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Schoenfeld AJ, Lee SM, Doger de Speville B, Gettinger SN, Hafliger S, Sukari A, Papa S, Rodriguez-Moreno JF, Graf Finckenstein F, Fiaz R, Catlett M, Chen G, Qi R, Masteller EL, Gontcharova V, He K. Lifileucel, an Autologous Tumor-infiltrating Lymphocyte Monotherapy, in Patients with Advanced Non-small Cell Lung Cancer Resistant to Immune Checkpoint Inhibitors. Cancer Discov 2024:742106. [PMID: 38563600 DOI: 10.1158/2159-8290.cd-23-1334] [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: 11/16/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
In this phase 2 multicenter study, we evaluated the efficacy and safety of lifileucel (LN-145), an autologous tumor-infiltrating lymphocyte cell therapy, in patients with metastatic non-small cell lung cancer (mNSCLC) who had received prior immunotherapy and progressed on their most recent therapy. The median number of prior systemic therapies was 2 (range, 1-6). Lifileucel was successfully manufactured using tumor tissue from different anatomic sites, predominantly lung. The objective response rate was 21.4% (6/28). Responses occurred in tumors with profiles typically resistant to immunotherapy, such as PD-L1-negative, low tumor mutational burden, and STK11 mutation. Two responses were ongoing at the time of data cutoff, including one complete metabolic response in a PD-L1-negative tumor. Adverse events were generally as expected and manageable. Two patients died of treatment-emergent adverse events: cardiac failure and multiple organ failure. Lifileucel is a potential treatment option for patients with mNSCLC refractory to prior therapy.
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Affiliation(s)
| | - Sylvia M Lee
- University of Washington, Seattle, WA, United States
| | | | | | - Simon Hafliger
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Sophie Papa
- King's College London, London, United Kingdom
| | | | | | - Rana Fiaz
- Iovance Biotherapeutics, Inc., San Carlos, CA, United States
| | - Melissa Catlett
- Iovance Biotherapeutics, Inc., San Carlos, CA, United States
| | - Guang Chen
- Iovance Biotherapeutics, Inc., San Carlos, CA, United States
| | - Rongsu Qi
- Iovance Biotherapeutics, Inc., San Carlos, CA, United States
| | | | | | - Kai He
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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2
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Meyer M, Mahr A, Brewer J, Daniel V, Dell'Aringa J, Goldstone T, Hersey S, Johnston I, Larson P, Loveridge M, MacBeath G, Moyer M, Nagorsen D, Papa S, Peiser L, Ranade K, Rizzi R, Roers A, Schendel D, Sivakumar P, Tran E, Türeci Ö, Weigand L, Wennborg A, Williams D, Yee C, Britten CM. A call to adapt the regulation of HLA testing for T cell receptor-based therapeutics. Nat Rev Drug Discov 2024; 23:1-2. [PMID: 38030734 DOI: 10.1038/d41573-023-00189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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3
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Iovinella M, Palmieri M, Papa S, Auciello C, Ventura R, Lombardo F, Race M, Lubritto C, di Cicco MR, Davis SJ, Trifuoggi M, Marano A, Ciniglia C. Biosorption of rare earth elements from luminophores by G. sulphuraria (Cyanidiophytina, Rhodophyta). Environ Res 2023; 239:117281. [PMID: 37827370 DOI: 10.1016/j.envres.2023.117281] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Lanthanides are indispensable constituents of modern technologies and are often challenging to acquire from natural resources. The demand for REEs is so high that there is a clear need to develop efficient and eco-friendly recycling methods. In the present study, freeze-dried biomass of the polyextremophile Galdieria sulphuraria was employed to recover REEs from spent fluorescent lamps (FL) luminophores by pretreating the freeze-dried biomass with an acid solution to favour ion exchange and enhance the binding sites on the cell surface available for the metal ions. Lanthanides were extracted from the luminophores using sulfuric acid solutions according to standardised procedures, and the effect of biosorbent dosage (0.5-5 mg/ml) and biosorption time (5-60 min) were evaluated. The content of individual REEs in the luminophores and the resulting algal biomass were determined using inductively coupled plasma mass spectrometry (ICP-MS). The most abundant REE in the luminophores was yttrium (287.42 mg/g dm, 91.60% of all REEs), followed by europium (20.98 mg/g, 6.69%); cerium, gadolinium, terbium and lanthanum was in trace. The best biosorption performances were achieved after 5 min and at the lowest biosorbent dosage (0.5 mg/mL). The highest total metal amount corresponded to 41.61 mg/g dried mass, and yttrium was the most adsorbed metal (34.59 mg/g dm, 82.88%), followed by cerium (4.01 mg/g); all other metals were less than 2 mg/g. The rapidity of the biosorption process and the low biosorbent dosage required confirmed this microalga as a promising material for creating an eco-sustainable protocol for recycling REEs.
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Affiliation(s)
- M Iovinella
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy; Department of Biology, University of York, Wentworth Way, YO10 5DD York, UK
| | - M Palmieri
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - S Papa
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - C Auciello
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - R Ventura
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - F Lombardo
- Department of Chemical Sciences, University of Naples Federico II, Via Cinthia, I-80126, Naples, Italy
| | - M Race
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio, 43, 03043, Cassino, Italy
| | - C Lubritto
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - M R di Cicco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy
| | - S J Davis
- Department of Biology, University of York, Wentworth Way, YO10 5DD York, UK
| | - M Trifuoggi
- Department of Chemical Sciences, University of Naples Federico II, Via Cinthia, I-80126, Naples, Italy
| | - A Marano
- Department of Chemical Sciences, University of Naples Federico II, Via Cinthia, I-80126, Naples, Italy
| | - C Ciniglia
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, 81100, Caserta, Italy; Department of Biology, University of York, Wentworth Way, YO10 5DD York, UK.
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4
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Boeke JD, Burns KH, Chiappinelli KB, Classon M, Coffin JM, DeCarvalho DD, Dukes JD, Greenbaum B, Kassiotis G, Knutson SK, Levine AJ, Nath A, Papa S, Rios D, Sedivy J, Ting DT. Proceedings of the inaugural Dark Genome Symposium: November 2022. Mob DNA 2023; 14:18. [PMID: 37990347 PMCID: PMC10664479 DOI: 10.1186/s13100-023-00306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
In November 2022 the first Dark Genome Symposium was held in Boston, USA. The meeting was hosted by Rome Therapeutics and Enara Bio, two biotechnology companies working on translating our growing understanding of this vast genetic landscape into therapies for human disease. The spirit and ambition of the meeting was one of shared knowledge, looking to strengthen the network of researchers engaged in the field. The meeting opened with a welcome from Rosana Kapeller and Kevin Pojasek followed by a first session of field defining talks from key academics in the space. A series of panels, bringing together academia and industry views, were then convened covering a wide range of pertinent topics. Finally, Richard Young and David Ting gave their views on the future direction and promise for patient impact inherent in the growing understanding of the Dark Genome.
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Affiliation(s)
- Jef D Boeke
- Institute for Systems Genetics, NYU Langone Health, New York, NY, 10016, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, 11201, USA
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Health, New York, NY, 10016, USA
| | - Kathleen H Burns
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Katherine B Chiappinelli
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, DC, USA
| | - Marie Classon
- Pfizer Centre for Therapeutic Innovation, San Diego, USA
| | - John M Coffin
- Department of Molecular Biology and Microbiology, Tufts University, Boston, MA, 02111, USA
| | - Daniel D DeCarvalho
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Joseph D Dukes
- Enara Bio Limited, Magdalen Centre, 1 Robert Robinson Avenue, The Oxford Science Park, Oxford, OX4 4GA, UK
| | - Benjamin Greenbaum
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - George Kassiotis
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Sarah K Knutson
- Rome Therapeutics, 201 Brookline Avenue, Suite 1001, Boston, MA, USA
| | - Arnold J Levine
- Simons Center for Systems Biology, Institute for Advanced Study, Princeton, NJ, USA
| | - Avindra Nath
- Section for Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sophie Papa
- Enara Bio Limited, Magdalen Centre, 1 Robert Robinson Avenue, The Oxford Science Park, Oxford, OX4 4GA, UK.
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Daniel Rios
- Rome Therapeutics, 201 Brookline Avenue, Suite 1001, Boston, MA, USA
| | - John Sedivy
- Center on the Biology of Aging, Brown University, Providence, RI, USA
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI, USA
| | - David T Ting
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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5
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Martella A, Gasparini S, Papa S, Giovene GL. The role of the foam formulation in improving psoriasis treatment acceptability: a real-life experience and a literature review. Eur Rev Med Pharmacol Sci 2023; 27:10697-10704. [PMID: 37975395 DOI: 10.26355/eurrev_202311_34350] [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: 11/19/2023]
Abstract
BACKGROUND Topical therapies represent the first-line treatment for mild-to-moderate psoriasis. Among various topical options, the fixed-dose combination of calcipotriene (Cal) and betamethasone dipropionate (BD) foam (Enstilar®, LEO Pharma, Ballerup, Denmark) showed superior efficacy to Cal and BD monotherapy and ointment and gel formulations. In addition, the Cal/BD foam is the only topical treatment allowed for either reactive treatment of relapse or twice-weekly maintenance use. Since treatment acceptability is crucial to optimize adherence, this paper presents a case series from a multicenter experience using the Cal/BD foam, to further characterize the use of this therapeutic approach. In addition, a narrative review of studies evaluating the acceptability of the Cal/BD foam, even compared with other formulations, is provided. CASE SERIES The case series involved adult patients with mild-to-moderate psoriasis treated with the Cal/BD foam from October 2021 to June 2022. A clinical and dermoscopic evaluation of plaques was provided for all patients. Data from the clinical practice report complete clinical resolution of plaques in most patients after 4 weeks of active treatment with the Cal/BD foam, and the dermoscopic clearance after a maximum of 8 weeks. Full adherence to treatment was also reported. Literature evidence suggests that the Cal/BD foam is easy to apply and presents high cosmetic acceptance, rapid onset of action, high efficacy, optimal safety, and a high patient preference. The high satisfaction obtained with Cal/BD foam suggests that this formulation is better accepted than others. CONCLUSIONS The Cal/BD foam represents a valuable approach for managing mild-to-moderate psoriasis, both in short and long-term treatment.
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Affiliation(s)
- A Martella
- Dermatologia Myskin, Poliambulatorio Specialistico Medico-Chirurgico, Tiggiano, Lecce, Italy.
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Papa S, Adami A, Metoudi M, Beatson R, George MS, Achkova D, Williams E, Arif S, Reid F, Elstad M, Beckley-Hoelscher N, Douri A, Delord M, Lyne M, Shivapatham D, Fisher C, Hope A, Gooljar S, Mitra A, Gomm L, Morton C, Henley-Smith R, Thavaraj S, Santambrogio A, Andoniadou C, Allen S, Gibson V, Cook GJR, Parente-Pereira AC, Davies DM, Farzaneh F, Schurich A, Guerrero-Urbano T, Jeannon JP, Spicer J, Maher J. Intratumoral pan-ErbB targeted CAR-T for head and neck squamous cell carcinoma: interim analysis of the T4 immunotherapy study. J Immunother Cancer 2023; 11:e007162. [PMID: 37321663 PMCID: PMC10277526 DOI: 10.1136/jitc-2023-007162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Locally advanced/recurrent head and neck squamous cell carcinoma (HNSCC) is associated with significant morbidity and mortality. To target upregulated ErbB dimer expression in this cancer, we developed an autologous CD28-based chimeric antigen receptor T-cell (CAR-T) approach named T4 immunotherapy. Patient-derived T-cells are engineered by retroviral transduction to coexpress a panErbB-specific CAR called T1E28ζ and an IL-4-responsive chimeric cytokine receptor, 4αβ, which allows IL-4-mediated enrichment of transduced cells during manufacture. These cells elicit preclinical antitumor activity against HNSCC and other carcinomas. In this trial, we used intratumoral delivery to mitigate significant clinical risk of on-target off-tumor toxicity owing to low-level ErbB expression in healthy tissues. METHODS We undertook a phase 1 dose-escalation 3+3 trial of intratumoral T4 immunotherapy in HNSCC (NCT01818323). CAR T-cell batches were manufactured from 40 to 130 mL of whole blood using a 2-week semiclosed process. A single CAR T-cell treatment, formulated as a fresh product in 1-4 mL of medium, was injected into one or more target lesions. Dose of CAR T-cells was escalated in 5 cohorts from 1×107-1×109 T4+ T-cells, administered without prior lymphodepletion. RESULTS Despite baseline lymphopenia in most enrolled subjects, the target cell dose was successfully manufactured in all cases, yielding up to 7.5 billion T-cells (67.5±11.8% transduced), without any batch failures. Treatment-related adverse events were all grade 2 or less, with no dose-limiting toxicities (Common Terminology Criteria for Adverse Events V.4.0). Frequent treatment-related adverse events were tumor swelling, pain, pyrexias, chills, and fatigue. There was no evidence of leakage of T4+ T-cells into the circulation following intratumoral delivery, and injection of radiolabeled cells demonstrated intratumoral persistence. Despite rapid progression at trial entry, stabilization of disease (Response Evaluation Criteria in Solid Tumors V.1.1) was observed in 9 of 15 subjects (60%) at 6 weeks post-CAR T-cell administration. Subsequent treatment with pembrolizumab and T-VEC oncolytic virus achieved a rapid complete clinical response in one subject, which was durable for over 3 years. Median overall survival was greater than for historical controls. Disease stabilization was associated with the administration of an immunophenotypically fitter, less exhausted, T4 CAR T-cell product. CONCLUSIONS These data demonstrate the safe intratumoral administration of T4 immunotherapy in advanced HNSCC.
