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Effectiveness and Safety of Immune Checkpoint Inhibitors in Cancer Patients With Autoimmune Disease: A Retrospective Cohort Study. 癌症自身免疫性疾病患者免疫检查点抑制剂的有效性和安全性:回顾性队列研究。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-11-06 DOI: 10.1097/CJI.0000000000000492
Arjun A Raghavan, Sid Goutam, Grace Musto, Marc Geirnaert, Carrie Ye, Liam J O'Neil, Jeffrey Graham

Although immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, patients with pre-existing autoimmune diseases (PADs) have largely been excluded from clinical trials evaluating this drug class. This study evaluates the effectiveness and safety of ICI therapy in individuals with PAD in a real-world setting. A retrospective study of patients exposed to ICI therapy between 2012 and 2019 was conducted. Patients with PAD were identified and matched to an ICI-exposed group without PAD based on age, sex, and cancer type. Primary outcomes included toxicity, time to treatment failure, overall survival, and objective response rate. The association between PAD status and outcomes was determined using Cox and logistic regression modeling. A total of 813 patients exposed to ICI therapy were identified, of which 8.2% (N=67) had a PAD. When compared with a matched cohort without PAD (N=132), there was no significant difference in the rates of new immune-related adverse events (irAEs, 42.4% in the non-PAD group vs. 47.8% in the PAD group, P=0.474). After controlling for the type of ICI, there was no significant association between PAD status and irAE (odds ratio 1.67, 95% CI: 0.9-3.21 P=0.1). There was no significant association between overall survival and PAD status (hazard ratio 1.12, 95% CI: 0.76-1.66. P=0.56) or between time to treatment failure and PAD status (hazard ratio 0.82, 95% CI: 0.6-1.12, P=0.22). There was an association between PAD status and objective response rate (odds ratio 3.28, 95% CI: 1.28-8.38, P=0.013). In summary, PAD status was not associated with enhanced toxicity when compared with patients without PAD, with similar oncologic effectiveness between these 2 groups.

尽管免疫检查点抑制剂(ICIs)已经彻底改变了癌症治疗,但已有自身免疫性疾病(PADs)的患者在很大程度上被排除在评估该药物类别的临床试验之外。本研究评估了ICI治疗PAD患者的有效性和安全性。对2012年至2019年间接受ICI治疗的患者进行了回顾性研究。根据年龄、性别和癌症类型,确定PAD患者,并将其与不患有PAD的ICI暴露组进行匹配。主要结果包括毒性、治疗失败时间、总生存率和客观反应率。PAD状态和结果之间的相关性使用Cox和逻辑回归模型确定。共确定813名接受ICI治疗的患者,其中8.2%(N=67)患有PAD。与没有PAD的匹配队列(N=132)相比,新的免疫相关不良事件发生率没有显著差异(irAE,非PAD组42.4%,PAD组47.8%,P=0.474),PAD状态与irAE之间没有显著相关性(比值比1.67,95%CI:0.9-3.21 P=0.1)。总生存率与PAD状态之间没有显著关联(危险比1.12,95%CI:0.76-1.66)。P=0.56)或治疗失败时间与PAD状态之间(危险比0.82,95%CI:0.6-12,P=0.22)。PAD状态与客观缓解率之间存在相关性(比值比3.28,95%CI:1.28-8.38,P=0.013)。总之,与无PAD的患者相比,PAD状态不与毒性增强相关,这两组之间的肿瘤学有效性相似。
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引用次数: 0
Effect of Concomitant Use of Proton Pump Inhibitors on Immunotherapy Clinical Response in Advanced Cancer Patients: Real-Life Setting. 同时使用质子泵抑制剂对晚期癌症患者免疫治疗临床反应的影响:现实生活环境。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-11-06 DOI: 10.1097/CJI.0000000000000494
Lorenzo Cantarelli, Fernando Gutiérrez Nicolás, Sara García Gil, Jose A Morales Barrios, Juana Oramas Rodriguez, Gloria J Nazco Casariego

