bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of RP1 combined with nivolumab in patients with anti–PD-1–failed melanoma from the IGNYTE clinical trial.
Authors: Wong Michael K.K. , Sacco Joseph J , Robert Caroline , Michels Judith , Bowles Tawnya Lynn , In Gino Kim , Tsai Katy K. , Lebbe Celeste , Gaudy-Marqueste Caroline , Muñoz Couselo Eva , Middleton Mark R. , Samson Adel , Schadendorf Dirk , Beasley Georgia , Niu Jiaxin , Chmielowski Bartosz , Wise-Draper Trisha M. , Zhu Junhong , Viana Marcus , Milhem Mohammed M.
Published: July 2024

9517

Background: Patients (pts) with melanoma who progress on anti–PD-1 therapy (anti–PD-1–failed) have limited treatment options. RP1 is an HSV-1–based oncolytic immunotherapy expressing human GM-CSF and a fusogenic protein (GALV-GP-R−). Here, we present data from pts with anti–PD-1–failed melanoma, including the initial cohort and updated data from a registration-directed (R-D) cohort, from the phase 1/2 IGNYTE study (NCT03767348). Methods: Pts had locally advanced or metastatic cutaneous melanoma with ≥1 measurable and injectable tumor (≥1 cm) and confirmed progressive disease (PD) while on therapy and received anti–PD-1 ± anti–CTLA-4 therapy for ≥8 consecutive weeks, with anti–PD-1 being the last treatment received. Pts on prior adjuvant anti–PD-1 therapy had confirmed PD while on adjuvant therapy. RP1 was initially given intratumorally at 1×106 plaque-forming units (PFU)/mL and then every 2 weeks (Q2W) at 1×107 PFU/mL for up to 8 total cycles (≤10 mL/cycle) combined with nivolumab (nivo; cycles 2–8, 240 mg IV); pts then received nivo alone (240 mg Q2W or 480 mg Q4W IV) for up to 2 years, with the option to receive additional courses of RP1 if specified criteria were met. Results: Overall, 156 pts were enrolled (initial melanoma cohort, n = 16; R-D cohort, n = 140); 46.2% of pts had been treated with prior anti–PD-1 combined with anti–CTLA-4, and 51.3% of patients had stage IVM1b-d disease. The overall objective response rate (ORR) was 31.4%, and 12.2% of pts achieved complete response (CR; Table). Responses were observed irrespective of prior anti–PD-1 therapy setting and disease stage (Table). Responses were seen in uninjected lesions and in bulky and visceral disease. The ORR for pts with primary anti–PD-1 resistance was 34.1%. In pts who failed prior ipilimumab + nivo, the ORR was 26.4% (Table). The median duration of response (time from baseline to end of response for responders) was > 24 months, with 100% of responses lasting > 6 months from baseline; 78% of responses were ongoing. Treatment-related adverse events (TRAEs) associated with RP1 + nivo were predominantly grade 1–2; there was 1 grade 5 TRAE (immune-mediated myocarditis attributed to nivo). Conclusions: The updated data from this expanded cohort show that RP1 + nivo provides durable and clinically meaningful antitumor activity in pts with anti–PD-1–failed melanoma. Responses were observed in both injected and uninjected lesions, including visceral lesions. The combination continues to be well tolerated. Clinical trial information: NCT03767348 . [Table: see text]
When to stop immunotherapy for advanced melanoma: Emulation of target trials.
Authors: Amiot Mathilde , Mortier Laurent , Dalle Stéphane , Dereure Olivier , Dalac Sophie , Dutriaux Caroline , Leccia Marie Thérèse , Maubec Eve , Arnault Jean-Philippe , Brunet-Possenti Florence , De Quatrebarbes Julie , Granel Brocard Florence , Gaudy-Marqueste Caroline , Pagès Cécile , Stoebner Pierre-Emmanuel , Legoupil Delphine , Montaudie Henri , Oriano Bastien , Lebbe Celeste , Porcher Raphaël
Published: July 2024

9521

Background: Immune checkpoint inhibitors (ICI) have demonstrated their effectiveness with a 7.5-year overall survival (OS) close to 50% for advanced stages. The design of clinical trials allowed treatment until progression or toxicity, or for a maximum duration of two years. Prolonged follow-up of responders after cessation shows sustained response and a low risk of relapse in the months following cessation. As of yet, the optimal duration of anti-PD-1 therapy for metastatic melanoma remains unestablished. The objective of this work was to evaluate the optimal duration of ICI. Methods: We conducted emulated trials using the cloning, weighting and censoring approach. Each emulated trial aimed at comparing the causal effect of stopping versus continuing ICI at a specific timepoint, in patients still under treatment and with disease control at that time. Results: The study comprised 1017 participants to the MELBASE cohort. Results of the 6-month discontinuation emulated trial showed a significantly lower OS if treatment was discontinued, compared to continuing treatment for at least three months. The 48-month survival difference was 37.8% (95% confidence interval [CI] 19.8 to 60.5), and the corresponding restricted mean survival time difference 8.3 months (95% CI: 4.1 to 12.7). The 12-month and 18-month discontinuation emulated trials both showed no evidence of benefit of either discontinuing or continuing ICI at any of those timepoints. The 24-month discontinuation emulated trial results were more in favor of stopping compared to continuing treatment at that decision point, with an absolute 48-month survival 10.5% higher (95% CI 4.4 to 18.1). Conclusions: These results suggest that a one-year course of immunotherapy is both necessary and sufficient for patients with advanced melanoma. Prolonged treatment beyond 2 years does not appear to be beneficial in terms of survival and could even be detrimental.[Table: see text]
Continuous intrathecal infusion of nivolumab in advanced melanoma with leptomeningeal disease.
Authors: Faillot Matthieu , Goldwirt Lauriane , Jouenne Fanelie , Kramkimel Nora , Baroudjian Barouyr , Ortiz-Carle Adrien , Nataf François , Oriano Bastien , Staquet Helene , Bacquet Raphael , Aractingi Sélim , Goutagny Stéphane , Mourah Samia , Lebbe Celeste , Decq Philippe
Published: July 2024

