PD‐1 inhibitor

  • 文章类型: Editorial
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  • 文章类型: Journal Article
    背景:目前治疗局部进展期胃癌(GC)的标准包括新辅助化疗和根治性手术。最近,这种情况的新辅助治疗涉及探索免疫治疗加化疗作为一种潜在方法.然而,疗效仍不确定。
    方法:单臂,本研究进行了2期研究,目的是评估卡莫瑞珠单抗联合mFOLFOX6新辅助治疗的疗效和耐受性,并通过多组学分析,确定可切除的局部晚期GC患者的潜在应答生物标志物.主要终点是病理完全缓解(pCR)率。次要终点包括R0率,接近pCR率,无进展生存期(PFS),无病生存率(DFS),总生存率(OS)。通过全外显子组测序评估多组学分析,转录组测序,以及新辅助治疗前后使用活检的多重免疫荧光(mIF)。
    结果:这项研究涉及60名患者,其中55人接受了胃切除术。其中,5人(9.1%)达到病理完全缓解(pCR),11(20.0%)达到接近pCR。未观察到因治疗引起的意外不良事件或围手术期死亡。并且该方案提供了可管理的安全性。通过多组学分析确定的分子变化与治疗反应相关,强调HER2阳性和CTNNB1突变与治疗敏感性和良好预后之间的关联。免疫细胞浸润分析和mIF进一步支持了这一发现。表达数据揭示了一个具有四个基因的风险模型(RALYL,SCGN,CCKBR,NTS)与反应不佳有关。此外,治疗后CD8+T淋巴细胞浸润与病理反应呈正相关。
    结论:研究结果表明,PD-1抑制剂和mFOLFOX6的组合对局部晚期GC具有疗效和可接受的毒性。需要延长随访以确定响应的持续时间。这项研究为制定精确的新辅助治疗方案奠定了必要的基础。
    BACKGROUND: The current standard of care for locally advanced gastric cancer (GC) involves neoadjuvant chemotherapy followed by radical surgery. Recently, neoadjuvant treatment for this condition has involved the exploration of immunotherapy plus chemotherapy as a potential approach. However, the efficacy remains uncertain.
    METHODS: A single-arm, phase 2 study was conducted to evaluate the efficacy and tolerability of neoadjuvant camrelizumab combined with mFOLFOX6 and identify potential biomarkers of response through multi-omics analysis in patients with resectable locally advanced GC. The primary endpoint was the pathological complete response (pCR) rate. Secondary endpoints included the R0 rate, near pCR rate, progression-free survival (PFS), disease-free survival (DFS), and overall survival (OS). Multi-omics analysis was assessed by whole-exome sequencing, transcriptome sequencing, and multiplex immunofluorescence (mIF) using biopsies pre- and post-neoadjuvant therapy.
    RESULTS: This study involved 60 patients, of which 55 underwent gastrectomy. Among these, five (9.1%) attained a pathological complete response (pCR), and 11 (20.0%) reached near pCR. No unexpected treatment-emergent adverse events or perioperative mortality were observed, and the regimen presented a manageable safety profile. Molecular changes identified through multi-omics analysis correlated with treatment response, highlighting associations between HER2-positive and CTNNB1 mutations with treatment sensitivity and a favourable prognosis. This finding was further supported by immune cell infiltration analysis and mIF. Expression data uncovered a risk model with four genes (RALYL, SCGN, CCKBR, NTS) linked to poor response. Additionally, post-treatment infiltration of CD8+ T lymphocytes positively correlates with pathological response.
    CONCLUSIONS: The findings suggest the combination of PD-1-inhibitor and mFOLFOX6 showed efficacy and acceptable toxicity for locally advanced GC. Extended follow-up is required to determine the duration of the response. This study lays essential groundwork for developing precise neoadjuvant regimens.