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Affiliation(s)
- Sophie Papa
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Antonella Adami
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Michael Metoudi
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Richard Beatson
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Molly Sarah George
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Daniela Achkova
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Evangelia Williams
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Sefina Arif
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Fiona Reid
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Maria Elstad
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Nicholas Beckley-Hoelscher
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Abdel Douri
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marc Delord
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Mike Lyne
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Dharshene Shivapatham
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher Fisher
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Hope
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sakina Gooljar
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arindam Mitra
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Linda Gomm
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Cienne Morton
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Rhonda Henley-Smith
- Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Selvam Thavaraj
- Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Alice Santambrogio
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Cynthia Andoniadou
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Sarah Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Gibson
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gary J R Cook
- London School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - David M Davies
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Farzin Farzaneh
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Anna Schurich
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Teresa Guerrero-Urbano
- Department of Head and Neck Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Pierre Jeannon
- Department of Head and Neck Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Maher
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Immunology, Eastbourne Hospital, Eastbourne, UK
- Leucid Bio Ltd, London, London, UK
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Masood A, Mootoo A, Maghsoudlou P, D'Cruz D, Srikandarajah K, Harries M, Hart N, Papa S, Spicer J. The threat of triple M and autoimmune overlap syndromes with immune checkpoint inhibitors - A series of case reports. Autoimmun Rev 2023; 22:103269. [PMID: 36623629 DOI: 10.1016/j.autrev.2023.103269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Ammara Masood
- Rheumatology Department, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.
| | - Amanda Mootoo
- Rheumatology Department, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Panayiotis Maghsoudlou
- Lane Fox Respiratory Medicine Department, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - David D'Cruz
- Rheumatology Department, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Krishnie Srikandarajah
- Department of Medical Oncology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mark Harries
- Department of Medical Oncology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Lane Fox Respiratory Medicine Department, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - James Spicer
- Department of Medical Oncology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
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8
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Daruish M, Papa S, L C Geh J, M Stefanato C. Papulonodular pigmented lesions in a patient with Stage IV malignant melanoma. Clin Exp Dermatol 2023; 48:57-59. [PMID: 36669192 DOI: 10.1093/ced/llac002] [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: 06/25/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023]
Abstract
A 78-year-old man received immunotherapy for in-transit metastatic melanoma papulonodules on his left lower abdomen in the form of intralesional injections of talimogene laherparepvec (T-VEC), an oncolytic genetically modified herpes virus. Despite therapy, the colour and size of the lesions remained clinically unchanged; however, histopathological examination revealed only melanophages in the absence of melanoma cells. The diagnosis of tumoral melanosis secondary to immunotherapy with T-VEC was made. This case emphasizes the importance of histopathological evaluation in assessing response to immunotherapy of in-transit metastatic melanoma lesions.
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Affiliation(s)
- Maged Daruish
- Department of Dermatopathology, St John's institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jenny L C Geh
- Department of Plastic Surgery, Guy's and St Thomas' NHS Trust, London, UK
| | - Catherine M Stefanato
- Department of Dermatopathology, St John's institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
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9
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Berry P, Kotha S, Zen Y, Papa S, El Menabawey T, Webster G, Joshi D, Heneghan M. Immune checkpoint inhibitor-related cholangiopathy: Novel clinicopathological description of a multi-centre cohort. Liver Int 2023; 43:147-154. [PMID: 35704341 DOI: 10.1111/liv.15340] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 06/12/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Cholestatic liver dysfunction is common in immune-related hepatitis (irH) during treatment with immune checkpoint inhibitors (CPI) for malignancy. We investigated the spectrum of bile duct injury and associated natural history in this cohort. METHOD Clinical, laboratory, radiological and histopathological data in patients with evidence of bile duct injury during CPI treatment from 2018 to 2020 was collected in three tertiary hospitals. RESULTS In this study, ten patients with confirmed bile duct disease were identified. Pembrolizumab was most commonly implicated (8/10). Median CPI cycles prior to bile duct injury was 6. Median alanine aminotransferase and alkaline phosphatase were 225 U/L and 1549 U/L respectively. Clinical jaundice was seen in 6/10 and radiological evidence of bile duct pathology in 8/10. Of five patients, who had liver biopsy, three cases (including two cases with normal MRCP) showed primary sclerosing cholangitis (PSC) like changes with periductal fibrosis. All patients were treated first-line with prednisolone following cessation of CPI, three with mycophenolate mofetil and one with tacrolimus, with clinical response in four patients. Five patients died after a mean follow-up of 27 weeks; cause of death was primarily related to progression of malignancy. CONCLUSION Within this heterogeneous cohort, we identified that CPI-related cholangiopathy responded poorly to immunosuppression and potentially progressed to bile duct loss. Thorough radiological and histological assessment is recommended, as identification of the cholangiopathy-associated phenotype may permit more informed advice regarding prognosis. Further data is required to determine detailed immunological characterisation in order to identify individuals at an increased risk of developing cholangiopathy.
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Affiliation(s)
- Philip Berry
- Department of Hepatology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Hepatology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Yoh Zen
- Department of Histopathology, King's College Hospital, London, UK
| | - Sophie Papa
- Department of Oncology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Tareq El Menabawey
- Department of hepato-biliary medicine, University college London Hospital, London, UK
| | - George Webster
- Department of hepato-biliary medicine, University college London Hospital, London, UK
| | - Deepak Joshi
- Department of Hepatology, King's college Hospital, London, UK
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10
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Alexander JL, Ibraheim H, Richards C, Shum B, Pavlidis P, Hunter N, Teare JP, Wotherspoon A, Furness A, Turajlic S, Pickering L, Larkin J, Speight A, Papa S, Powell N. Oral beclomethasone dipropionate is an effective treatment for immune checkpoint inhibitor induced colitis. J Immunother Cancer 2022; 10:e005490. [PMID: 36113896 PMCID: PMC9486376 DOI: 10.1136/jitc-2022-005490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systemic corticosteroids are the mainstay of treatment for immune checkpoint inhibitor induced (CPI) colitis but are associated with complications including life-threatening infection. The topically acting oral corticosteroid beclomethasone dipropionate (BD) is an effective treatment for mild to moderate flares of ulcerative colitis, and has fewer side effects than systemic corticosteroids. We hypothesized that BD would be an effective treatment for CPI-induced colitis. METHODS We performed a retrospective analysis of all patients who started BD for CPI-induced colitis at three UK cancer centers between November 2017 and October 2020. All patients underwent endoscopic assessment and biopsy. The initial regimen of BD was 5 mg once daily for 28 days. Data were collected from electronic patient records. Clinical outcomes were assessed at 28 days after initiation of treatment. RESULTS Twenty-two patients (14 male) with a median age of 64 (range 45-84) with CPI-induced colitis were treated with BD. At baseline, the median number of loose stools in a 24-hour period was six (common terminology criteria for adverse events, CTCAE grade diarrhea=2). Thirteen patients (59%) were dependent on systemic corticosteroids prior to starting BD. Baseline sigmoidoscopy showed moderate inflammation (Mayo Endoscopic Score (MES) = 2) in two patients (9%), mild inflammation (MES=1) in nine patients (41%) and normal findings (MES=0) in eleven patients (50%). Twenty patients (91%) had histopathological features of inflammation. All 22 patients (100%) had a clinical response to BD and 21 (95%) achieved clinical remission with a return to baseline stool frequency (CTCAE diarrhea=0). Ten patients (45%) had symptomatic relapse on cessation of BD, half within 7 days of stopping. All patients recaptured response on restarting BD. No adverse events were reported in patients treated with BD. CONCLUSIONS Topical BD represents an appealing alternative option to systemic immunosuppressive treatments to treat colonic inflammation. In this study, BD was effective and safe at inducing remission in CPI-induced colitis, which was refractory to systemic corticosteroids. Further randomized studies are needed to confirm these findings and determine the optimum dosing regimen.
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Affiliation(s)
- James L Alexander
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Hajir Ibraheim
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Camellia Richards
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ben Shum
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Polychronis Pavlidis
- Experimental Immunobiology, King's College London, London, UK
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nikki Hunter
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Furness
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Lisa Pickering
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Ally Speight
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nick Powell
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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11
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Davies A, Salisbury J, Mehra V, Papa S, Basu T. A rapidly expanding cutaneous tumour in the context of a Janus kinase inhibitor agent following allogeneic stem cell transplant. Clin Exp Dermatol 2022; 47:2059-2064. [PMID: 36004622 DOI: 10.1111/ced.15305] [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] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
Ruxolitinib is a selective, Janus kinase (JAK)1 and JAK2 inhibitor, which is effective in management of chronic graft-versus-host disease (cGvHD). However, the ensuing immunosuppressive effects can give rise to aggressive cutaneous tumours, including Merkel cell carcinoma. We present this case to highlight the development of cutaneous tumours with ruxolitinib, an increasingly used therapy, and the challenge of managing such tumours in the context of refractory cGvHD.
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Affiliation(s)
- Anna Davies
- Department of Dermatology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Jon Salisbury
- Department of Histopathology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Varun Mehra
- Department of Haematology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tanya Basu
- Department of Dermatology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
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12
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Monroy‐Iglesias MJ, Hadi H, Russell B, Moss C, Flanders L, Dolly S, Papa S, Van Hemelrijck M. Safe delivery of systemic anti-cancer treatment for skin cancers during the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2022; 37:e13-e16. [PMID: 35972811 PMCID: PMC9537981 DOI: 10.1111/jdv.18514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Maria Jose Monroy‐Iglesias
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUK
| | - Hajer Hadi
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUK
| | - Beth Russell
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUK
| | - Charlotte Moss
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUK
| | - Lucy Flanders
- Medical OncologyGuy's and St Thomas' NHS Foundation Trust (GSTT)LondonUK
| | - Saoirse Dolly
- Medical OncologyGuy's and St Thomas' NHS Foundation Trust (GSTT)LondonUK
| | - Sophie Papa
- Medical OncologyGuy's and St Thomas' NHS Foundation Trust (GSTT)LondonUK
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUK
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13
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Rossi N, Lee KA, Bermudez MV, Visconti A, Thomas AM, Bolte LA, Björk JR, de Ruijter LK, Newton-Bishop J, Harland M, Shaw HM, Harries M, Sacco J, Board R, Lorigan P, de Vries EGE, Segata N, Taams L, Papa S, Spector TD, Nathan P, Weersma RK, Hospers GAP, Fehrmann RSN, Bataille V, Falchi M. Circulating inflammatory proteins associate with response to immune checkpoint inhibition therapy in patients with advanced melanoma. EBioMedicine 2022; 83:104235. [PMID: 36007304 PMCID: PMC9421308 DOI: 10.1016/j.ebiom.2022.104235] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inflammation can modulate tumour growth and progression, and influence clinical response to treatment. We investigated the potential of circulating inflammatory proteins for response stratification of immune checkpoint inhibitor (ICI) therapy for advanced melanoma. METHODS Study subjects were 87 patients with unresectable stage III or IV cutaneous melanoma from the multiple centres across the United Kingdom (UK) and the Netherlands (NL) who received ipilimumab, nivolumab, or pembrolizumab, or a combination of ipilimumab and nivolumab. Serum samples were collected before and during ICI therapy at follow-up visits scheduled every third week over a 12-week period. We performed targeted quantification of 92 proteins involved in inflammation and tested for association of their pre-treatment and on-treatment levels, as well as longitudinal changes, with overall response rate, progression-free survival, and overall survival. FINDINGS We observed consistently higher pre-treatment levels of interleukin-6 (IL-6), hepatocyte growth factor (HGF), and monocyte chemotactic protein 2 (MCP-2), in non-responders compared to responders (meta-analysis p=3.31 × 10-4, 2.29 × 10-4, and 1.02 × 10-3, respectively). Patients' stratification according to the median value of IL-6, HGF, and MCP-2 highlighted a cumulative negative effect of pre-treatment levels of the three proteins on response (p=1.13 × 10-2), with overall response rate among patients presenting with combined elevated IL-6, HGF, and MCP-2 levels being three-fold lower (26.7%) compared to patients with none of the three proteins elevated (80.0%, p=9.22 × 10-3). Longitudinal data analysis showed that on-treatment changes in circulating inflammatory proteins are not correlated with response. INTERPRETATION Our findings are in line with an increasing body of evidence that the pro-inflammatory cytokine IL-6 can influence response to ICI in advanced melanoma, and further support a role of circulating HGF and MCP-2 levels as prognostic biomarkers as suggested by previous smaller studies. Inflammatory proteins may serve as predictive biomarkers of ICI response and valuable targets for combination therapy. FUNDING This work was supported by the Seerave Foundation and Dutch Cancer Society.
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Affiliation(s)
- Niccolò Rossi
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Karla A Lee
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Maria V Bermudez
- Centre for Inflammation Biology and Cancer Immunology, King's College London, UK
| | - Alessia Visconti
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | | | - Laura A Bolte
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Johannes R Björk
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Laura Kist de Ruijter
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Julia Newton-Bishop
- Division of Haematology and Immunology, Institute of Medical Research at St James's, University of Leeds, UK
| | - Mark Harland
- Division of Haematology and Immunology, Institute of Medical Research at St James's, University of Leeds, UK
| | - Heather M Shaw
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Mark Harries
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Sacco
- Liverpool Clatterbridge Cancer Centre, Liverpool, UK
| | - Ruth Board
- Department of Oncology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Paul Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Leonie Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, UK
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Studies, King's College London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Paul Nathan
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Veronique Bataille
- Department of Twin Research and Genetic Epidemiology, King's College London, UK; Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK.
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology, King's College London, UK.
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14
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Hughes DJ, Subesinghe M, Taylor B, Bille A, Spicer J, Papa S, Goh V, Cook GJR. 18F FDG PET/CT and Novel Molecular Imaging for Directing Immunotherapy in Cancer. Radiology 2022; 304:246-264. [PMID: 35762888 DOI: 10.1148/radiol.212481] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Immunotherapy has transformed the treatment landscape of many cancers, with durable responses in disease previously associated with a poor prognosis. Patient selection remains a challenge, with predictive biomarkers an urgent unmet clinical need. Current predictive biomarkers, including programmed death-ligand 1 (PD-L1) (measured with immunohistochemistry), are imperfect. Promising biomarkers, including tumor mutation burden and tumor infiltrating lymphocyte density, fail to consistently predict response and have yet to translate to routine clinical practice. Heterogeneity of immune response within and between lesions presents a further challenge where fluorine 18 fluorodeoxyglucose PET/CT has a potential role in assessing response, stratifying treatment, and detecting and monitoring immune-related toxicities. Novel radiopharmaceuticals also present a unique opportunity to define the immune tumor microenvironment to better predict which patients may respond to therapy, for example by means of in vivo whole-body PD-L1 and CD8+ T cell expression imaging. In addition, longitudinal molecular imaging may help further define dynamic changes, particularly in cases of immunotherapy resistance, helping to direct a more personalized therapeutic approach. This review highlights current and emerging applications of molecular imaging to stratify, predict, and monitor molecular dynamics and treatment response in areas of clinical need.
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Affiliation(s)
- Daniel J Hughes
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Manil Subesinghe
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Benjamin Taylor
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Andrea Bille
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - James Spicer
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Sophie Papa
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Vicky Goh
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
| | - Gary J R Cook
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, 4th Floor, Lambeth Wing, London SE1 7EH, UK (D.J.H., M.S., V.G., G.J.R.C.); King's College London and Guy's and St Thomas' PET Centre, London, UK (D.J.H., M.S., G.J.R.C.); Comprehensive Cancer Centre (B.T., A.B.), Department of Thoracic Surgery (A.B.), and Department of Radiology (V.G.), Guy's and St Thomas' NHS Foundation Trust, London, UK; and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK (J.S., S.P.)