9522

Background: The prognosis of melanoma patients with leptomeningeal disease (LMD) remains poor (median OS of 3.5 months). Intrathecal (IT) drug administration could bypass the blood-cerebrospinal fluid (CSF) barrier and has been explored in many cancers using chemotherapies or monoclonal antibodies. According to a recent phase I trial (PMID36997799), nivolumab IT delivery appears safe while its efficacy remains to be further investigated. Methods: We retrospectively reviewed melanoma patients with LMD treated with continuous IT administration of nivolumab (after decision in multidisciplinary tumor boards) at 2 institutions from February 2021 to October 2023. Patients received 10 to 13.5 mg/day of IT nivolumab delivered through a catheter (cath) connected to an implanted pump. Nivolumab concentrations were monitored in spinal CSF via an independent access port. All patients were enrolled in the MelBase cohort. Results: 11 patients (5 females, median age 52) were treated with continuous IT nivolumab with median (IQR) time to follow-up of 2.5 (1.1-6.3) months (m). Nivolumab was delivered through a spinal (n=10) and ventricular (n=1) cath. All patients had progressed on systemic immunotherapy (ipilimumab + nivolumab n=10, nivolumab n=1). Five patients had symptomatic LMD. All patients were ECOG 0 or 1 except one patient ECOG 3 (due to neurological deficit). Primary tumors were cutaneous (n=8), mucosal (n=1) and unknown (n=2). Tumors were BRAFV600 (n=10) and NRASQ61-mutated (n=1). All but 3 patients had stable extracranial disease. Concomitant systemic therapies were the following: corticosteroids (n=5), intravenous nivolumab (first 3 months of IT therapy) (n=1), and targeted therapies (n=4). The median duration of IT treatment was 1.5 (0.5-2.7) m. The median overall survival (OS) was 2.5 (1.1-NA) m. OS at 3, 12 and 19 m were 36.4 % (16.6-79.5), 27.3 % (10.4-71.6) and 13.6 % (10.4-71.6), respectively. Three patients had prolonged survival (19 m n=2, 12 m n=1). Treatment-related adverse events (all reversible) occurred in 5 patients: hemorrhage on cath path (n=1, grade 2), immune-mediated meningoencephalitis (n=1, grade 3), intracranial hypotension syndrome (n=3, grade 2). Steady state was obtained after 3 weeks of continuous IT infusion. Pharmacokinetics data are summarized in Table. Conclusions: Survival data are slightly inferior to those previously published. However 3 patients had prolonged survival (>=1 year). Median nivolumab concentrations in CSF were comparable to through plasma concentrations at steady state after 3mg/kg IV infusion. High plasma concentrations suggest rapid clearance of nivolumab from the CSF, possibly related to reverse transcytosis of immunoglobulins. [Table: see text]
Camrelizumab plus apatinib and temozolomide as first-line therapy for advanced acral melanoma: 2-year survival results from CAP 03.
Authors: Gu Junjie , Lian Bin , Mao Lili , Li Caili , Bai Xue , Zhou Li , Cui Chuanliang , Chi Zhihong , Sheng Xinan , Wang Xuan , Tang Bixia , Yan Xieqiao , Li Siming , Kong Yan , Dai Jie , Wei Xiaoting , Li Juan , Guo Jun , Si Lu
Published: July 2024

9547

Background: Acral melanoma is the predominant subtype in Asia, which presents with aggressive biological behavior. First-line immunotherapy yields modest efficacy in advanced acral melanoma, suggesting the need of combination therapy. Our CAP 03 study investigated the combination of anti-PD-1 antibody plus antiangiogenic agent and chemotherapy for the first-line treatment of advanced acral melanoma, and the primary analysis has been published on JAMA Oncology in June 2023 (objective response rate [ORR], 64%; median progression-free survival [PFS], 18.4 months). Here we updated the efficacy results with a median follow-up of 30.3 months (95% CI, 28.9-32.5; reverse Kaplan-Meier method) at data cutoff date on January 8, 2024. Methods: In this single-center phase 2 trial (NCT04397770), patients with pathologically confirmed unresectable stage III or IV acral melanoma and without prior systemic therapy for advanced disease were recruited. Patients received first-line intravenous camrelizumab (200 mg once every 2 weeks) plus oral apatinib (250 mg once a day) and intravenous temozolomide (200 mg/m2 once a day on days 1-5 every 4 weeks) until disease progression or intolerable toxicity. The primary endpoint was ORR per Response Evaluation Criteria In Solid Tumors, version 1.1. Imaging assessment was performed after 4 weeks, then every 8 weeks until one year, and every 3 months thereafter. Overall survival (OS) was followed every 3 months. Results: Between May 2020 and August 2021, a total of 50 patients were enrolled. The confirmed ORR was 66.0% (33 of 50; 95% CI, 51.2%-78.8%). The median PFS was 21.2 months (95% CI, 10.1-27.1). The median OS was not reached, and the 1-year and 2-year OS rates were 88.0% (95% CI, 75.2%-94.4%) and 64.8% (95% CI, 49.5%-76.5%), respectively. Further analyses indicated comparable PFS benefit in subgroups by age (<65 years vs ≥65 years), sex (male vs female), Eastern Cooperative Oncology Group performance status (0 vs 1), NRAS status (variant vs wild-type), stage, lactic dehydrogenase (LDH) level, and PD-L1 combined positive score (<5 vs ≥5). Regarding OS, similar trends were observed in these subgroups, except that patients with normal LDH had better median OS than those with elevated LDH (not reached vs 22.6 months, log-rank nominal P=0.033). Conclusions: This first-line triplet combination shows encouraging survival benefits in patients with advanced acral melanoma, regardless of NRAS status or PD-L1 expression level. Follow-up is still ongoing to obtain mature OS data. Clinical trial information: NCT04397770 .
Melphalan/hepatic delivery system versus best available care in patients with unresectable metastatic uveal melanoma: Randomized FOCUS trial results.
Authors: Zager Jonathan S. , Orloff Marlana M. , Ferrucci Pier Francesco , Choi Junsung , Eschelman David J. , Glazer Evan Scott , Ejaz Aslam , Richtig Erika , Ochsenreither Sebastian , Reddy Sunil A. , Lowe Michael C. , Beasley Georgia , Gesierich Anja Heike , Gschnell Martin , Dummer Reinhard , Arance Ana Maria , Fenwick Stephen William , John Johnny , Wheater Matthew , Ottensmeier Christian H.H ,   FOCUS Trial Authors
Published: July 2024

