bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between genomic alterations and response of triple-negative breast cancers (TNBC) to talimogene laherparepvec (TVEC) in combination with neoadjuvant chemotherapy (NACT).
Authors: Soliman Hatem Hussein , Han Hyo S. , Mooney Blaise , Costa Ricardo L , Lee Marie Catherine , Niell Bethany , Chau Alec , Falcon Shannon , Soyano Muller Aixa Elena , Armaghani Avan J. , Khakpour Nazanin , Weinfurtner Robert J , Hoover Susan , Kiluk John , Laronga Christine , Rosa Marilin , Khong Hung T. , Czerniecki Brian J.
Published: June 2023

598

Background: TVEC is an engineered oncolytic virus (OVs) approved for the treatment of melanoma. We published a phase 1/2 trial combining TVEC with NACT in early stage TNBC demonstrating increased pathologic complete response (pCR) compared to expected rates with NACT. RNAseq was performed on 37 pretreatment samples from enrolled patients to identify potential predictive genomic alterations. Methods: Transcriptomic RNA sequencing analysis was performed on macrodissected tumor tissue through the Moffitt Molecular Genomics core using Illumina Truseq RNA exome kits. Read adapters were detected using BBMerge (v37.88) and removed with cutadapt (v1.8.1). For gene expression analysis, processed raw reads were aligned to human genome HG19 using STAR (v2.5.3a). Gene expression was evaluated as read count at gene level with HTSeq (v0.6.1) and Gencode gene model v19. Gene expression data were normalized and differential expression between experimental groups were evaluated using DEseq2 (v 1.38.2). Ensembl was used for SNP data search. Results: Tumor mutation burden was not significantly different between pCR and non-pCR samples (median 227 vs 222 mut/MB, p = .11). Top 5 upregulated non-immunoglobulin genes associated with pCR in baseline samples were MYBL1, DNAH8, NR2E1, FGFR2, and SLC12A1 (FDR < 1%). A single nucleotide polymorphism (SNP) of the EIF2A gene (c.C290G, p.T97S) was the top variant associated with response present in 21/37 samples (non-pCR = 17/21 vs. pCR = 4/21, FDR = < 1%). This exon 4 coding region SNP is present in 17% of Black, 35% of White, and 46% of Asian individuals but its biologic or clinical significance is unknown. Lower EIF2A pathway activation was associated with inferior response to therapy. Additional data will be presented at the meeting. Conclusions: Genomic alterations including a EIF2A SNP were correlated with response to OV plus NAC in TNBC. EIF2A is an important mediator of cellular responses to OV and may play a role in susceptibility to oncolysis. Additional investigation and validation of these variations in experimental models of OV susceptibility may provide predictive biomarkers for TNBC patients treated with OV plus NAC therapy. Clinical trial information: NCT02779855 .
Randomised phase III trial of the hypoxia modifier nimorazole added to radiotherapy with benefit assessed in hypoxic head and neck cancers determined using a gene signature (NIMRAD).
Authors: Thomson David , Slevin Nick , Baines Helen , Betts Guy , Bolton Steve , Evans Mererid , Garcez Kate , Irlam Joely , Lee Lip , Melillo Nicola , Mistry Hitesh , More Elisabet , Nutting Christopher , Price James , Ryder David , Schipani Stefano , Sen Mehmet , Yang Huiqi , West Catharine ,   on behalf of the NIMRAD Investigators
Published: June 2023

6006

Background: Tumour hypoxia is an adverse prognostic factor in head and neck squamous cell carcinoma (HNSCC). We assessed whether patients with hypoxic HNSCC benefited from the addition of nimorazole to definitive radiotherapy (RT). Methods: NIMRAD was a phase III, multi-centre, placebo-controlled, double-blind trial in patients with HNSCC unsuitable for concurrent platinum chemotherapy or cetuximab with definitive RT (NCT01950689). Patients were randomized 1:1 to receive nimorazole (1.2 g/m2 daily, prior to RT) + RT (65 Gy in 30 fractions over 6 weeks) or placebo (taken via the same schedule) + RT. The primary endpoint was loco-regional control (freedom from loco-regional progression, FFLRP) in patients with hypoxic tumours, defined as greater than or equal to the median hypoxia score of the first 50 patients analysed (≥0.079), using a validated 26-gene signature. The planned sample size was 340 patients allowing for signature generation in 85%, assumed HR 0.50 for nimorazole effectiveness in the hypoxic group, and requiring 66 loco-regional failures to have 80% power in a two-tail log-rank test at the 5% significance level. Results: 338 patients were randomised by 19 UK centres from May 2014 to May 2019, with a median follow-up of 3.1 years (95%CI 2.9-3.4). Hypoxia scores were available for 286 (85%). The median patient age was 73 years (range 44-88); and clinical factors were balanced between the arms, both for the whole population and hypoxic group (Table). There were 36 (25.9%) loco-regional failures in the hypoxic group, where nimorazole + RT did not improve FFLRP (adjusted HR 0.72; 95% CI 0.36-1.44; p=0.35), or overall survival (adjusted HR 0.96; 0.53-1.72; p=0.88) compared with placebo + RT. Similarly, nimorazole + RT did not improve FFLRP or OS in the whole population. In total (n=338), 73% of patients allocated nimorazole adhered to the drug for ≥50% of RT fractions. Nimorazole + RT caused more acute nausea compared with placebo + RT (CTCAE v4.0 G1+2: 56.6% vs 42.4%, G3: 10.1% vs 5.3%, respectively; p=0.003), with no differences in other early or late toxicities. Conclusions: Addition of the hypoxia modifier nimorazole to RT for locally advanced HNSCC in older and less fit patients did not improve loco-regional control or survival. Clinical trial information: NCT01950689 . [Table: see text]
Final overall survival analysis of JUPITER-02: A phase 3 study of toripalimab versus placebo in combination with gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (NPC).
Authors: Mai Hai-Qiang , Chen Qiu-Yan , Chen Dong-Ping , Hu Chaosu , Yang Kunyu , Wen Jiyu , Li Jin-Gao , Shi Yingrui , Jin Feng , Xu Ruilian , Pan Jian-ji , Qu Shenhong , Li Ping , Hu Chunhong , Liu Yi-Chun , Jiang Yi , He Xia , Wang Hung-Ming , Lim Darren Wan-Teck , Xu Rui-Hua ,   Coherus Biosciences and Shanghai Junshi Biosciences
Published: June 2023