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15
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Patel AJ, Willsmore ZN, Khan N, Richter A, Naidu B, Drayson MT, Papa S, Cope A, Karagiannis SN, Perucha E, Middleton GW. Regulatory B cell repertoire defects predispose lung cancer patients to immune-related toxicity following checkpoint blockade. Nat Commun 2022; 13:3148. [PMID: 35672305 PMCID: PMC9174492 DOI: 10.1038/s41467-022-30863-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 05/22/2022] [Indexed: 12/20/2022] Open
Abstract
Checkpoint blockade with Pembrolizumab, has demonstrated durable clinical responses in advanced non-small cell lung cancer, however, treatment is offset by the development of high-grade immune related adverse events (irAEs) in some patients. Here, we show that in these patients a deficient Breg checkpoint fails to limit self-reactive T cell enhanced activity and auto-antibody formation enabled by PD-1/PD-L1 blockade, leading to severe auto-inflammatory sequelae. Principally a failure of IL-10 producing regulatory B cells as demonstrated through functional ex vivo assays and deep phenotyping mass cytometric analysis, is a major and significant finding in patients who develop high-grade irAEs when undergoing treatment with anti-PD1/PD-L1 checkpoint blockade. There is currently a lack of biomarkers to identify a priori those patients at greatest risk of developing severe auto-inflammatory syndrome. Pre-therapy B cell profiling could provide an important tool to identify lung cancer patients at high risk of developing severe irAEs on checkpoint blockade.
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Affiliation(s)
- Akshay J Patel
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zena N Willsmore
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - Naeem Khan
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Babu Naidu
- Institute of Inflammation and Ageing (IIA), College of Medical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sophie Papa
- Immunoengineering Group, King's College London, London, SE1 9RT, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, SE1 9RT, UK
| | - Andrew Cope
- Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, King's College London, London, SE1 1UL, UK
- Centre for Rheumatic Diseases, King's College London, SE1 1UL, London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, King's College London, London, SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, SE1 9RT, UK
| | - Esperanza Perucha
- Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, King's College London, London, SE1 1UL, UK
- Centre for Rheumatic Diseases, King's College London, SE1 1UL, London, UK
| | - Gary W Middleton
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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16
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Badagliacca R, Mercurio V, Romeo E, Correale M, Masarone D, Papa S, Tocchetti C, Agostoni P. Beta-blockers in pulmonary arterial hypertension: Time for a second thought? Vascul Pharmacol 2022; 144:106974. [DOI: 10.1016/j.vph.2022.106974] [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] [Received: 12/06/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
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17
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Challapalli A, Watkins S, Cogill G, Stewart G, Ellis S, Sykes A, Nobes J, Yip K, Barthakur U, Board R, Gadve A, O'Toole L, Kent C, Mackenzie J, Papa S, Fusi A, Fife K. Cemiplimab in advanced cutaneous squamous cell carcinoma: UK experience from the Named Patient Scheme. J Eur Acad Dermatol Venereol 2022; 36:e590-e592. [PMID: 35298050 DOI: 10.1111/jdv.18082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/09/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- A Challapalli
- University Hospitals Bristol & Weston NHS Foundation Trust
| | - S Watkins
- University Hospitals Birmingham NHS Foundation Trust
| | - G Cogill
- University Hospitals Plymouth NHS Trust
| | | | - S Ellis
- Portsmouth Hospitals NHS Trust
| | - A Sykes
- The Christie NHS Foundation Trust
| | - J Nobes
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - K Yip
- East Suffolk and North Essex NHS Foundation Trust
| | | | - R Board
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - A Gadve
- NHS Greater Glasgow and Clyde
| | - L O'Toole
- Hull University Teaching Hospitals NHS Trust
| | - C Kent
- University Hospitals of Leicester NHS Trust
| | | | - S Papa
- School of Cancer and Pharmaceutical Studies, King's College London
| | - A Fusi
- St George's University Hospitals NHS Foundation Trust
| | - K Fife
- Cambridge University Hospitals NHS Foundation Trust, UK
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18
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Fox L, Monroy-Iglesias MJ, Aggarwal A, Haire K, Purushotham A, Spicer J, Papa S, Rigg A, Dolly S, Sullivan R, Van Hemelrijck M. Association between COVID-19 burden and delays to diagnosis and treatment of cancer patients in England. J Cancer Policy 2022; 31:100316. [PMID: 35559868 PMCID: PMC8653402 DOI: 10.1016/j.jcpo.2021.100316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Background Methods Results Conclusion Policy summary
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Affiliation(s)
- Louis Fox
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK
| | - Maria J Monroy-Iglesias
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK.
| | - Ajay Aggarwal
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kate Haire
- Southeast London Cancer Alliance, London, UK
| | - Arnie Purushotham
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - James Spicer
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anne Rigg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK
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19
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Adams R, Coumbe JEM, Coumbe BGT, Thomas J, Willsmore Z, Dimitrievska M, Yasuzawa-Parker M, Hoyle M, Ingar S, Geh J, MacKenzie Ross A, Healy C, Papa S, Lacy KE, Karagiannis SN. BRAF inhibitors and their immunological effects in malignant melanoma. Expert Rev Clin Immunol 2022; 18:347-362. [PMID: 35195495 DOI: 10.1080/1744666x.2022.2044796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The treatment of cutaneous melanoma has been revolutionised by the development of small molecule inhibitors targeting the MAPK pathway, including inhibitors of BRAF (BRAFi) and MEK (MEKi), and immune checkpoint blockade antibodies, occurring in tandem. Despite these advances, the 5-year survival rate for patients with advanced melanoma remains only around 50%. Although not designed to alter immune responses within the tumour microenvironment (TME), MAPK pathway inhibitors (MAPKi) exert a range of effects on the host immune compartment which may offer opportunities for therapeutic interventions. AREAS COVERED We review the effects of MAPKi especially BRAFi, on the TME, focussing on alterations in inflammatory cytokine secretion, the recruitment of immune cells and their functions, both during response to BRAFi treatment and as resistance develops. We outline potential combinations of MAPKi with established and experimental treatments. EXPERT OPINION MAPKi in combination or in sequence with established treatments such as checkpoint inhibitors, anti-angiogenic agents, or new therapies such as adoptive cell therapies, may augment their immunological effects, reverse tumour-associated immune suppression and offer the prospect of longer-lived clinical responses. Refining therapeutic tools at our disposal and embracing "old friends" in the melanoma treatment arsenal, alongside new target identification, may improve the chances of therapeutic success.
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Affiliation(s)
- Rebecca Adams
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Jack E M Coumbe
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Ben G T Coumbe
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Jennifer Thomas
- The Royal Marsden, Downs Road, Sutton, Surrey, United Kingdom
| | - Zena Willsmore
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Marija Dimitrievska
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Monica Yasuzawa-Parker
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Maximilian Hoyle
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Suhaylah Ingar
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Jenny Geh
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Alastair MacKenzie Ross
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Ciaran Healy
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,ImmunoEngineering, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, United Kingdom.,Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London SE1 9RT, United Kingdom
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20
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Pezzuto B, Badagliacca R, Muratori M, Farina S, Bussotti M, Correale M, Bonomi A, Vignati C, Sciomer S, Papa S, Palazzo Adriano E, Agostoni P. ROLE OF CARDIOPULMONARY EXERCISE TEST IN THE PREDICTION OF HEMODYNAMIC IMPAIRMENT IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION. Pulm Circ 2022; 12:e12044. [PMID: 35506106 PMCID: PMC9052996 DOI: 10.1002/pul2.12044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Periodic repetition of right heart catheterization (RHC) in pulmonary arterial hypertension (PAH) can be challenging. We evaluated the correlation between RHC and cardiopulmonary exercise test (CPET) aiming at CPET use as a potential noninvasive tool for hemodynamic burden evaluation. One hundred and forty‐four retrospective PAH patients who had performed CPET and RHC within 2 months were enrolled. The following analyses were performed: (a) CPET parameters in hemodynamic variables tertiles; (b) position of hemodynamic parameters in the peak end‐tidal carbon dioxide pressure (PETCO2) versus ventilation/carbon dioxide output (VE/VCO2) slope scatterplot, which is a specific hallmark of exercise respiratory abnormalities in PAH; (c) association between CPET and a hemodynamic burden score developed including mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, and right atrial pressure. VE/VCO2 slope and peak PETCO2 significantly varied in mPAP and PVR tertiles, while peak oxygen uptake (peak VO2) and O2 pulse varied in the tertiles of all hemodynamic parameters. PETCO2 versus VE/VCO2 slope showed a strong hyperbolic relationship (R2 = 0.7627). Patients with peak PETCO2 > median (26 mmHg) and VE/VCO2 slope < median (44) presented lower mPAP and PVR (p < 0.005) than patients with peak PETCO2 < median and VE/VCO2 slope > median. Multivariate analysis individuated peak VO2 (p = 0.0158) and peak PETCO2 (p = 0.0089) as hemodynamic score independent predictors; the formula 11.584 − 0.0925 × peak VO2 − 0.0811 × peak PETCO2 best predicts the hemodynamic score value from CPET data. A significant correlation was found between estimated and calculated scores (p < 0.0001), with a precise match for patients with mild‐to‐moderate hemodynamic burden (76% of cases). The results of the present study suggest that CPET could allow to estimate the hemodynamic burden in PAH patients.
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Affiliation(s)
- B Pezzuto
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - R Badagliacca
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - S Farina
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - M Bussotti
- Cardiac Rehabilitation Department IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - M Correale
- University Hospital Ospedali Riuniti Foggia Italy
| | - A Bonomi
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - C Vignati
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - S Sciomer
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - S Papa
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - E Palazzo Adriano
- Cardiac Rehabilitation Department IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - P Agostoni
- Centro Cardiologico Monzino IRCCS Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
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21
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Amereller F, Deutschbein T, Joshi M, Schopohl J, Schilbach K, Detomas M, Duffy L, Carroll P, Papa S, Störmann S. Differences between immunotherapy-induced and primary hypophysitis-a multicenter retrospective study. Pituitary 2022; 25:152-158. [PMID: 34518996 PMCID: PMC8821509 DOI: 10.1007/s11102-021-01182-z] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis (IIH) and primary hypophysitis (PH) DESIGN: Retrospective multicenter cohort study including 56 patients with IIH and 60 patients with PH. METHODS All patients underwent extensive endocrine testing. Data on age, gender, symptoms, endocrine dysfunction, MRI, immunotherapeutic agents and autoimmune diseases were collected. RESULTS Median time of follow-up was 18 months in IIH and 69 months in PH. The median time from initiation of immunotherapy to IIH diagnosis was 3 months. IIH affected males more frequently than PH (p < 0.001) and led to more impaired pituitary axes in males (p < 0.001). The distribution of deficient adenohypophysial axes was comparable between both entities, however, central hypocortisolism was more frequent (p < 0.001) and diabetes insipidus considerably less frequent in IIH (p < 0.001). Symptoms were similar except that visual impairment occurred more rarely in IIH (p < 0.001). 20 % of IIH patients reported no symptoms at all. Regarding MRI, pituitary stalk thickening was less frequent in IIH (p = 0.009). Concomitant autoimmune diseases were more prevalent in PH patients before the diagnosis of hypophysitis (p = 0.003) and more frequent in IIH during follow-up (p = 0.002). CONCLUSIONS Clinically, IIH and PH present with similar symptoms. Diabetes insipidus very rarely occurs in IIH. Central hypocortisolism, in contrast, is a typical feature of IIH. Preexisting autoimmunity seems not to be indicative of developing IIH.
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Affiliation(s)
- Felix Amereller
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany.
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Mamta Joshi
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
| | - Mario Detomas
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Leo Duffy
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Paul Carroll
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
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22
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Russell B, Moss C, Tsotra E, Gousis C, Josephs D, Enting D, Karampera C, Khan M, Roca J, Sita-Lumsden A, Owczarczyk K, Wylie H, Haire A, Smith D, Zaki K, Swampillai A, Lei M, Manik V, Michalarea V, Kristeleit R, Mera A, Sawyer E, Flanders L, De Francesco I, Papa S, Ross P, Spicer J, Dann B, Jogia V, Shaunak N, Kristeleit H, Rigg A, Montes A, Van Hemelrijck M, Dolly S. The Impact of COVID-19 on the Delivery of Systemic Anti-Cancer Treatment at Guy's Cancer Centre. Cancers (Basel) 2022; 14:cancers14020266. [PMID: 35053432 PMCID: PMC8773464 DOI: 10.3390/cancers14020266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to assess the outcome of cancer patients undergoing systemic anti-cancer treatment (SACT) at our centre to help inform future clinical decision-making around SACT during the COVID-19 pandemic. METHODS Patients receiving at least one episode of SACT for solid tumours at Guy's Cancer Centre between 1 March and 31 May 2020 and the same period in 2019 were included in the study. Data were collected on demographics, tumour type/stage, treatment type (chemotherapy, immunotherapy, biological-targeted) and SARS-CoV2 infection. RESULTS A total of 2120 patients received SACT in 2020, compared to 2449 in 2019 (13% decrease). From 2019 to 2020, there was an increase in stage IV disease (62% vs. 72%), decrease in chemotherapy (42% vs. 34%), increase in immunotherapy (6% vs. 10%), but similar rates of biologically targeted treatments (37% vs. 38%). There was a significant increase in 1st and 2nd line treatments in 2020 (68% vs. 81%; p < 0.0001) and reduction in 3rd and subsequent lines (26% vs. 15%; p = 0.004) compared to 2019. Of the 2020 cohort, 2% patients developed SARS-CoV2 infections. CONCLUSIONS These real-world data from a tertiary Cancer Centre suggest that despite the challenges faced due to the COVID-19 pandemic, SACT was able to be continued without any significant effects on the mortality of solid-tumour patients. There was a low rate (2%) of SARS-CoV-2 infection which is comparable to the 1.4%-point prevalence in our total cancer population.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (H.W.); (A.H.); (M.V.H.)
- Correspondence:
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (H.W.); (A.H.); (M.V.H.)
| | - Eirini Tsotra
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Charalampos Gousis
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Debra Josephs
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Deborah Enting
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Christina Karampera
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Muhammad Khan
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Jose Roca
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Kasia Owczarczyk
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (H.W.); (A.H.); (M.V.H.)
