bluuebunny/crossref_metadata_2025 huggingface dataset:
Upgrading the non-gene-editing, allogeneic ThisCART platform for extending persistence in vivo.
Authors: Liu Kaichun , Pc Z , He Ling , Zhang Yinhang , Chen Shanshan , Jiang Yuchen , Xu Guanggui , Fu Jianmin , Wang Baolei , Li Sujun , Wang Xingbing , Li Jun
Published: June 2023

e14569

Background: Lack of in vivo persistence is the major challenge in allogeneic CAR-T field. Various HLA-related gene-editing strategies are being explored to prevent rejection by host T and NK cells (Table 1). This study reports a platform upgrade on ThisCART (TCR and HLA-I intracellular sequestered), represented by ThisCART19C cells. Methods: ThisCART19C cells were produced with a single lentivirus vector, encoding a CD19-targeting CAR, a KDEL-tagged anti-CD3 scFv, and the HCMV US11 protein. The surface expression of CAR19, TCRαβ and HLA-A/B/E was measured by flow cytometer. Specific tumor cytotoxicity was evaluated both in vitro and in vivo. Furthermore, the safety of donor derived ThisCART19C cells were tested in a xenogeneic GvHD model. Results: Similar to our ThisCART19A product currently in multi-center trials, ThisCART19C cells were readily produced to a quantity and quality supporting clinical investigation. ThisCART19C cells demonstrated an anticipated and stable surface immunotype: CAR19+, TCRαβ-, HLA-A-, HLA-B-，HLA-E+，with great potential for simultaneous evasion of both host T and NK cells. Similar to autologous CD19-directed CAR-T, ThisCART19C exhibited potent CD19-specific cytotoxicity in vitro and in vivo. No xenogeneic GvHD reaction was observed in murine model over an extended period. Conclusions: To our knowledge, ThisCART19C represents the first application of viral evading strategy in promoting the clinical persistence of allogeneic CAR-T cells. Its efficient processing, potent cytotoxicity and favored preclinical safety profile warrant clinical investigation. [Table: see text]
A multi-targeted T-cell engagement of PD1-resistant colorectal cancer cells via delivery of glycopeptide conjugates.
Authors: Adesokan Yemi , Schwarzfischer Marlene , Wyss Romain , Miao Yong , Asare Paul , Spalinger Marianne Rebecca , Scharl Michael
Published: June 2023

e14571

Background: Glycan-based cancer immunotherapies are novel therapeutic strategies that use the pivotal role of aberrant glycosylation patterns in cancer progression. Targeting hybrid epitopes consisting of altered glycans and carrier peptides enhances the efficacy and specificity of the anti-tumor immune response. Here, we exploit ensembles of glycopeptide conjugates to steer a multi-targeted yet tumor-specific T-cell response, a technology we call GLAAD (glycopeptides with adjuvant and tumor-associated antigen delivery). By inducing T cells that recognize and eliminate tumor cells and promoting their antigenicity in a therapeutic setting, we show the potential of our GLAAD candidate GNU-101 to overcome the transient and heterogeneous responses frequently observed with traditional immunotherapies. Methods: Using the MC38 syngeneic mouse model of colorectal cancer (CRC) in a therapeutic setting, we tested whether GNU-101 reduces tumor burden when orally administered alone or combined with immune checkpoint inhibitors (ICI). On day 0, 20 C57/BL6J mice were injected subcutaneously with MC38 CRC cells in each flank. On day 6, mice were supplemented with 3% GNU-101 in the drinking water, while control mice received normal drinking water. On days 6, 9, 12, and 15, half of the mice in each group received an anti-PD1 antibody (aPD1), while the others received isotype control. On day 16, the mice were sacrificed. Results: In this therapeutic setting, a standalone therapy of GNU-101 successfully reduced tumor growth as demonstrated by a statistically significant reduction in both tumor volume and weight. As expected, the aPD1 therapy had only a non-significant effect on tumor growth. Remarkably, its efficacy was improved when combined with GNU-101, leading to a statistically significant reduction of >90% in tumor volume and weight. The analysis of the immune cell population in the tumor microenvironment revealed the activation of CD8 T cells and a reduction of immunosuppressive signals, which likely mediates the anti-tumor efficacy of GNU-101. This was obvious by a higher abundance of CD8 T cells producing IFNγ and secreting granzyme B & perforin and, conversely, lower amounts of Tim3+ CD8 T cells and regulatory T cells (FoxP3+ CD4 T cells) found in mice treated with GNU-101 vs control mice. Conclusions: We demonstrate the immunomodulatory and therapeutic potential of GNU-101 in a pre-clinical mouse study in which the growth of established tumors was significantly reduced, either as a standalone therapy or in combination with existing treatment. By specifically promoting anti-cancer CD8+ T cells while reducing immunosuppressive signals, this easy-to-administer glycopeptide has the potential to create the conditions for long-term cancer control and improve treatment outcomes in cancer that are frequently resistant to immunotherapy, such as many epithelial cancers.
Immunomodulatory AVM0703 enhances R-CHOP anti-lymphoma effect with reduced toxicity: Immune-resistant, aggressive A20 lymphoma model.
Authors: Deisher Theresa , Mittal Sandeep , Sawas Spencer , Patterson Elizabeth , Nakamura Evan , Jarzyna Peter
Published: June 2023

