4, alleviating inhibition signals on T cells. Recently, we published proof-of-concept results on a novel checkpoint inhibitor, NKG2A. This receptor is expressed on cytotoxic lymphocytes, including NK cells and subsets of activated CD8+ T cells. Blocking antibodies to NKG2A unleashed the reactivity of these effector cells resulting in tumor control in multiple mouse models and an early clinical trial. Monalizumab is inhibiting this checkpoint in human beings and future clinical trials will have to reveal its potency in combination with other cancer treatment options.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Disease Models, Animal
- Histocompatibility Antigens Class I/immunology
- Histocompatibility Antigens Class I/metabolism
- Humans
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Mice
- NK Cell Lectin-Like Receptor Subfamily C/antagonists & inhibitors
- NK Cell Lectin-Like Receptor Subfamily C/immunology
- NK Cell Lectin-Like Receptor Subfamily C/metabolism
- Neoplasms/drug therapy
- Neoplasms/immunology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
- HLA-E Antigens
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Affiliation(s)
- Thorbald van Hall
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, 2333, ZA, Leiden, the Netherlands.
| | - Pascale André
- Innate Pharma Research Labs, Innate Pharma, Marseille, France
| | - Amir Horowitz
- Department of Oncological Sciences, Precision Immunology Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dan Fu Ruan
- Department of Oncological Sciences, Precision Immunology Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Linda Borst
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, 2333, ZA, Leiden, the Netherlands
| | - Robert Zerbib
- Innate Pharma Research Labs, Innate Pharma, Marseille, France
| | - Emilie Narni-Mancinelli
- Aix Marseille Université, INSERM, CNRS, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Sjoerd H van der Burg
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, 2333, ZA, Leiden, the Netherlands
| | - Eric Vivier
- Innate Pharma Research Labs, Innate Pharma, Marseille, France.
- Aix Marseille Université, INSERM, CNRS, Centre d'Immunologie de Marseille-Luminy, Marseille, France.
- Service d'Immunologie, Marseille Immunopole, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
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Cohen R, Lefebvre G, Posner M, Bauman J, Salas S, Even C, Saada-Bouzid E, Seiwert T, Colevas D, Calmels F, Zerbib R, André P, Boyer-Chammard A, Fayette J. Monalizumab in combination with cetuximab in patients (pts) with recurrent or metastatic (R/M) head and neck cancer (SCCHN) previously treated or not with PD-(L)1 inhibitors (IO): 1-year survival data. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Massard C, Cassier P, Bendell J, Marie D, Blery M, Morehouse C, Ascierto M, Zerbib R, Mitry E, Tolcher A. Preliminary results of STELLAR-001, a dose escalation phase I study of the anti-C5aR, IPH5401, in combination with durvalumab in advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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André P, Denis C, Soulas C, Bourbon-Caillet C, Lopez J, Arnoux T, Bléry M, Bonnafous C, Gauthier L, Morel A, Rossi B, Remark R, Breso V, Bonnet E, Habif G, Guia S, Lalanne AI, Hoffmann C, Lantz O, Fayette J, Boyer-Chammard A, Zerbib R, Dodion P, Ghadially H, Jure-Kunkel M, Morel Y, Herbst R, Narni-Mancinelli E, Cohen RB, Vivier E. Anti-NKG2A mAb Is a Checkpoint Inhibitor that Promotes Anti-tumor Immunity by Unleashing Both T and NK Cells. Cell 2018; 175:1731-1743.e13. [PMID: 30503213 PMCID: PMC6292840 DOI: 10.1016/j.cell.2018.10.014] [Citation(s) in RCA: 721] [Impact Index Per Article: 120.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/03/2018] [Accepted: 10/02/2018] [Indexed: 02/08/2023]
Abstract
Checkpoint inhibitors have revolutionized cancer treatment. However, only a minority of patients respond to these immunotherapies. Here, we report that blocking the inhibitory NKG2A receptor enhances tumor immunity by promoting both natural killer (NK) and CD8+ T cell effector functions in mice and humans. Monalizumab, a humanized anti-NKG2A antibody, enhanced NK cell activity against various tumor cells and rescued CD8+ T cell function in combination with PD-x axis blockade. Monalizumab also stimulated NK cell activity against antibody-coated target cells. Interim results of a phase II trial of monalizumab plus cetuximab in previously treated squamous cell carcinoma of the head and neck showed a 31% objective response rate. Most common adverse events were fatigue (17%), pyrexia (13%), and headache (10%). NKG2A targeting with monalizumab is thus a novel checkpoint inhibitory mechanism promoting anti-tumor immunity by enhancing the activity of both T and NK cells, which may complement first-generation immunotherapies against cancer. Blocking NKG2A unleashes both T and NK cell effector functions Combined blocking of the NKG2A and the PD-1 axis promotes anti-tumor immunity Blocking NKG2A and triggering CD16 illustrates the efficacy of dual checkpoint therapy
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Affiliation(s)
- Pascale André
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France.