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (H.W.); (A.H.); (M.V.H.)
| | - Daniel Smith
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Kamarul Zaki
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Angela Swampillai
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Mary Lei
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Vishal Manik
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Vasiliki Michalarea
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Rebecca Kristeleit
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Anca Mera
- Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.D.); (V.J.)
| | - Elinor Sawyer
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Lucy Flanders
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Irene De Francesco
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (K.O.); (D.S.); (A.S.); (M.L.); (V.M.); (E.S.); (I.D.F.)
| | - Sophie Papa
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
- Immunoengineering Group, King’s College London, London SE1 9RT, UK
| | - Paul Ross
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - James Spicer
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
- Pharmacy, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK;
| | - Bill Dann
- Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.D.); (V.J.)
| | - Vikash Jogia
- Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.D.); (V.J.)
| | - Nisha Shaunak
- Pharmacy, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK;
| | - Hartmut Kristeleit
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Anne Rigg
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Ana Montes
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (H.W.); (A.H.); (M.V.H.)
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (E.T.); (C.G.); (D.J.); (D.E.); (C.K.); (M.K.); (J.R.); (A.S.-L.); (K.Z.); (V.M.); (R.K.); (L.F.); (S.P.); (P.R.); (J.S.); (H.K.); (A.R.); (A.M.); (S.D.)
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23
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Dubus M, Varin J, Papa S, Chevrier J, Quilès F, Francius G, Audonnet S, Mauprivez C, Gangloff S, Siboni R, Ohl X, Reffuveille F, Kerdjoudj H. Bone marrow mesenchymal stem cells offer an immune-privileged niche to Cutibacterium acnes in case of implant-associated osteomyelitis. Acta Biomater 2022; 137:305-315. [PMID: 34678484 DOI: 10.1016/j.actbio.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/23/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
Considered as some of the most devastating complications, Cutibacterium acnes (C. acnes)-related osteomyelitis are among the hardest infections to diagnose and treat. Mesenchymal stem cells (MSCs) secrete number of immunomodulatory and antimicrobial soluble factors, making them an attractive treatment for bacterial infection. In this study, we examined MSCs/C. acnes interaction and analyzed the subsequent MSCs and bacteria's behaviors. Human bone marrow-derived MSCs were infected by C. acnes clinical strain harvested from non-infected bone site. Following 3 h of interaction, around 4% of bacteria were found in the intracellular compartment. Infected MSCs increased the secretion of prostaglandin E2 and indolamine 2,3 dioxygenase immunomodulatory mediators. Viable intracellular bacteria analyzed by infrared spectroscopy and atomic force microscopy revealed deep modifications in the wall features. In comparison with unchallenged bacteria, the viable intracellular bacteria showed (i) an increase in biofilm formation on orthopaedical-based materials, (ii) an increase in the invasiveness of osteoblasts and (iii) persistence in macrophage, suggesting the acquisition of virulence factors. Overall, these results showed a direct impact of C. acnes on bone marrow-derived MSCs, suggesting that blocking the C. acnes/MSCs interactions may represent an important new approach to manage chronic osteomyelitis infections. STATEMENT OF SIGNIFICANCE: The interaction of bone commensal C. acnes with bone marrow mesenchymal stem cells induces modifications in C. acnes wall characteristics. These bacteria increased (i) the biofilm formation on orthopaedical-based materials, (ii) the invasiveness of bone forming cells and (iii) the resistance to macrophage clearance through the modification of the wall nano-features and/or the increase in catalase production.
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Chauhan J, Aasaithambi S, Márquez-Rodas I, Formisano L, Papa S, Meyer N, Forschner A, Faust G, Lau M, Sagkriotis A. Understanding the Lived Experience of Patients with Melanoma: Real-World Evidence Generated through a European Social Media Listening Analysis (Preprint). JMIR Cancer 2021; 8:e35930. [PMID: 35699985 PMCID: PMC9237767 DOI: 10.2196/35930] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cutaneous melanoma is an aggressive malignancy that is proposed to account for 90% of skin cancer–related mortality. Individuals with melanoma experience both physical and psychological impacts associated with their diagnosis and treatment. Health-related information is being increasingly accessed and shared by stakeholders on social media platforms. Objective This study aimed to assess how individuals living with melanoma across 14 European countries use social media to discuss their needs and provide their perceptions of the disease. Methods Social media sources including Twitter, forums, and blogs were searched using predefined search strings of keywords relating to melanoma. Manual and automated relevancy approaches filtered the extracted data for content that provided patient-centric insights. This contextualized data was then mined for insightful concepts around the symptoms, diagnosis, treatment, impacts, and lived experiences of melanoma. Results A total of 182,400 posts related to melanoma were identified between November 2018 and November 2020. Following exclusion of irrelevant posts and using random sampling methodology, 864 posts were identified as relevant to the study objectives. Of the social media channels included, Twitter was the most commonly used, followed by forums and blogs. Most posts originated from the United Kingdom (n=328, 38%) and Spain (n=138, 16%). Of the relevant posts, 62% (n=536) were categorized as originating from individuals with melanoma. The most frequently discussed melanoma-related topics were treatment (436/792, 55%), diagnosis and tests (261/792, 33%), and remission (190/792, 24%). The majority of treatment discussions were about surgery (292/436, 67%), followed by immunotherapy (52/436, 12%). In total, 255 posts discussed the impacts of melanoma, which included emotional burden (n=179, 70%), physical impacts (n=61, 24%), effects on social life (n=43, 17%), and financial impacts (n=10, 4%). Conclusions Findings from this study highlight how melanoma stakeholders discuss key concepts associated with the condition on social media, adding to the conceptual model of the patient journey. This social media listening approach is a powerful tool for exploring melanoma stakeholder perspectives, providing insights that can be used to corroborate existing data and inform future studies.
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Affiliation(s)
| | | | - Iván Márquez-Rodas
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer, Universidad Complutense, Madrid, Spain
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Sophie Papa
- School of Cancer and Pharmaceutical Studies, King's College London, London, United Kingdom
| | - Nicolas Meyer
- Department of Onco-Dermatology, Toulouse Cancer Institute, Toulouse, France
- Oncology Department, Toulouse University Hospital, Toulouse, France
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Guy Faust
- Department of Oncology, University Hospitals of Leicester, Leicester, United Kingdom
| | - Mike Lau
- Novartis Pharma AG, Basel, Switzerland
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Schoenfeld A, Lee S, Paz-Ares L, Doger B, Gettinger S, Haefliger S, Orcurto A, Sukari A, Papa S, Rodriguez Moreno JF, Finckenstein FG, Jagasia M, Fiaz R, Sulur G, Chen G, Gontcharova V, He K. 458 First phase 2 results of autologous tumor-infiltrating lymphocyte (TIL; LN-145) monotherapy in patients with advanced, immune checkpoint inhibitor-treated, non-small cell lung cancer (NSCLC). J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundA majority of patients with advanced NSCLC develop disease progression with first-line immune-checkpoint inhibitors (ICI) ± chemotherapy. In the setting of ICI resistance, effective strategies to provide deep and durable responses are urgently needed. Lifileucel (LN-144) and LN-145 are centrally manufactured (cryopreserved drug-product, 22-day manufacturing process) autologous TIL products that have demonstrated activity in advanced melanoma, cervical cancer, and head and neck carcinoma.1–4 Here, we report the first safety and efficacy data for LN-145 as monotherapy in patients with advanced NSCLC.MethodsIOV-COM-202 (NCT03645928) is a phase 2 multicenter, multicohort, open-label study evaluating autologous TIL cell therapy in patients with solid tumors. We report data from Cohort 3B, investigating LN-145 monotherapy in patients with advanced or metastatic NSCLC. Eligibility required 1–3 prior lines of systemic therapy, including either ICI or oncogene-directed therapy. Treatment included nonmyeloablative lymphodepletion, TIL infusion, and ≤6 interleukin-2 doses. Primary endpoints were safety (incidence of Grade ≥3 treatment-emergent adverse events [TEAEs]) and objective response rate (ORR, investigator-assessed using RECIST v1.1). Exploratory biomarker analyses, including T-cell receptor (TCR) repertoire, were performed.ResultsAs of 24June2021, 28 patients received LN-145 (full-analysis set [FAS]; table 1) and 24 were efficacy-evaluable; all had received prior ICI. TIL were most commonly harvested from lung metastases (57.1%). Safety was consistent with the underlying disease and known TEAE profiles of nonmyeloablative lymphodepletion and interleukin-2. Grade ≥3 TEAEs in ≥30% of patients were thrombocytopenia and anemia. The ORR in the FAS and efficacy-evaluable set was 21.4% (6/28) and 25.0% (6/24; figure 1), respectively. Median duration of response was not reached and 83% (5/6) of responses were ongoing at last follow-up (median study follow-up, 8.2 months). One patient had a complete metabolic response, ongoing at 20.7 months; 2 responses occurred in patients who were PD-L1–negative. All responders received ≥2 prior lines of systemic therapy. Twenty-six patients had TIL available from the final drug-product for TCR repertoire analysis; mean (min-max) number of unique TCR clones was 13,142 (3093–35,734) and Shannon Entropy index was 7.34 (3.7–12). Updated data will be presented.Abstract 458 Figure 1Best percentage change from baseline in target lesion sum of diameters for efficacy-evaluable setAbstract 458 Table 1Baseline patient demographic and clinical characteristics; efficacy parametersConclusionsLN-145 was successfully manufactured and one-time treatment produced an expected safety profile and durable responses in heavily pretreated patients with NSCLC, regardless of PD-L1 expression. The activity of LN-145 monotherapy is encouraging and warrants further investigation of LN-145 as a single-agent and in combination in patients with NSCLC in ongoing studies IOV-LUN-202 (NCT04614103) and IOV-COM-202 Cohorts 3A and 3C (3B closed to enrollment).AcknowledgementsThis study and analysis were funded by Iovance Biotherapeutics, Inc. (San Carlos, CA, USA). Writing support was provided by Amanda Kelly (Iovance); graphics support was provided by Cognition Studio (Seattle, WA, USA).Trial RegistrationNCT03645928ReferencesSarnaik AA, et al. J Clin Oncol 2021; doi: 10.1200/JCO.21.00612.. Thomas SS, et al. J Clin Oncol 2021;39: (suppl; abstract 9537).Jazaeri A, et al. J Clin Oncol 2019;37: (suppl; abstract 2538).Jimeno A, et al. J Immunother Cancer 2020;8: (suppl; abstract A378).Ethics ApprovalThe study was approved by Advarra Institutional Review Board, approval number Pro00035064 and all study participants provided written consent via signature of the IRB-approved Informed Consent form.
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McKenzie DR, Muñoz-Ruiz M, Monin L, Alaguthurai T, Lechmere T, Abdul-Jawad S, Graham C, Pollock E, Graham R, Sychowska K, Seow J, Tremain C, Gousis C, Domingo-Vila C, Cooper J, Vidler J, Owczarczyk K, Swampillai A, Kristeleit H, Malim MH, Fields P, Patten PEM, Papa S, North BV, Tree T, Doores KJ, Hayday AC, Irshad S. Humoral and cellular immunity to delayed second dose of SARS-CoV-2 BNT162b2 mRNA vaccination in patients with cancer. Cancer Cell 2021; 39:1445-1447. [PMID: 34678151 PMCID: PMC8506107 DOI: 10.1016/j.ccell.2021.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Thanussuyah Alaguthurai
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK; Breast Cancer Now Research Unit, King's College London, London, UK
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - Sultan Abdul-Jawad
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - Emily Pollock
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, UK
| | - Rosalind Graham
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - Kamila Sychowska
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, UK
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | | | | | - Clara Domingo-Vila
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, UK
| | - Jack Cooper
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jennifer Vidler
- Department of Haematological Medicine, King's College Hospital, London, UK
| | | | - Angela Swampillai
- Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Michael H Malim
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - Paul Fields
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK; Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Piers E M Patten
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Sophie Papa
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK; Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Timothy Tree
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - Adrian C Hayday
- The Francis Crick Institute, London, UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, UK
| | - Sheeba Irshad
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St. Thomas' NHS Foundation Trust, London, UK; Cancer Research UK (CRUK) Clinician Scientist, London, UK.
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Russell B, Moss CL, Shah V, Ko TK, Palmer K, Sylva R, George G, Monroy-Iglesias MJ, Patten P, Ceesay MM, Benjamin R, Potter V, Pagliuca A, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Sita-Lumsden A, Josephs D, Enting D, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Harrison C, Fields P, Wrench D, Rigg A, Sullivan R, Kulasekararaj A, Dolly S, Van Hemelrijck M. Risk of COVID-19 death in cancer patients: an analysis from Guy's Cancer Centre and King's College Hospital in London. Br J Cancer 2021; 125:939-947. [PMID: 34400804 PMCID: PMC8366163 DOI: 10.1038/s41416-021-01500-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/26/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Using an updated dataset with more patients and extended follow-up, we further established cancer patient characteristics associated with COVID-19 death. METHODS Data on all cancer patients with a positive reverse transcription-polymerase chain reaction swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) at Guy's Cancer Centre and King's College Hospital between 29 February and 31 July 2020 was used. Cox proportional hazards regression was performed to identify which factors were associated with COVID-19 mortality. RESULTS Three hundred and six SARS-CoV-2-positive cancer patients were included. Seventy-one had mild/moderate and 29% had severe COVID-19. Seventy-two patients died of COVID-19 (24%), of whom 35 died <7 days. Male sex [hazard ratio (HR): 1.97 (95% confidence interval (CI): 1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer [2.03 (1.16-3.56)] and a cancer diagnosis for >2-5 years [2.81 (1.41-5.59)] or ≥5 years were associated with an increased mortality. Age >60 years and raised C-reactive protein (CRP) were also associated with COVID-19 death. Haematological cancer, a longer-established cancer diagnosis, dyspnoea at diagnosis and raised CRP were indicative of early COVID-19-related death in cancer patients (<7 days from diagnosis). CONCLUSIONS Findings further substantiate evidence for increased risk of COVID-19 mortality for male and Asian cancer patients, and those with haematological malignancies or a cancer diagnosis >2 years. These factors should be accounted for when making clinical decisions for cancer patients.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
| | - Charlotte L Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Vallari Shah
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Thinzar Ko Ko
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kieran Palmer
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rushan Sylva
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Gincy George
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Piers Patten
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Reuben Benjamin
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sheeba Irshad
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Paul Ross
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - James Spicer
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Shahram Kordasti
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kamarul Zaki
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Angela Swampillai
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Elinor Sawyer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Clinical Oncology, Guy's and St Thomas NHS Foundation Trust (GSTT), London, UK
| | - Andrea D'Souza
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Simon Gomberg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Claire Harrison
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Paul Fields
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - David Wrench
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Anne Rigg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Austin Kulasekararaj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
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van Schalkwyk MCI, van der Stegen SJC, Bosshard-Carter L, Graves H, Papa S, Parente-Pereira AC, Farzaneh F, Fisher CD, Hope A, Adami A, Maher J. Development and Validation of a Good Manufacturing Process for IL-4-Driven Expansion of Chimeric Cytokine Receptor-Expressing CAR T-Cells. Cells 2021; 10:cells10071797. [PMID: 34359966 PMCID: PMC8307141 DOI: 10.3390/cells10071797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/08/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
Adoptive cancer immunotherapy using chimeric antigen receptor (CAR) engineered T-cells holds great promise, although several obstacles hinder the efficient generation of cell products under good manufacturing practice (GMP). Patients are often immune compromised, rendering it challenging to produce sufficient numbers of gene-modified cells. Manufacturing protocols are labour intensive and frequently involve one or more open processing steps, leading to increased risk of contamination. We set out to develop a simplified process to generate autologous gamma retrovirus-transduced T-cells for clinical evaluation in patients with head and neck cancer. T-cells were engineered to co-express a panErbB-specific CAR (T1E28z) and a chimeric cytokine receptor (4αβ) that permits their selective expansion in response to interleukin (IL)-4. Using peripheral blood as starting material, sterile culture procedures were conducted in gas-permeable bags under static conditions. Pre-aliquoted medium and cytokines, bespoke connector devices and sterile welding/sealing were used to maximise the use of closed manufacturing steps. Reproducible IL-4-dependent expansion and enrichment of CAR-engineered T-cells under GMP was achieved, both from patients and healthy donors. We also describe the development and approach taken to validate a panel of monitoring and critical release assays, which provide objective data on cell product quality.