e14583

Background: Rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (RCHOP) is the standard of care for most aggressive B-cell lymphomas. RCHOP requires numerous treatment cycles, typically 6, with challenging side effects, including toxicity and long-term secondary malignancies. Trials have demonstrated that 4 cycles of RCHOP was non-inferior to 6 with similar secondary malignancies, however, real world experience has demonstrated that long term outcomes are superior when patients achieve minimal residual disease negative (MRD-) status after the 3rd cycle (1,2). Addition of a novel agent to RCHOP that could reduce the number of cycles to 3 while maintaining response, could overcome the long-term side-effects and allow frail and elderly patients to receive full dose RCHOP in each cycle to improve outcomes. For example, addition of Lenalidomide with RCHOP improved outcomes in ABC-DLBCL patients (3), but leads to therapy related myeloid neoplasm in recent studies (4). AVM0703, an immunomodulatory drug, mobilizes bispecific and i-TCR double-positive NKT cells (AVM_NKT). In the aggressive, immune resistant A20 mouse lymphoma model, neoadjuvant AVM0703 was additive/synergistic, when cyclophosphamide/fludarabine (CyFlu) was dosed 3 + 24 hours later, with no additional toxicities. Therefore, we hypothesized that combining AVM0703 with RCHOP would be an effective and well tolerated treatment of DLBCL. Methods: Tumor-bearing mice were made by sc flank injection of 2x106 murine A20 B-cells in 10-week-old Balb/c mice. When tumor size reached established ~100 mm3, 48 mice (1:1 male: female) were randomized (12 mice each cohort) 1) Placebo 2) 1 cycle RCHOP 3) AVM0703 (18mg/kg HED) 4) AVM0703+1 cycle RCHOP combination treated as described previously (5,6). When Placebo tumors reached ~ 2000 mm3, all mice were sacrificed and tumors, blood, spleen, bone marrow were analyzed for the presence of remnant A20, and immune cell state by flow cytometer. Results: One RCHOP only mouse died from the chemo. There were no deaths in AVM0703+RCHOP group. Tumor remnant live A20 were significantly reduced in all 3 treatment groups compared to Placebo. Interestingly, AVM0703+RCHOP significantly increased the number of MRD- A20 tumors compared to RCHOP alone. Conclusions: Based on this study we plan to determine whether 3 cycles of AVM0703+RCHOP can induce long term CR and if AVM0703 could replace R and reduce long term side effects. 1) Poeschel Lancet 2019. 2) Spurgeon J Natl Canc Inst 2016. 3) Nowakowski JCO 2021. 4) Sperling Blood 2022. 5) Bascuas J Transl Med 2016. 6) Bongard PLoS Pathog 2019. [Table: see text]
Anti-drug antibodies related to CTLA-4, PD-1, or PD-L1 inhibitors across tumour types: A systematic review.
Authors: Pinato David J. James , Galle Peter R , Mitchell Catherine R , Ndirangu Kerigo , Ramji Zahra , Redhead Gabrielle , Finn Richard S.
Published: June 2023

e14600

Background: Treatment-emergent anti-drug antibodies (ADAs) are postulated to reduce the efficacy of immune checkpoint inhibitors. A systematic review (SR) was conducted to evaluate the incidence of treatment-emergent ADAs with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors and their impact on treatment outcomes in patients with cancer. Methods: Electronic databases MEDLINE, EMBASE and Cochrane Library were searched in February 2022 for studies reporting incidence of ADAs and the impact of immunogenicity on treatment efficacy in oncology patients treated with PD-1, PD-L1, or CTLA-4 checkpoint inhibitors. Results: Of the 4,612 articles identified, 34 publications reporting on 68 trials were included. An additional 41 and 32 records were identified from clinicaltrials.gov and packaging inserts respectively. In total, 141 trials of 15 checkpoint inhibitors and 16 tumour types were included. There was considerable variability in the reporting of ADAs, and comparisons between trials were challenging due to intra-study heterogeneity. The incidence of ADAs ranged from 0 to 74%. Across trials, in analyses with the largest sample sizes, atezolizumab was associated with the highest incidence of ADAs (29.6%), then nivolumab (12.2%), followed by the remaining treatments (0-4.4%). The incidence of neutralising antibodies (nAbs) mirrored ADA distribution, being highest for atezolizumab (4.3–27.5%) vs other treatments. Only 17 trials reported on ADA impact on treatment outcomes. Of 11 trials examining efficacy, two reported a negative effect of ADAs, eight reported no measurable effect and another had insufficient patient numbers. The impact of ADAs on treatment safety, and pharmacokinetics was also inconclusive. Conclusions: Treatment-emerging ADAs are inconsistently reported across trials and documented in up to 30% of subjects treated with checkpoint inhibitors across indications. Emergence of nAbs follows but does not perfectly mirror ADA titers, raising questions around the functional meaning of different ADAs. Standardised reporting of ADAs and nAbs should be advocated to facilitate more conclusive immunologic and clinical insight as to the relationship with ADAs and response. [Table: see text]
Safety and clinical efficacy of sintilimab in pediatric patients with advanced or recurrent malignancies in a phase I study.
Authors: Que Yi , Lu Suying , Wang Juan , Sun Feifei , Zhu Jia , Huang Junting , Zhen Zijun , Zhang Yizhuo
Published: June 2023