6009

Background: There are currently no FDA-approved IO therapies for NPC. Toripalimab in combination with Gemcitabine-Cisplatin (GP) chemotherapy had shown significant improvement over chemotherapy alone in progression-free survival (PFS) as first-line treatment for recurrent or metastatic (r/m) NPC at the interim PFS analysis of JUPITER-02 (NCT03581786) study. The final overall survival (OS) analysis results are summarized here. Methods: Patients with r/m NPC (n = 289) were randomized (1:1) to receive toripalimab 240 mg (n = 146) or placebo (n = 143) in combination with GP once every 3 weeks (Q3W) for up to 6 cycles, followed by monotherapy with toripalimab or placebo Q3W until disease progression, intolerable toxicity, or completion of 2 years of treatment. Stratification factors were ECOG performance score (0 vs. 1) and extent of disease (recurrent vs. primary metastatic) at enrollment. The primary endpoint was PFS by an independent review committee. Secondary endpoints included OS and safety. Results: By the cutoff date of Nov 18, 2022, when 133 events were reached for the final OS analysis, the median survival follow up was 30.1 months. A significant improvement in OS was observed for the toripalimab arm over the placebo arm: HR = 0.63 (95% CI: 0.45-0.89), two-sided p = 0.0083. The median OS was not reached in the toripalimab arm and was 33.7 months in the placebo arm. The 2-year and 3-year OS rates were 78.0% vs. 65.1%, and 64.5% vs. 49.2% respectively. A consistent effect on OS, favoring the toripalimab arm, was observed in nearly all subgroups, including PD-L1 high and PD-L1 low expression subgroups. No new safety signals were identified in the toripalimab arm since the interim report. The incidence of Grade ≥3 adverse events (AEs) (89.7% vs 90.2%) and fatal AEs (3.4% vs 2.8%) were similar between two arms. However, AEs leading to discontinuation of toripalimab/placebo (11.6% vs 4.9%), immune-related (irAEs) (54.1% vs. 21.7%) and Grade ≥3 irAEs (9.6% vs. 1.4%) were more frequent in the toripalimab arm. Conclusions: The addition of toripalimab to GP chemotherapy as 1st-line treatment for r/m NPC provided clinically important and highly significant OS advantage over GP alone with a manageable safety profile. These results support the use of toripalimab with GP chemotherapy as the new standard care for this population. Clinical trial information: NCT03581786 .
Circulating tumor DNA (ctDNA) monitoring in patients with breast cancer receiving neoadjuvant palbociclib and endocrine therapy: A secondary analysis of the NeoRHEA phase 2 study.
Authors: Stanciu Alexandra , Papagiannis Andreas , Pipinikas Christodoulos , Campbell Nathan , Brandão Mariana , Cailleux Frederic , Agostinetto Elisa , Ameye Lieveke , Paesmans Marianne , Besse-Hammer Tatiana , Awada Ahmad , Piccart-Gebhart Martine J. , Sotiriou Christos , Neven Patrick , Duhoux Francois P. , Rosenfeld Nitzan , Vuylsteke Peter , Ignatiadis Michail
Published: June 2023

601

Background: Personalized circulating tumor DNA (ctDNA) assays are being evaluated in early breast cancer (BC). We investigated the value of ctDNA monitoring in the NeoRHEA study. Methods: NeoRhea (NCT03065621) is a single arm phase 2 study in which patients with estrogen receptor (ER)+/HER2- early breast cancer were treated with neoadjuvant palbociclib + endocrine therapy (ET) for 4 months. Plasma samples were collected at four timepoints: pre-treatment (BL), after the first treatment cycle (C1D28), before surgery (Surgery) and one month post Surgery (End of Study). ctDNA detection was evaluated using the personalized RaDaR assay. Whole-exome sequencing (WES) was performed on BL tumor biopsies followed by a personalized assay development using tumor, plasma and normal DNA in order to track up to 48-patient specific somatic variants in plasma cell-free DNA (cfDNA) using next generation sequencing. Associations between ctDNA detection and BL clinical-pathological characteristics, cell cycle arrest (CCCA) defined as Ki67 ≤2.7% at surgery, residual cancer burden (RCB) rate and breast cancer free survival (BCFS) were investigated. Results: Of 100 patients enrolled, 78 patients and 302 plasma samples were successfully profiled by the RaDaR assay. The number of variants targeted by the assay ranged between 7-48 (median = 25). The median estimated variant allele fraction for ctDNA positive samples was 0.02% (range 0.0009%-0.91%). A total of 42/76 patients were ctDNA positive at BL, 4/76 at C1D28, 4/75 at Surgery and 0/75 at End of Study. Out of 78 patients, 68% were postmenopausal, 78 % had cT2 and 69% cN0 tumors, 20% had multifocal/multicentric tumors, 18% had histological grade 3 tumors, 76% had CCCA (Ki67 not available in 20 patients) and 34% RCB 3 at surgery. ctDNA detection at BL was higher in histological grade 3 tumors (p = 0.03), lower in multifocal/multicentric tumors (p = 0.01), higher in RCB III tumors, (p = 0.01) but was not associated with CCCA. With a median follow-up of 3.8 years (range 1-5 years), 4 patients developed distant and one patient locoregional recurrences. ctDNA detection after one month of treatment (logrank p = 0.02), but not at baseline (p = 0.59) nor at surgery (p = 0.67) was associated with worse BCFS. Conclusions: Detection of ctDNA in early-stage breast cancer is challenging. Our data suggests association of ctDNA detection with some pathological and clinical variables. Independent validation is needed. Clinical trial information: NCT03065621 .
Neoadjuvant nivolumab alone or in combination with relatlimab or ipilimumab in resectable head and neck squamous cell carcinoma (HNSCC).
Authors: Ferris Robert L. , Gooding William E. , Chiosea Simion I. , Duvvuri Umamaheswar , Kim Seungwon , Kubik Mark , Sridharan Shaum , Fenton Moon Jung , Skinner Heath Devin , Kelly Zahra Rahman , Li Housaiyin , Vujanovic Lazar , Zandberg Dan Paul
Published: June 2023