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Affiliation(s)
- May C. I. van Schalkwyk
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Sjoukje J. C. van der Stegen
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Leticia Bosshard-Carter
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Helen Graves
- Immune Monitoring Laboratory, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK;
| | - Sophie Papa
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
- Guy’s and St Thomas’ NHS Foundation Trust, Department of Medical Oncology, Great Maze Pond, London SE1 9RT, UK
| | - Ana C. Parente-Pereira
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Farzin Farzaneh
- The Rayne Institute, School of Cancer and Pharmaceutical Sciences, King’s College London, London SE5 9NU, UK;
| | - Christopher D. Fisher
- Good Manufacturing Practice Unit, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK; (C.D.F.); (A.H.)
| | - Andrew Hope
- Good Manufacturing Practice Unit, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK; (C.D.F.); (A.H.)
| | - Antonella Adami
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - John Maher
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Department of Clinical Immunology and Allergy, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)207188-1468
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Alexander JL, Ibraheim H, Sheth B, Little J, Khan MS, Richards C, Hunter N, Chauhan D, Ratnakumaran R, McHugh K, Pinato DJ, Nathan P, Choy J, Crusz SM, Furness A, Turajlic S, Pickering L, Larkin J, Teare JP, Papa S, Speight A, Sharma A, Powell N. Clinical outcomes of patients with corticosteroid refractory immune checkpoint inhibitor-induced enterocolitis treated with infliximab. J Immunother Cancer 2021; 9:e002742. [PMID: 34233964 PMCID: PMC8264884 DOI: 10.1136/jitc-2021-002742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (CPIs) have changed the treatment landscape for many cancers, but also cause severe inflammatory side effects including enterocolitis. CPI-induced enterocolitis is treated empirically with corticosteroids, and infliximab (IFX) is used in corticosteroid-refractory cases. However, robust outcome data for these patients are scarce. METHODS We conducted a multicenter (six cancer centers), cohort study of outcomes in patients treated with IFX for corticosteroid-refractory CPI-induced enterocolitis between 2007 and 2020. The primary outcome was corticosteroid-free clinical remission (CFCR) with Common Terminology Criteria for Adverse Events (CTCAE) grade 0 for diarrhea at 12 weeks after IFX initiation. We also assessed cancer outcomes at 1 year using RECIST V1.1 criteria. RESULTS 127 patients (73 male; median age 59 years) were treated with IFX for corticosteroid-refractory CPI-induced enterocolitis. Ninety-six (75.6%) patients had diarrhea CTCAE grade >2 and 115 (90.6%) required hospitalization for colitis. CFCR was 41.2% at 12 weeks and 50.9% at 26 weeks. In multivariable logistic regression, IFX-resistant enterocolitis was associated with rectal bleeding (OR 0.19; 95% CI 0.04 to 0.80; p=0.03) and absence of colonic crypt abscesses (OR 2.16; 95% CI 1.13 to 8.05; p=0.03). Cancer non-progression was significantly more common in patients with IFX-resistant enterocolitis (64.4%) as compared with patients with IFX-responsive enterocolitis (37.5%; p=0.013). CONCLUSION This is the largest study to date reporting outcomes of IFX therapy in patients with corticosteroid-refractory CPI-induced enterocolitis. Using predefined robust endpoints, we have demonstrated that fewer than half of patients achieved CFCR. Our data also indicate that cancer outcomes may be better in patients developing prolonged and severe inflammatory side effects of CPI therapy.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Bhavisha Sheth
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Jessica Little
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Muhammad Saheb Khan
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Camellia Richards
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nikki Hunter
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Dharmisha Chauhan
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Kathleen McHugh
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - David J Pinato
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Paul Nathan
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Julia Choy
- Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Andrew Furness
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Lisa Pickering
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Julian P Teare
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ally Speight
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Anand Sharma
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
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Pellizzari G, Martinez O, Crescioli S, Page R, Di Meo A, Mele S, Chiaruttini G, Hoinka J, Batruch I, Prassas I, Grandits M, López-Abente J, Bugallo-Blanco E, Ward M, Bax HJ, French E, Cheung A, Lombardi S, Figini M, Lacy KE, Diamandis EP, Josephs DH, Spicer J, Papa S, Karagiannis SN. Immunotherapy using IgE or CAR T cells for cancers expressing the tumor antigen SLC3A2. J Immunother Cancer 2021; 9:jitc-2020-002140. [PMID: 34112739 PMCID: PMC8194339 DOI: 10.1136/jitc-2020-002140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 01/21/2023] Open
Abstract
Background Cancer immunotherapy with monoclonal antibodies and chimeric antigen receptor (CAR) T cell therapies can benefit from selection of new targets with high levels of tumor specificity and from early assessments of efficacy and safety to derisk potential therapies. Methods Employing mass spectrometry, bioinformatics, immuno-mass spectrometry and CRISPR/Cas9 we identified the target of the tumor-specific SF-25 antibody. We engineered IgE and CAR T cell immunotherapies derived from the SF-25 clone and evaluated potential for cancer therapy. Results We identified the target of the SF-25 clone as the tumor-associated antigen SLC3A2, a cell surface protein with key roles in cancer metabolism. We generated IgE monoclonal antibody, and CAR T cell immunotherapies each recognizing SLC3A2. In concordance with preclinical and, more recently, clinical findings with the first-in-class IgE antibody MOv18 (recognizing the tumor-associated antigen Folate Receptor alpha), SF-25 IgE potentiated Fc-mediated effector functions against cancer cells in vitro and restricted human tumor xenograft growth in mice engrafted with human effector cells. The antibody did not trigger basophil activation in cancer patient blood ex vivo, suggesting failure to induce type I hypersensitivity, and supporting safe therapeutic administration. SLC3A2-specific CAR T cells demonstrated cytotoxicity against tumor cells, stimulated interferon-γ and interleukin-2 production in vitro. In vivo SLC3A2-specific CAR T cells significantly increased overall survival and reduced growth of subcutaneous PC3-LN3-luciferase xenografts. No weight loss, manifestations of cytokine release syndrome or graft-versus-host disease, were detected. Conclusions These findings identify efficacious and potentially safe tumor-targeting of SLC3A2 with novel immune-activating antibody and genetically modified cell therapies.
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Affiliation(s)
- Giulia Pellizzari
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Olivier Martinez
- Immunoengineering Group, King's College London, London, England, UK
| | - Silvia Crescioli
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Robert Page
- Immunoengineering Group, King's College London, London, England, UK
| | - Ashley Di Meo
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Silvia Mele
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Giulia Chiaruttini
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Jan Hoinka
- Computational Biology Branch, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Ihor Batruch
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Melanie Grandits
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Jacobo López-Abente
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | | | | | - Heather J Bax
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Elise French
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Anthony Cheung
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK.,Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, King's College London, London, England, UK
| | - Sara Lombardi
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK.,School of Cancer and Pharmaceutical Sciences, King's College London, London, England, UK
| | - Mariangela Figini
- Biomarker Unit, Dipartimento di Ricerca Applicata e Sviluppo Tecnologico (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Katie E Lacy
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK
| | - Eleftherios P Diamandis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada
| | - Debra H Josephs
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK.,Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - James Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, England, UK
| | - Sophie Papa
- Immunoengineering Group, King's College London, London, England, UK .,Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Sophia N Karagiannis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, England, UK .,Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, King's College London, London, England, UK
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31
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Monin L, Laing AG, Muñoz-Ruiz M, McKenzie DR, del Molino del Barrio I, Alaguthurai T, Domingo-Vila C, Hayday TS, Graham C, Seow J, Abdul-Jawad S, Kamdar S, Harvey-Jones E, Graham R, Cooper J, Khan M, Vidler J, Kakkassery H, Sinha S, Davis R, Dupont L, Francos Quijorna I, O'Brien-Gore C, Lee PL, Eum J, Conde Poole M, Joseph M, Davies D, Wu Y, Swampillai A, North BV, Montes A, Harries M, Rigg A, Spicer J, Malim MH, Fields P, Patten P, Di Rosa F, Papa S, Tree T, Doores KJ, Hayday AC, Irshad S. Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: interim analysis of a prospective observational study. Lancet Oncol 2021. [DOI: 10.1016/s1470-2045%2821%2900213-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Monin L, Laing AG, Muñoz-Ruiz M, McKenzie DR, Del Molino Del Barrio I, Alaguthurai T, Domingo-Vila C, Hayday TS, Graham C, Seow J, Abdul-Jawad S, Kamdar S, Harvey-Jones E, Graham R, Cooper J, Khan M, Vidler J, Kakkassery H, Sinha S, Davis R, Dupont L, Francos Quijorna I, O'Brien-Gore C, Lee PL, Eum J, Conde Poole M, Joseph M, Davies D, Wu Y, Swampillai A, North BV, Montes A, Harries M, Rigg A, Spicer J, Malim MH, Fields P, Patten P, Di Rosa F, Papa S, Tree T, Doores KJ, Hayday AC, Irshad S. Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: interim analysis of a prospective observational study. Lancet Oncol 2021; 22:765-778. [PMID: 33930323 PMCID: PMC8078907 DOI: 10.1016/s1470-2045(21)00213-8] [Citation(s) in RCA: 401] [Impact Index Per Article: 133.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The efficacy and safety profiles of vaccines against SARS-CoV-2 in patients with cancer is unknown. We aimed to assess the safety and immunogenicity of the BNT162b2 (Pfizer-BioNTech) vaccine in patients with cancer. METHODS For this prospective observational study, we recruited patients with cancer and healthy controls (mostly health-care workers) from three London hospitals between Dec 8, 2020, and Feb 18, 2021. Participants who were vaccinated between Dec 8 and Dec 29, 2020, received two 30 μg doses of BNT162b2 administered intramuscularly 21 days apart; patients vaccinated after this date received only one 30 μg dose with a planned follow-up boost at 12 weeks. Blood samples were taken before vaccination and at 3 weeks and 5 weeks after the first vaccination. Where possible, serial nasopharyngeal real-time RT-PCR (rRT-PCR) swab tests were done every 10 days or in cases of symptomatic COVID-19. The coprimary endpoints were seroconversion to SARS-CoV-2 spike (S) protein in patients with cancer following the first vaccination with the BNT162b2 vaccine and the effect of vaccine boosting after 21 days on seroconversion. All participants with available data were included in the safety and immunogenicity analyses. Ongoing follow-up is underway for further blood sampling after the delayed (12-week) vaccine boost. This study is registered with the NHS Health Research Authority and Health and Care Research Wales (REC ID 20/HRA/2031). FINDINGS 151 patients with cancer (95 patients with solid cancer and 56 patients with haematological cancer) and 54 healthy controls were enrolled. For this interim data analysis of the safety and immunogenicity of vaccinated patients with cancer, samples and data obtained up to March 19, 2021, were analysed. After exclusion of 17 patients who had been exposed to SARS-CoV-2 (detected by either antibody seroconversion or a positive rRT-PCR COVID-19 swab test) from the immunogenicity analysis, the proportion of positive anti-S IgG titres at approximately 21 days following a single vaccine inoculum across the three cohorts were 32 (94%; 95% CI 81-98) of 34 healthy controls; 21 (38%; 26-51) of 56 patients with solid cancer, and eight (18%; 10-32) of 44 patients with haematological cancer. 16 healthy controls, 25 patients with solid cancer, and six patients with haematological cancer received a second dose on day 21. Of the patients with available blood samples 2 weeks following a 21-day vaccine boost, and excluding 17 participants with evidence of previous natural SARS-CoV-2 exposure, 18 (95%; 95% CI 75-99) of 19 patients with solid cancer, 12 (100%; 76-100) of 12 healthy controls, and three (60%; 23-88) of five patients with haematological cancers were seropositive, compared with ten (30%; 17-47) of 33, 18 (86%; 65-95) of 21, and four (11%; 4-25) of 36, respectively, who did not receive a boost. The vaccine was well tolerated; no toxicities were reported in 75 (54%) of 140 patients with cancer following the first dose of BNT162b2, and in 22 (71%) of 31 patients with cancer following the second dose. Similarly, no toxicities were reported in 15 (38%) of 40 healthy controls after the first dose and in five (31%) of 16 after the second dose. Injection-site pain within 7 days following the first dose was the most commonly reported local reaction (23 [35%] of 65 patients with cancer; 12 [48%] of 25 healthy controls). No vaccine-related deaths were reported. INTERPRETATION In patients with cancer, one dose of the BNT162b2 vaccine yields poor efficacy. Immunogenicity increased significantly in patients with solid cancer within 2 weeks of a vaccine boost at day 21 after the first dose. These data support prioritisation of patients with cancer for an early (day 21) second dose of the BNT162b2 vaccine. FUNDING King's College London, Cancer Research UK, Wellcome Trust, Rosetrees Trust, and Francis Crick Institute.