e14601

Background: This is a first phase I study investigating the safety and efficacy of sintilimab in pediatric patients with advanced or recurrent malignancies. Methods: During dose escalation, patients received a single-dose intravenous infusion of sintilimab. The planned dosing groups were 1, 3 and 10 mg/kg. During dose expansion, patients received sintilimab every three weeks. Primary endpoints were determination of dose-limiting toxicities at the maximum administered dose, safety and tolerability, and the proportion of patients with objective response to sintilimab according to the Response Evaluation Criteria in Solid Tumours version 1.1. PD-L1 expression of tumor in subjects were identified by immunohistochemistry (DACO,22C3). Whole exome sequencing (WES) was performed in 15 patients to characterize the mutational landscape and CNV status. Results: 29 patients were enrolled, including 10 patients with Hodgkin lymphoma (HL), 19 patients with other tumor types. Some special pathological types, including thymoma, choroid plexus carcinoma, and NK-T cell lymphoma are included. Patients were pretreated with a median of 3 prior lines of systemic treatment. Sintilimab was well tolerated without dose-limiting toxicity. By the safety data cutoff date, all patients experienced treatment related adverse events (TRAE) with most adverse events being grade 1 or 2, and ≥ grade 3 TRAEs occurred in 10%. Among all 27 subjects evaluated, 4 confirmed complete response (2HL, 1 NK/T lymphoma, 1 anaplastic ependymoma), 7 confirmed partial responses (4 HL, 1 Ewing sarcoma, 1 diffuse large-B lymphoma and 1 thymoma), and 7 stable disease were observed, for an objective response rate of 40.7%, and a disease control rate of 66.7%. Subjects with PD-L1-positive expression benefited more from sintilimab treatment than PD-L1-negative subjects (66.7% ORR versus 33.3% ORR, p=0.314) although statistically insignificant. The genomic profiling of WES indicatedpatients with a specific genomic mutation type predict the response of PD-1 therapy. Conclusions: Sintilimab was well tolerated and demonstrated promising anti-tumor activity in pediatric HL. The completion of the current phase I study has led to the initiation of the first prospective anti-PD-1 registration trial in Asia focusing on pediatric patients and serve as the basis for its potential study in combinatorial regimens for childhood cancer. Clinical trial information: NCT04400851 . [Table: see text]
Efficacy and safety of switching other tyrosine kinase inhibitors to regorafenib combined with primary PD-1 antibodies in patients with hepatocellular carcinoma.
Authors: Pan Shida , Yu Yingying , Wang Siyu , Qiu Qin , Shen Yingjuan , Yang Luo , Liu Xiaomeng , Luan Junqing , Meng Fanping
Published: June 2023

e14612

Background: Currently, formal tyrosine kinase inhibitors (TKIs) such as sorafenib or lenvatinib in combination with PD-1/PD-L1 immune checkpoint inhibitor had achieved promising results in patients with hepatocellular carcinoma (HCC). However, a portion of patients experienced drug-resistant tumor progression and/or severe adverse events associated with TKIs during the course of treatment, resulting in unfavorable disease control and poorer overall survival. Therefore, a better medication strategy is urgently needed in aim to improve the prognosis of these patients who experienced discontinuing medication of TKIs. Methods: We reviewed the medical data of 23 HCC patients with disease progression after received sorafenib or lenvatinib combined with PD-1 antibodies from Jan Feb 2020 to Sep 2021 at the Fifth Medical Center of PLA General Hospital in China. These patients had switched to regorafenib PO for 3 weeks on/1 week off combined with primary PD-1 antibodies after experienced tumor progression and/or severe adverse events with respect to sorafenib or Lenvatinib. All patients were followed up regularly. Changes of tumor lesions, survival data and adverse events (AEs) were detailed recorded after switched. All AEs were evaluated according to the CTCAE v5. Results: Initially, 20 (87.0%) patients were treated with lenvatinib and 3 (13.0%) patients were treated with sorafenib before switched to regorafenib. Of all patients, tumor progression caused 15 (65.2%) switching and severe AEs caused 8 (34.8%) switching, and the initial daily dose of regorafenib were 80mg (95.6%) and 40 mg (4.4%), respectively. Before switched to regorafenib, the most common mild AEs were hypertension, hypothyroidism and granulocytopenia, and the most common severe AEs were rash, hepatitis, and lung infections. In contrast, the most common AEs was mild hoarseness after switched to regorafenib. During the follow-up, 12 (52.2%) patients died, 3 (13.0%) patients lost and 8 (34.8%) patients sustained survival. The overall median survival time (MST) was 22.47 months [95% confidence interval (CI): 2.98 months to 41.96 months], the MST after switched to regorafenib was 10.53 months (95% CI: 0.257 months to 20.81 months). Of note, size of tumor lesion decreased in 7 (30.4%) patients and increased in 3 (13.0%) patients, and the other 13 (56.6%) patients could not be evaluated due to incomplete data after switching to regorafenib. Conclusions: For patients who are resistant to other TKIs, switching to regorafenib showed good efficacy and manageable safety. Therefore, this treatment protocol can be considered as a potential treatment for patients without clinical benefits after first or second-line combination therapy.
Doxorubicin to enhance the abscopal effect depending on tumor cell mitochondrial DNA and cGAS/STING.
Authors: Wang Liqun , Luo Ren , Onyshchenko Kateryna , Gabriele.Niedermann@Uniklinik- No Firstname
Published: June 2023