9556

Background: Metastatic uveal melanoma (mUM) has a poor prognosis, with liver metastases typically presenting a therapeutic challenge. Melphalan/Hepatic Delivery System (melphalan/HDS) is a drug/medical device combination used for liver-directed treatment of unresectable mUM patients. The purpose of the FOCUS study, an open label, multicenter randomized Phase 3 study, was to assess efficacy and safety of melphalan/HDS versus best alternative care (BAC). Methods: Eligible patients with unresectable mUM were randomized 1:1 to treatment with melphalan/HDS (3.0 mg/kg ideal body weight) once every 6-8 weeks for a maximum of 6 cycles or BAC. The primary endpoint was overall survival (OS). The planned study size was 240 patients; due to slow enrollment and patient reluctance to receive BAC treatment, the study design was amended to a single-arm melphalan/HDS study, and all efficacy analyses of the randomized study were treated as exploratory. Results: From February 2016 to October 2018 a total of 129 patients were screened and 85 were enrolled at 22 centers in the US and Europe; eligible patients were randomized to receive melphalan/HDS (N=43) or BAC (N=42) and 72 patients received study treatment. Exploratory analyses of efficacy endpoints showed numerical differences consistently favoring the melphalan/HDS arm vs. BAC (median OS: 18.5 vs 14.5 months; median progression free survival: 9.1 vs 3.3 months; objective response rate: 27.5% vs 9.4%; and disease control rate: 80.0% vs 46.9%). Serious adverse events (SAEs) occurred in 51.2% of melphalan/HDS and in 21.9% of BAC patients. Most common (>5%) SAEs included thrombocytopenia (19.5%), and neutropenia (9.8%), leukopenia (9.8%) and febrile neutropenia (7.3%) in melphalan/HDS patients and cholecystitis, nausea and vomiting (6.3% each) in BAC patients. No treatment-related deaths were observed. Conclusions: Treatment with melphalan/HDS shows clinically meaningful efficacy and demonstrates a favorable benefit-risk profile in patients with unresectable mUM as compared to best alternative care. Clinical trial information: NCT02678572 .
Antigen-specific profiling for neoadjuvant anti-PD-1 therapy in melanoma.
Authors: Yoon Daniel , Wang Guanning , Nandi Ajeya , Kim Justin , Nickie Aaron , Park Stella , Carberry Mary , Giles Lydia , Patel Khushboo , Amaravadi Ravi K. , Schuchter Lynn M. , Karakousis Giorgos Constantine , Xu Xiaowei , Mitchell Tara C. , Huang Alexander C.
Published: July 2024

9576

Background: Anti-PD-1 therapy (aPD-1) has had significant clinical success in extending survivability of melanoma patients. However, two-third of the patients do not achieve long-lasting benefits, and currently, there exists no reliable method for predicting clinical response. We test whether monitoring melanoma-specific CD8 T cells in blood, lymph node, and tumor enables us to gain insights into the mechanism of clinical resistance, and identify potential predictive biomarkers. Methods: We leveraged a phase 2 clinical trial of neoadjuvant PD-1 blockade at University of Pennsylvania where patients with stage III melanoma patients receive a pre-treatment biopsy, treatment with a single dose of the aPD-1 therapy, followed by tumor and lymph node resection 4 weeks later, allowing for access to paired blood and tumor samples. We used a combinatorial tetramer system to track panels of 10 HLA-restricted melanoma and viral-specific CD8 T cell populations simultaneously. Results: Out of 35 patients analyzed, 53% of patients had detectable melanoma-specific CD8 T cells. Notably, these cells exhibited exhausted phenotypes both in blood and tumor, whereas viral-specific T cells displayed features resembling effector and memory CD8 T cells in blood and tumor, respectively. Thus. the presence of tumor antigen emerges as a crucial determinant in shaping the phenotype of melanoma-specific CD8 T cells, above that of the tissue microenvironment. Analysis of resected lymph node samples following PD-1 blockade reveals their supportive role in activating and proliferating anti-tumor T cells. Finally, pathologic responders to PD-1 blockade are characterized by both a higher quantity and a less exhausted phenotype of tumor-specific CD8 T cells. This suggests that assessing both the quantity and quality of these T cells can serve as a predictive indicator to distinguish responders from non-responders. Conclusions: These findings highlight the feasibility of antigen-specific profiling in a clinical trial setting, the importance of melanoma-specific CD8 T cells in checkpoint blockade responses, and their potential use an early on-treatment biomarker of clinical outcomes.
Neoadjuvant pembrolizumab and lenvatinib in resectable mucosal melanoma: NeoPlus study update.
Authors: Mao Lili , Dai Jie , Bai Xue , Kong Yan , Cui Chuanliang , Chi Zhihong , Sheng Xinan , Lian Bin , Tang Bixia , Yan Xieqiao , Wang Xuan , Li Siming , Zhou Li , Wei Xiaoting , Li Juan , Li Caili , Wu Xiaowen , Guo Jun , Si Lu ,   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital and Institute, Beijing, China
Published: July 2024