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Affiliation(s)
| | - Adam G Laing
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | | | - Irene Del Molino Del Barrio
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK; UCL Cancer Institute, University College London, London, UK
| | - Thanussuyah Alaguthurai
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK
| | - Clara Domingo-Vila
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Thomas S Hayday
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Carl Graham
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Sultan Abdul-Jawad
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Shraddha Kamdar
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | - Rosalind Graham
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Jack Cooper
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Muhammad Khan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jennifer Vidler
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Helen Kakkassery
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Shubhankar Sinha
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Richard Davis
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Liane Dupont
- Breast Cancer Now Research Unit, King's College London, London, UK
| | - Isaac Francos Quijorna
- Regeneration Group, Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte O'Brien-Gore
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | | | - Josephine Eum
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Maria Conde Poole
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Magdalene Joseph
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Daniel Davies
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, UK
| | - Yin Wu
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK; Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | | | | | - Ana Montes
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Harries
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anne Rigg
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Spicer
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Paul Fields
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Piers Patten
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Francesca Di Rosa
- Institute of Molecular Biology and Pathology, National Research Council of Italy, Rome, Italy
| | - Sophie Papa
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy Tree
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Adrian C Hayday
- The Francis Crick Institute, London, UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Sheeba Irshad
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Russell B, Moss CL, Palmer K, Sylva R, D’Souza A, Wylie H, Haire A, Cahill F, Steel R, Hoyes A, Wilson I, Macneil A, Shifa B, Monroy-Iglesias MJ, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Zaki K, Sita-Lumsden A, Josephs D, Enting D, Swampillai A, Sawyer E, Fields P, Wrench D, Rigg A, Sullivan R, Van Hemelrijck M, Dolly S. COVID-19 Risk Factors for Cancer Patients: A First Report with Comparator Data from COVID-19 Negative Cancer Patients. Cancers (Basel) 2021; 13:2479. [PMID: 34069565 PMCID: PMC8161328 DOI: 10.3390/cancers13102479] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/11/2023] Open
Abstract
Very few studies investigating COVID-19 in cancer patients have included cancer patients as controls. We aimed to identify factors associated with the risk of testing positive for SARS CoV2 infection in a cohort of cancer patients. We analyzed data from all cancer patients swabbed for COVID-19 between 1st March and 31st July 2020 at Guy's Cancer Centre. We conducted logistic regression analyses to identify which factors were associated with a positive COVID-19 test. Results: Of the 2152 patients tested for COVID-19, 190 (9%) tested positive. Male sex, black ethnicity, and hematological cancer type were positively associated with risk of COVID-19 (OR = 1.85, 95%CI:1.37-2.51; OR = 1.93, 95%CI:1.31-2.84; OR = 2.29, 95%CI:1.45-3.62, respectively) as compared to females, white ethnicity, or solid cancer type, respectively. Male, Asian ethnicity, and hematological cancer type were associated with an increased risk of severe COVID-19 (OR = 3.12, 95%CI:1.58-6.14; OR = 2.97, 95%CI:1.00-8.93; OR = 2.43, 95%CI:1.00-5.90, respectively). This study is one of the first to compare the risk of COVID-19 incidence and severity in cancer patients when including cancer patients as controls. Results from this study have echoed those of previous reports, that patients who are male, of black or Asian ethnicity, or with a hematological malignancy are at an increased risk of COVID-19.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Charlotte L. Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Kieran Palmer
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | - Rushan Sylva
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Andrea D’Souza
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Renee Steel
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
| | - Angela Hoyes
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - Isabelle Wilson
- Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK;
| | - Alyson Macneil
- Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.S.)
| | - Belul Shifa
- Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.S.)
| | - Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Sophie Papa
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Sheeba Irshad
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Paul Ross
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - James Spicer
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Shahram Kordasti
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Kamarul Zaki
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Angela Swampillai
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
| | - Elinor Sawyer
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Paul Fields
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - David Wrench
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - Anne Rigg
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
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SEYLANOVA N, Cennamo A, Flanders L, Shaunak N, Papa S, Ostermann M, Lumlertgul N. POS-209 IMMUNE CHECKPOINTS INHIBITORS-ASSOCIATED ACUTE KIDNEY INJURY: A SINGLE-CENTRE STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Monroy-Iglesias MJ, Russell B, Moss C, George G, Palmer K, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Sylva R, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Kulasekararaj A, Ko TK, Shah V, Rigg A, Sullivan R, Van Hemelrijck M, Dolly S. Abstract S12-03: Clinical and demographic characteristics associated with shorter time to COVID-19 death. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy’s Cancer Centre and one of its partner trusts (King’s College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.
Citation Format: Maria J. Monroy-Iglesias, Beth Russell, Charlotte Moss, Gincy George, Kieran Palmer, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Sharam Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Rushan Sylva, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmistha Ghosh, Claire Harrison, Angela Swampillai, Elinor Sawyer, Andrea D'Souza, Simon Gomberg, Paul Fields, David Wrench, Kavita Raj, Mary Gleeson, Kate Bailey, Richard Dillon, Matthew Streetly, Austin Kulasekararaj, Thinzar Ko Ko, Vallari Shah, Anne Rigg, Richard Sullivan, Mieke Van Hemelrijck, Saoirse Dolly. Clinical and demographic characteristics associated with shorter time to COVID-19 death [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-03.
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Affiliation(s)
- Maria J. Monroy-Iglesias
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Beth Russell
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Charlotte Moss
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Gincy George
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Kieran Palmer
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sophie Papa
- 3Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sheeba Irshad
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Paul Ross
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - James Spicer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sharam Kordasti
- 6Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Danielle Crawley
- 7Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London; Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Harriet Wylie
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Fidelma Cahill
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Anna Haire
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Rushan Sylva
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Kamarul Zaki
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Fareen Rahman
- 8Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom, London, United Kingdom,
| | - Ailsa Sita-Lumsden
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Debra Josephs
- 9Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Deborah Enting
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Mary Lei
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sharmistha Ghosh
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Claire Harrison
- 10King’s College Hospital NHS Foundation Trust; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Angela Swampillai
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Elinor Sawyer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Andrea D'Souza
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Simon Gomberg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Paul Fields
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - David Wrench
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kavita Raj
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Mary Gleeson
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kate Bailey
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Richard Dillon
- 12Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT); Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King’s College London, London, United Kingdom,
| | - Matthew Streetly
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Austin Kulasekararaj
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Thinzar Ko Ko
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Vallari Shah
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Anne Rigg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Richard Sullivan
- 14School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Saoirse Dolly
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
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Flanders L, Russell B, Moss C, Palmer K, Sylva R, George G, Crawley D, Wylie H, Cahill F, Haire A, D'Souza A, Gomberg S, Sullivan R, Rigg A, Van Hemelrijck M, Harries M, De Francesco I, Morris S, Papa S, Dolly S. Abstract P28: COVID-19 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT): The Guy’s Cancer Centre experience. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-p28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The COVID-19 pandemic has influenced treatment decisions in cancer patients. There is increasing evidence that not all oncology patients are at increased risk of COVID-19 infection or death. This study aimed to look at rate of SARS-CoV-2 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT) during the pandemic in Guy’s Cancer Centre. Methods: All patients with skin cancer receiving SACT at Guy’s Cancer Centre between March 1st and May 31st 2020 were included. Demographic data: sex, age, socio-economic status (SES), ethnicity, comorbidities, medications and smoking history were collected along with cancer characteristics: cancer type, stage, treatment paradigm, modality and line. COVID-19 infection was confirmed by PCR and severity defined by the World Health Organisation classification. Patients with radiological or clinical diagnoses alone were excluded. Results: Of 116 skin cancer patients on SACT over the 3-month period, 89% had Melanoma, 5% Kaposi’s Sarcoma (KS), 3% Squamous Cell, 2% Merkel Cell, 1% Basal Cell Carcinoma and 1% Angiosarcoma. 53% were male and 78% were of low SES. 62% were being treated with palliative intent and 70% of these were on first line palliative treatment. The median age was 57.6 years in COVID-19 positive patients (n=3) compared to 60.3 years in the negative group (n=113). 58.6% received immunotherapy, 28.4% targeted therapy, 7.8% chemotherapy and 4.3% combined treatment. Of the 3 patients (2.6%) with confirmed COVID-19 infection, the two patients with KS were receiving liposomal doxorubicin hydrochloride and the other paclitaxel chemotherapy and the patient with Melanoma was receiving encorafenib and binimetinib. All COVID-19 positive patients were of low SES, 2 females and 1 male. There was a low rate of co-morbidities with hypertension in 1 COVID-19 positive patient and none in the negative group. All 3 confirmed COVID-19 patients developed severe pneumonia and were diagnosed within 7 days of the onset of symptoms. There were no COVID related deaths and one disease-related death in the negative cohort. Conclusion: There was a low rate of COVID-19 infection in the 116 skin cancer patients on SACT (2.6%) with 60% of patients on immunotherapy. All 3 confirmed cases had severe pneumonia with no COVID-19 related deaths (0%); 2 were receiving chemotherapy and 1 on targeted therapy. Patients on treatment were encouraged to shield between hospital attendances during this period which may account for the reduced rate of SARS-CoV-2 infection. This data supports the emerging observations that immunotherapy does not confer an increased risk of severe COVID-19 infection in cancer patients. This observation is confounded by the relatively young age and low co-morbidity rates in the cohort which may have contributed to the low infection and mortality rate.
Citation Format: Lucy Flanders, Beth Russell, Charlotte Moss, Kieran Palmer, Rushan Sylva, Gincy George, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Andrea D'Souza, Simon Gomberg, Richard Sullivan, Anne Rigg, Mieke Van Hemelrijck, Mark Harries, Irene De Francesco, Stephen Morris, Sophie Papa, Saiorse Dolly. COVID-19 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT): The Guy’s Cancer Centre experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P28.
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Affiliation(s)
- Lucy Flanders
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | | | | | - Rushan Sylva
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | - Danielle Crawley
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | | | - Anna Haire
- 2King’s College London, London, United Kingdom
| | - Andrea D'Souza
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Simon Gomberg
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Richard Sullivan
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Anne Rigg
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | - Mark Harries
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Irene De Francesco
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Stephen Morris
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Sophie Papa
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Saiorse Dolly
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
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Runbeck E, Crescioli S, Karagiannis SN, Papa S. Utilizing Immunocytokines for Cancer Therapy. Antibodies (Basel) 2021; 10:antib10010010. [PMID: 33803078 PMCID: PMC8006145 DOI: 10.3390/antib10010010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cytokine therapy for cancer has indicated efficacy in certain diseases but is generally accompanied by severe toxicity. The field of antibody-cytokine fusion proteins (immunocytokines) arose to target these effector molecules to the tumor environment in order to expand the therapeutic window of cytokine therapy. Pre-clinical evidence has shown the increased efficacy and decreased toxicity of various immunocytokines when compared to their cognate unconjugated cytokine. These anti-tumor properties are markedly enhanced when combined with other treatments such as chemotherapy, radiotherapy, and checkpoint inhibitor antibodies. Clinical trials that have continued to explore the potential of these biologics for cancer therapy have been conducted. This review covers the in vitro, in vivo, and clinical evidence for the application of immunocytokines in immuno-oncology.
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Affiliation(s)
- Erin Runbeck
- ImmunoEngineering Group, School of Cancer and Pharmaceutical Studies, King’s College London, London SE19RT, UK;
| | - Silvia Crescioli
- St. John’s Institute of Dermatology, School of Basic and Medical Biosciences, King’s College London, London SE1 9RT, UK; (S.C.); (S.N.K.)
| | - Sophia N. Karagiannis
- St. John’s Institute of Dermatology, School of Basic and Medical Biosciences, King’s College London, London SE1 9RT, UK; (S.C.); (S.N.K.)
| | - Sophie Papa
- ImmunoEngineering Group, School of Cancer and Pharmaceutical Studies, King’s College London, London SE19RT, UK;
- Correspondence:
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Willsmore ZN, Coumbe BGT, Crescioli S, Reci S, Gupta A, Harris RJ, Chenoweth A, Chauhan J, Bax HJ, McCraw A, Cheung A, Osborn G, Hoffmann RM, Nakamura M, Laddach R, Geh JLC, MacKenzie-Ross A, Healy C, Tsoka S, Spicer JF, Josephs DH, Papa S, Lacy KE, Karagiannis SN. Combined anti-PD-1 and anti-CTLA-4 checkpoint blockade: Treatment of melanoma and immune mechanisms of action. Eur J Immunol 2021; 51:544-556. [PMID: 33450785 DOI: 10.1002/eji.202048747] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/23/2020] [Indexed: 12/19/2022]
Abstract
Cytotoxic T-lymphocyte associated protein-4 (CTLA-4) and the Programmed Death Receptor 1 (PD-1) are immune checkpoint molecules that are well-established targets of antibody immunotherapies for the management of malignant melanoma. The monoclonal antibodies, Ipilimumab, Pembrolizumab, and Nivolumab, designed to interfere with T cell inhibitory signals to activate immune responses against tumors, were originally approved as monotherapy. Treatment with a combination of immune checkpoint inhibitors may improve outcomes compared to monotherapy in certain patient groups and these clinical benefits may be derived from unique immune mechanisms of action. However, treatment with checkpoint inhibitor combinations also present significant clinical challenges and increased rates of immune-related adverse events. In this review, we discuss the potential mechanisms attributed to single and combined checkpoint inhibitor immunotherapies and clinical experience with their use.
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Affiliation(s)
- Zena N Willsmore
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Ben G T Coumbe
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Silvia Crescioli
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Sara Reci
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Ayushi Gupta
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Robert J Harris
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Alicia Chenoweth
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Heather J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Alexa McCraw
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Anthony Cheung
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
| | - Gabriel Osborn
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Ricarda M Hoffmann
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Roman Laddach
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, United Kingdom
| | - Jenny L C Geh
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Ciaran Healy
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, United Kingdom
| | - James F Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Debra H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- ImmunoEngineering, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, United Kingdom
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
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Abdul-Jawad S, Baù L, Alaguthurai T, Del Molino Del Barrio I, Laing AG, Hayday TS, Monin L, Muñoz-Ruiz M, McDonald L, Francos Quijorna I, McKenzie D, Davis R, Lorenc A, Chan JNE, Ryan S, Bugallo-Blanco E, Yorke R, Kamdar S, Fish M, Zlatareva I, Vantourout P, Jennings A, Gee S, Doores K, Bailey K, Hazell S, De Naurois J, Moss C, Russell B, Khan AA, Rowley M, Benjamin R, Enting D, Alrifai D, Wu Y, Zhou Y, Barber P, Ng T, Spicer J, Van Hemelrijck M, Kumar M, Vidler J, Lwin Y, Fields P, Karagiannis SN, Coolen ACC, Rigg A, Papa S, Hayday AC, Patten PEM, Irshad S. Acute Immune Signatures and Their Legacies in Severe Acute Respiratory Syndrome Coronavirus-2 Infected Cancer Patients. Cancer Cell 2021; 39:257-275.e6. [PMID: 33476581 PMCID: PMC7833668 DOI: 10.1016/j.ccell.2021.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023]
Abstract
Given the immune system's importance for cancer surveillance and treatment, we have investigated how it may be affected by SARS-CoV-2 infection of cancer patients. Across some heterogeneity in tumor type, stage, and treatment, virus-exposed solid cancer patients display a dominant impact of SARS-CoV-2, apparent from the resemblance of their immune signatures to those for COVID-19+ non-cancer patients. This is not the case for hematological malignancies, with virus-exposed patients collectively displaying heterogeneous humoral responses, an exhausted T cell phenotype and a high prevalence of prolonged virus shedding. Furthermore, while recovered solid cancer patients' immunophenotypes resemble those of non-virus-exposed cancer patients, recovered hematological cancer patients display distinct, lingering immunological legacies. Thus, while solid cancer patients, including those with advanced disease, seem no more at risk of SARS-CoV-2-associated immune dysregulation than the general population, hematological cancer patients show complex immunological consequences of SARS-CoV-2 exposure that might usefully inform their care.