e14616

Background: Localized radiotherapy (RT) can cause a T cell-mediated abscopal effect on non-irradiated tumor lesions, especially in combination with immune checkpoint blockade (ICB). However, this effect is still clinically rare and improvements are highly desirable. We investigated whether triple combination with a low dose of clinically approved liposomal doxorubicin (Doxil) could augment abscopal responses compared with RT+ICB, Doxil+ICB, or RT+Doxil. Methods: We used Doxil in combination with RT and αPD1 in two tumor models (B16-CD133 melanoma and MC38 colon carcinoma) with mice bearing two tumors, only one of which was irradiated. Results: Triple therapy with RT, αPD1, and single low-dose Doxil strongly enhanced the RT-induced abscopal effect compared to all double and single treatments in both tumor models ( p < 0.05, n = 5-10 mice/group). Complete cures of non-irradiated tumors were mainly observed in triple-treated mice. Triple therapy induced more cross-presenting dendritic cells (DCs) and tumor-specific CD8 T cells than RT/αPD1 and Doxil/αPD1 ( p < 0.05, n = 5 mice/group), particularly in non-irradiated tumors. CD8 T cell depletion or implanting STING-deficient tumor cells abolished the abscopal effect. By using inhibitors and knockout cells, we show that doxorubicin/Doxil-induced IFNβ1 markedly depended on the cGAS/STING pathway ( p < 0.05) which drives antitumor CD8 T cell responses through cross-presenting DCs. In mitochondrial DNA (mtDNA)-depleted tumor cells, doxorubicin/Doxil induced less IFNβ1 ( p < 0.05), the related T cell-recruiting chemokine CXCL10 ( p < 0.0001), and ATP ( p < 0.0001); coincubation with mtDNA-depleted tumor cells strongly reduced IFNβ1 ( p < 0.01) secretion by DCs. Implantation of mtDNA-depleted tumor cells, particularly at the non-irradiated site, substantially diminished the Doxil-enhanced abscopal effect and tumor infiltration by tumor-specific CD8 T cells ( p < 0.05). Conclusions: Single low-dose Doxil can substantially enhance the RT-induced abscopal effect, with a strong increase in cross-presenting DCs and CD8 tumor-specific T cells particularly in abscopal tumors compared with RT/αPD1 and Doxil/αPD1. The mtDNA/cGAS/STING/IFN-I axis is important for the immunogenic doxorubicin effects. Our ﬁndings may be helpful for the planning of clinical radiochemoimmunotherapy trials in (oligo)metastatic patients.
A phase 2 study of alrizomadlin, a novel MDM2/p53 inhibitor, in combination with pembrolizumab for treatment of patients with malignant peripheral nerve sheath tumor (MPNST).
Authors: Somaiah Neeta , Van Tine Brian Andrew , Chmielowski Bartosz , Drabick Joseph J. , Chawla Sant P. , McKean Meredith , Spira Alexander I. , O'Byrne Kenneth John , Foresto Steven A. , Movva Sujana , Kim AeRang , Gastman Brian , Pressey Joseph Gerald , Paudyal Ben , De Asit , Winkler Robert E. , Li Mingyu , Ahmad Mohammad , Yang Dajun , Zhai Yifan
Published: June 2023

e14627

Background: MPNST is a rare and aggressive soft tissue malignancy accounting for 10% of all soft tissue sarcomas. This disease is characterized by high risk of local recurrence and distant metastasis, and there is no current effective standard of care treatment option for patients with MPNST, with the only curative option of complete resection. Therefore, further treatment options are warranted. Investigational mouse double minute 2 (MDM2) inhibitor alrizomadlin restores TP53 function, activating p53-mediated apoptosis in tumor cells. Alrizomadlin also functions as a host immunomodulator and may restore antitumor activity in patients with MPNST that progressed on PD-1/PD-L1 inhibitors. Methods: This US/Australian multicenter trial evaluated alrizomadlin combined with PD-1 inhibitor pembrolizumab in patients with MPNST that progressed on available therapy or in those for whom therapy was unavailable. ECOG performance status was between 0-2 for eligible patients. Alrizomadlin 150 mg was administered orally every other day for 2 consecutive weeks, with 1 week off, and pembrolizumab 200 mg intravenously for 30 minutes on Day 1 of a 21-day cycle. Results: As of December 12, 2022, preliminary clinical results are reported for 24 patients with MPNST, of whom 16 were male, with a median (range) age of 35 (14-73) years. Treatment (alrizomadlin or pembrolizumab)-related adverse events of any grade (>10%) were reported in 18 patients. They included nausea (41.7%), vomiting and anemia (37.5% each), fatigue and diarrhea (33.3% each), thrombocytopenia (25.0%), and decreased leukocyte and lymphocyte counts (12.5% each). A total of 12.5% of patients reported treatment-related serious adverse events, including colitis, abdominal pain, diarrhea, and pericardial effusion. Among17 efficacy evaluable patients, the clinical benefit rate, as defined by the combination of overall response rate and stable disease for ≥ 4 cycles, was 53% per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v.1.1) and iRECIST. The median (range) treatment duration was 10 (4-20) cycles. Conclusions: Alrizomadlin combined with pembrolizumab is well tolerated and demonstrates meaningful clinical benefit in patients with MPNST for whom standard of care therapy is unavailable. Internal study identifiers: APG-115-US-002. Clinical trial information: NCT03611868 .
Prognostic value of human leukocyte antigen G (HLA-G) expression in solid tumors: A systematic review and meta-analysis.
Authors: Bartolome Jorge , Molto Consolacion , Benitez Fuentes Javier David , Fernández-Hinojal Gonzalo , Manzano Aránzazu , Perez Segura Pedro , Mittal Abhenil , Tamimi Faris , Amir Eitan , Ocana Alberto
Published: June 2023

e14639

Background: Identification of modulators of the immune response with inhibitory properties that could be susceptible for therapeutic intervention is a key goal in cancer research. An example is the human leukocyte antigen G (HLA-G), a nonclassical major histocompatibility complex (MHC) class I molecule, involved in cancer progression. Methods: We performed a systematic review and meta-analysis on the role of HLA-G expression and outcome in solid tumors. A total of 25 studies met the inclusion criteria comprising data from 4871 patients reporting overall survival (OS) outcomes, and 961 patients, in 5 studies, for disease free survival (DFS). This study was performed in accordance with PRISMA guidelines and registered in PROSPERO. Results: HLA-G expression was associated with worse OS (HR 2.09, 95% CI = 1.67 to 2.63; P < .001), that was higher in gastric (HR = 3.40; 95% CI = 1.64 to 7.03), pancreatic (HR = 1.72; 95% CI = 0.79 to 3.74) and colorectal (HR = 1.55; 95% CI = 1.16 to 2.07) cancer. No significant differences were observed between the most commonly utilized antibody (4H84) and other methods of detection. HLA-G expression was associated with DFS which approached but did not meet statistical significance. Conclusions: We describe the first meta-analysis associating HLA-G expression and worse survival in a variety of solid tumors.
Precision immuno-oncology (IO) ISH/IF multiplex panel: Spatial detection of cytokines and IO biomarkers.
Authors: Patel Bhavika , Dennison Brenna , Allen Stephanie , Stapleton Jacob , Archuleta Roni , Rath Mary Lou , Mehra Navi , Talwalkar Sameer S.
Published: June 2023