The alteration of the gut microbiota mediated by proton pump inhibitor (PPI) drugs could be involved in the clinical response associated with immunotherapy [immunocheckpoint inhibitors (ICIs)] in cancer patients. Due to the current controversy in the scientific evidence, it has been proposed to evaluate the correlation between the concomitant use of PPIs and the effectiveness of immunotherapy in a real clinical practice setting. Single-center retrospective cohort study that included patients treated with anti-PD-1 or anti-CTLA4, including nivolumab, pembrolizumab, atezolizumab, or the combination ipilimumab-nivolumab in metastatic neoplastic disease. The clinical effectiveness of ICI, measured in progression-free survival (PFS) and overall survival (OS), was compared between the PPI-use versus PPI-no-use group. PPI-use group was associated with lower PFS [hazard ratio (HR):1.89 (1.38-2.59), P<0.001] and OS [HR: 2.02 (1.45-2.82), P<0.001] versus PPI-no-use group. However, this difference was not observed for pembrolizumab PFS [HR: 1.38 (0.93-2.39), P=0.160] and OS [HR: 1.41 (0.81-2.44), P=0.187]. The study showed significantly lower PFS and OS in the chronic PPI-use group (P<0.001), recent PPI-use group (P<0.001) and concomitant PPI-use group (P=0.001, 0.007) versus PPI-no-use group. However, late PPI use >30 days after the onset of ICI has no significant effect on the efficacy of treatment [HR: 0.92 (0.49-1.70), P=0.791; HR: 1.10 (0.59-2.05), P=0.756]. The concomitant use of PPIs in immunotherapy is associated with worse clinical outcomes compared with the group without PPI use. In addition, the study shows how the late use of PPIs does not have a significant effect on clinical benefit.

质子泵抑制剂(PPI)药物介导的肠道微生物群的改变可能与癌症患者免疫疗法[免疫检查点抑制剂(ICIs)]相关的临床反应有关。由于目前科学证据存在争议,有人提出在实际临床实践中评估PPIs的同时使用与免疫疗法有效性之间的相关性。单中心回顾性队列研究,包括在转移性肿瘤疾病中接受抗PD-1或抗CTLA4治疗的患者,包括nivolumab、pembrolizumab、atezolizumab或ipilimumab-niovolumab组合。在PPI使用组和PPI不使用组之间比较ICI的临床有效性,以无进展生存期(PFS)和总生存期(OS)衡量。PPI使用组PFS较低[危险比(HR):1.89(1.38-2.59),ICI发作后P30天对治疗效果没有显著影响[HR:0.92(0.49-1.70),P=0.791;HR:1.10(0.59-2.05),P=0.756]。与未使用PPI的组相比,在免疫治疗中同时使用PPI与更差的临床结果相关。此外,该研究表明,PPI的后期使用对临床益处没有显著影响。
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引用次数: 0
Predicting PD-L1 Status in Solid Tumors Using Transcriptomic Data and Artificial Intelligence Algorithms 利用转录组学数据和人工智能算法预测实体肿瘤中PD-L1的状态
4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-11-02 DOI: 10.1097/cji.0000000000000489
Ahmad Charifa, Alfonso Lam, Hong Zhang, Andrew Ip, Andrew Pecora, Stanley Waintraub, Deena Graham, Donna McNamara, Martin Gutierrez, Andrew Jennis, Ipsa Sharma, Jeffrey Estella, Wanlong Ma, Andre Goy, Maher Albitar
Programmed death ligand-1 (PD-L1) immunohistochemistry (IHC) is routinely used to predict the clinical response to immune checkpoint inhibitors (ICIs); however, multiple assays and antibodies have been used. This study aimed to evaluate the potential of targeted transcriptome and artificial intelligence (AI) to determine PD-L1 RNA expression levels and predict the ICI response compared with traditional IHC. RNA from 396 solid tumors samples was sequenced using next-generation sequencing (NGS) with a targeted 1408-gene panel. RNA expression and PD-L1 IHC were assessed across a broad range of PD-L1 expression levels. AI was used to predict the PD-L1 status. PD-L1 RNA levels assessed by NGS demonstrated robust linearity across high and low expression ranges, and those assessed using NGS and IHC (tumor proportion score and tumor-infiltrating immune cells) had a similar pattern. RNA sequencing provided in-depth information on the tumor microenvironment and immune response, including CD19, CD22, CD8A, CTLA4 , and PD-L2 expression status. Subanalyses showed a sustained correlation of mRNA expression with IHC (tumor proportion score and immune cells) across different solid tumor types. Machine learning showed high accuracy in predicting PD-L1 status, with the area under the curve varying between 0.83 and 0.91. Targeted transcriptome sequencing combined with AI is highly useful for predicting PD-L1 status. Measuring PD-L1 mRNA expression by NGS is comparable to measuring PD-L1 expression by IHC for predicting ICI response. RNA expression has the added advantages of being amenable to standardization and avoiding interpretation bias, along with an in-depth evaluation of the tumor microenvironment.
程序性死亡配体-1 (PD-L1)免疫组织化学(IHC)通常用于预测对免疫检查点抑制剂(ICIs)的临床反应;然而,已经使用了多种检测方法和抗体。本研究旨在评估靶向转录组和人工智能(AI)与传统IHC相比在确定PD-L1 RNA表达水平和预测ICI反应方面的潜力。利用新一代测序技术(NGS)对396例实体瘤样本的RNA进行了靶向1408基因测序。在广泛的PD-L1表达水平范围内评估RNA表达和PD-L1 IHC。AI预测PD-L1状态。NGS评估的PD-L1 RNA水平在高表达范围和低表达范围内显示出强大的线性,使用NGS和IHC(肿瘤比例评分和肿瘤浸润免疫细胞)评估的PD-L1 RNA水平具有相似的模式。RNA测序提供了肿瘤微环境和免疫应答的深入信息,包括CD19、CD22、CD8A、CTLA4和PD-L2的表达状态。亚分析显示,mRNA表达与不同实体瘤类型的IHC(肿瘤比例评分和免疫细胞)持续相关。机器学习对PD-L1状态的预测准确率较高,曲线下面积在0.83 ~ 0.91之间变化。靶向转录组测序结合人工智能在预测PD-L1状态方面非常有用。通过NGS测量PD-L1 mRNA表达与通过IHC测量PD-L1表达预测ICI反应相当。RNA表达具有标准化和避免解释偏差的额外优势,以及对肿瘤微环境的深入评估。
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引用次数: 0
Antigen-loaded Monocyte Administration and Flt3 Ligand Augment the Antitumor Efficacy of Immune Checkpoint Blockade in a Murine Melanoma Model. 抗原负载的单核细胞给药和Flt3配体增强小鼠黑色素瘤模型中免疫检查点阻断的抗肿瘤效力。
IF 3.2 4区 医学 Q3 IMMUNOLOGY Pub Date : 2023-11-01 Epub Date: 2023-09-20 DOI: 10.1097/CJI.0000000000000487
Vincent M D'Anniballe, Min-Nung Huang, Benjamin D Lueck, Lowell T Nicholson, Ian McFatridge, Michael D Gunn