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Affiliation(s)
- Sultan Abdul-Jawad
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Luca Baù
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Thanussuyah Alaguthurai
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK
| | - Irene Del Molino Del Barrio
- Cancer Immunotherapy Accelerator, UCL Cancer Institute, University College and King's College, London, UK; Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Adam G Laing
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Thomas S Hayday
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | | | | | - Louisa McDonald
- Oncology and Haematology Clinical Trials (OHCT), Guy's and St Thomas' NHS Foundation Trust, London UK
| | | | | | - Richard Davis
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Anna Lorenc
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Julie Nuo En Chan
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Sarah Ryan
- Department of Inflammation Biology, King's College London, London, UK
| | - Eva Bugallo-Blanco
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Rozalyn Yorke
- Department of Inflammation Biology, King's College London, London, UK
| | - Shraddha Kamdar
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Matthew Fish
- Peter Gorer Department of Immunobiology, King's College London, London, UK; Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Iva Zlatareva
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Pierre Vantourout
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Aislinn Jennings
- Peter Gorer Department of Immunobiology, King's College London, London, UK; Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Gee
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Katie Doores
- Department of Infectious Diseases, King's College London, London, UK
| | - Katharine Bailey
- Department of Haematology, Guy's and St Thomas' NHS Foundation trust, London, UK
| | - Sophie Hazell
- Department of Haematology, Guy's and St Thomas' NHS Foundation trust, London, UK
| | - Julien De Naurois
- Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charlotte Moss
- Department of Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Beth Russell
- Department of Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Aadil A Khan
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
| | - Mark Rowley
- London Institute for Mathematical Sciences, Mayfair, London, UK; Saddle Point Science Ltd, London, UK
| | - Reuben Benjamin
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Deborah Enting
- Department of Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Doraid Alrifai
- Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yin Wu
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Cancer Immunotherapy Accelerator, UCL Cancer Institute, University College and King's College, London, UK; Peter Gorer Department of Immunobiology, King's College London, London, UK; The Francis Crick Institute, London, UK
| | - You Zhou
- Systems Immunity University Research Institute and Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Paul Barber
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Tony Ng
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- Department of Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Mayur Kumar
- Department of Gastroenterology, Princess Royal University Hospital, Kent, UK
| | - Jennifer Vidler
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Yadanar Lwin
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Paul Fields
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematology, Guy's and St Thomas' NHS Foundation trust, London, UK
| | - Sophia N Karagiannis
- Breast Cancer Now Research Unit, King's College London, London, UK; St. John's Institute of Dermatology, King's College London, London, UK; NIHR Biomedical Research Centre, and King's College London, London, UK
| | - Anthony C C Coolen
- Targeted Therapy Team, The Institute of Cancer Research, London, UK; London Institute for Mathematical Sciences, Mayfair, London, UK; Saddle Point Science Ltd, London, UK; Department of Biophysics, Radboud University, Nijmegen, The Netherlands
| | - Anne Rigg
- Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Papa
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adrian C Hayday
- Peter Gorer Department of Immunobiology, King's College London, London, UK; The Francis Crick Institute, London, UK
| | - Piers E M Patten
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK; Medical Research Council (MRC) Clinical Academic Research Partnership, London, UK
| | - Sheeba Irshad
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust, London, UK; Cancer Research UK (CRUK) Clinician Scientist, London, UK.
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40
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van Akkooi ACJ, Haferkamp S, Papa S, Franke V, Pinter A, Weishaupt C, Huber MA, Loquai C, Richtig E, Gokani P, Öhrling K, Louie KS, Mohr P. A Retrospective Chart Review Study of Real-World Use of Talimogene Laherparepvec in Unresectable Stage IIIB-IVM1a Melanoma in Four European Countries. Adv Ther 2021; 38:1245-1262. [PMID: 33368016 PMCID: PMC7889564 DOI: 10.1007/s12325-020-01590-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
Introduction Talimogene laherparepvec (T-VEC; IMLYGIC®, Amgen Inc.) is an oncolytic immunotherapy approved in Europe for the treatment of unresectable metastatic melanoma (stage IIIB–IVM1a). This study characterised real-world use of T-VEC in four European countries. Methods Data on demographics, treatment pattern, safety, and clinical effectiveness were examined in a retrospective chart review of patients with stage IIIB–IVM1a unresectable melanoma treated with T-VEC in surgical (the Netherlands) and medical (Austria, Germany, UK) oncology settings. Results Overall, 66 patients were included (the Netherlands: n = 31; Austria, Germany, UK: n = 35). The median age was 69 years and 59.1% were female. At the time of T-VEC initiation, 47 patients (71.2%) had stage IIIB/C disease; of these, 30 were from the Netherlands. Although 72.7% patients overall received T-VEC as first-line therapy, this was higher in the Netherlands than the other countries (93.5% vs 54.3%). Of the 47 patients who discontinued T-VEC, 26 (55.3%) had no remaining injectable lesions (potentially indicating complete response); 20/26 of these patients were from the Netherlands. One patient discontinued T-VEC due to toxicity. Conclusion This study is the first comprehensive multinational evaluation of the use of T-VEC to treat unresectable stage IIIB/C–IVM1a melanoma in real-world clinical practice in Europe. The differences between European countries were apparent, with physicians in the Netherlands using T-VEC in patients with earlier advanced disease stage and in the first-line setting compared with other countries. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01590-w.
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Affiliation(s)
- Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands.
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Viola Franke
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Margit A Huber
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | | | | | | | - Peter Mohr
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany
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Willsmore ZN, Harris RJ, Crescioli S, Hussein K, Kakkassery H, Thapa D, Cheung A, Chauhan J, Bax HJ, Chenoweth A, Laddach R, Osborn G, McCraw A, Hoffmann RM, Nakamura M, Geh JL, MacKenzie-Ross A, Healy C, Tsoka S, Spicer JF, Papa S, Barber L, Lacy KE, Karagiannis SN. B Cells in Patients With Melanoma: Implications for Treatment With Checkpoint Inhibitor Antibodies. Front Immunol 2021; 11:622442. [PMID: 33569063 PMCID: PMC7868381 DOI: 10.3389/fimmu.2020.622442] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 10/28/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
The contributions of the humoral immune response to melanoma are now widely recognized, with reports of positive prognostic value ascribed to tumor-infiltrating B cells (TIL-B) and increasing evidence of B cells as key predictors of patient response to treatment. There are disparate views as to the pro- and anti-tumor roles of B cells. B cells appear to play an integral role in forming tumor-associated tertiary lymphoid structures (TLSs) which can further modulate T cell activation. Expressed antibodies may distinctly influence tumor regulation in the tumor microenvironment, with some isotypes associated with strong anti-tumor immune response and others with progressive disease. Recently, B cells have been evaluated in the context of cancer immunotherapy. Checkpoint inhibitors (CPIs), targeting T cell effector functions, have revolutionized the management of melanoma for many patients; however, there remains a need to accurately predict treatment responders. Increasing evidence suggests that B cells may not be simple bystanders to CPI immunotherapy. Mature and differentiated B cell phenotypes are key positive correlates of CPI response. Recent evidence also points to an enrichment in activatory B cell phenotypes, and the contribution of B cells to TLS formation may facilitate induction of T cell phenotypes required for response to CPI. Contrastingly, specific B cell subsets often correlate with immune-related adverse events (irAEs) in CPI. With increased appreciation of the multifaceted role of B cell immunity, novel therapeutic strategies and biomarkers can be explored and translated into the clinic to optimize CPI immunotherapy in melanoma.
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Affiliation(s)
- Zena N Willsmore
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Robert J Harris
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Silvia Crescioli
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Khuluud Hussein
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Helen Kakkassery
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Deepika Thapa
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Anthony Cheung
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom.,Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Heather J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom.,School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, United Kingdom
| | - Alicia Chenoweth
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom.,Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
| | - Roman Laddach
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom.,Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, United Kingdom
| | - Gabriel Osborn
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Alexa McCraw
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Ricarda M Hoffmann
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Jenny L Geh
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Ciaran Healy
- Department of Plastic Surgery at Guy's, King's, and St. Thomas' Hospitals, London, United Kingdom
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, United Kingdom
| | - James F Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, United Kingdom
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,ImmunoEngineering, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Linda Barber
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, United Kingdom
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom.,Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
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Badagliacca R, D'Alto M, Ghio S, Greco A, Papa S, Romeo E, Casu G, Corda M, Paciocco P, D'Agostino C, Galgano G, Stolfo D, Correale M, Naeije R, Vizza C. Determinants of pulmonary vascular resistance reduction with upfront oral therapy in idiopathic pulmonary arterial hypertension: relevance in risk assessment. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In pulmonary arterial hypertension (PAH) upfront oral therapy represents the standard of care for naive patients at low and intermediate risk. However little is known about associated changes in risk assessment and prediction of low risk status achievement.
Purpose
To evaluate determinants of PVR reduction in patients treated with upfront oral therapy and to create a score to predict PVR reduction after upfront oral treatment and compared its additive value on top of the European and REVEAL scoring system in predicting treatment response.
Methods
One-hundred-eighty-one consecutive naive PAH patients treated with upfront therapy at 11 italian centers were retrospectively evaluated. Evaluation included clinical, hemodynamic and simple echocardiographic parameters, together with European and REVEAL 2.0 risk scores.
Results
At the time of diagnosis, the majority of the patients was idiopathic PAH (80.6%), female (66.3%), at intermediate risk, 71.8% and 55.2%, respectively, according to the European (average method) and the REVEAL 2.0 risk scores. Ambrisentan-Tadalafil was the most frequent combination used (62%). The median PVR reduction obtained after 180 days (IQR 79–394) was −40.4% (IQR −25.8; −45.3).
Age ≥60 years, male-sex, baseline mPAP 48 mmHg associated with low CI (<2.5 l/min/m2), and RV/LV ratio >1 associated with low TAPSE (<18 mm) emerged as independent predictors of poor PVR reduction, defined as the lower tertile of PVR changes (−25.8%). A treatment response score was created deriving weighted integers from the beta coefficient.
At second evaluation 78 (43.1%) patients achieved or remained at European-derived low risk status, while 63 (34.8%) considering the REVEAL 2.0 score.
Multivariate analysis for the prediction of treatment failure, defined as the absence of low-risk status at follow-up, demonstrated the incremental prognostic power of the models incorporating the treatment response score (≥3) on top of the European and REVEAL 2.0 scores, improving risk discrimination by 63.2% (IDI index 0.056) and 36.8% (IDI index 0.080), respectively.
Conclusions
A significant proportion of PAH patients treated with upfront oral combination are not able to achieve a low-risk status. The treatment response score helps clinicians in predicting treatment failure at the time of diagnosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - M D'Alto
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - A Greco
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - S Papa
- Sapienza University of Rome, Rome, Italy
| | - E Romeo
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - G Casu
- San Francesco Hospital, Nuoro, Italy
| | - M Corda
- AO Brotzu Hospital, Cagliari, Italy
| | - P Paciocco
- University of Milan-Bicocca, Milan, Italy
| | | | - G Galgano
- Regional General Hospital F. Miulli, Acquaviva Delle Fonti, Italy
| | - D Stolfo
- University Hospital Riuniti, Trieste, Italy
| | - M Correale
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - R Naeije
- Free University of Brussels (VUB), Brussels, Belgium
| | - C.D Vizza
- Sapienza University of Rome, Rome, Italy
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Russell B, Moss CL, Papa S, Wylie H, Haire A, Cahill F, Lei M, Ghosh S, Sullivan R, Rigg AS, Dolly S, Van Hemelrijck M. Disparities in COVID-19 severity and risk of death in cancer patients: Experiences from a U.K. cancer center. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
285 Background: There has been widespread evidence emerging regarding disparities between COVID-19 outcomes in patients of varying ethnicities and background. It is, however, unclear how various patient characteristics affect COVID-19 severity and risk of death in a cancer population. Methods: Our Cancer Centre was at the epicentre of the COVID-19 outbreak in the UK. A total of 156 cancer patients had a confirmed COVID-19 diagnosis between the 29th of February through the 12th of May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. The regression models were defined through a directed acyclic graph (DAG) to decide upon the minimal adjustments required for each statistical model. Results: Of the 156 COVID-19 positive cancer patients, the most frequently reported tumour types were urological/gynaecological (29%), followed by haematological (18%) and breast (15%). 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis of cancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnoea (2.60 (1.00-6.76)), gastro-intestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) were linked with greater COVID-19 severity. During median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before (2.14 (1.04-4.44), dyspnoea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positively associated with COVID-19 death. Socioeconomic status (SES) was not found to be associated with either COVID-19 severity or risk of death. We will present updated data with more mature follow-up. Conclusions: In cancer patients, Asian ethnicity was found to be positively associated with COVID-19 death compared to Caucasian patients. However, SES was not associated with COVID-19 severity or risk of death thereby implying this was not due to poor access to healthcare. Future studies hence need to identify the underlying biological and/or societal reasons explaining these ethnic disparities in COVID-19 outcomes for cancer patients.