e14654

Background: Cytokines have a large impact on the tumor microenvironment by affecting cell growth, survival, inflammation, and differentiation. Understanding the spatial biology within the tumor microenvironment, including the cytokine organization within specific cell types, can lead to better treatment plans for patients. Methods: We developed a hybrid multiplex panel, using RNA in-situ hybridization (ISH) and immunofluorescence (IF) to investigate the spatial biology of the tumor microenvironment. This panel also enabled us to simultaneously detect the RNA of cytokines and protein of specific immuno-oncology (IO) biomarkers. This allows us to visualize spatially, not only the organization of cell types but also to identify the cellular sources of specific cytokines. In this study, we analyzed the tumor microenvironment of samples from non-small cell lung cancer (NSCLC) and breast cancer in two panels for cytokine RNAs and IO protein biomarkers. Panel 1 included TNFa and IL-2 cytokines combined with CD68 and CD163 IO protein biomarkers. Panel 2 consisted of IL-6 and IL-2 cytokines with PAX5 and CD3 IO protein biomarkers. Staining was completed on the Leica Bond RX autostainer, and slides were scanned using the PhenoImager Fusion. Visiopharm software wasused to analyze the tumor microenvironment of tissue samples and localize cytokines in specific cell types. Results: CD163 positive macrophages (M2 phenotype) were seen predominantly within the tumors (NSCLC and breast cancer) whereas CD68 positive macrophages were identified towards the periphery in the non-tumor microenvironment. NSCLC tumor cells showed higher expression levels of IL-2, IL-6 and TNFa compared to breast cancer tumor cells. Predominance of CD3 positive T cells was noted with relative lack of PAX5 positive B cells within both NSCLC and breast cancer tumors. Multiplexing enabled assessment of relative expression levels of IL-2, IL-6 and TNFa in T lymphocytes and macrophages and TNFa in dendritic cells. Conclusions: Our hybrid multiplex panel can provide insights into the visualization of spatial organization of tumor microenvironment. It also enables semi-quantitative assessments for the expression levels of cytokines and their relative expression within tumor and immune cells, thereby helping to correlate response to treatment, especially with checkpoint inhibitors.
Safety and tolerability of immune checkpoint inhibitor (CPI) use in advanced hepatocellular carcinoma (aHCC) with Child-Pugh (CP) class B and C.
Authors: Valerin Jennifer Brooke , Kaakour Dalia , Mar Nataliya , Vosoughi Elham
Published: June 2023

e14676

Background: The vast majority of HCC cases occur in the setting of liver cirrhosis. Patients with decompensated cirrhosis CHILD-Pugh Class B and C (CPB and CPC) are usually excluded from clinical trials. Here we report the safety and tolerability of CPI in patients with CPB/CPC. Methods: A retrospective chart review was performed of all patients with aHCC who received therapy with CPI from 1/2019 to 12/2022 at our institution. Patients with CP class B and C were included in this study. Safety endpoints included rates of immune-related adverse events (irAEs), grade ≥3 adverse events (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 5.0]), duration of treatment with CPI and overall survival (OS) were reported. Results: We performed this retrospective chart review of 60 patients with aHCC who were treated with CPI at our institution. A total of 22 patients with CPB and CPC at the time of CPI initiation were included, 86.4% with CPB (n=19) and 13.6% with CPC (n=3). Median age was 68 (range 40-82). Amongst patients with CPB, 10 patients (45.4%) had CP score 7 (CP7) and 9 patients (40.9%) had CP score 8 or 9. Single agent nivolumab was the most common CPI used, followed by pembrolizumab and combination of ipilimumab and nivolumab, 38.4%, 27.3% and 13.6% respectively. Any grade irAEs were reported in 54.5% of patients (n=12).9% of patients (n=2) had grade ≥3 irAEs. In the CP7 subgroup, the rate of irAEs reported was 40% and no grade ≥3 irAEs were observed. In contrast, 55.5% of patients with CP 8 and 9 experienced irAEs and of those, 11.1% had grade ≥3 irAEs (n=1). In the CPC subgroup, 2 out of 3 patients reported irAEs (75%), one with a grade 4 irAE. GI complications(n=5) were the most common irAEs reported, followed by endocrine (n=4) and dermatologic complications (n=3). The median time on treatment was 1.63 months (95% CI,1.08-2.99). The median overall survival from the time of CPI initiation was 3.7 months (95% CI, 1.97-9.79). Conclusions: Immunotherapy has an acceptable safety and toxicity profile in aHCC patients with CP7. Higher rate of irAEs were observed in patients with CP ≥8. Further studies are warranted to evaluate the safety of CPI in patients with CP ≥8. We reported shorter duration of treatment with CPI and shorter OS in real world practice compared with those reported in the CheckMate 040 trial.[Table: see text]
Tumor immunity portrait: An AI-driven molecular predictor combining tumor microenvironment and tumor mutational burden for immune checkpoint inhibitor response prediction.
Authors: Shilo Polina , Tarasov Artem , Filatova Anna , Danilov Konstantin , Valiev Ivan , Kotlov Nikita , Brown Jessica H. , Ogloblina Anna , Bagaev Alexander , Fowler Nathan
Published: June 2023