9580

Background: Combination therapy of anti-PD1 agent with VEGFR inhibitor is a promising therapeutic approach in unresectable or metastatic mucosal melanoma. We conducted this study evaluating neoadjuvant lenvatinib and pembrolizumab in pts with resectable mucosal melanoma. Methods: This was a single-arm, open-label, single-center, phase 2 study conducted from Sep 2021. Eligible pts were adults (18-75 yr) with histologically confirmed, resectable mucosal melanoma. Pts received lenvatinib 20mg qd and pembrolizumab 200mg q3w for 2 cycles, followed by surgery. Pembrolizumab (200mg q3w) continued post operatively for further 15 cycles. The primary endpoint was complete pathologic response (pCR). Secondary endpoints were Relapse free survival (RFS, time from surgery to any event), Overall survival (OS) and safety. Results: Between Sep 2021 and Apr 2023, 26 pts were enrolled, median age was 57 yrs(range: 49-75), 19 were female. Primary sites included: 11 female genital, 8 ano-rectal, 5 head & neck (1 nasal, 4 oral),2 esophageal. 15 pts (58%) were localized disease,11 (42%) were regional lymphatic disease. BRAF V600, NRAS or KIT mutations were presented in 1, 3 and 2 pts, respectively. 21 pts underwent surgery, 2 pts had a pCR (9.5%), 2 near PCR, 4 pPR, with a pathologic response rate of 38% (8/21,95%CI 18-62%). 5 pts did not proceed with planned surgery for pts preference. As of Dec 2023, 12 of 21 resected pts had relapsed (9/11 in female genital,2/4 in ano-rectal, 1/5 in head & neck). Median follow up time was 19.1 months (95%CI 13.7-24.5). Median RFS was 12.4 months (95%CI 4.0-20.8), no difference was observed among these primary sites (female genital: 6.6 months, ano-rectal: 14.1 months, head & neck: not reached). Median DMFS was not reached. IHC data of the resected tumor showed higher CD8+ T cells density in responders (R: pCR+near PCR+ pPR) than non-responders (NR: pNR) (p = 0.046). Tertiary lymphoid structures were detected in 9 pts. Most common TRAEs were hypertension (13, 50%), proteinuria (12, 46%), LDH increased (9,35%), hypothyroidism (8, 31%). Three pts experienced a dose reduction and 5 experienced a dose interruption due to an AE. No grade 4-5 toxicities were observed. Conclusions: Updated results confirmed that the combination of pembrolizumab plus lenvatinib as neoadjuvant therapy had moderate anti-tumor efficacy in resectable mucosal melanoma. Increased CD8+ T cell infiltration was observed in tumor with pathologic response, supporting further investigation in mucosal melanoma.
Characterization of driver oncogenic mutations of in-transit melanoma metastases.
Authors: El Moheb Mohamad , Kim Susan , Cao Chunyan , Zhang Yunwei , Shafiei Mahnoush S , Shen Chengli , Haden Kathleen , Dengel Lynn T , Fallahi-Sichani Mohammad , Tsung Allan , Slingluff Craig , Witt Russell G
Published: July 2024

9586

Background: In-transit melanoma (ITM) is a distinctive form of melanoma metastasis, marked by aggressive locoregional progression and characterized by the entrapment of tumor cells within the lymphatic channels before reaching regional lymph nodes (LN). The mechanisms leading to lymphatic trapping rather than progression to distant metastasis are not well-understood. Previous research indicates a clonal origin for ITM, suggesting specific early-stage genetic alterations may drive this clinical phenotype. In this study, we sought to identify driver oncogenic mutations specific to ITM that may serve as potential targets. Methods: We analyzed data from the MSK-IMPACT database, which includes targeted sequencing of 341-468 genes for patients with cutaneous melanoma. Patients were stratified into four groups based on the type of sample sequenced: in-transit, primary tumor, regional LN, and distant metastases. We examined the prevalence of driver mutations and genetic variants across these groups, adjusting for multiple comparisons. Results: A total of 528 patients were included, of which 74 were in the ITM, 103 in the primary, 133 in the regional LN, and 218 in the metastatic group. The mean age of the cohort was 59 years (SD = 16) and 67% were male. Among the in-transit samples, 68% were treatment-naïve at the time of sequencing, 36% received anti-PD1 monotherapy, and 12% received anti-PD-1 combination therapy. None of the patients received targeted therapy. NRAS Q61 driver mutations were significantly more common in ITM than all other groups (all p<0.05). NF-1 driver mutations were significantly less common in ITM than distant metastasis (p=0.007) (Table). Comparative analysis across all genes showed a lower incidence of NF-1 mutations in ITM relative to metastatic samples (12% vs 38%, p=0.007). Gene interaction analysis showed mutual exclusivity between NRAS and PAK5 mutations in ITM (p=0.02), but not in other groups (p>0.05). Conclusions: This study reveals distinct driver oncogenic mutations specific to ITM, characterized by a high incidence of NRAS mutations, retained NF-1 function and the novel finding of mutual exclusivity between NRAS and PAK5. Closer examination of the interplay between NRAS, NF-1 and PAK5 interactions in ITM may provide deeper insights into the molecular mechanisms of ITM and offer potential therapeutic targets for ITM. [Table: see text]
The 15-gene expression profile test is independent from PRAME and 7-gene next-generation sequencing: Results from 3,267 clinically tested uveal melanomas.
Authors: Cook Robert W. , Alsina Katherina , Siegel Jennifer J. , Oelschlager Kristen M. , Borman Sherri
Published: July 2024