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  • 文章类型: Journal Article
    背景:Retifanlimab是一种针对程序性死亡蛋白1的人源化单克隆抗体,INCB001158是一种口服精氨酸酶抑制剂。本Ib期研究调查了retifanlimab,INCB001158及其在日本晚期实体瘤患者中的组合。
    方法:患者在第1部分中接受了retifanlimab(每4周500mg[Q4W]静脉注射)或递增剂量的INCB001158(75或100mg,每天两次[BID])单药治疗,在第2部分中接受了retifanlimab(500mgQ4W)和INCB001158(100mgBID)的主要终点是安全性,耐受性,剂量限制毒性(DLT),并确定日本患者的推荐II期剂量。
    结果:18例患者(retifanlimab或INCB001158单药和联合治疗;n=6)在日本的2个地点登记。没有DLT,致命不良事件(AE),或因不良事件而停产。皮疹(均为1级)是retifanlimab最常见的治疗引起的AE(n=6)。retifanlimab(n=4)或INCB001158(n=2)单药治疗和联合治疗(n=4)报告了治疗相关的AE;免疫相关的AE(甲状腺疾病,2级)结合报告。用retifanlimab单药治疗观察到两个反应(1个完全,1个部分)和1个稳定的疾病(SD),总有效率为33.3%(95%置信区间[CI],4.3-77.7)和疾病控制率(DCR)为50%(95%CI,11.8-88.2)。三名患者使用INCB001158单药治疗(DCR50%;95%CI,11.8-88.2)。联合治疗未观察到反应或SD。
    结论:Retifanlimab,INCB001158及其组合具有可接受的安全性。有希望的retifanlimab抗肿瘤活性值得在日本患者中进行进一步研究。
    BACKGROUND: Retifanlimab is a humanized monoclonal antibody targeting programmed death protein-1, and INCB001158 is an oral arginase inhibitor. This phase Ib study investigated retifanlimab, INCB001158, and their combination in Japanese patients with advanced solid tumors.
    METHODS: Patients received retifanlimab (500 mg every 4 weeks [Q4W] i.v.) or escalating doses of INCB001158 (75 or 100 mg twice daily [BID]) monotherapy in Part 1 and combination of retifanlimab (500 mg Q4W) and INCB001158 (100 mg BID) in Part 2. Primary endpoints were safety, tolerability, dose-limiting toxicities (DLTs), and determination of recommended phase II doses in Japanese patients.
    RESULTS: Eighteen patients (retifanlimab or INCB001158 monotherapy and combination; n = 6 each) were enrolled at 2 sites in Japan. There were no DLTs, fatal adverse events (AEs), or discontinuations due to AEs. Rash (all grade 1) was the most common treatment-emergent AE with retifanlimab (n = 6). Treatment-related AEs were reported with retifanlimab (n = 4) or INCB001158 (n = 2) monotherapy and with combination (n = 4); an immune-related AE (thyroid disorder, grade 2) was reported with combination. Two responses were observed with retifanlimab monotherapy (1 complete, 1 partial) and 1 stable disease (SD), for an overall response rate of 33.3% (95% confidence interval [CI], 4.3-77.7) and disease control rate (DCR) of 50% (95% CI, 11.8-88.2). Three patients had SD with INCB001158 monotherapy (DCR 50%; 95% CI, 11.8-88.2). No responses or SD were observed with combination therapy.
    CONCLUSIONS: Retifanlimab, INCB001158, and their combination had acceptable safety profiles. Promising retifanlimab antitumor activity warrants further investigation in Japanese patients.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    未经证实:免疫检查点抑制剂(ICIs)已被认为是各种癌症的新型治疗方法。据报道,ICI对罕见癌症有效,包括唾液腺癌(SGC)。我们旨在分析ICIs在SGC患者中的疗效和安全性。
    UNASSIGNED:我们回顾性分析了接受至少一个周期的nivolumab或pembrolizumab治疗的SGC患者的肿瘤学结果和免疫相关不良事件(irAE)。
    未经证实:在12名患者中,有两个完整的响应(CR),两个有部分反应,五个患有稳定的疾病,三个患有进行性疾病。总有效率为33.3%。低分化癌(多形性腺瘤)和唾液导管癌患者均获得CR。无进展生存期为1至18个月(中位数,4个月),而总生存期为2至25个月(中位数,13.5个月)。只有一名患者出现3级多形性红斑,该患者的病情在单独停用pembrolizumab后得到改善。
    未经证实:程序性死亡-1阻滞是SGC患者的有效治疗方法,包括侵袭性组织学类型。
    UNASSIGNED: Immune checkpoint inhibitors (ICIs) have been considered as novel therapeutic approaches for various cancers. ICIs were reportedly efficacious against rare cancers, including salivary gland carcinoma (SGC). We aimed to analyze the efficacy and safety of ICIs in patients with SGC.
    UNASSIGNED: We retrospectively analyzed the oncologic outcomes and immune-related adverse events (irAEs) in patients with SGC treated with at least one cycle of nivolumab or pembrolizumab.
    UNASSIGNED: Among 12 patients, there were two with a complete response (CR), two with a partial response, five with stable diseases, and three with progressive diseases. The overall response rate was 33.3%. A CR was achieved in patients with poorly differentiated carcinoma (carcinoma ex pleomorphic adenoma) and salivary duct carcinoma. The progression-free survival ranged between 1 and 18 months (median, 4 months), while the overall survival ranged between 2 and 25 months (median, 13.5 months). An irAE was observed in only one patient who developed grade 3 erythema multiforme, and this patient\'s condition improved with withdrawal of pembrolizumab alone.