e14691

Background: Low response rates and toxicities from immune checkpoint inhibitors (ICI) highlight the need for improved ICI response prediction tools. Increasing evidence shows the tumor microenvironment (TME) plays a critical role in therapy response; however, current ICI response prediction methods often use a single tumor characteristic (i.e., tumor mutational burden [TMB]). Here, we present the BostonGene Tumor Immunity Portrait, an AI-driven molecular predictor based on the TME subtype combined with TMB status to identify ICI responders in non-small cell lung cancer (NSCLC), melanoma, and gastric cancer (GC). Methods: We collected a meta cohort from 26 publicly available datasets (n = 2,077) composed of NSCLC, melanoma, and GC patients that received ICI therapy. A transcriptomic-based TME subtyping approach was used to classify the TME as fibrotic (F), immune-enriched, fibrotic (IE/F), immune-enriched (IE), or desert (D) (Bagaev, Cancer Cell, 2021). TMB status (low < 10; high > 10) was determined by whole exome sequencing. A logistic regression model was used to generate a score of 0, 1, 2, or 3 based on the sum of points assigned to the TME subtype (F = 0 points, IE/F and D = 1 point, IE = 2 points) and to the TMB status (high = 1 point and low = 0 points). Each score corresponded to one of four Tumor Immunity Portrait types: 0 - Immunosuppressive; 1 - Resistant; 2 - Neutral; 3 - Immune Primed. Results: Tumor Immunity Portrait types were associated with increasing ICI response rates in each cancer type. Immune Primed type (IE + TMB-High) response rates in melanoma and GC were 76.2% and 100%, respectively. Immunosuppressive type (F + TMB-Low) was associated with ICI non-response in melanoma (p = 0.003) and NSCLC (p < 0.001). The Tumor Immunity Portrait accurately predicted ICI non-response, shown by the negative predictive value (NPV) of the Immunosuppressive type (F + TMB-Low) for NSCLC (100%), melanoma (92.3%), and GC (96.1%). Conclusions: Using an integrated approach combining the tumor’s characteristics and TME, the BostonGene Tumor Immunity Portrait provides accurate prediction of ICI non-response in 3 cancer types, warranting further validation for use in personalized treatment decision making. [Table: see text]
Microbiome, socioeconomic status (SES), fiber intake, and response to checkpoint inhibitor therapy in patients with non-small cell lung cancer (NSCLC): A pilot study.
Authors: Patel Monaliben , Bebek Gurkan , Vu Brandon , Ghannoum Mahmoud , Berger Nathan A. , Bruno Debora S.
Published: June 2023

e14710

Background: Lung cancer affects a disproportional number of socioeconomically disadvantaged patients (pts). Responses to checkpoint inhibitor therapy (CIT) vary. Microbiome diversity may correlate with benefit from CIT. High fiber diets lead to microbiome diversity. We hypothesize that unexplained lung cancer disparities may be in part due to differences in microbiome diversity determined by unhealthy dietary patterns dictated by lower SES. Methods: Following IRB review, 25 pts with metastatic NSCLC starting CIT-based treatment were enrolled. Pre-treatment oral and fecal samples were collected. 24-hour dietary recalls were obtained. SES index was calculated based on education, employment, housing and annual income. High fiber intake was defined as > 20 g/day. Best treatment response per RECIST 1.1 was assessed. Microbial 16s rRNA were sequenced with Illumina MiSeq platform. Sequence analyses utilized QIIME 2 with DADA2 plugin. Taxonomic assignments used the Greengenes database. Microbiome composition was analyzed by calculating alpha diversity (Chao1, Shannon diversity and Simpson index), beta diversity and differential abundance of microbial compositions. Hierarchical linear model was constructed for each SES variable with and without biological covariates. Results: Pts with samples >1000 operational taxonomic unit (OTU) levels were included (N = 22) in the analysis. 50% were male, median age was 71, 36% (8/22) were of Black race and 23% (5/22) were of low SES. Median fiber intake was 11.9 grams. Males had higher alpha diversity than females (p=.038). Pts with high fiber intake had greater fecal Proteobacteria compared to low fiber intake pts (p<0.05). Bacteroides and Firmicutes fecal levels were significantly different for all pts compared to Human Microbiome Project (HMP) reported normal levels (p<0.01). Actinobacteria and Proteobacteria levels for low-fiber intake pts were also significantly elevated compared to HMP normal levels (p<0.05). There were no differences observed in microbiome when comparing SES index. However, high SES index patients had elevated fecal levels of Actinobacteria, Firmicutes and Proteobacteria and lower levels of Bacteroides compared to HMP levels. There was a trend towards higher alpha diversity of oral samples in partial responders pts compared to those with stable or progression of the disease (p=0.08). Conclusions: Pts with metastatic NSCLC exhibited different microbial composition compared to HMP normal levels. Associations between SES and microbial distribution in such pts warrant further investigation. Increased sample size is needed to better determine differences in oral microbiome in responders to immunotherapy and better evaluate the role of sex in this setting.
Retrospective analysis of digital biomarker predictability of immune checkpoint inhibitor therapy outcomes in patients with NSCLC.
Authors: Abousaud Marin , Frame David , Harvey R. Donald , Kaddoura Layan , Ekpenyong Asari , Abousaud Aseala , Steuer Conor Ernst , Derstine Brian , Wang Nicholas C. , Mackler Emily R.
Published: June 2023