| | - Caroline Denis
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Caroline Soulas
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | | | - Julie Lopez
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Thomas Arnoux
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Mathieu Bléry
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | | | | | - Ariane Morel
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Benjamin Rossi
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Romain Remark
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Violette Breso
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Elodie Bonnet
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Guillaume Habif
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Sophie Guia
- Aix Marseille Université, INSERM, CNRS, Centre d'Immunologie de Marseille-Luminy, 13009 Marseille, France
| | - Ana Ines Lalanne
- Unité INSERM U932, Immunité et Cancer, Institut Curie, 75248 Paris Cedex 5, France
| | - Caroline Hoffmann
- Unité INSERM U932, Immunité et Cancer, Institut Curie, 75248 Paris Cedex 5, France; Service ORL et Chirurgie cervico-faciale, Institut Curie, 75248 Paris Cedex 5, France
| | - Olivier Lantz
- Unité INSERM U932, Immunité et Cancer, Institut Curie, 75248 Paris Cedex 5, France
| | | | | | - Robert Zerbib
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Pierre Dodion
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Hormas Ghadially
- MedImmune, Ltd., Aaron Klug Building, Granta Park, Cambridge, CB21 6GH, UK
| | | | - Yannis Morel
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France
| | - Ronald Herbst
- MedImmune, LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Emilie Narni-Mancinelli
- Aix Marseille Université, INSERM, CNRS, Centre d'Immunologie de Marseille-Luminy, 13009 Marseille, France
| | - Roger B Cohen
- Abramson Cancer Center, 3400 Civic Center Boulevard West Pavilion, Philadelphia, PA, USA
| | - Eric Vivier
- Innate Pharma, 117 Avenue de Luminy, 13009 Marseille, France; Aix Marseille Université, INSERM, CNRS, Centre d'Immunologie de Marseille-Luminy, 13009 Marseille, France; Service d'Immunologie, Marseille Immunopole, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France.
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Fayette J, Lefebvre G, Posner M, Bauman J, Salas S, Even C, Saada-Bouzid E, Seiwert T, Colevas D, Calmels F, Zerbib R, Boyer Chammard A, Cohen R. Results of a phase II study evaluating monalizumab in combination with cetuximab in previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cohen R, Fayette J, Posner M, Lefebvre G, Bauman J, Salas S, Even C, Seiwert T, Colevas D, Jimeno A, Saada E, Burtness B, André P, Paturel C, Bonnafous C, Soulié AM, Tirouvanziam-Martin A, Zerbib R, Boyer-Chammard A. Abstract CT158: Phase II study of monalizumab, a first-in-class NKG2A monoclonal antibody, in combination with cetuximab in previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Preliminary assessment of safety and efficacy. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Monalizumab is an immune checkpoint inhibitor targeting NKG2A receptors expressed on subsets of tumor-infiltrating cytotoxic CD8 T cells and Natural Killer (NK) cells. NKG2A ligand is HLA-E, a non-classical HLA class I molecule often upregulated in cancer. Preclinical experiments have shown that blocking NKG2A binding to HLA-E may promote NK and T cell anti-tumor responses. NK cell stimulation with a checkpoint inhibitor might also enhance antibody dependent cellular cytotoxicity (ADCC) induced by cetuximab. Although approved in SCCHN after platinum-based therapy, cetuximab has limited activity in that setting (12% response rate).
Methods This is a multicenter non-randomized study (NCT02643550). After previous exploration of 5 dose levels of monalizumab (0.4, 1, 2, 4 or 10 mg/kg every 2 weeks) in combination with fixed doses of cetuximab (400 mg/m² load then 250 weekly) using a 3+3 design, the cohort expansion used monalizumab at the highest dose tested (10 mg/kg) and included a futility analysis after the first 11 patients (pts). The trial was open to pts ≥ 18 years old with SCCHN progressing after platinum-based therapy with no more than 2 previous lines, regardless of HLA-E or human papilloma virus status. The primary endpoint for anti-tumor activity was overall response rate per RECIST, assessed every 8 weeks. Pts were treated until disease progression or unacceptable toxicity.