6018

Background: PD-1 inhibition using nivolumab (nivo) monotherapy is modestly effective in metastatic HNSCC. Neoadjuvant trials using nivo may permit development of more effective combinations in surgically resectable HNSCC. We evaluated combinations with nivo plus additional immune checkpoints, CTLA-4 (ipilimumab, ipi) and LAG-3 (relatlimab, rela). Methods: Phase II randomized trial of neoadjuvant nivo alone (240 mg q2 weeks), or with ipi (1 mg/kg q3 weeks) or rela (160 mg q4 weeks) for 4 weeks prior to surgery. Response was scored using RECIST and standard pathologic response criteria. Patients were stratified by p16, PD-L1, and LAG-3, with staining assessed by immunohistochemistry. Freshly digested tumors were subjected to single cell RNA sequencing (scRNAseq) for T cell receptors and gene pathways to identify biomarkers of response or progression. The Cochran-Armitage trend test was used to explore associations with increasing pathological response efficacy. Results: 41 patients (pts) have been enrolled, with 33 evaluable for this analysis. Of these 33, median age is 63 (32-81), primary site oral cavity (n=25), oropharynx (n=5, 3 HPV), larynx (n=3), clinical T2 (n = 5), T3 (n = 12), T4 (n = 13), and cN0/1 (n = 22), cN2 (n = 9), and PD-L1 CPS > 1 (n=25). There were no serious study drug-related AEs or unexpected surgical delays/complications. Pathologic response (Table) was more frequent with nivo/rela (11/13) vs. nivo/ipi (6/10) or nivo (4/10). Partial (>50%) or major (>90%) pathologic responses were more frequent and deeper in the combination arms. Minor (<50%) pathologic responses were more frequent with nivo/rela, and similar between nivo/ipi and nivo. There was no association between RECIST response, PD-L1, or LAG3 and pathologic response. Combined PD-L1 and LAG3 expression was not associated with pathologic response in the nivo/rela arm, however more patients with combined positivity had a >50% response (4 vs. 0). Expansion of CD8+ T cells, as well as expanded proportion of CD8+ CXCL13+ T cells in responder tumors were identified in post-treatment specimens using scRNAseq. Conclusions: Neoadjuvant nivo/ipi or nivo/rela combinations were safe and associated with promising pathologic responses compared to nivo monotherapy. Anti-tumor CD8+ T cell populations and targetable pathways are emerging in responder patients. The trial continues to enroll and further evaluation of this strategy is warranted. Clinical trial information: NCT04080804 . [Table: see text]
Influence of widely targeted quantitative lipidomics on plasma lipid predictors and pathway dysregulation for nasopharyngeal carcinoma.
Authors: Chen Xi , Guo Xiang , Lv Xing
Published: June 2023

6030

Background: Dysregulation of lipid metabolism is closely associated with cancer progression. We aimed to establish a prognostic model to predict distant metastasis-free survival (DMFS) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC), based on widely targeted quantitative lipidomics. Methods: We measured and quantified the plasma lipid profiles of 179 patients with NPC using widely targeted quantitative lipidomics. Then, patients were randomly split into the training (125 patients, 69.8%) and validation (54 patients, 30.2%) sets. To identify distant metastasis-associated lipids, univariate Cox regression was applied to the training set ( p< 0.05). We employed a deep survival method called DeepSurv to develop our proposed model based on significant lipid species ( p< 0.01) and clinical biomarkers to predict DMFS. Concordance index and receiver operating curve analyses were performed to assess model effectiveness. We also explored the potential role of lipid alterations in the prognosis of NPC. Results: A total of 665 plasma endogenous lipid species consisting of 27 lipid classes and subclasses from 179 patients with NPC were annotated in lipidomics analysis. Forty lipids were recognized as distant metastasis-associated ( p< 0.05) by univariate Cox regression. The concordance indices of our proposed model were 0.764 (95% confidence interval (CI), 0.682–0.846) and 0.760 (95% CI, 0.649–0.871) in the training and validation sets, respectively. We also calculated the C-index values of the baseline survival model based only on clinical biomarkers, with 0.718 (95% CI, 0.591–0.845) and 0.672 (95% CI, 0.511–0.833) being detected in the training and validation sets, respectively, indicating the outstanding predictive performance of lipid biomarkers. High-risk patients had poorer 5-year DMFS compared with low-risk patients (Hazard ratio, 26.18; 95% CI, 3.52–194.80; p< 0.0001). Moreover, the six lipids were significantly correlated with immunity- and inflammation-associated biomarkers and were mainly enriched in metabolic pathways. Conclusions: Widely targeted quantitative lipidomics reveals plasma lipid predictors and pathway dysregulation for locoregionally advanced NPC, the prognostic model based on that demonstrated superior performance in predicting metastasis in NPC patients.
A phase II trial of paclitaxel plus biweekly cetuximab for patients with recurrent or metastatic head and neck cancer previously treated with both platinum-based chemotherapy and anti-PD-1 antibody.
Authors: Koyama Taiji , Kiyota Naomi , Imamura Yoshinori , Boku Shogen , Shibata Nobuhiro , Satake Hironaga , Tanaka Kaoru , Hayashi Hidetoshi , Iwae Shigemichi , Onoe Takuma , Asada Yukinori , Yamazaki Tomoko , Nose Taku , Ohata Shinya , Kimbara Shiro , Nagatani Yoshiaki , Minami Hironobu
Published: June 2023