Undifferentiated monocytes can be loaded with tumor antigens (Ag) and administered intravenously to induce antitumor cytotoxic T lymphocyte (CTL) responses. This vaccination strategy exploits an endogenous Ag cross-presentation pathway, where Ag-loaded monocytes (monocyte vaccines) transfer their Ag to resident splenic dendritic cells (DC), which then stimulate robust CD8 + CTL responses. In this study, we investigated whether monocyte vaccination in combination with CDX-301, a DC-expanding cytokine Fms-like tyrosine kinase 3 ligand (Flt3L), could improve the antitumor efficacy of anti-programmed cell death (anti-PD-1) immune checkpoint blockade. We found that Flt3L expanded splenic DC over 40-fold in vivo and doubled the number of circulating Ag-specific T cells when administered before monocyte vaccination in C57BL/6 mice. In addition, OVA-monocyte vaccination combined with either anti-PD-1, anti-programmed cell death ligand 1 (anti-PD-L1), or anti-cytotoxic T lymphocyte antigen-4 (anti-CTLA-4) suppressed subcutaneous B16/F10-OVA tumor growth to a greater extent than checkpoint blockade alone. When administered together, OVA-monocyte vaccination improved the antitumor efficacy of Flt3L and anti-PD-1 in terms of circulating Ag-specific CD8 + T cell frequency and inhibition of subcutaneous B16/F10-OVA tumor growth. To our knowledge, this is the first demonstration that a cancer vaccine strategy and Flt3L can improve the antitumor efficacy of anti-PD-1. The findings presented here warrant further study of how monocyte vaccines can improve Flt3L and immune checkpoint blockade as they enter clinical trials.