Results As of 12/19/2017, 26 pts were enrolled in the expansion part, and 16 pts had a minimum of 16 weeks of follow-up to be evaluable for efficacy. The safety profile was as expected, similar to the single agent experience with either agent. The majority of adverse events (AE) were of Grade 1-2 severity, rapidly reversible and easily manageable, with 3 treatment-related grade 3-4 AE and 1 pt stopped monalizumab due to safety. Median age was 62 years (range: 34-77); 56 % were male; PS was 0 or 1; 4 were HPV+. All 16 pts had received prior platinum-based therapy, 8 prior immune therapy, 2 prior cetuximab with radiation. There were 6 pts with partial responses (PR) (4 confirmed; 2 not yet confirmed) of whom 2 were previously treated with immune therapy and 1 had disease deemed resistant to cetuximab. Median treatment duration for confirmed PR is 25+ weeks (16, 23+, 28+, 35+), 9 pts had stable disease (SD). The study was not stopped for futility and is planned to enroll up to 40 pts. Further follow-up is needed to evaluate duration of response, progression-free and overall survival.
Conclusion Preliminary data suggest promising antitumor activity of the combination of monalizumab and cetuximab compared to historical data with single agent cetuximab, with acceptable safety. These encouraging results will need to be confirmed on larger sample size with longer follow up.
Citation Format: Roger Cohen, Jérôme Fayette, Marshall Posner, Gautier Lefebvre, Jessica Bauman, Sébastien Salas, Caroline Even, Tanguy Seiwert, Dimitrios Colevas, Antonio Jimeno, Esma Saada, Barbara Burtness, Pascale André, Carine Paturel, Cécile Bonnafous, Anne-Marie Soulié, Anne Tirouvanziam-Martin, Robert Zerbib, Agnès Boyer-Chammard. Phase II study of monalizumab, a first-in-class NKG2A monoclonal antibody, in combination with cetuximab in previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Preliminary assessment of safety and efficacy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT158.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Esma Saada
- 11Centre Antoine Lacassagne, Nice, France
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Vey N, Karlin L, Sadot-Lebouvier S, Broussais F, Berton-Rigaud D, Rey J, Charbonnier A, Marie D, André P, Paturel C, Zerbib R, Bennouna J, Salles G, Gonçalves A. A phase 1 study of lirilumab (antibody against killer immunoglobulin-like receptor antibody KIR2D; IPH2102) in patients with solid tumors and hematologic malignancies. Oncotarget 2018; 9:17675-17688. [PMID: 29707140 PMCID: PMC5915148 DOI: 10.18632/oncotarget.24832] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [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: 10/05/2017] [Accepted: 03/02/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose Anti-KIR monoclonal antibodies (mAbs) can enhance the antitumor responses of natural killer (NK) cells. We evaluated the safety of the anti-KIR2D mAb lirilumab in patients with various cancers. Experimental design Thirty-seven patients with hematological malignancies (n = 22) or solid tumors (n = 15) were included in the study. Dose escalation (0.015 to 10 mg/kg) was conducted following a 3 + 3 design. Patients were scheduled to receive four cycles of treatment. In a second (extension) phase 17 patients were treated at 0.015 (n = 9) or 3 mg/kg (n = 8). Results No dose-limiting toxicity was recorded. The most frequent lirilumab-related adverse events were pruritus (19%), asthenia (16%), fatigue (14%), infusion-related reaction (14%), and headache (11%), mostly mild or moderate. Pharmacokinetics was dose-dependent and linear, with minimal accumulation resulting from the 4-weekly repeated administrations. Full KIR occupancy (>95%) was achieved with all dosages, and the duration of occupancy was dose-related. No significant changes were observed in the number or distribution of lymphocyte subpopulations, nor was any reduction in the distribution of KIR2D-positive NK cells. Conclusions This phase 1 trial demonstrated the satisfactory safety profile of lirilumab up to doses that enable full and sustained blockade of KIR.