9598

Background: The 15-gene expression profile (15-GEP) test is the gold standard in the US for metastatic risk prediction in uveal melanoma (UM). Studies have shown that the 15-GEP is superior to and independent of other clinicopathologic and molecular risk factors, including PRAME expression status and BAP1 mutation status. Supplemental tests for PRAME and the 7-gene NGS panel ( BAP1, SF3B1, EIF1AX, GNA11, GNAQ, CYSLTR2, PLCB4)are validated and can now be run clinically from the same biopsy specimen. However, the discordance between 15-GEP, PRAME and NGS in clinical specimens is unknown. This study aimed to determine whether PRAME status or DNA mutation status could be used to predict the 15-GEP result. Methods: Data from fine-needle aspiration biopsy or formalin-fixed paraffin-embedded UM specimens submitted for routine comprehensive clinical testing with all three commercial tests (15-GEP, PRAME, and NGS) between February 2018 and December 2023 were collected through an Institutional Review Board-approved protocol. Results: Overall, 3267 tumors with comprehensive molecular testing were analyzed. 15-GEP testing yielded 65.9% (n=2152/3267) Class 1 and 34.1% (n=1115) Class 2 tumors. While Class 2 tumors were more than twice as likely to be PRAME(+) vs Class 1, 54.3% (606/1115) of Class 2 cases were PRAME(–), and 20.9% (450/2152) of Class 1 cases were PRAME(+) resulting in a PRAME/15-GEP discordance rate of 32.3% (10-56/3267). Mutations in genes associated with increasing metastatic risk ( EIF1AX, SF3B1, and BAP1, respectively) were identified in 58.7% (1918/3267) of cases. Most EIF1AX mutations (569/623, 91.3%) occurred in Class 1 tumors that were PRAME(–), while most SF3B1mutations were found in Class 1, PRAME(+) tumors (244/404, 60.4%). Most BAP1 mutations (863/976, 88.4%) occurred in Class 2 (high risk) tumors, of which 53.9% (465/863) were PRAME(–). Importantly, 56.0% (1205/2152) of Class 1 tumors did not harbor detectable EIF1AX or SF3B1 mutations, and 22.6% (252/1115) of Class 2 tumors did not harbor a detectable BAP1 mutation, yielding an NGS/15-GEP discordance rate of 44.6% (1457/3267). Conclusions: The validated PRAME and NGS tests described here, which can be performed from the same initial biopsy sample taken for 15-GEP testing, provide results that are not systematically associated with 15-GEP class. Given that the 15-GEP has been shown to be superior to both PRAME and NGS in predicting metastatic outcomes, it is recommended that these supplemental tests only be considered in the context of a 15-GEP test result to prevent potentially over or under identifying high-risk biology. An ongoing prospective study with long term outcomes for over 1700 UM patients led by the Collaborative Ocular Oncology Group (COOG2) will provide insight into how best to effectively integrate these supplementary biomarkers with the 15-GEP class result.
Exosome-delivered microRNAs confer adriamycin-resistance through modulating the immune and metabolism-related gene PTEN in HER2-negative breast cancer.
Authors: Yang Sujin , Zhu Bei , Wu Jia-hao , Cheng Tian-cheng , Zheng Lin , Chen Wei-xian
Published: July 2024

e12500

Background: Anthracycline is widely used in breast cancer (BCa) chemotherapy, but acquired drug resistance remains a challenge. Increasing evidence suggests that changes in the tumour immune microenvironment (TIME) consistently contribute to the development of chemoresistance. Methods: TIME scores and tumor-infiltrating immune cells (TICs) scores were used to investigate the prognosis, characteristics and gene transcriptomic profiling of HER2-negative BCa patients who received anthracycline chemotherapy. Exosomes from MCF/7-ADR (ADR-exos) and MCF/7-S cell lines were characterized. Dysregulated miRNAs were obtained by using miRNA microarray analysis on BCa cells and their corresponding exosomes. Protein profiling was performed to identify differentially expressed proteins in up- and down-regulated miR-222 cells. Ability of ADR-exos to transfer drug-resistance mediated by miR-222 was assessed by immunofluorescence assay and flow cytometry. Conditions to load miR-222 mimic or inhibitor into exosomes were optimized. Influence of miR-222 inhibitor-containing exosomes on the downstream pathway of miR-222 and the potential therapeutic effects were evaluated. Relationship between miR-222/PTEN and drug resistance in circulating exosomes from mice after doxorubicin chemotherapy was investigated. Results: Firstly, we discovered the complicated and heterogeneous TICs subtypes and their unique biological behaviors in HER2-negative BCa. Then, we identified 85 differentially expressed immunologic signature gene sets and 7202 corresponding immune-related genes in three subtypes quantified by gene set variation analysis. We identified 12 up-regulated and 13 down-regulated genes using miRNA microarray analysis in doxorubicin-resistant cells and their exosomes. Mass spectrometry found 45 differentially expressed proteins affected by miR-222. Moreover, we successfully established miRNA mimic/inhibitor-containing exosomes to explore the solo function of exosomal miR-222 in doxorubicin-resistance both in vitro and in vivo. For the first time, we detected the levels of miR-222 and its target gene PTEN in circulating exosomes from mice after doxorubicin-based chemotherapy and explored the potential clinical implications of miR-222/PTEN-containing exosomes in chemotherapy and immune suppression of BCa. Conclusions: Doxorubicin-resistant cells can transmit drug-resistance to sensitive cells via delivering miR-222 by modulating the immune- and metabolism-related gene PTEN without interference from other relevant drug-resistance factors in exosomes. Therefore, miR-222-containing exosomes and their target gene PTEN may be a promising biomarker for predicting chemotherapy efficacy and tumor immunity regulation in BCa patients receiving anthracycline chemotherapy.
Breast cancer recurrence rate after mastectomy in young females.
Authors: Sahib Hamsa , Azhar Waqas , Saini Nitin , Robinson Kathy J , Delfino Kristin , Rao Krishna A.
Published: July 2024