6032

Background: An important unmet need in treatment options remains for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC) previously treated with both platinum-based chemotherapy and anti-PD-1 antibody (PD-1 Ab). Recent retrospective studies suggest that previous treatment with Immune checkpoint inhibitor might augment the efficacy of subsequent chemotherapy. This phase II trial aimed to evaluate the efficacy and safety of paclitaxel plus biweekly cetuximab (PTX+bwCmab) for patients with R/M-HNSCC previously treated with both platinum and PD-1 Ab. Methods: This is a single-arm, multicenter phase II trial. Key eligibility criteria were R/M-HNSCC; previous treatment with both platinum-based chemotherapy and PD-1 Ab; ECOG performance status 0 or 1; measurable disease per RECIST v1.1; and adequate organ function. PTX+bwCmab consisted of weekly paclitaxel 100 mg/m2 (days 1, 8, 15) and biweekly cetuximab 500 mg/m2 (days 1, 15) with a cycle of 28 days. Primary endpoint was objective response rate (ORR). We set a null hypothesis of 10% and alternative of 30% with a one-sided alfa of 0.05 and power of 90%. Secondary endpoints were progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events (AEs) (CTCAE v5.0). Binominal confidence intervals (CIs) for ORR and DCR were estimated by the exact method. Time-to-event analyses were calculated by the Kaplan-Meier method with 95% CIs. Results: Between August 2020 and August 2022, 35 patients were enrolled, of whom 32 were evaluable for response. ORR was 68.7% (95% CI: 49.9-83.8), which met the prespecified criteria for the primary endpoint of ORR. With a median follow-up period for survivors of 16.6 months, median PFS and OS were 5.7 and 13.4 months, respectively. DCR was 93.7% (95% CI: 79.1-99.2). The most common AEs of any grade were skin rash (65%), peripheral nerve neuropathy (45%), neutropenia (40%), fatigue (40%) and paronychia (37%). Grade 3 and 4 adverse events included neutropenia (34%), mucositis (8%), pneumonitis (8%) and febrile neutropenia (5%). These AEs were manageable and no treatment-related death within 30 days was observed. Conclusions: PTX+bwCmab showed highly encouraging efficacy and tolerability in RM-HNSCC patients previously treated with both platinum and PD-1 Ab. Although preliminary, these results suggest that this is a promising treatment option for this hitherto untreatable patient group. Further evaluation is warranted. Clinical trial information: jRCTs051200040 .
Phase I/IIa clinical trial of a small molecule EBNA1 inhibitor, VK-2019, in patients with Epstein Barr virus–positive nasopharyngeal cancer with pharmacokinetic and pharmacodynamic correlative studies.
Authors: Colevas A. Dimitrios Dimitrios , Rudek Michelle A. , Even Caroline , Lee Victor Ho-Fun , Gillison Maura L. , Khan Saad A. , Lu Rong , Winters Elizabeth , Biedermann Savanna , Lai Steven , Messick Troy
Published: June 2023

6035

Background: Epstein-Barr Virus (EBV) is associated with a diverse collection of malignancies, including nasopharyngeal carcinoma (NPC). One viral-encoded protein, EBNA1, is consistently expressed in all known EBV-associated malignancies and is critical for the replication and maintenance of the EBV genome in latently infected cells. VK-2019 is a first-in-class, orally bioavailable EBNA1 inhibitor that blocks latent replication and proliferation in preclinical studies. Methods: We conducted a Phase I/IIa clinical trial of VK-2019 as a single therapeutic agent in patients with advanced (recurrent or metastatic) NPC. An accelerated titration design allowed dose escalation to proceed rapidly from 60 mg/day to 1800 mg/day. Blood samples for detailed pharmacokinetic analyses were collected after the first and multiple doses. In addition, tumor biopsies were collected from 2 patients at the 1800 mg/day dose level at baseline and during treatment and analyzed for EBV copy number and viral and cellular gene expression. Results: A total of 22 advanced NPC patients were enrolled. VK-2019 was well tolerated with mostly grade 1-3 adverse events being reported. VK-2019 is rapidly absorbed with a biphasic distribution and a terminal T1/2 of ~12h after single or multiple doses. Cmax and AUC increases with dose escalation through 920 mg with large variability at 1800mg. Accumulation has been observed with multiple doses up to 460mg. Based on preclinical efficacy models, target exposures are at or above expected activity levels for patients at least on the 920 mg daily dose and above. A partial response ( > 30% decrease in tumor size) was observed for one patient. Preliminary results from biopsies from 2 patients show decreases in EBV copy number and viral gene expression (LMP2 and gp150). We also observed decreases in EBER-positive cells in one patient. Conclusions: In this study, VK-2019 was well tolerated, exhibiting an excellent safety profile and exposure above in vitro efficacy. An MTD has not been yet established. Preliminary results indicate a decrease in EBV copy number and viral gene expression in latently infected tumor cells in some patients. Alternate dose schedules are justified to determine the clinical efficacy of an EBNA1 inhibitor in patients with advanced NPC. Funded by NCI, R01-CA235633 and Cullinan Oncology. Clinical trial information: NCT04925544 .
Platinum/taxane/pembrolizumab vs platinum/5FU/pembrolizumab in patients with recurrent/metastatic (r/m) head and neck squamous cell carcinoma (HNSCC).
Authors: Sun Lova , Cohen Roger B. , Colevas A. Dimitrios Dimitrios
Published: June 2023