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Affiliation(s)
- Norbert Vey
- Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France
| | - Lionel Karlin
- Centre Hospitalier Universitaire de Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | | | | | | | - Jérôme Rey
- Institut Paoli-Calmettes, Marseille, France
| | | | | | | | | | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest-Site René Gauducheau, St Herblain, France
| | - Gilles Salles
- Centre Hospitalier Universitaire de Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France
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Cohen RB, Salas S, Even C, Kotecki N, Jimeno A, Soulié AM, Tirouvanziam-Martin A, Zerbib R, André P, Boyer-Chammard A, Fayette J. Abstract 5666: Safety of the first-in-class anti-NKG2A monoclonal antibody monalizumab in combination with cetuximab: a phase Ib/II study in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Monalizumab (IPH2201) is a first-in-class immune checkpoint inhibitor targeting CD94-NKG2A receptors expressed on tumor infiltrating cytotoxic CD8 T lymphocytes and NK cells. HLA-E, the ligand of this inhibitory checkpoint receptor is up-regulated in SCCHN, protecting cancer from killing by CD94-NKG2A+ cells. Monalizumab blocks binding of CD94-NKG2A to HLA-E, reducing inhibitory signaling and thereby enhancing NK and T cell anti-tumor responses. Cetuximab is an anti-EGFR monoclonal antibody blocking oncogenic signaling and inducing Fcγ receptor-mediated antibody dependent cellular cytotoxicity (ADCC). In vitro cetuximab-mediated ADCC is inhibited by HLA-E expression on target cells and this inhibition can be circumvented with CD94-NKG2A blockade. Combination of monalizumab and cetuximab might provide greater antitumor activity than either drug alone.
Methods:
A multicenter, non-randomized dose-escalation and expansion study is evaluating monalizumab plus cetuximab in patients with R/M SCCHN (NCT02643550). Patients ≥ 18 years who progressed after platinum-based chemotherapy (regardless of the number of previous lines of treatment) were enrolled, without regard to HLA-E or human papilloma virus status. Using a 3+3 design, 5 dose levels of monalizumab (0.4, 1, 2, 4 or 10 mg/kg every 2 weeks) were explored with fixed doses of cetuximab (400 mg/m² load followed by 250 mg/m² weekly). Patients were treated until disease progression or unacceptable toxicity. The primary objective was to evaluate safety and Dose Limiting Toxicity (DLT). The secondary objectives were to estimate the Maximum Tolerated Dose (MTD) and the Recommended Phase II Dose (RP2D), and to determine the pharmacokinetics, pharmacodynamics and immunogenicity of the combination.
Results:
Enrolment began in December, 2015. As of October 11, 2016, 13 patients with R/M SCCHN were enrolled at dose levels 0.4, 1, 2 and 4 mg/kg. Median age was 60 years (range: 40-74); 92% were male; PS was 0 or 1; all patients had received prior systemic therapy (1 prior line in 1 patient and > 2
lines in 12 patients) for R/M SCCHN including platinum based chemotherapy (100% of the patients) and cetuximab (85%). There were no DLTs, infusion related reactions, immune related disorders or deaths related to treatment. No discontinuation attributable to treatment-related adverse events and no treatment-related grade 3 and 4 adverse events were reported, except fatigue (grade 3) in one patient. Updated data including pharmacodynamics and pharmacokinetics on the full dose escalation part will be presented.
Conclusion:
Monalizumab + cetuximab were well tolerated with no additional safety concerns compared to monalizumab or cetuximab alone. The dose-expansion phase of the study will be initiated in the near future.
Citation Format: Roger B. Cohen, Sébastien Salas, Caroline Even, Nuria Kotecki, Antonio Jimeno, Anne-Marie Soulié, Anne Tirouvanziam-Martin, Robert Zerbib, Pascale André, Agnès Boyer-Chammard, Jérôme Fayette. Safety of the first-in-class anti-NKG2A monoclonal antibody monalizumab in combination with cetuximab: a phase Ib/II study in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5666. doi:10.1158/1538-7445.AM2017-5666
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Affiliation(s)
| | - Sébastien Salas
- 2Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | | | - Antonio Jimeno
- 5University of Colorado Cancer Center, Aurora, Denver, CO