e12591

Background: Breast cancer is the most commonly diagnosed female cancer worldwide and the most common cause of cancer mortality in women. Surgical treatment of early breast cancer includes lumpectomy or mastectomy with or without reconstruction. Despite the surgeon’s best effort to perform a radical resection of the breast tissue during mastectomy to achieve locoregional control, residual fibroglandular tissue was found in 20% of breasts on postoperative breast MRI, which carries a risk of recurrence. Younger women with breast cancer have inferior survival rates despite receiving more aggressive therapy. Tumors in young women are more likely to be poorly differentiated, hormone receptor-negative, have a high proliferation index, and more lymphovascular invasion, which is partially explained by patients’ genetic profile. Another factor that could contribute to poor outcomes is the advanced stage at the time of diagnosis, including larger tumor size and higher rates of axillary lymph node positivity. This knowledge has motivated us to conduct this study that is dedicated to looking at the recurrence rate in young females following mastectomy. Methods: This is a retrospective study that collected data from young female patients who were diagnosed with breast cancer between January 2010 and August 2018, had an age at diagnosis of 18-45 years old, and underwent unilateral or bilateral mastectomy with or without reconstruction. The study also looked at the patient’s risk factors and genetic profile. Results: A total of 115 patients were diagnosed with early-stage breast cancer between January 2010 and August 2018 and underwent mastectomy. 81.74% were Caucasian females, and 8.7% were African American females. The mean age of diagnosis was 36.9 years. The mean BMI was 30.5 kg/m2. 59.13% of patients had a family history of breast cancer. The most common genetic mutations were BRCA1 at 7.83% and BRCA2 at 8.7%. 71% of patients underwent a bilateral mastectomy. 76% of patients had reconstruction. 77% of tumors were ER-positive, 68% PR-positive, and 26% HER2-positive. 49.4% of tumors were Nottingham grade 3. 52% of patients had no nodal involvement, while 35% had N1 disease. 34.6% had lymphovascular invasion. We found that 18/115 patients had recurrence of breast cancer following mastectomy. 5/17 patients had locoregional recurrence, while 12/17 patients had a distant recurrence; 1 patient’s recurrence data was unavailable. The median time to recurrence was 1147.5 days (335 to 3107). The 5-year recurrence free survival rate is 86% ± 3%. Conclusions: Our study found that 15.65% of young females had recurrence after mastectomy. To our knowledge, this is the first dedicated study to look at the recurrence rate after mastectomy in this young, high-risk patient population. Our study aims to encourage larger studies in young females with breast cancer to help tailor the treatment plan in this population.
3D cell cultures exhibit increased drug resistance, particularly to taxanes.
Authors: Maestri Chiara , Kumar Jahanvi , Nitiyanandan Rajeshwar , Trus Ivan , Parker Ricardo , Apfel Brigitte , Apfel Christian
Published: July 2024

e12599

Background: Cell culture platforms could be categorized into two main types: 2D and 3D. 3D cell cultures, known for mimicking the physiological cellular environment, are commonly preferred by researchers to assess drug responses as they accurately reproduce aspects of the in vivo cell behavior. We hypothesized that dose-response curves of 2D and 3D platforms may be drug dependent, with some being more sensitive or resistant depending on the platform. Methods: MCF-7 cancer cells were cultured and plated using a 2D flat bottom well plate platform or using a matrix-based and a matrix-free 3D platform. Cells were treated with chemotherapies and targeted therapies for four days and cellular sensitivity was assessed through a viability assay. Four-parameter logistic (4PL) dose response curves were generated and IC50 values (µM/Cmax) were quantified to understand the differences in dose response curves between the 2D and 3D cellular platforms. Results: While the dose-response curves generally correlate between 2D vs. 3D matrix-based (r2=0.82, p<0.001) and 2D vs. 3D matrix-free methods (r2=0.78, p<0.001), noteworthy variations were observed for certain drugs, particularly paclitaxel (2D IC50= 66; 3D matrix-based IC50 = ≥100; 3D matrix-free IC50 = ≥100) and docetaxel (2D IC50 = ≥34; 3D matrix-based IC50 = ≥100; 3D matrix-free IC50 = ≥100). Additionally, a general increase in resistance was evident when cells formed 3D structures compared to the 2D monolayer condition, as indicated by regression analysis (Y-intercept = 0.55, CI95% 0.32 to 0.78; slope = 0.47, CI95% 0.20 to 0.75). Conclusions: Our findings reveal that taxanes such as paclitaxel and docetaxel exhibit distinctive resistance patterns in 3D structures. In addition, a substantial increase in cellular resistance is observed in 3D cellular models when compared to the 2D assay for most drugs. Despite the overall correlation, these drug-specific differences should be considered. Thus, the next generation of an extreme drug resistance assay, aimed at enhancing the quality of life for patients by avoiding ineffective therapies, might preferentially employ a 3D platform to tailor patients’ cancer therapies.
Patient reported outcomes for anterior and postpectoral prosthesis implantation in single-port laparoscopic breast.
Authors: He Xiangmei , Zhang Juliang , Hou Lan , Chang Kexin , Wang Donghui , Li Danxi , Jiao Yangchi
Published: July 2024

e12601

Background: Breast reconstruction surgery is on the rise and can significantly improve patients' quality of life, and single-port lumpectomy breast reconstruction surgery is becoming more widely used because of its minimally invasive nature, clear field of view, and aesthetics. However, patient-reported outcome studies of anterior versus posterior pectoralis muscle in this procedure are still scarce, and more evidence is needed to provide guidance to clinicians. Methods: Patients who underwent single-port laparoscopic breast reconstruction surgery at Xijing Hospital between March 2021 to December 2023 were included and divided into two groups according to the position of the prosthesis in the pectoral muscle. Patient safety was assessed for surgical safety and tumor safety. Patient Reported Outcome (PRO) was assessed using the BREAST-Q questionnaire. Results: General situation: This study was included in 58 patients with a single -hole laparoscopic breast reconstruction, and 48 patients were included in the post -pectoral muscle group. Tumor safety: 100% recurrence-free survival, 100% disease-free survival, and 100% overall survival in the follow-up patients; there was no significant difference between the anterior and posterior pectoral muscle groups in the single-port cavity. Surgical safety: there was no significant difference between the pre-pectoral and post-pectoral groups in terms of operative time, intraoperative bleeding, nipple areola complex ischemia, periosteal contracture. there were significant differences in postoperative infection, postoperative pain, and flap ischemia between the two groups, with the anterior pectoralis muscle group having a lower rate of postoperative infection, less pain, and a lower rate of flap ischemia. Patient-reported outcomes: The breast satisfaction of the breast reconstruction of the thoracic muscles under the laparoscopy, the higher social psychological health score, and the lower score in chest pain. Conclusions: In our research, the two groups of patients with single -hole laparoscopic breast reconstruction did not have a bad ending, and the single -hole laparoscopic pectoral muscle reconstruction had lower postoperative complications, and had better patient reporting ending Therefore, without considering the economic situation, we recommend the reconstruction of a single -hole laparoscopic pectoral muscles.
The predictive role of Ki67 in pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer: A retrospective study of 246 cases.
Authors: Weydandt Laura , Agabejli Saida , Lia Massimiliano , Wimberger Pauline , Aktas Bahriye , Link Theresa
Published: July 2024