6039

Background: Pembrolizumab +/- chemotherapy is standard of care for patients (pts) with r/m HNSCC. Despite approval of platinum/5FU/pembrolizumab based upon the KN-048 study, a taxane is often substituted for 5FU due to ease of administration and tolerability. No studies have directly compared these approaches. We describe nationwide patterns of taxane vs 5FU chemoimmunotherapy in r/m HNSCC and compare survival and time on treatment between the two. Methods: This study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database, and included pts treated with frontline pembrolizumab plus platinum-based chemotherapy (either taxane or 5FU) for r/m HNSCC. Demographic, cancer, and clinical outcomes were summarized. Categorical variables were compared using Pearson’s chi-square test; continuous variables were compared using T-test. Overall survival (OS) was estimated using Kaplan Meier methodology, and compared using log-rank test. Multivariable Cox regression for overall survival adjusting for age, sex, race, year of diagnosis, ECOG performance status (PS), smoking history, primary tumor site, PD-L1, HPV status, cisplatin use, socioeconomic status, insurance, and practice type was performed, with multiple imputation by chained equations for missing variables. Results: Of 444 pts, 321 (72%) received 5FU and 123 (28%) received taxane (108 paclitaxel, 15 docetaxel). Use of cisplatin rather than carboplatin was higher in the 5FU group than the taxane group (16.8% vs 4.9%, p=0.001). Taxane use was higher in academic vs community practices (50.7% vs 23.9%, p<0.001); within community sites, Northeast states had highest taxane use (27.5%) and Western states had lowest taxane use (16.7%). Pts with Medicare or Medicaid were more likely to receive taxane (35.5%) vs commercial (23.6%) or other (26.7%) insurance. OS did not differ between taxane and 5FU groups (mOS 12.7 vs 13.5 months, p=0.743). On multivariable Cox regression, HR for death associated with taxane vs 5FU was 1.01 (95%CI 0.73-1.41). HPV positive status was associated with improved survival (HR 0.58, 95%CI 0.40-0.83). PS>1 (HR 1.38, 95%CI 0.96-1.98) and cisplatin use (HR 1.37, 95%CI 0.95-1.98) showed non-significant trends towards worse survival. Taxane-treated pts received more treatment cycles (mean 11.3 vs 8.8 cycles, p=0.015) and were on treatment slightly longer (mean 6.9 vs 6.0 months, p=0.289) than 5FU-treated pts. Conclusions: In US pts with r/m HNSCC undergoing chemoimmunotherapy, rates of taxane vs 5FU use vary by academic setting, geographic region, and insurance status. There was no difference in survival between 5FU and taxane, and taxane-treated pts received more cycles of therapy. Platinum-taxane appears to be a non-inferior alternative to platinum-5FU with pembrolizumab for r/m HNSCC, and should be allowed in clinical trials.
A phase 1 clinical trial of DB-020 intratympanic injections administered prior to high dose cisplatin chemotherapy to reduce ototoxicity.
Authors: Rischin Danny , O'Leary Stephen John , Hart Christopher David , Diwakarla Chandra Sai , Seetharamu Nagashree , Lee John , Raines Shane , Quigley Tera , Wolff Heather M , Lapuerta Pablo , Panizza Benedict J
Published: June 2023

6043

Background: Hearing loss with cisplatin (CP) chemotherapy is common. DB-020 is a formulation of thiosulfate for intratympanic (IT) injection being developed to reduce CP ototoxicity. The primary objective of this Phase 1 study was to evaluate the safety and tolerability of repeated IT injections of DB-020. A secondary objective was to compare hearing changes with DB-020 vs. placebo. Methods: Subjects scheduled for at least 3 cycles of CP and cumulative exposure of ≥280 mg/m2 were randomized to blinded, bilateral, IT injection with DB-020 (12% or 25%) in one ear and placebo in the other, once every 3 or 4 weeks, up to 3 hours before receiving CP. Subjects with moderate or severe hearing loss at baseline were excluded. Ototoxicity was defined by American Speech-Language-Hearing criteria: ≥20 dB threshold increase at any one test frequency, or ≥10 dB threshold increase in any two adjacent frequencies, or loss of response at three consecutive frequencies where responses were previously obtained. Severe ototoxicity was ≥20 dB threshold increase in any two adjacent frequencies. A pre-specified interim analysis evaluated safety, ototoxicity (with Mcnemar’s test using the last observation carried forward), and average threshold shifts (from air conduction audiometry, analyzed with a mixed model with repeated measures). Results: Nineteen subjects were randomized, with mean age of 57 years (84% male and 100% white) and mean cumulative CP dose 248 mg/m2. Most (95%) had head and neck cancers (5% had lung cancer). Seventeen subjects had both baseline and follow-up audiometry, and 16/17 had baseline audiograms within 5 dB of the median threshold for age-matched controls. Free CP systemic levels were similar to reference values. Ear pain (15/19 subjects, 78.9%) and tinnitus (8/19 subjects, 42.1%) were common. Ear pain was more common in DB-020 treated ears, and tinnitus was more common in placebo treated ears. There were no tympanic perforations, no serious adverse events in the category of ear and labyrinth disorders, and no deaths. Ototoxicity was significantly more common and more severe in placebo treated ears (Table). As the overall study objectives were met at this interim analysis, no further enrollment was pursued. Conclusions: In this initial clinical trial experience there was no significant safety signal, and DB-020 IT injections showed a meaningful reduction in cisplatin ototoxicity. These results warrant further clinical development. Clinical trial information: NCT04262336 . [Table: see text]
Association between locoregional failure and NFE2L2/KEAP1/CUL3 pathway mutations in NRG/RTOG 9512: A randomized trial of hyperfractionation vs. conventional fractionation in T2N0 glottic squamous cell carcinoma (SCC).
Authors: Guan Li , Torres-Saavedra Pedro A. , Zhao Xiaobei , Major Michael B. , Holmes Brittany J. , Nguyen Ngan , Kumaravelu Parasakthy , Hodge Tim , Diehn Maximilian , Zevallos Jose , Emami Bahman , Sagar Stephen M. , Morrison William H. , Schultz Christopher J. , Caudell Jimmy J. , Jones Christopher U. , Yom Sue S. , Harris Jonathan , Le Quynh-Thu , Hayes David N.
Published: June 2023