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Benson DM, Cohen AD, Jagannath S, Munshi NC, Spitzer G, Hofmeister CC, Efebera YA, Andre P, Zerbib R, Caligiuri MA. A Phase I Trial of the Anti-KIR Antibody IPH2101 and Lenalidomide in Patients with Relapsed/Refractory Multiple Myeloma. Clin Cancer Res 2015; 21:4055-61. [PMID: 25999435 DOI: 10.1158/1078-0432.ccr-15-0304] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/25/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Natural killer (NK) cells may play an important role in the immune response to multiple myeloma; however, multiple myeloma cells express killer immunoglobulin-like receptor (KIR) ligands to prevent NK cell cytotoxicity. Lenalidomide can expand and activate NK cells in parallel with its direct effects against multiple myeloma; however, dexamethasone may impair these favorable immunomodulatory properties. IPH2101, a first-in-class antiinhibitory KIR antibody, has acceptable safety and tolerability in multiple myeloma as a single agent. The present work sought to characterize lenalidomide and IPH2101 as a novel, steroid-sparing, dual immune therapy for multiple myeloma. EXPERIMENTAL DESIGN A phase I trial enrolled 15 patients in three cohorts. Lenalidomide was administered per os at 10 mg on cohort 1 and 25 mg on cohorts 2 and 3 days 1 to 21 on a 28-day cycle with IPH2101 given intravenously on day 1 of each cycle at 0.2 mg/kg in cohort 1, 1 mg/kg in cohort 2, and 2 mg/kg in cohort 3. No corticosteroids were utilized. The primary endpoint was safety, and secondary endpoints included clinical activity, pharmacokinetics (PK), and pharmacodynamics (PD). RESULTS The biologic endpoint of full KIR occupancy was achieved across the IPH2101 dosing interval. PD and PK of IPH2101 with lenalidomide were similar to data from a prior single-agent IPH2101 trial. Five serious adverse events (SAE) were reported. Five objective responses occurred. No autoimmunity was seen. CONCLUSIONS These findings suggest that lenalidomide in combination with antiinhibitory KIR therapy warrants further investigation in multiple myeloma as a steroid-sparing, dual immune therapy. This trial was registered at www.clinicaltrials.gov (reference: NCT01217203).
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Affiliation(s)
- Don M Benson
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
| | - Adam D Cohen
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | | | - Nikhil C Munshi
- Dana Farber Cancer Institute, Boston, Massachusetts. Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Gary Spitzer
- St. Francis Hospital, Greenville, South Carolina
| | | | - Yvonne A Efebera
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Decaux O, Renault A, Sébille V, Moreau P, Attal M, Voillat L, Pegourie B, Tiab M, Facon T, Zerbib R, Grosbois B, Bellissant E. Predictive factors of survival after thalidomide therapy in advanced multiple myeloma: long-term follow-up of a prospective multicenter nonrandomized phase II study in 120 patients. Clin Lymphoma Myeloma Leuk 2012; 12:418-22. [PMID: 23025991 DOI: 10.1016/j.clml.2012.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/19/2012] [Accepted: 06/15/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Thalidomide monotherapy has demonstrated consistent results in the treatment of advanced multiple myeloma. We report a 9-year follow-up of a French multicenter nonrandomized phase II study that evaluated the effect of oral thalidomide in 120 patients with advanced multiple myeloma. Independent predictors of survival were response to last therapy, performance status, serum β(2)-microglobulin level, platelet count, and response at day 60 of treatment. BACKGROUND Thalidomide monotherapy has demonstrated consistent results in the treatment of advanced multiple myeloma. PATIENTS AND METHODS We report the 9-year follow-up of a French multicenter, nonrandomized, phase II study that evaluated the effect of oral thalidomide in advanced multiple myeloma. Thalidomide was started at 200 mg/d and increased to 400 mg/d at day 15. RESULTS One hundred twenty patients were enrolled in 2 months at 33 centers. The overall response rate was 31.7% (38/120) on day 60. Overall survival rates were 47.5% (95% confidence interval [CI], 38.6-56.4), 25.0% (95% CI, 17.3-32.7), 11.7% (95% CI, 5.9-17.4), and 7.5% (95% CI, 2.8-12.2) at 1, 3, 6, and 9 years, respectively. Independent predictors of short survival at 1, 3, 6, and 9 years were multiple myeloma refractory to last therapy, performance status ≥ 2, serum β(2)-microglobulin level ≥ 3.5 mg/L, platelet count < 152 × 10(9)/L, and nonresponse at day 60 (Cox proportional hazards regression model). CONCLUSION Our study identified 5 independent unfavorable prognostic factors associated with short survival. These prognostic factors were very robust, allowing the prediction of patient survival not only during the first year but also during 3, 6, and even 9 years after the beginning of treatment.
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Affiliation(s)
- Olivier Decaux
- Department of Internal Medicine, Rennes 1 University, Rennes University Hospital, Rennes, France.