e12610

Background: While Ki67 is a routine diagnostic measure for early hormone receptor positive breast cancer, it is not integrated into the standard procedure for patients with Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer patients, given the substantial risk linked to HER2 expression alone. Consequently, the predictive significance of Ki67 in achieving pathological complete response (pCR) or invasive disease-free survival (IDFS) in this subgroup remains uncertain. Methods: This retrospective, bi-centric analysis focused on HER2-positive early breast cancer patients undergoing neoadjuvant chemotherapy from 2015 to 2023. We assessed the correlation between Ki67 values and the achievement of pathological complete response (pCR, defined as ypT0/is, pN0). Multivariable logistic regression analyzed the independent association of various clinical parameters, including Ki67, with pCR. Ki67 values were categorized into risk groups (low <15%, intermediate 15.1-35%, high >35%) following the GepardTrio data [1]. Kaplan-Meier estimator calculated differences in overall and invasive disease-free survival. Results: The study included 246 HER2-positive early breast cancer patients with known Ki67 expression, followed for a median of 42 months. The median age was 52 years. Final nodal status was pN0 in 80.5%, pN1 in 15%, and pN2 in 3.3%. Hormone receptor positivity was observed in 66% of patients. 147 patients (60%) achieved pCR. Median Ki67 was 30. When categorized, 13% were low, 41.5% intermediate, and 45.5% high risk. No correlation between Ki67 and pCR was observed (p=0.25). HER2 IHC score 3+ significantly increased pCR compared to IHC 2+ (62.2% vs. 44.6%, p=0.023). Hormone receptor-positive tumors had a lower pCR rate (52.7% vs. 72.4%, p=0.0016. 5-year overall survival was 96.5% for pCR and 83.8% for non-pCR (p=0.008). 5-year invasive disease-free survival showed no difference between low Ki67 (89.5%), intermediate Ki67 (79.9%), and high Ki67 (80.9%) groups (p=0.77). Conclusions: In this study, Ki67 did not predict pCR in HER2-positive breast cancer, providing no additional clinical value. HER2 IHC score and hormone receptor status were predictive indicators for pCR. Ki67 expression appears to lack additional value in HER2-positive breast cancer, considering resource implications. 1. Denkert C et al: Ann Oncol. 2013 Nov;24(11):2786-93. doi: 10.1093/annonc/mdt350. Epub 2013 Aug 22. PMID: 23970015.
Prediction of pathologic complete response to chemoimmunotherapy in triple-negative breast cancer using tumor-infiltrating lymphocytes: Exploiting cutoff values.
Authors: BARROSO-SOUSA ROMUALDO , Sousa Isadora Martins de , Marin Comini Ana Carolina , Celeste Tavares Monique , Madasi Pinheiro Fernanda , Bines Jose , Dal Ponte Ferreira Rafael , Rosa Daniela Dornelles , Santos Candice Lima , Souza Zenaide Silva , Suzuki Daniele Assad , de Araujo Julio Antônio Pereira , Gagliato Debora De Melo , Dos Anjos Carlos Henrique , Zucchetti Bruna M , Ferrari Anezka Carvalho Rubin de Celis , Lopes De Brito Mayana , Monteiro Maria Marcela F. , Testa Laura , Bonadio Renata Colombo
Published: July 2024

e12629

Background: Triple-negative breast cancer (TNBC) prognosis is significantly influenced by tumor-infiltrating lymphocytes (TILs), but the lack of validated cutoff values has limited their clinical applicability. In the era of neoadjuvant pembrolizumab plus chemotherapy (P+CT) as a new standard of care, the role of TILs as predictors of response to chemoimmunotherapy remains uncertain. Methods: This study aimed to assess TILs as predictors of pathologic complete response (pCR) within the Neo-Real study, a multicenter, real-world data investigation on neoadjuvant P+CT in TNBC. TILs were evaluated using the standardized methodology of the International TILs Working Group. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to evaluate the predictive ability of TILs expression and multivariable models for pCR. Results: The analysis included 128 patients (pts) treated with neoadjuvant P+CT (68% stage II, 26% stage III). The proportion of pts in each TILs’ category and results of ROC curve analysis are presented in the Table. A cutoff value of 10% demonstrated the highest accuracy in predicting pCR, while a high specificity was observed at a cutoff value of 50%. Thus, the probability of residual disease if TILs ≥ 50% is considerably low. Incorporating categorized clinical and pathological variables, a multivariable logistic regression model, using TILs (≥ 10% vs < 10%), Ki67 (≥ 50% vs < 50%), and tumor stage (III vs II), exhibited the highest AUC (0.688) for predicting pCR. Conclusions: Our study underscores the predictive value of TILs for pCR in TNBC following neoadjuvant P+CT. The cutoff value of ≥ 50% identified patients with a very high probability of pCR. The results reinforce TILs’ use as a biomarker for treatment de-escalation, especially for pts with TILs ≥ 50%. Further enhancement of TILs' predictive potential may be achieved through multivariable models. [Table: see text]
Adoption of decentralized trial elements in cancer clinical trials supporting FDA approvals during COVID-19.
Authors: Patel Timil , Corneli Amy , Balcazar Pamela , Lipset Craig H. , Calvert Sarah , Mervin-Blake Sabrena , Nalawade Vinit , Kluetz Paul Gustav
Published: July 2024