6054

Background: Radiotherapy (RT) is the primary treatment for patients with T2N0 glottic SCC. ~30% of these patients experience locoregional relapse despite dose escalation. Mutations in the NFE2L2/KEAP1/CUL3 pathway have been linked to radioresistance preclinically and in small retrospective studies. We tested the hypothesis that patients with T2 glottic SCCs having these mutations would show radioresistance and more local (LF) and locoregional failures (LRF) when treated with RT compared to those without, using samples from a phase III trial. Methods: Of 250 randomized patients with T2N0 glottic SCC receiving definitive RT in RTOG 9512, 119 had available biospecimens that were subjected to amplicon-based next generation sequencing (appropriate to low-input DNA from biopsy specimens) to assess for presence of NFE2L2/KEAP1/CUL3 mutations without regard to outcomes. The association between binary mutation status and LF, LRF, disease-free survival (DFS), and overall survival (OS) was assessed using (cause-specific) Cox models (2-sided alpha of 0.05). LR/LRF rates were estimated by the cumulative incidence method and DFS/OS rates by the Kaplan-Meier method. Results: Nineteen of 119 patients (16.0%; 95% confidence interval [CI] 9.4, 22.6) had mutations in the NFE2L2/KEAP1/CUL3 pathway. Patient and tumor characteristics were similar between those with and without mutation.There were 32 LF, 37 LRF, and 80 DFS events, and 52 deaths. Patients with mutation compared to those without had significantly higher LF and LRF rates (Table). Median DFS was 0.9 years (95% CI 0.4, not reached) for the mutation group compared to 4.2 years (95% CI 3.2, 6.4) for those without. The hazard ratio (HR) for DFS was significantly higher for the mutated compared to the non-mutated group in the first 2 years after randomization but declined thereafter (Table), likely due to limited events after 2 years in the mutation group. There was no significant difference in OS between the two groups (HR = 0.76; 95% CI 0.35, 1.6; p = 0.48). Conclusions: NFE2L2/KEAP1/CUL3 pathway mutations may predict radiation treatment failure in T2N0 glottic cancer. They may also be a prognostic biomarker for DFS, but the current evidence supports the harmful effect of these mutations only during the first 2 years from randomization. Clinical trial information: NCT00002727 . [Table: see text]
Clinical validity of TTMV-HPV DNA liquid biopsies for the diagnosis and surveillance of HPV-associated oropharyngeal carcinoma.
Authors: Roof Scott A. , Ferrandino Rocco , Chen Sida , Kappauf Catharine , Barlow Joshua , Gold Brandon , Westra William , Berger Michael , Teng Marita S , Khan Mohemmed N , Bakst Richard Lorne , Sindhu Kunal K. , Genden Eric Michael , Chai Raymond L , Posner Marshall R. , Misiukiewicz Krzysztof
Published: June 2023

6060

Background: While there are several HPV biomarker assays, a commercially available assay evaluating tumor tissue modified viral DNA (TTMV-HPV DNA) (NavDx, Naveris Inc, Natick, MA) has shown impressive results in clinical trials and small cohort studies. Our aim was to establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary, real-world clinical setting. Methods: In this retrospective analysis, we evaluated the accuracy of the TTMV-HPV DNA assay in detecting HPVOPSCC in the diagnostic (pre-treatment) and surveillance phases of care between April 2020 and October 2022. For the diagnostic cohort, patients with OPSCC and at least one TTMV-HPV DNA measurement prior to initiation of primary therapy were included in the analysis. For the surveillance cohort, all TTMV-HPV DNA tests performed 3 months after completion of primary therapy for pathologically confirmed HPV-associated OPSCC were evaluated, regardless of pre-treatment TTMV-HPV DNA testing. Patients with suspected recurrence, but without pathologic confirmation, were excluded. HPV status was defined utilizing positive p16 staining on immunohistochemistry (93.2% diagnosis; 97.9% surveillance) or HPV polymerase chain reaction/in situ hybridization (79.6% diagnosis; 89.7% surveillance). Results: In the diagnostic cohort, 163 patients were included. The cohort included mostly men (87%) with median age 63, of which 93.3% had HPVOPSCC versus 6.7% had HPV negative OPSCC. The sensitivity in pre-treatment diagnosis was 91.5%; its specificity was 100%. In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. 23 patients had pathologically confirmed recurrences. The assay demonstrated 79.2% sensitivity and 100% specificity in detecting the recurrences. Positive predictive value was 100% and negative predictive value was 98.2%. The median lead time from positive test to pathologic confirmation was 28 days, 6/18 (30%) had lead time >50 days (maximum 507 days). Conclusions: The commercially available NavDx TTMV-HPV DNA assay demonstrated 100% specificity, and therefore excellent positive predictive value, in both diagnosis and surveillance. However, the sensitivity was lower, 91.5% for the diagnosis cohort and 79.2% for the surveillance cohort, signifying that a negative value may require further work-up. Further studies will be required to determine the optimal timing of testing and how results should inform treatment decisions. [Table: see text]
Peripheral blood epigenetic immune-profiling and survival outcomes with anti-programmed death (PD)-1 based therapy in recurrent/metastatic (R/M) squamous cell carcinoma of head and neck (SCCHN).
Authors: Sehgal Kartik , Zhang Ze , Shirai Keisuke , Butler Rondi , Lee Min Kyung , Molinaro Annette , Wiencke John Kirk , Koestler Devin , Salas Lucas A , Christensen Brock C , Kelsey Karl , Haddad Robert I.
Published: June 2023