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Yakoub-Agha I, Mary JY, Hulin C, Doyen C, Marit G, Benboubker L, Voillat L, Moreau P, Berthou C, Stoppa AM, Maloisel F, Rodon P, Dib M, Pegourie B, Casassus P, Slama B, Damaj G, Zerbib R, Harousseau JL, Mohty M, Facon T. Low-dose vs. high-dose thalidomide for advanced multiple myeloma: a prospective trial from the Intergroupe Francophone du Myélome. Eur J Haematol 2012; 88:249-59. [DOI: 10.1111/j.1600-0609.2011.01729.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Kropff M, Baylon HG, Hillengass J, Robak T, Hajek R, Liebisch P, Goranov S, Hulin C, Bladé J, Caravita T, Avet-Loiseau H, Moehler TM, Pattou C, Lucy L, Kueenburg E, Glasmacher A, Zerbib R, Facon T. Thalidomide versus dexamethasone for the treatment of relapsed and/or refractory multiple myeloma: results from OPTIMUM, a randomized trial. Haematologica 2011; 97:784-91. [PMID: 22133776 DOI: 10.3324/haematol.2011.044271] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Thalidomide has potent antimyeloma activity, but no prospective, randomized controlled trial has evaluated thalidomide monotherapy in patients with relapsed/refractory multiple myeloma. DESIGN AND METHODS We conducted an international, randomized, open-label, four-arm, phase III trial to compare three different doses of thalidomide (100, 200, or 400 mg/day) with standard dexamethasone in patients who had received one to three prior therapies. The primary end-point was time to progression. RESULTS In the intent-to-treat population (N=499), the median time to progression was 6.1, 7.0, 7.6, and 9.1 months in patients treated with dexamethasone, and thalidomide 100, 200, and 400 mg/day, respectively; the difference between treatment groups was not statistically significant. In the per-protocol population (n=465), the median time to progression was 6.0, 7.0, 8.0, and 9.1 months, respectively. In patients who had received two or three prior therapies, thalidomide significantly prolonged the time to progression at all dose levels compared to the result achieved with dexamethasone. Response rates and median survival were similar in all treatment groups, but the median duration of response was significantly longer in all thalidomide groups than in the dexamethasone group. Adverse events reported in the thalidomide groups, such as fatigue, constipation and neuropathy, confirmed the known safety profile of thalidomide. CONCLUSIONS Although thalidomide was not superior to dexamethasone in this randomized trial, thalidomide monotherapy may be considered an effective salvage therapy option for patients with relapsed/refractory multiple myeloma, particularly those with a good prognosis and those who have received two or three prior therapies. The recommended starting dose of thalidomide monotherapy is 400 mg/day, which can be rapidly reduced for patients who do not tolerate this treatment. ( CLINICAL TRIAL REGISTRATION NUMBER NCT00452569).
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Affiliation(s)
- Martin Kropff
- Department of Medicine, University of Muenster, Muenster D-48129, Germany.
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Abgrall JF, Guibaud I, Bastie JN, Flesch M, Rossi JF, Lacotte-Thierry L, Boyer F, Casassus P, Slama B, Berthou C, Rodon P, Leporrier M, Villemagne B, Himberlin C, Ghomari K, Larosa F, Rollot F, Dugay J, Allard C, Maigre M, Isnard F, Zerbib R, Cauvin JM. Thalidomide versus placebo in myeloid metaplasia with myelofibrosis: a prospective, randomized, double-blind, multicenter study. Haematologica 2006; 91:1027-32. [PMID: 16885042] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In non-randomized studies, thalidomide appeared to be effective in myeloid metaplasia with myelofibrosis (MMM). We compared thalidomide to placebo for treatment of anemia in MMM. DESIGN AND METHODS A prospective phase II B, randomized double-blind multicenter trial comparing thalidomide 400 mg/d with placebo for 180 days was conducted in 52 anemic patients (hemoglobin pounds Sterling 9 g/dL or transfused). The main outcome measure was a 2 g/L increase in hemoglobin or 20% reduction in transfusions. RESULTS In the thalidomide group only 10 patients completed 6 months of treatment. At 180 days, in an intention-to-treat analysis, no difference was observed between the thalidomide and placebo groups as regards improvement of hemoglobin levels (one patient in each group) or reduction of red blood cell transfusions (three vs five patients, respectively). The spleen size, determined by ultrasonography, increased significantly less in the thalidomide group than in the placebo group (p < 0.05). Thalidomide had no apparent benefit on the Dupriez score, the severity score, survival, death, or any other clinical or biological parameter. Somnolence, gastro-intestinal signs, weight gain, and edema were significantly more frequent in the thalidomide group. Outpatient discontinuation of thalidomide was significantly correlated with a high severity score > 4 (odds ratio, OR = 16; p < 0.01), and g-glutamyl transferase levels > 40 IU/L (OR = 12; p < 0.05). INTERPRETATION AND CONCLUSIONS Thalidomide (200-400 mg/d) does not demonstrate substantial efficacy in anemic MMM patients. The natural history of disease in the placebo group revealed spontaneous periods of remission of anemia. Tolerance of thalidomide was significantly correlated wih the severity and liver involvement of the disease.