e13802

Background: The COVID-19 pandemic significantly disrupted the conduct of cancer clinical trials. Facilitated by emergency FDA guidance, many sponsors integrated decentralized clinical trial (DCT) elements to prioritize patient safety and maintain access. The FDA’s Oncology Center of Excellence, in collaboration with the Clinical Trials Transformation Initiative (CTTI), assessed the adoption of DCT elements in registrational cancer clinical trials conducted during the pandemic that resulted in an FDA approval. Methods: CTTI sent trial sponsors a recruitment email with a link to an online survey and the name of the trial that resulted in an FDA approval. Sponsors were asked to select the DCT elements used in that trial prior to and in response to the pandemic, challenges faced when implementing these approaches, and the likelihood of using the approaches in the future. Data were collected from December 6, 2022 to January 17, 2023. Descriptive statistics were used to summarize sponsor responses. Results: Out of 52 eligible studies, 19 surveys were completed from 13 unique sponsors (37%; 12 pharmaceutical companies and 1 chose not to disclose). Sixty-three percent of sponsors identified as a large pharmaceutical company with a market cap of over $10 billion. The majority of cancer clinical trials (89%) occurred both in the United States and abroad, with almost all sponsors (95%) incorporating at least one DCT element during the pandemic. The most widely adopted DCT elements were remote site monitoring (89%), telemedicine (68%), remote laboratory assessments (63%), remote distribution of investigational product (58%) and local imaging assessments (47%). The main challenges in implementing DCT elements included site institutional policies (83%), site challenges with technology adoption (61%) and site regulatory restraints (56%). Many sponsors intend to incorporate some degree of decentralization in future cancer clinical trials, with remote site monitoring (95%), remote collection of patient-reported outcomes (68%), telemedicine (68%), and electronic informed consent (58%) being deemed "highly likely" or "likely" for future adoption. Conclusions: The COVID-19 pandemic accelerated the use of DCT elements in cancer clinical trials. This study represents the first systematic evaluation of the use of DCT elements in cancer clinical trials intended for regulatory submission and provides proof of concept that cancer trials with DCT elements can generate data suitable for FDA review and marketing approval. The appropriate use of DCT elements holds promise to expand clinical trial access and reduce patient burden. Further characterization and mitigation of clinical site-level challenges is warranted to encourage continued adoption of DCT elements in cancer clinical trials.
Survival implications and radiographic predictors of prognosis in patients with IDH-mutant astrocytoma with CDKN2A/b homozygous deletion: An international, multi-centered study.
Authors: Wetzel Ethan A. , Hsieh Annie Lee , Nohman Amin , Reuss David , Eyupoglus Ilker , Hua Lingyang , Youssef Gilbert , Wen Patrick Y. , Cahill Daniel P. , Jungk Christine , Juratli Tareq A. , Miller Julie J.
Published: July 2024

e14035

Background: Isocitrate Dehydrogenase (IDH) 1 or 2 mutations are associated with improved prognosis in glioma patients. Despite their less aggressive clinical course when compared to IDH-wild type gliomas, molecularly-defined IDH-mutant glioma subtypes with poor prognosis have been identified. Among these, CDKN2A/B homozygous deletion represents the strongest negative genetic predictor of prognosis yet identified in IDH-mutant astrocytoma. With the WHO 2021 classification recognizing CDKN2A/B homozygous deletion as sufficient for the designation of astrocytoma, IDH-mutant, WHO Grade 4, the translational implications and potential for therapies targeting CDKN2A/B homozygous deletion are an area of active investigation. We sought to further characterize overall (OS) and progression-free survival (PFS) of CDKN2A/B deleted patients within a large, multi-centered, international cohort and identify clinical characteristics that predict survival for patients with CDKN2A/B deletion. Methods: Patients with IDH-mutant glioma with CDKN2A/B homozygous deletion were retrospectively identified across four institutions (Massachusetts General Hospital, USA; University Hospital Heidelberg, Germany; University Hospital Dresden, Germany, and Foudan-Shanghai, China). IDH-mutation status was determined by immunohistochemistry or next-generation sequencing. CDKN2A/B status was determined by hybridized DNA capture or FISH. Results: We identified 75 patients with IDH-mutant astrocytoma with CDKN2A/B homozygous deletion. The cohort had a median follow-up time of 5.0 years, was 56% male, and had an average age of 38.8 years. Patients were treated with chemotherapy and radiation following initial surgery in 77% of cases. Preoperative contrast enhancement and T2 FLAIR mismatch were identified in 56 and 44% of cases, respectively. Compared to a cohort of 51 patients with CDKN2A/B intact, grade 4, IDH-mutant astrocytoma, those with CDKN2A/B-deleted tumors had significantly shorter median OS and PFS (OS: 4 vs 13.5 years, HR = 6.8, HR 95% CI = 3.1, 14.6, p < 0.0001; PFS: 2.8 vs 5.9 years, HR = 3.0, HR 95% CI = 1.7, 5.2, p = 0.0001). Within the CDKN2A/B deleted cohort, preoperative contrast enhancement predicted worse OS, but not PFS (OS: HR = 2.7, 95% CI = 1.1, 7.4, p = 0.04; PFS: HR = 1.17, 95% CI = 0.7, 3.7, p = 0.24). Conclusions: These data reinforce the strong negative prognostic impact of CDKN2A/B homozygous deletion on OS and PFS and identify a novel association between preoperative contrast enhancement and shorter OS in patients with CDKN2A/Bdeleted, IDH-mutant astrocytoma.