6062

Background: Most patients with R/M SCCHN do not derive durable benefit from standard-of-care anti-PD-1-based therapy. The currently utilized biomarker, PD-ligand-1 combined proportion score is limited by the availability and heterogeneity of tumor samples. There is an unmet need to develop easily accessible peripheral blood-based biomarkers for response to immunotherapy. Methods: We are conducting a prospective multi-center study to identify peripheral blood derived DNA-based methylation biomarkers measured in patients with R/M SCCHN on treatment with FDA-approved anti-PD-1 based therapy. DNA isolated from these samples undergo bisulfite conversion, methylation profiling using Illumina EPIC microarray, and cellular deconvolution to generate peripheral blood immune profiles (PMID 35140201), including granulocytic (g) and monocytic (m) myeloid derived suppressor cell (MDSC) scores. Associations between baseline peripheral blood immune profiles before the start of treatment with progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan Meier curves and Cox proportional hazards models adjusted for age and sex. Additionally, logistic regression models adjusted for age and sex were utilized to investigate the baseline immune profiles between subgroups of patients who received anti-PD-1 monotherapy with durable clinical benefit for at least 1 year (Group A) versus progression or death within 100 days (Group B) from start of therapy. Results: 61 patients with R/M SCCHN who received anti-PD-1 based therapy as of Oct 31, 2022, were eligible for this preliminary analysis. Mean (SD) age of the entire population was 66.4 (11.8) years, 82% were male. gMDSC score was the only immune parameter with a statistically significant association with PFS (HR 2.6 (1.40 – 4.87) independent of age and sex, with higher scores stratified by median value associated with shorter PFS (Median PFS: 75 days vs. 145 days). Memory CD4 T cells, total CD4 T cells, percentage of T regulatory /CD4 cells, and absolute memory B cells were significantly associated with OS in this population, independent of age and sex (Table). Among the subgroup treated with anti-PD-1 monotherapy, Group A with durable benefit (n = 7, 86% male, mean age: 64.7 years) had significantly higher proportion of CD4 naïve/total CD4 cells (p = 0.03), and significantly lower gMDSC (p = 0.015) & mMDSC (p = 0.000049) scores, compared with Group B (n = 27, 78% male, mean age: 66.4 years). Conclusions: Peripheral blood DNA-based epigenetic immune profiling can recognize clinically relevant methylation biomarkers of benefit from anti-PD-1 therapy before the start of treatment. [Table: see text]
Radiotherapy alone versus concurrent or adjuvant chemoradiotherapy for nasopharyngeal carcinoma patients with negative Epstein-Barr virus DNA post-induction chemotherapy.
Authors: Kong Fang-Fang , Pan Guang-Sen , Du Cheng-Run , Zhang Zhen , Hu Chaosu , Ying Hong-Mei
Published: June 2023

6064

Background: Induction chemotherapy (IC) plus concurrent chemoradiotherapy has been recommended as the standard treatment for locoregionally advanced nasopharyngeal carcinoma(LA-NPC). However, concurrent chemotherapy was associated with increased toxicities, poor tolerance, and low completion rates. The aim of this study was to compare the efficacy and toxicity of IC+ radiotherapy (RT) and IC+ concurrent or adjuvant chemoradiotherapy (IC+CCRT/AC) in patients with negative post-IC EBV DNA. Methods: A total of 547 NPC patients with negative plasma EBV DNA post-IC were included. Patients were classified into the IC+RT group and the IC+ concurrent or adjuvant chemoradiotherapy (IC+CCRT/AC) group. Locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and progression-free survival (PFS) were estimated and compared using the Kaplan-Meier method. Propensity-score matching (PSM) was performed to balance the variables. Results: The median follow-up time was 37 months. The 3-year LRFS, DMFS, OS, and PFS rates for the whole group were 92.2%, 92.4%, 96.4%, and 84.4%, respectively. There was no significant difference in LRFS, DMFS, OS, and PFS between the IC+RT and the IC+CCRT/AC group both before PSM (3-year rates of 91.1% vs. 92.6%, p = 0.94; 95.6% vs. 91.5%, p = 0.08; 95.2% vs. 96.8%, p = 0.80; 85.9% vs. 84.0%, p = 0.38) and after PSM (90.7% vs. 92.7%, p = 0.77; 96.8% vs. 93.7%, p = 0.29; 94.5% vs. 93.9%, p = 0.57; 84.7% vs. 85.6%, p = 0.96). Multivariate analysis demonstrated that treatment schedule was not an independent predictor for survival rates. Patients in the IC+RT group had fewer treatment-related acute toxicities and better tolerance. Conclusions: IC+RT displayed similar survival outcomes as IC+CCRT/AC for NPC patients with negative post-IC EBV DNA. Our current data seems not to support the routine use of concurrent or adjuvant chemotherapy after IC for unselected patients.
Prospective study of integrating post-radiotherapy [18F] fluorodeoxyglucose-positron emission tomography/computed tomography scan and plasma Epstein-Barr virus DNA in surveillance of locoregionally advanced nasopharyngeal carcinoma.
Authors: Tang Lin-Quan , Liu Li-Ting , Yang Zhen-Chong , Shen Jia-Yi , Luo Mei-Juan , Hu Ying-Ying , Lu Zi-Jian , Xiao Bei-Bei , Yang Jin-Hao , Lv Xiao-Fei , Jia Guo-Dong , Guo Shan-Shan , Chen Qiu-Yan , Fan Wei , Mai Hai-Qiang
Published: June 2023

6072

Background: To evaluate the role of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan at 12-weeks after the end of Radiotherapy (RT) integrated with plasma EBV DNA in surveillance and standardized implementation of locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Methods: This prospective study was conducted in patients with stage III-IVa LA-NPC. FDG-PET/CT examination and plasma Epstein-Barr virus (EBV) DNA measurements was performed pretreatment and at 12-weeks after the end RT. The primary study endpoint was the negative predictive value (NPV) and other supporting diagnostic test characteristics of 12-weeks FDG-PET/CT for the surveillance of residual locoregional disease and new distant metastasis. Results: From June 2018 to December 2019, 506 eligible patients were enrolled and entered follow-up (median,45 months). At 12 weeks after the end of RT, there were 22 (4.3%) patients have residual locoregional disease, 30 (5.9%) patients developed distant metastasis and 6 (1.2%) patients presented both residual locoregional disease and distant metastasis. The NPV of 12-weeks FDG-PET/CT for overall residual diseases and distant metastasis was 96.3% (95% confidence interval [CI], 94.0%-97.8%) with sensitivity of 72.4% (95%CI, 58.9%-83.0%), specificity of 93.3% (95%CI, 90.5%-95.4%), positive predictive value (PPV) of 58.3% (95%CI, 46.1%-69.6%) and accuracy of 90.9% (95%CI, 88.4%-93.4%). In EBV DNA-based risk subgroups, the NPV of 12-weeks PDG-PET/CT was 96.8% (95%CI, 94.5%-98.2%) in patients with undetectable 12-weeks plasma EBV DNA and 87.0% (95%CI, 65.3%-96.5%) in patients with detectable 12-weeks plasma EBV DNA. Conclusions: 12-weeks PDG-PET/CT was reliable in the surveillance of LA-NPC and could help optimize the follow-up strategy and provide implications for timely and effective therapeutic regimen, especially for patients in different EBV DNA-based risk groups. Clinical trial information: NCT03601390 .
CT radiomic signature to predict overall survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma.
Authors: Song Bolin , Yang Kailin , Viswanathan Vidya Sankar , Lee Jonathan , Stock Sarah , Fu Pingfu , Saba Nabil F. , Koyfman Shlomo A. , Lewis James S. , Madabhushi Anant
Published: June 2023