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Yakoub-Agha I, Doyen C, Hulin C, Marit G, Voillat L, Grosbois B, Harousseau J, Duguet C, Zerbib R, Facon T, Mary J. A multicenter prospective randomized study testing non-inferiority of thalidomide 100 mg/day as compared with 400 mg/day in patients with refractory/relapsed multiple myeloma: Results of the final analysis of the IFM 01–02 study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7520] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7520 Background: Thalidomide (THAL) is effective in pts with relapsed or refractory multiple myeloma (RRMM). A study by Yakoub-Agha et al of 83 patients (Hematol J, 2002) supported this effectiveness but showed a high incidence of THAL toxicity ≥ grade II, related to either THAL cumulative dose or dose-intensity. Themean daily dose of THAL in the first 90-day treatment period, however, did not influence response, overall survival (OS), or event-free survival. Given the dose-related toxicities and an unknown minimally effective THAL dose, the IFM conducted a prospective randomized study to compare the efficacy of THAL 100 mg/d with 400 mg/d in pts with RRMM after ≥2 lines of prior therapy. Methods: The study design was approved by the ethics committee at Lille University Hospital, and all pts gave written informed consent. Given the improved response seen with THAL plus dexamethasone (DEX), this combination was specified per protocol in both study arms for treatment failure (TF) defined as progression at any time or stable disease after 3 months of THAL treatment. THAL dose reduction for toxicity was permitted, but no increase over the initial dose was allowed. All pts received pamidronate routinely. The primary end point was 1-year OS. Secondary endpoints were response rate, EFS, and safety. Results: All results are based on intent-to-treat analyses. In all, 400 pts were enrolled (400 mg, n = 195; 100 mg, n = 205). The 2 groups were comparable in terms of patient characteristics, disease features including Ch13 deletion and prior therapy. Pts in the THAL 100 mg arm received DEX more frequently for TF than those in the 400 mg group, but this difference did not influence 1-year OS: 73 ± 3% vs 69 ± 3% in the 400 mg and 100 mg groups, respectively. The hypothesis of inferiority of 100 mg was rejected. Also, THAL 100 mg was better tolerated than 400 mg with less high-grade somnolence, constipation, and peripheral neuropathy (p < .001, p = .01 et p = .05, respectively). There was no difference regarding deep vein thrombosis. Conclusion: THAL 100 mg/d is comparable in terms of survival with 400 mg/d (with DEX as salvage therapy in case of TF in both arms) in pts with RRMM and better tolerated. [Table: see text]
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Affiliation(s)
- I. Yakoub-Agha
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Doyen
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Hulin
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - G. Marit
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - L. Voillat
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - B. Grosbois
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - J. Harousseau
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Duguet
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - R. Zerbib
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - T. Facon
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - J. Mary
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
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Grosbois B, Bellissant E, Zerbib R, Muret P, Moreau P, Voillat L, Attal M, Yakoub-Agha I. Traitement du myélome multiple en phase avancée par le thalidomide : étude prospective sur 121 patients avec dosage sérique de thalidomide chez 39 patients. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pierrefiche G, Zerbib R, Laborit H. Anxiolytic activity of melatonin in mice: involvement of benzodiazepine receptors. Res Commun Chem Pathol Pharmacol 1993; 82:131-42. [PMID: 7905658] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The anxiolytic properties of melatonin are revealed by two behavioral studies. In a free exploratory situation, the holeboard test, melatonin decreased head-dip performance. In an unconditioned conflict test, the light/dark box choice situation, melatonin increased the time spent in the lit box as well as the number of transitions between the two compartments. Melatonin was given in a dose range from 0.5 to 5.0 mg/kg body weight i.p. 30 minutes before testing in daytime. Moreover, the anxiolytic activity of diazepam (2.5 mg/kg i.p.) was evaluated and found to be completely inhibited by the specific benzodiazepine antagonist flumazenil (10 mg/kg i.p. 30 minutes before). In the same manner flumazenil counteracted melatonin activity in the two tests. Involvement of the benzodiazepine/GABAergic system in the anxiolytic activity of melatonin is discussed.