e14713

Background: Immune checkpoint inhibitor (ICI) therapy (pembrolizumab monotherapy and pembrolizumab combined with platinum-based chemotherapy) is recommended as first line for patients with PD-L1 positive advanced or metastatic non-small cell lung cancer (NSCLC) without actionable biomarkers due to incredible improvements in overall survival (OS). Despite this, 15-20% of patients do not respond to ICI therapy in NSCLC. This study examines the effect of body composition features, via analytic morphomics, in conjunction with current clinical and laboratory data to predict ICI response. Methods: This retrospective analysis included 35 patients from the University of Michigan (UM) with newly diagnosed advanced or metastatic NSCLC (adenocarcinoma) receiving single-agent pembrolizumab or in combination with chemotherapy between January 2018 – December 2020. Clinical/ laboratory data included patient gender, age, BMI, neutrophil to lymphocyte ratio (NLR), PDL1 %, and albumin. Analytic Morphomics was performed using proprietary, semi-automated high-throughput CT image processing (mBIOHEALTH, Inc.). Multivariable Cox regression analysis identified clinical and morphomic characteristics predictive of OS at 6 months. Risk models were developed on the UM cohort and tested on an external validation dataset of 24 adenocarcinoma patients from Emory Healthcare who received similar treatment between January 2018 to December 2021. Results: Among the evaluable patients at both sites, 15 (43%) at UM and 19 (79%) at Emory were female, mean age was 66 years at UM and 70 years at Emory, and 6-month OS (95% CI) was 89% (80%, 100%) at UM and 71% (55%, 92%) at Emory. Five regression models with risk scores were assessed with the UM data and then tested with the Emory dataset. Of the five models, 2 matched in their predictability of 6-month OS at both sites. The first, a model of clinical and laboratory features only (age, BMI, PDL1 > = 50%, NLR, and albumin) which had an AUC of 0.79 at UM and 0.66 at Emory. The other utilized an L3 skeletal muscle z-score threshold ( < = -1) alone (previously studied as a measurement of sarcopenia) with an AUC of 0.741 at UM and 0.57 at Emory. Conclusions: Our analysis indicates that the measurement of muscle z-score prior to initiating treatment with ICIs in patients with NSCLC could serve as an indicator for those patients who are unlikely to benefit from therapy. This may be especially important for ICI therapy as skeletal muscle effects the immune function through myokines. Sarcopenia has been associated with immune senescence and thus may play a significant role in decreasing response to ICI therapy. More analysis is warranted with a larger patient population.
Analysis of systemic immune changes in patients with advanced cancer treated with immunotoxin LMB-100 and tofacitinib.
Authors: Skorupan Nebojsa , Peer Cody J. , Yu Yunkai , Lee Min-Jung , Lee Sunmin , Rastogi Shraddha , Sato Nahoko , Choo-Wosoba Hyoyoung , Hassan Raffit , Figg William Douglas , Cao Liang , Trepel Jane B. , Pastan Ira , FitzGerald David J.P. , Alewine Christine
Published: June 2023

e15017

Background: LMB-100 recombinant immunotoxin delivers a modified Pseudomonas exotoxin A payload to mesothelin-expressing tumors. Almost all patients receiving LMB-100 develop anti-drug antibodies (ADAs) after 2 cycles/ 6 doses of the drug, therefore reducing peak serum drug concentrations to near the lower limit of detection. Tofacitinib is an oral JAK inhibitor that had been shown to prevent ADA formation in pre-clinical studies. Apart from assessing safety and tolerability, this trial sought to determine whether co-administration of tofacitinib with LMB-100 delays the formation of neutralizing ADAs so more patients could achieve the peak LMB-100 concentration of > 600 ng/mL during treatment cycle 2. Correlative data examining circulating immune cell subsets and cytokines pre- and on-treatment are presented here. Methods: Patients with pancreatic adenocarcinoma (n = 13) and other mesothelin-expressing solid tumors (n = 3; cholangiocarcinoma, appendix, cystadenocarcinoma) were treated for up to 3 cycles (21 days) with LMB-100 given on days 4, 6, and 8 at 2 dose levels (100 and 140 mcg/kg), accompanied by oral tofacitinib for the first 10 days of the cycle (10 mg BID). Adverse events were assessed as per CTCAE 5.0. Analysis of the cytokine data was performed using a Wilcoxon signed-rank test. Results: DLTs of grade 3 cardiac toxicity (n = 1) and grade 4 hyponatremia (n = 1) were seen at the 140mcg/kg dose of LMB-100. One patient treated at 100 mcg/kg developed a grade 4 pericardial effusion, resulting in early closure of the study for safety. The two patients who experienced cardiac toxicity had lower baseline CD4+ cells and increased CD19+ cells post-LMB-100 treatment. Four out of 8 evaluable patients achieved LMB-100 concentration above the threshold during cycle 2, and 2 out of 3 did so during cycle 3. Analysis of peripheral blood cytokine levels showed sustained increases in TNF-α, IL-8, and IL-10 following LMB-100 administration through to the start of cycle 2. Percentage of Tregs increased through cycle 1 in patients who developed drug-neutralizing ADAs and was significantly higher than in patients with LMB-100 levels above threshold at the start of cycle 2. Conclusions: Combination of LMB-100 with tofacitinib is not safe. An insufficient number of patients was treated to conclusively assess the ability of tofacitinib to stop or delay ADA formation. Increases in circulating Tregs were observed in patients with early neutralizing ADA formation. Clinical trial information: NCT04034238 .
Methylated ctDNA as a biomarker for detecting previously undetectable clinically significant somatic mutations.
Authors: Ye Patrick Peiyong , Woodward Brian D. , Langpap Sydne , Viens Robb , Shelburne Katherine , Zhou Wen , Zhu Joyce , Wignall Jan , Searle Naomi , Varga Matthew Gordon , Palmer Gary A. , Tsao David , Atay Oguzhan , Husain Hatim
Published: June 2023