未分化的单核细胞可以负载肿瘤抗原(Ag)并静脉内给药以诱导抗肿瘤细胞毒性T淋巴细胞(CTL)反应。这种疫苗接种策略利用内源性Ag交叉呈递途径,其中负载Ag的单核细胞(单核细胞疫苗)将其Ag转移到驻留的脾树突状细胞(DC),然后刺激强大的CD8+CTL反应。在本研究中,我们研究了单核细胞疫苗接种与CDX-301(一种DC扩增细胞因子Fms样酪氨酸激酶3配体(Flt3L))联合是否可以提高抗程序性细胞死亡(抗PD-1)免疫检查点阻断的抗肿瘤疗效。我们发现,Flt3L在C57BL/6小鼠单核细胞接种前给药时,使脾脏DC在体内扩增了40倍以上,并使循环Ag特异性T细胞的数量增加了一倍。此外,与单独的检查点阻断相比,OVA单核细胞疫苗接种与抗PD-1、抗程序性细胞死亡配体1(抗PD-L1)或抗细胞毒性T淋巴细胞抗原-4(抗CTLA-4)联合在更大程度上抑制皮下B16/F10-OVA肿瘤生长。当同时给药时,OVA单核细胞疫苗在循环Ag特异性CD8+T细胞频率和抑制皮下B16/F10-OVA肿瘤生长方面提高了Flt3L和抗PD-1的抗肿瘤功效。据我们所知,这首次证明癌症疫苗策略和Flt3L可以提高抗PD-1的抗肿瘤效力。本文的发现值得进一步研究单核细胞疫苗在进入临床试验时如何改善Flt3L和免疫检查点阻断。
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引用次数: 0
Immune-Related Sclerosing Cholangitis and Subsequent Pyogenic Liver Abscesses in Two Patients With Melanoma Treated by Triplet Therapy: A Case Report. 三联疗法治疗两例黑色素瘤患者的免疫相关硬化性胆管炎和随后的化脓性肝脓肿:一例报告。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-11-01 Epub Date: 2023-09-19 DOI: 10.1097/CJI.0000000000000486
Viola Schön, Daniel Stocker, Christoph Jüngst, Reinhard Dummer, Egle Ramelyte

Immune checkpoint inhibitors have improved the treatment of many cancers. However, immune-related (IR) adverse events can limit their use. A rare but potentially severe IR adverse event is IR-cholangitis, which is mostly induced by anti-programmed cell death 1 (PD1) antibodies and is often corticosteroid-resistant. Consequently, immunosuppressive therapy is increased, which interferes with the antitumor response and bears the risk of infection. We report on 2 patients with BRAF V600E mutant melanoma, who presented with IR-sclerosing cholangitis under triplet therapy with atezolizumab [anti-programmed cell death ligand 1 (PD-L1) antibody], vemurafenib (BRAF inhibitor), and cobimetinib (MEK inhibitor). In both cases, the administration of corticosteroids initially resulted in a marginal improvement but was followed by a rebound of biliary enzymes and the subsequent emergence of pyogenic liver abscesses with bacteremia. Liver abscesses developed without preceding invasive procedures, which implies that a more restrictive approach to immunosuppressive therapy for IR-cholangitis should be considered. To our knowledge, we report the first 2 cases of IR-cholangitis and subsequent liver abscesses without prior invasive intervention, the first cases of IR-cholangitis induced by triplet therapy, and 2 of the few anti-PD-L1 induced cases contributing to the evidence that both anti-PD1 and anti-PD-L1 antibodies induce IR-cholangitis. Treatment strategies for IR-cholangitis need to be improved to prevent life-threatening infectious complications.