6073

Background: Chemoradiation is the standard of care for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). However, not all patients would benefit from chemotherapy, especially patients with low-risk characteristics. We aim to develop and validate a prognostic and predictive radiomic image signature (pRiS) to inform survival and chemotherapy benefit in stage I and stage II HPV-associated OPSCC. Methods: Radiographic scans for 491 patients with stage I and stage II HPV-associated OPSCC were acquired from 4 independent sources and divided into three cohorts D1-D3. D1 comprised computed tomography (CT) scans from 60 radiotherapy treated patients and was used to identify prognostic features via a LASSO Cox model to predict overall and disease-free survival. The prognostic performance of pRiS was evaluated on two test sets (D2, n = 162; D3, n = 269) using concordance index (C-index). An integrated nomogram was developed to demonstrate the incremental value of the pRiS to the existing clinical factors for individualized survival estimation. Patients from D2 and D3 who received either radiotherapy alone or chemoradiation were used to validate pRiS as predictive of added benefit of chemotherapy. Results: Seven radiomic features were selected to construct the image biomarker pRiS, which was found to be prognostic of overall survival (OS) on univariate analysis in D2 (hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.1–4.16, p = 0.02) and D3 (HR = 2.74, 95% CI, 1.34–5.62, p = 0.006). Chemotherapy was associated with improved OS for high-pRiS patients in both D2 (radiation vs chemoradiation, HR = 4.47, 95% CI, 1.73–11.6, p = 0.002) and D3 (radiation vs chemoradiation, HR = 2.99, 95% CI, 1.04–8.63, p = 0.04). In contrast, chemotherapy did not improve OS for low-pRiS patients, which indicates these patients did not derive additional benefit from chemotherapy and could be considered for treatment de-escalation. Conclusions: The proposed radiomic signature was prognostic of patient survival and the binary pRiS group informed chemotherapy benefit for stage I and II HPV-associated OPSCC patients. [Table: see text]
Neoadjuvant chemoimmunotherapy for the treatment of locally advanced laryngeal and hypopharyngeal squamous cell carcinoma: A single-arm phase 2 clinical trial.
Authors: Chen Yanfeng , Yang Ankui , Mao Yan-Ping
Published: June 2023

6077

Background: Standard treatment for patients with locally advanced laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) is total laryngectomy, which seriously affects the quality of life. Neoadjuvant treatment with Nab-paclitaxel plus cisplatin(TP) has favorable efficacy with acceptable toxicity for laryngeal preservation in LHSCC. Programmed death 1 (PD-1) blockade plus chemotherapy has shown a survival benefit and recommended as the first-line treatment in recurrent or metastatic head and neck cancer, but the safety and activity in the combination of TP and PD-1 blockade in locally advanced LHSCC need investigation. Methods: In this single-center, single-arm, phase 2 trial, newly diagnosed pts with stage T3-4N0-3M0 laryngeal SCC or T2-4N0-3M0 hypopharyngeal SCC were recruited. Eligible patients received chemotherapy [Nab-paclitaxel 240 mg/m2 plus cisplatin 75 mg/m2] and toripalimab[240 mg, d1]every 3 weeks for 3 cycles. After induction treatment, patients achieving clinical partial response (cPR) or complete response (cCR) received definitive radiotherapy, while those with stable diseases(SD) and progression disease(PD) received surgery plus adjuvant radiotherapy. Toripalimab was given intravenously once every 3 weeks for up to 10 cycles, including 3 cycles before. The primary endpoint was the objective response rate (ORR) according to RECIST 1.1 by investigator assessment to neoadjuvant chemoimmunotherapy. The secondary endpoints included laryngectomy-free survival (LFS), disease failure-free survival (DFS)and overall survival OS at 2 years, quality of life (QOL) and toxic effects. Results: From October 2020 to May 2022，25 patients received neoadjuvant chemoimmunotherapy (median age 58 years; 23.9% men), 52% (13/25) and 48% (12/25) were hypopharyngeal and laryngeal squamous cell carcinoma. 80% (20/25) were clinical T3/4 and 64.0% (16/25) ≥N2. After neoadjuvant chemoimmunotherapy, 2 patients achieved CR, 21 achieved PR, with an ORR of 92%(23/25), 23 patients with CR/PR of the primary tumor received concurrent radiotherapy and immune maintenance therapy, 2 patients with SD/PD received laryngectomy. At a median follow-up of 17 months (range 8-27 months), 1-year DFS was 88.0% , 1-year OS was 96.0% , 1-year LPS was 92.0%, Respectively, only grade 1-2 adverse events occurred in 100% of patients, including loss of appetite (100%), anemia (92.0%), nausea (84.0%), vomiting (52.0%), hypothyroidism (16.0%), peripheral neuritis (20%), leukopenia (12.0%), rash (12.0%). Conclusions: Neoadjuvant treatment with TP plus toripalimab achieved impressive ORR and 1-year LPS rate with manageable toxicities in patients with LHSCC. Further follow-up is needed to confirm the long-term efficacy. Clinical trial information: ChiCTR2000033506 .