e15020

Background: Treatment selection liquid biopsies can be re-run upon clinical progression to identify the new clinically significant somatic mutations that might be contributing to resistance to therapy or that can help guide the selection of an alternative therapy. However, there are not currently any biomarkers or tests that suggest an increased likelihood for the detection of new, i.e. previously undetected, clinically significant somatic mutations in a subsequent treatment selection liquid biopsy assay. Methods: We explored whether a methylation-based liquid biopsy could indicate when new clinically significant alterations are more likely to be detected in a treatment selection liquid biopsy. As part of a retrospective study of metastatic lung cancer patients (N = 75 new treatment starts), both a treatment selection assay and a therapy monitoring methylation assay were performed on plasma collected pre-treatment for a subset of patients that underwent at least two separate treatment regimens. By quantifying the number of methylated ctDNA molecules at > 500 genomic locations, the methylation assay assessed the total burden of methylated ctDNA (represented as tumor methylation score), as well as the percent of methylated molecules originating from newly methylated genomic loci, representing a change in the methylation profile. Results: When the methylation assay detected at least a 2x increase in the tumor methylation score, indicating a significant increase in the fraction of ctDNA present in the patient’s blood, new clinically significant somatic mutations (including actionable ERBB2 alterations) were found 83% of the time. This appeared to be more frequent than among patients without an increase in tumor methylation score, where new clinically significant somatic mutations were found 33% of the time. Importantly, when the increase in the methylation score was coupled with a significant change in the methylation profile, new clinically significant mutations were identified in 100% of patients. Conclusions: The preliminary data suggests that an overall increase in methylated ctDNA, in combination with a significant change in methylation profile, is correlated with detecting new, previously undetected clinically significant somatic mutations in a treatment selection assay. Leveraging this methylated ctDNA assay may inform clinicians as to when to run another treatment selection assay, thereby potentially identifying the appearance of clinically significant somatic mutations which could influence clinical decision making and affect patient clinical outcomes.
A next-generation sequencing methylation assay for sub-typing small cell lung cancer in cell-free DNA.
Authors: Huang chung-Ying , Berkebile Ashley D. , Parker Allison , Hernandez Jennifer , Meacham Frazer , Garg Kavita , Guo Jiannan
Published: June 2023

e15021

Background: Liquid biopsy provides an easy access and minimally invasive technique to inform cancer patient management in clinics as well as clinical trials. Detecting genomic alterations in circulating tumor DNA (ctDNA) has demonstrated clinical utility and actionability in therapy selection and longitudinal monitoring. The development of a comprehensive assay that provides multi-omic information is imperative to expand the utility of liquid biopsy. Methods: Agilent Resolution ctDNA diagnostic assays can detect all four major types of actionable genomic alterations for cancer patients: SNVs, Indels, fusions, and CNVs. The Agilent Resolution ctDx FIRST assay has recently been approved by the FDA as a companion diagnostic assay for non-small cell lung cancer (NSCLC). Applying the same core technology, we developed an additional assay that enables methylation profiling in cfDNA. The custom methylation-specific panel targets informative regions to detect tumor signals and potentially profile the disease by subtype. Recent reports suggest that small cell lung cancer (SCLC) may be stratified into subtypes based on gene expression, including that of ASCL-1, NEUROD1, and POU2F3. We used the proposed SCLC subtyping model to test the feasibility of subtyping SCLC by cfDNA methylation profiles. A baseline methylation profile was established using cell-free DNA from healthy donors. Test samples included genomic DNA from SCLC cell lines and plasma samples of SCLC patients with matching tissue, where available. Results: We applied a methylation-specific bioinformatic pipeline that generates error-corrected unique molecules. The methylation workflow showed unique coverage comparable to our ctDx assay and produced consistent results from input DNA as low as 1ng. We found consistent methylation patterns in cfDNA among healthy donors. SCLC cell lines showed distinct profiles that could be classified into sub-types. When spiked into healthy donor cfDNA background, the tumor signals were distinguishable down to ~0.5%. Plasma samples from SCLC patients showed profiles consistent with that of SCLC sub-types defined by cell lines. Matching plasma and tissue samples produced concordant sub-typing results, supporting the feasibility of disease subtyping in both sample types. Samples were also tested by a custom SCLC panel to analyze genomic alterations. Prevalent variants in SCLC were detected, including SNVs in TP53, PIK3CA, RB1, and MYC amplifications. Conclusions: We showed a cfDNA methylation profiling platform that could support disease sub-typing for SCLC. This platform has great potential in disease stratification and patient management.
Somatic hereditary gene panel analysis: A pilot study from Uzbekistan.
Authors: Olimova Zilola Avazovna
Published: June 2023

e15044

Background: Molecular diagnostics is gaining importance in routine clinical practice. Availability of actionable genetic changes in hereditary panel of genes has acquired even larger interest. This study is an attempt evaluate the limited somatic genetic alterations in small population of Uzbek patients. Methods: Somatic tumor sample material was analyzed using FOUNDATIONONER CDx (F1CDx) - the NGS based in vitro diagnostic device for detection of substitutions, insertion and deletion alterations(indels), and copy numbers alterations (CNAs) in 324 genes and select gene rearrangements, as well as genomic signatures. Our focus of hereditary panel included following genes-TP53, CDH1, PTEN, STK11, PALB2, CHEK2, ATM, NBN, BARD1, BRCA1 and BRCA2. Results: Out of 76 patients analyzed 50 were found have at list one abnormal gene from the above hereditary panel. TP53 was frequent pathogenic mutation in 50 of 76 patients. Commonest hereditary gene alterations were seen in ATM gene -12/50(6%). BRCA2 mutations existed in 7 of 50(3,5%), PTEN – 6/50(3%), PALB-2 – 4/50(2%), CHEK-2 – 5/50(2,5%), NBN – 5/50(2,5%), STK11 – 3/50(1,5%), CDH1 – 2/50(1%), BRCA1-2(1%), BARD1 – 1/50(0,5%). Some patients had multiple gene combinations. One of the patients had four gene abnormality-PTEN, PALB2, CHEK2, and BRCA2.Three patients have 3(1,5%) somatic hereditary mutations, 23(11,5%) patients have two abnormal hereditary genes and 38(19%) patients had changes in single gene only. Important actionable mutations (BRCA, PALB2 and CHEK2 were found in 15(11,4%) patients. Conclusions: This is the first exploratory analysis of somatic hereditary multi-gene panel. About 11% of the patients were found to have actionable gene mutations.