免疫检查点抑制剂改善了许多癌症的治疗。然而,免疫相关(IR)不良事件可能会限制其使用。一种罕见但潜在严重的IR不良事件是IR胆管炎,它主要由抗程序性细胞死亡1(PD1)抗体诱导,通常对皮质类固醇具有耐药性。因此,免疫抑制治疗增加,干扰抗肿瘤反应并承担感染风险。我们报告了2例BRAF V600E突变型黑色素瘤患者,他们在atezolizumab[抗程序性细胞死亡配体1(PD-L1)抗体]、vemurafenib(BRAF抑制剂)和cobimetinib(MEK抑制剂)的三重疗法下出现IR硬化性胆管炎。在这两种情况下,皮质类固醇的给药最初都略有改善,但随后胆道酶反弹,随后出现化脓性肝脓肿伴菌血症。肝脓肿在没有既往侵入性手术的情况下发生,这意味着应该考虑对IR胆管炎进行更严格的免疫抑制治疗。据我们所知,我们报告了前2例未经侵入性干预的IR胆管炎和随后的肝脓肿,第一例由三联疗法诱导的IR胆管炎,以及少数抗PD-L1诱导的病例中的2例,这有助于证明抗PD-1和抗PD-L1抗体都诱导IR胆管管炎。IR胆管炎的治疗策略需要改进,以防止危及生命的感染性并发症。
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引用次数: 0
Laser Interstitial Thermal Therapy Induces Robust Local Immune Response for Newly Diagnosed Glioblastoma With Long-term Survival and Disease Control. 激光间质热疗对新诊断的胶质母细胞瘤诱导强大的局部免疫反应,具有长期生存和疾病控制。
IF 3.2 4区 医学 Q3 IMMUNOLOGY Pub Date : 2023-11-01 Epub Date: 2023-09-19 DOI: 10.1097/CJI.0000000000000485
Jay S Chandar, Shovan Bhatia, Shreya Ingle, Mynor J Mendez Valdez, Dragan Maric, Deepa Seetharam, Jelisah F Desgraves, Vaidya Govindarajan, Lekhaj Daggubati, Martin Merenzon, Alexis Morell, Evan Luther, Ali G Saad, Ricardo J Komotar, Michael E Ivan, Ashish H Shah

Laser interstitial thermal therapy (LITT) is a minimally invasive neurosurgical technique used to ablate intra-axial brain tumors. The impact of LITT on the tumor microenvironment is scarcely reported. Nonablative LITT-induced hyperthermia (33-43˚C) increases intra-tumoral mutational burden and neoantigen production, promoting immunogenic cell death. To understand the local immune response post-LITT, we performed longitudinal molecular profiling in a newly diagnosed glioblastoma and conducted a systematic review of anti-tumoral immune responses after LITT. A 51-year-old male presented after a fall with progressive dizziness, ataxia, and worsening headaches with a small, frontal ring-enhancing lesion. After clinical and radiographic progression, the patient underwent stereotactic needle biopsy, confirming an IDH-WT World Health Organization Grade IV Glioblastoma, followed by LITT. The patient was subsequently started on adjuvant temozolomide, and 60 Gy fractionated radiotherapy to the post-LITT tumor volume. After 3 months, surgical debulking was conducted due to perilesional vasogenic edema and cognitive decline, with H&E staining demonstrating perivascular lymphocytic infiltration. Postoperative serial imaging over 3 years showed no evidence of tumor recurrence. The patient is currently alive 9 years after diagnosis. Multiplex immunofluorescence imaging of pre-LITT and post-LITT biopsies showed increased CD8 and activated macrophage infiltration and programmed death ligand 1 expression. This is the first depiction of the in-situ immune response to LITT and the first human clinical presentation of increased CD8 infiltration and programmed death ligand 1 expression in post-LITT tissue. Our findings point to LITT as a treatment approach with the potential for long-term delay of recurrence and improving response to immunotherapy.