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Affiliation(s)
- G Pierrefiche
- Laboratoire d'Eutonologie-Hopital Boucicaut, Paris, France
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Zerbib R, Ouhayoun JP, Freyss G. [Bone augmentation in implant surgery]. J Parodontol 1991; 10:177-88. [PMID: 2072279] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors experience on twelve patients in the field of bone grafting prior to implant surgery is presented. The technique employed depends largely on the anatomical location of bone insufficiency, such as: 1) Where there is not enough bone beneath sinus locations, grafting with cancellous iliac bone blended with coral particles is suggested. 2) Where the jaw is not sufficiently thick, such as in the incisor-cuspid regions, the authors employ cancellous and/or cortical bone grafts. 3) Horizontal osteotomy and interposition of cortical-cancellous bone graft is proposed where there is a lack of bone height in the incisor-cuspid regions. The results of the various techniques are analysed from a clinical, radiographic and histologic perspective. Twelve patients have been treated with 2 years follow-up.
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Affiliation(s)
- R Zerbib
- Département de Parodontologie, Paris VII, Garancière
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Abstract
Restraint stress for ten days (two times two hours daily) induces a hypersensitivity of the central cholinergic system, reflected by antagonism to amnesia induced by scopolamine at 0.1 mg/kg in a passive avoidance test and by hypersensitivity to the hypothermic effect of oxotremorine at 1 mg/kg. A restraint stress for 30 days, on the other hand, diminishes animal retention in the passive avoidance test and causes a hyposensitivity to oxotremorine-induced hypothermia, reflecting a hypoactivity of the central cholinergic system. An acute 24-hour stress causes no change. The relationship between chronic stress and associated memory deficits is discussed.
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Affiliation(s)
- R Zerbib
- Laboratoire d'Eutonologie, Hôpital Boucicaut, Paris, France
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Laborit H, Zerbib R. [Action of PMA (phorbol myristate acetate), scopolamine, propranolol, and oxotremorine on memorization of an active or passive avoidance test]. Encephale 1989; 15:29-35. [PMID: 2721436] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The role of various second messengers in the learning and retention of a passive or active avoidance has been investigated in mice. Scopolamine at 3 mg/kg i.p. inhibits muscarinic M1 and M2 receptors and thus acetylcholine activation of the phosphoinositide cycle. This results in amnesia of passive avoidance but has no effect on active avoidance learning. Oxotremorine at 0.05 mg/kg i.p., whose preferential M2 muscarinic action limits acetylcholine release and also inhibits adenylate cyclase activity, causes amnesia of the retention of a passive avoidance and antagonizes the learning of an active avoidance. DL-propranolol at 40 mg/kg i.p., which inhibits cAMP formation, does not affect retention of a passive avoidance but antagonizes that of an active avoidance. Similarly, phorbol myristate acetate a 0.1 mg/kg i.p., which activates protein kinase C, has no effect on the retention of a passive avoidance but antagonizes that of an active avoidance. The results tend to show a distinct role for cAMP-dependent protein kinase, which would participate in memorization processes of an active avoidance, and for protein kinase C, which would participate in that of a passive avoidance. The authors discuss the involvement of different neurophysiological mechanisms as a function of the type of behavior, depending on whether or not it is related to the control of environmental situations.
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Affiliation(s)
- H Laborit
- Hôpital Boucicaut, Laboratoire d'Eutonologie, Paris
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Pierrefiche G, Zerbib R, Baron JB, Laborit H. [The effect of magnetic fields on scar formation of experimental wounds]. Acta Belg Med Phys 1988; 11:137-41. [PMID: 3239321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Seite R, Vuillet-Luciani J, Zerbib R, Cataldo C, Escaig J, Pebusque MJ, Autillo-Touati A. Thee-dimensional organization of tubular and filamentous nuclear inclusions and associated structures in sympathetic neurons as revealed by serial sections and tilting experiments. J Ultrastruct Res 1979; 69:211-31. [PMID: 226727 DOI: 10.1016/s0022-5320(79)90111-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Seïte R, Zerbib R, Vuillet-Luciani J, Vio M. Nuclear inclusions in sympathetic neurons: a quantitative and ultrastructural study in the superior cervical and celiac ganglia of the cat. J Ultrastruct Res 1977; 61:254-9. [PMID: 599606 DOI: 10.1016/s0022-5320(77)80050-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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