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Affiliation(s)
- Beth Russell
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Charlotte L Moss
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Sophie Papa
- Guy's And St Thomas NHS Foundation Trust, London, United Kingdom
| | | | - Anna Haire
- Guy's Cancer Centre, London, United Kingdom
| | - Fidelma Cahill
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Mary Lei
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | | | - Richard Sullivan
- King’s Health Partners Comprehensive Cancer Centre, London, United Kingdom
| | - Anne Sagar Rigg
- Guys and St Thomas' Hospitals NMS Foundation Trust, Beckenham, United Kingdom
| | - Saoirse Dolly
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
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44
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Samani A, Zhang S, Spiers L, Suwaidan AA, Merrick S, Tippu Z, Payne M, Faust G, Papa S, Fields P, Van Hemelrijck M, Josephs DH. Impact of age on the toxicity of immune checkpoint inhibition. J Immunother Cancer 2020; 8:e000871. [PMID: 33033183 PMCID: PMC7545628 DOI: 10.1136/jitc-2020-000871] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Indications for immune checkpoint inhibitor therapy are increasing. As the population ages, many patients receiving such drugs will be older adults. Such patients are under-represented in clinical trials, and therefore the safety of immune checkpoint inhibitors in this population has not been adequately assessed. A retrospective multicenter analysis of toxicities was performed in patients with advanced or metastatic solid cancers receiving anti-programmed cell death protein 1 (anti-PD-1) and/or anti-CTLA4 antibodies across three age cohorts (<65 years, 65-74 years and ≥75 years) using univariable and multivariable analyzes. Eligible patients (n=448) were divided into age cohorts: <65 years (n=185), 65-74 years (n=154) and ≥75 years (n=109). Fewer patients in the oldest cohort (7.3%) received an anti-CTLA4 antibody containing regimen compared with the younger cohorts (21.1% and 17.5%). There was no significant difference overall in all grade or ≥G3 toxicities between age cohorts. Significantly fewer patients in the older (65-74 years and ≥75 years) age cohorts discontinued treatment because of toxicity (10.1% and 7.4%) compared with in the <65 years cohort (20.5%; p=0.006). Using logistic regression, only treatment type (ipilimumab containing) was significantly associated with all grade toxicity. However, there was a significantly lower incidence of all-grade endocrine toxicity in the oldest cohort (11.0%) compared with the youngest cohort (22.7%, p=0.02; OR 0.43, 95% CI 0.21 to 0.87), while all-grade dermatological toxicity showed the reverse trend (28.4% vs 18.9%; OR 1.85, 95% CI 1.04 to 3.30). Results were corroborated in the sensitivity analysis using only data from patients who received PD-1 inhibitor monotherapy. This multicenter, real-world cohort demonstrates that immune checkpoint inhibitor therapy is safe and well tolerated regardless of age, with no appreciable increase in adverse events in older adult patients.
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Affiliation(s)
- Amit Samani
- Department of Surgery and Cancer, Imperial College London, London, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Shuai Zhang
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Laura Spiers
- Department of Oncology, University of Oxford & Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Ali Abdulnabi Suwaidan
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Sophie Merrick
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Zayd Tippu
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Miranda Payne
- Department of Oncology, University of Oxford & Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Guy Faust
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Paul Fields
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Debra H Josephs
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
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Moss C, Russell B, Lei M, Ghosh S, Papa S, Sullivan R, Van Hemelrijck M, Rigg A. Abstract PO-028: One piece of the jigsaw for the cancer recovery strategy: Prevalence of COVID-19 in patients with cancer. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-po-028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: COVID-19 has forced governments to make drastic changes to the health care system. While these may have reduced COVID-19 morbidity/mortality, there have been unintended consequences on society and non-COVID-19 health issues. Although initial data start to inform us how to care for cancer patients during COVID-19, there is as yet no long-term follow-up. To start making informed decisions about cancer care, it is crucial to understand the scale of COVID-19 infection in cancer patients. Therefore, we introduced swab testing for patients visiting Guy’s Cancer Centre.
Methods: Our Centre in South-East London treats approximately 8,800 patients annually (including 4,500 new diagnoses) and is one of the largest Comprehensive Cancer Centres in the UK at the epicenter of the UK COVID-19 epidemic. The first COVID-19-positive cancer patient was reported on 29 February, 2020. Until 30 April, 2020, a COVID-19 swab was ordered for cancer patients with symptoms necessitating hospitalization or if they were scheduled to undergo a cancer-related treatment. From 1 May, 2020, COVID-19 testing was introduced as standard of care, with about 25% of patients being swabbed daily depending upon staff and testing kit availability. We analyzed data from 7-15 May, 2020 for COVID-19 test results in all cancer patients at our Centre.
Results: 2,647 patients attended for outpatient, chemotherapy, or radiotherapy appointments from across South East London (and England). Of these, 654 were swabbed for COVID-19 (25%). Over 57% of patients filled out a symptom assessment, and 97% were asymptomatic. Of the patients tested, nine were positive for COVID-19 (1.38%) of whom seven were asymptomatic. Based on data from the Office for National Statistics, between 28 April-10 May, 2020, 0.27% of the community population had COVID-19 (95%CI: 0.17-0.41). However, for those working in patient-facing health care or resident-facing social care roles, this was estimated at 1.33% (95CI%: 0.39-3.28). Nevertheless, London has been the region hardest hit by COVID-19, so the rate of 1.38% among asymptomatic cancer patients, the majority of whom will have been shielding, is likely to be more representative of the local situation. However, this “snapshot” of prevalence is not enough for an evolving situation.
Conclusion: Cancer service providers will need to understand their local cancer population prevalence and keep this under regular review. The absolute priority is that cancer patients have the confidence to attend hospitals and be reassured that they will be treated in a COVID-19-managed environment.
Citation Format: Charlotte Moss, Beth Russell, Mary Lei, Sharmista Ghosh, Sophie Papa, Richard Sullivan, Mieke Van Hemelrijck, Anne Rigg, Guy's Cancer Real World Evidence Programme. One piece of the jigsaw for the cancer recovery strategy: Prevalence of COVID-19 in patients with cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-028.
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Affiliation(s)
| | | | - Mary Lei
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharmista Ghosh
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sophie Papa
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Anne Rigg
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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46
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Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sullivan R, Rigg A, Dolly S, Van Hemelrijck M. Abstract S09-03: Factors affecting COVID-19 outcomes in cancer patients: A first report from Guy’s Cancer Centre in London. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-s09-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current precautionary management decisions being made for cancer patients are based on assumptions supported by limited evidence, based on small case series from China and Italy and larger series from New York and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain. Hence, there is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies.
Methods: We used data from a single large UK Cancer Centre to assess demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February-12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death.
Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis of cancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnea (2.60 (1.00-6.76)), gastrointestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) were linked with greater COVID-19 severity. During median follow-up of 47d, 34 patients had died of COVID-19 (22%). Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before (2.14 (1.04-4.44), dyspnea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin (0.04 (0.01-0.04).
Conclusions: Our analysis of one of the largest single-center series of COVID-19-positive cancer patients to date confirms a similar distribution of age, sex, and comorbidities as reported for other populations. With respect to cancer-specific observations, patients who have lived longer with their cancer were found to be more susceptible to a greater infection severity, possibly reflecting the effect of more advanced malignant disease, as almost half of the severe cohort were on third-line metastatic treatment, or the impact of this infection. The latter was also found to be associated with COVID-19 death in cancer patients, as were Asian ethnicity and palliative treatment. Further validation will be provided from other large case series, as well as from those including longer follow-up, to provide more definite guidance for oncologic care.
Citation Format: Beth Russell, Charlotte Moss, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Shahram Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmista Ghosh, Claire Harrison, Angela Swampillai, Richard Sullivan, Anne Rigg, Saoirse Dolly, Mieke Van Hemelrijck, Guy's Cancer Real World Evidence Programme. Factors affecting COVID-19 outcomes in cancer patients: A first report from Guy’s Cancer Centre in London [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S09-03.
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Affiliation(s)
| | | | - Sophie Papa
- 1King's College London, London, United Kingdom,
| | | | - Paul Ross
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Anna Haire
- 1King's College London, London, United Kingdom,
| | - Kamarul Zaki
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fareen Rahman
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Mary Lei
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharmista Ghosh
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Harrison
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Anne Rigg
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Saoirse Dolly
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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47
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Moss C, Dolly S, Russell B, Lei M, Ghosh S, Papa S, Sullivan R, Van Hemelrijck M, Rigg A. One Piece of the Jigsaw for the Cancer Recovery Strategy: Prevalence of COVID-19 in Patients With Cancer. Cancer Control 2020; 27:1073274820950844. [PMID: 32885663 PMCID: PMC7658857 DOI: 10.1177/1073274820950844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/16/2022] Open
Abstract
COVID-19 has forced governments to make drastic changes to healthcare systems. To start
making informed decisions about cancer care, we need to understand the scale of COVID-19
infection. Therefore, we introduced swab testing for patients visiting Guy’s Cancer
Centre. Our Centre is one of the largest UK Cancer Centers at the epicenter of the UK
COVID-19 epidemic. The first COVID-19 positive cancer patient was reported on 29 February
2020. We analyzed data from 7-15 May 2020 for COVID-19 tests in our cancer patients. 2,647
patients attended for outpatient, chemotherapy, or radiotherapy appointments. 654 were
swabbed for COVID-19 (25%). Of those tested, 9 were positive for COVID-19 (1.38%) of which
7 were asymptomatic. Cancer service providers will need to understand their local cancer
population prevalence. The absolute priority is that cancer patients have the confidence
to attend hospitals and be reassured that they will be treated in a COVID-19 managed
environment.
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Affiliation(s)
- Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology and Urology Research (TOUR), 4616King's College London, London, United Kingdom
| | - Saoirse Dolly
- Department of Medical Oncology, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology and Urology Research (TOUR), 4616King's College London, London, United Kingdom
| | - Mary Lei
- Department of Medical Oncology, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharmista Ghosh
- Department of Medical Oncology, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sophie Papa
- Department of Medical Oncology, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, 4616King's College London, London, United Kingdom
| | - Richard Sullivan
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, 4616King's College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology and Urology Research (TOUR), 4616King's College London, London, United Kingdom
| | - Anne Rigg
- Department of Medical Oncology, 8945Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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48
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Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Rigg A, Sullivan R, Dolly S, Van Hemelrijck M. Factors Affecting COVID-19 Outcomes in Cancer Patients: A First Report From Guy's Cancer Center in London. Front Oncol 2020; 10:1279. [PMID: 32903324 PMCID: PMC7396540 DOI: 10.3389/fonc.2020.01279] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies. Methods: We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and 12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with a severe case of the disease. An initial cancer diagnosis >24 months before COVID-19 [OR: 1.74 (95% CI: 0.71-4.26)], presenting with fever [6.21 (1.76-21.99)], dyspnea [2.60 (1.00-6.76)], gastro-intestinal symptoms [7.38 (2.71-20.16)], or higher levels of C-reactive protein [9.43 (0.73-121.12)] were linked with greater COVID-19 severity. During a median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Being of Asian ethnicity [3.73 (1.28-10.91)], receiving palliative treatment [5.74 (1.15-28.79)], having an initial cancer diagnosis >24 months before [2.14 (1.04-4.44)], dyspnea [4.94 (1.99-12.25)], and increased CRP levels [10.35 (1.05-52.21)] were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin [0.04 (0.01-0.04)]. Conclusions: A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in cancer patients.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophie Papa
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sheeba Irshad
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Paul Ross
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - James Spicer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Shahram Kordasti
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Kamarul Zaki
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Fareen Rahman
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Ailsa Sita-Lumsden
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mary Lei
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Sharmistha Ghosh
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Angela Swampillai
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Elinor Sawyer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Andrea D'Souza
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Simon Gomberg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Paul Fields
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - David Wrench
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kavita Raj
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Mary Gleeson
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kate Bailey
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Richard Dillon
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Matthew Streetly
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Anne Rigg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Saoirse Dolly
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
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Powell N, Ibraheim H, Raine T, Speight RA, Papa S, Brain O, Green M, Samaan MA, Spain L, Yousaf N, Hunter N, Eldridge L, Pavlidis P, Irving P, Hayee B, Turajlic S, Larkin J, Lindsay JO, Gore M. British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis. Lancet Gastroenterol Hepatol 2020; 5:679-697. [PMID: 32553146 DOI: 10.1016/s2468-1253(20)30014-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/15/2022]
Abstract
Immune checkpoint inhibitors are a novel class of cancer treatment that have improved outcomes for a subset of cancer patients. They work by antagonising inhibitory immune pathways, thereby augmenting immune-mediated antitumour responses. However, immune activation is not cancer-specific and often results in the activation of immune cells in non-cancer tissues, resulting in off-target immune-mediated injury and organ dysfunction. Diarrhoea and gastrointestinal tract inflammation are common and sometimes serious side-effects of this type of therapy. Prompt recognition of gastrointestinal toxicity and, in many cases, rapid institution of anti-inflammatory or biologic therapy (or both) is required to reverse these complications. Management of organ-specific complications benefits from multidisciplinary input, including engagement with gastroenterologists for optimal management of immune checkpoint inhibitor-induced enterocolitis. In this British Society of Gastroenterology endorsed guidance document, we have developed a consensus framework for the investigation and management of immune checkpoint inhibitor-induced enterocolitis.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/toxicity
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/toxicity
- Consensus
- Endoscopy/methods
- Endoscopy, Digestive System/methods
- Enterocolitis/chemically induced
- Enterocolitis/drug therapy
- Enterocolitis/metabolism
- Gastroenterology/organization & administration
- Gastrointestinal Diseases/chemically induced
- Gastrointestinal Diseases/diagnostic imaging
- Gastrointestinal Diseases/pathology
- Guidelines as Topic
- Humans
- Infliximab/therapeutic use
- Lactoferrin/metabolism
- Leukocyte L1 Antigen Complex/metabolism
- Neoplasms/drug therapy
- Patient Care Management/methods
- Societies, Medical/organization & administration
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- United Kingdom/epidemiology
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Affiliation(s)
- Nick Powell
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK.
| | - Hajir Ibraheim
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK
| | - Tim Raine
- Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard A Speight
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Michael Green
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - Polychronis Pavlidis
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Inflammation and Cancer Immunology, King's College London, London, UK
| | - Peter Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Samra Turajlic
- The Royal Marsden Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | | | - James O Lindsay
- The Royal London Hospital, Barts Health NHS Trust, London, UK; Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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50
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Affiliation(s)
- Daniel Larcombe-Young
- King's College London , School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London, UK
| | - Sophie Papa
- King's College London , School of Cancer and Pharmaceutical Sciences, ImmunoEngineering Group, Guy's Cancer Centre, Great Maze Pond, London, UK.,Depart of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond , London, UK
| | - John Maher
- King's College London , School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London, UK.,Leucid Bio Ltd., Guy's Hospital, Great Maze Pond , London, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust , London UK.,Department of Immunology, Eastbourne Hospital , Eastbourne, UK
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