激光间质热疗(LITT)是一种微创神经外科技术,用于消融轴内脑肿瘤。LITT对肿瘤微环境的影响几乎没有报道。非消融性LITT诱导的热疗(33-43˚C)增加了肿瘤内的突变负担和新抗原的产生,促进免疫原性细胞死亡。为了了解LITT后的局部免疫反应,我们对一例新诊断的胶质母细胞瘤进行了纵向分子分析,并对LITT后抗肿瘤免疫反应进行了系统回顾。一名51岁的男性在跌倒后出现进行性头晕、共济失调和头痛恶化,并伴有额环增强的小病变。在临床和放射学进展后,患者接受了立体定向针活检,确认为IDH-WT世界卫生组织IV级胶质母细胞瘤,随后进行了LITT。随后,患者开始接受替莫唑胺辅助治疗,并对LITT后的肿瘤体积进行60Gy分次放疗。3个月后,由于病变周围血管源性水肿和认知能力下降,进行了手术减容,H&E染色显示血管周围淋巴细胞浸润。术后连续3年的影像学检查没有发现肿瘤复发的迹象。该患者在确诊后9年仍存活。LITT前和LITT后活检的多重免疫荧光成像显示CD8增加,巨噬细胞浸润活化,程序性死亡配体1表达。这是对LITT原位免疫反应的首次描述,也是LITT后组织中CD8浸润增加和程序性死亡配体1表达增加的首次人类临床表现。我们的研究结果表明,LITT是一种有可能长期延迟复发和改善免疫治疗反应的治疗方法。
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引用次数: 0
Recurrent Cystitis Associated With 2 Programmed Death 1 Inhibitors: A Rare Case Report and Literature Review. 与2种程序性死亡1抑制剂相关的复发性膀胱炎:一例罕见病例报告和文献综述。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-11-01 Epub Date: 2023-09-18 DOI: 10.1097/CJI.0000000000000484
Yong Fan, Juan Zhao, Yue Mi, Zhening Zhang, Yan Geng, Liqun Zhou, Lin Shen, Zhuoli Zhang

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced cancer, however, often with immune-related adverse events (irAEs). Adverse events involving the bladder were extremely rare with only few cases. Herein, we described a rare, recurrent cystitis associated with 2 programmed death 1 inhibitors (pembrolizumab and toripalimab) in 1 patient with advanced liver cancer. Cystitis associated with toripalimab, a novel humanized programmed death 1 monoclonal antibody, was first presented in our case. Cystitis is an extremely rare irAE associated with ICIs, especially anti-programmed death 1 antibodies. With widening indications of ICIs in clinical practice, physicians should be also aware of this rare irAE.

免疫检查点抑制剂(ICIs)已经彻底改变了晚期癌症的治疗,然而,通常伴有免疫相关不良事件(irAE)。涉及膀胱的不良事件极为罕见,只有少数病例。在此,我们描述了一例罕见的复发性膀胱炎,与1例晚期癌症患者的2种程序性死亡1抑制剂(pembrolizumab和toripalimab)相关。与托里帕利单抗相关的膀胱炎是一种新型人源化程序性死亡1单克隆抗体,首次出现在我们的病例中。膀胱炎是一种极为罕见的与ICIs相关的irAE,尤其是抗程序性死亡1抗体。随着临床实践中ICIs适应症的扩大,医生也应该意识到这种罕见的irAE。
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引用次数: 0
Durvalumab-induced Pure White Cell Aplasia. 杜伐单抗诱导的纯白细胞发育不全。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-10-30 DOI: 10.1097/CJI.0000000000000491
Ji Lin, Paola Rodriguez-Martinez, Thein Hlaing Oo, Shuyu E, Jeffrey Jorgensen, Cristhiam M Rojas-Hernandez

Immune checkpoint inhibitors (ICI) have gained approval as a treatment for a wide array of cancers. Their mechanism of action prevents the inactivation of cytotoxic T-cells, allowing for its cytotoxic response. However, the upregulation of the immune system by ICI also leads to many undesired adverse events known as immune-related adverse events (irAEs), ranging from dermatologic manifestations, such as rashes, to inflammation of mucous membranes, to hematologic toxicities. Here, we report a case of ICI-induced pure white cell aplasia, secondary to the agent durvalumab, which responded to treatment with filgrastim, prednisone, and cyclosporine. ICI-neutropenia accounts for 0.6% of all irAEs or 17% of hematologic irAEs. Given the rarity of hematologic irAEs, the available treatment guidelines are based on expert consensus. As ICI becomes more widely used, we can expect an increase in the prevalence of rare irAEs as well. This case report aims to present a rare side effect of ICI and demonstrate its response to immunosuppressive therapy while providing guidance for future clinicians and further elucidating the mechanism behind these irAEs.

免疫检查点抑制剂(ICI)作为一种治疗多种癌症的药物已获得批准。它们的作用机制防止细胞毒性T细胞失活,从而产生细胞毒性反应。然而,ICI对免疫系统的上调也会导致许多被称为免疫相关不良事件(irAE)的不良事件,从皮疹等皮肤病表现到粘膜炎症,再到血液学毒性。在此,我们报告了一例ICI诱导的纯白细胞再生障碍,继发于药物杜伐单抗,该药物对非格拉司汀、泼尼松和环孢菌素治疗有反应。ICI中性粒细胞减少症占所有irAE的0.6%或血液学irAE的17%。鉴于血液系统irAE的罕见性,现有的治疗指南基于专家共识。随着ICI的使用越来越广泛,我们可以预期罕见irAE的患病率也会增加。本病例报告旨在介绍ICI的一种罕见副作用,并证明其对免疫抑制治疗的反应,同时为未来的临床医生提供指导,并进一步阐明这些irAE背后的机制。
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引用次数: 1
Three-Year Overall Survival of Patients With Advanced Non-Small-Cell Lung Cancers With ≥50% PD-L1 Expression Treated With First-Line Pembrolizumab Monotherapy in a Real-World Setting (ESCKEYP GFPC Study). PD-L1表达≥50%的晚期非小细胞肺癌患者在现实世界中接受一线Pembrolizumab单一疗法治疗的三年总生存率(ESCKEYP-GFPC研究)。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-10-09 DOI: 10.1097/CJI.0000000000000490
Chantal Decroisette, Laurent Greillier, Hubert Curcio, Maurice Pérol, Charles Ricordel, Jean-Bernard Auliac, Lionel Falchero, Remi Veillon, Sabine Vieillot, Florian Guisier, Marie Marcq, Grégoire Justeau, Laurence Bigay-Game, Marie Bernardi, Hélène Doubre, Julian Pinsolle, Karim Amrane, Christos Chouaïd, Renaud Descourt

Outside clinical trials, few data are available on the effect of long-term first-line pembrolizumab in patients with advanced non-small-cell lung cancers with ≥50% of tumor cells expressing programmed cell death ligand 1 (PD-L1). This French, multicenter study included consecutive advanced patients with non-small-cell lung cancer given first-line pembrolizumab alone between May 2017 (authorization date for this indication) and November 2019 (authorization date for pembrolizumab-chemotherapy combination). Information was collected from patients' medical files, with a local evaluation of the response and progression-free survival (PFS). Overall survival (OS) was calculated from pembrolizumab onset using the Kaplan-Meier method. The analysis concerned 845 patients, managed in 33 centers: median age: 65 (range: 59-72) years, 67.8% men, 78.1% Eastern Cooperative Oncology Group performance status 0/1, 38.9%/51.5%/6.6% active, ex or never-smokers, respectively, 10.9%/16.8% taking or recently took corticosteroids/antibiotics, 69.6% nonsquamous histology, 48.9% ≥75% PD-L1-positive, and 20.8% had brain metastases at diagnosis. After a median (95% CI) follow-up of 45 (44.1-45.9) months, respective median (95% CI) PFS and OS lasted 8.2 (6.9-9.2) and 22 (8.5-25.9) months; 3-year PFS and OS rates were 25.4% and 39.4%, respectively. Multivariate analysis retained never-smoker status, adenocarcinoma histology, Eastern Cooperative Oncology Group performance status ≥2, and neutrophil/lymphocyte ratio >4 as being significantly associated with shorter survival, but not brain metastases at diagnosis or <75% PD-L1 tumor-cell expression. These long-term results of pembrolizumab efficacy based on a nationwide "real-world" cohort reproduced those obtained in clinical trials.

在临床试验之外,很少有数据表明长期一线pembrolizumab对晚期非小细胞肺癌患者的影响,其中≥50%的肿瘤细胞表达程序性细胞死亡配体1(PD-L1)。这项法国多中心研究包括2017年5月(该适应症的授权日期)至2019年11月(pembrolizumab化疗联合用药的授权日期。从患者的医疗档案中收集信息,并对反应和无进展生存期(PFS)进行局部评估。使用Kaplan-Meier方法从pembrolizumab发作开始计算总生存率(OS)。该分析涉及845名患者,在33个中心进行管理:中位年龄:65岁(范围:59-72),67.8%为男性,78.1%为东部肿瘤协作组绩效状态0/1,38.9%/51.5%/6.6%为活动期、戒烟或从不吸烟,10.9%/16.8%服用或最近服用皮质类固醇/抗生素,69.6%为非鳞状组织学,48.9%≥75%为PD-L1阳性,20.8%在诊断时有脑转移。中位(95%CI)随访45个月(44.1-45.9)后,PFS和OS的中位(95%CI)分别持续8.2个月(6.9-9.2)和22个月(8.5-25.9);3年PFS和OS的发生率分别为25.4%和39.4%。多因素分析表明,从不吸烟状态、腺癌组织学、东方肿瘤协作组表现状态≥2和中性粒细胞/淋巴细胞比率>4与较短的生存期显著相关,但与诊断时的脑转移或
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引用次数: 0
Mesothelin-targeted CAR-NK Cells Derived From Induced Pluripotent Stem Cells Have a High Efficacy in Killing Triple-negative Breast Cancer Cells as Shown in Several Preclinical Models. 来源于诱导的多能干细胞的内皮靶向CAR-NK细胞在杀死三阴性乳腺癌症细胞方面具有高效力,如几个临床前模型所示。
IF 3.9 4区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-10-01 Epub Date: 2023-08-15 DOI: 10.1097/CJI.0000000000000483
Mei Yang, Tian Guan, Chun-Fa Chen, Li-Fang He, Hao-Ming Wu, Ren-Dong Zhang, Yun Li, Yan-Chun Lin, Haoyu Zeng, Jun-Dong Wu

The emergence of immunotherapy has introduced a promising, novel approach to cancer treatment. While multiple chimeric antigen receptor (CAR) T-cell therapies have demonstrated remarkable clinical efficacy against leukemia, their effect on solid tumors has been limited. One potential option for treating solid tumors is the engineering of natural killer (NK) cells with CARs. Mesothelin (MSLN), a tumor differentiation antigen, is expressed on triple-negative breast cancer (TNBC) cells, making it a potential target for CAR-NK therapy in the treatment of TNBC. We first constructed induced pluripotent stem cells with stable anti-MSLN-CAR expression and subsequently differentiated these cells into mesothelin-targeted CAR-NK (MSLN-NK) cells. We then assessed the effects of MSLN-NK cells on TNBC cells both in vitro (using the MDA-MB-231 cell line), in vivo (in a CDX mouse model), and ex vivo (using patient-specific primary cells and patient-specific organoids), in which MSLN surface expression was confirmed. Our CDX study results indicated that MSLN-NK cells effectively killed MDA-MB-231 (MD231) cells in vitro, reduced tumor growth in the CDX mouse model of TNBC, and lysed patient-specific primary cells and patient-specific organoids derived from the tumor samples of TNBC patients. Our data demonstrated that MSLN-NK cells had high efficacy on killing TNBC cells in in vitro, in vivo, and ex vivo. Therefore, MSLN-NK could be a promising treatment option for TNBC patients.

免疫疗法的出现为癌症的治疗提供了一种有前景的新方法。尽管多种嵌合抗原受体(CAR)T细胞疗法已证明对白血病具有显著的临床疗效,但其对实体瘤的作用有限。治疗实体瘤的一个潜在选择是用CARs工程化自然杀伤(NK)细胞。Mesoothelin(MSLN)是一种肿瘤分化抗原,在癌症(TNBC)三阴性细胞上表达,使其成为CAR-NK治疗TNBC的潜在靶点。我们首先构建了具有稳定抗MSLN CAR表达的诱导多能干细胞,随后将这些细胞分化为间皮素靶向CAR-NK(MSLN-NK)细胞。然后,我们在体外(使用MDA-MB-231细胞系)、体内(在CDX小鼠模型中)和离体(使用患者特异性原代细胞和患者特异性类器官)评估了MSLN-NK细胞对TNBC细胞的影响,其中证实了MSLN表面表达。我们的CDX研究结果表明,MSLN-NK细胞在体外有效杀死MDA-MB-231(MD231)细胞,在TNBC的CDX小鼠模型中减少肿瘤生长,并裂解来自TNBC患者肿瘤样本的患者特异性原代细胞和患者特异性类器官。我们的数据表明,MSLN-NK细胞在体外、体内和离体中对TNBC细胞具有高效杀伤作用。因此,MSLN-NK可能是TNBC患者的一种很有前途的治疗选择。
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引用次数: 2
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Journal of Immunotherapy
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