    UNASSIGNED: Programmed death-1 blockade was an effective therapy for patients with SGC, including aggressive histologic types.
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  • 文章类型: Journal Article
    检查点抑制剂是新型且有前途的抗癌剂。然而,急性心包炎是第二常见的化疗相关心脏毒性,其死亡率高达21%.心脏MRI提供一站式心脏分析,可精确检测与化疗相关的心脏毒性,无需肾毒性对比染料和电离辐射。
    Checkpoint inhibitors are novel and promising anticancer agents. However, acute pericarditis is the second most common chemotherapy-associated cardiotoxicity and associated with high mortality up to 21%. Cardiac MRI offers a one-stop-shop cardiac analysis to precisely detect chemotherapy-associated cardiotoxicity without nephrotoxic contrast dye and ionizing radiation.
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  • 文章类型: Journal Article
    CheckMate040评估了纳武单抗在晚期肝细胞癌(HCC)患者中的疗效和安全性。需要了解nivolumab的安全性以支持治疗相关不良事件(TRAE)的管理。该分析评估了纳武单抗单药治疗I/II期的安全性,开放标签CheckMate040研究。
    在剂量递增和扩展阶段的患者中,分析了在首次剂量和最后一次剂量后30天之间发生的选择TRAEs(sTRAEs;具有潜在免疫学病因的TRAEs需要更频繁的监测)。发病时间(TTO)时间解决(TTR),并评估sTRAEs的复发,并评估了免疫调节药物(IMM)治疗的结果。
    分析包括262名患者。最常见的sTRAE是皮肤(35.5%),其次是胃肠道事件(14.5%)和肝事件(14.1%);大多数为1/2级,10.7%的患者经历3/4级事件.一名患者患有5级肺炎。TTO的中位数(范围)范围为皮肤sTRAE的3.6(0.1-59.9)周,肾脏sTRAE的47.6(47.1-48.0)周。总的来说,68%的sTRAEs解决了,胃肠道sTRAE的中位(范围)TTR为3.7(0.1-123.3)周,内分泌sTRAE为28.4(0.1-79.1)周。根据已建立的毒性管理算法,大多数胃肠道和所有肝脏事件均通过治疗解决。57名患者(40%)sTRAE用IMM管理。用nivolumab再次攻击后,sTRAE的复发并不常见。
    Nivolumab在对晚期HCC患者的分析中证明了可控制的安全性。大多数sTRAE通过治疗解决。
    Nivolumab是先前治疗过的晚期肝细胞癌患者的可行治疗选择,因为它已经证明了持久的肿瘤反应和有希望的生存。Nivolumab具有可管理的安全性。本分析中最常见的选择性治疗相关不良事件(sTRAEs)为皮肤相关(35%)。在大约14%的患者中观察到胃肠道和肝脏sTRAE。大多数sTRAE解决(68%)。如果及早解决,安全事件更容易管理。应强调对患者进行有关症状和体征的教育,以及早期报告和咨询的重要性。
    CheckMate 040 assessed the efficacy and safety of nivolumab in patients with advanced hepatocellular carcinoma (HCC). Understanding the safety profile of nivolumab is needed to support the management of treatment-related adverse events (TRAEs). This analysis assessed the safety of nivolumab monotherapy in the phase I/II, open-label CheckMate 040 study.
    Select TRAEs (sTRAEs; TRAEs with potential immunologic etiology requiring more frequent monitoring) occurring between first dose and 30 days after last dose were analyzed in patients in the dose-escalation and -expansion phases. Time to onset (TTO), time to resolution (TTR), and recurrence of sTRAEs were assessed, and the outcome of treatment with immune-modulating medication (IMM) was evaluated.
    The analysis included 262 patients. The most common sTRAE was skin (35.5%), followed by gastrointestinal (14.5%) and hepatic (14.1%) events; the majority were grade 1/2, with 10.7% of patients experiencing grade 3/4 events. One patient had grade 5 pneumonitis. Median (range) TTO ranged from 3.6 (0.1-59.9) weeks for skin sTRAEs to 47.6 (47.1-48.0) weeks for renal sTRAEs. Overall, 68% of sTRAEs resolved, with median (range) TTR ranging from 3.7 (0.1-123.3+) weeks for gastrointestinal sTRAEs to 28.4 (0.1-79.1) weeks for endocrine sTRAEs. Most gastrointestinal and all hepatic events resolved with treatment in accordance with established toxicity management algorithms. In 57 patients (40%), sTRAEs were managed with IMM. Reoccurrence of sTRAEs was uncommon following rechallenge with nivolumab.
    Nivolumab demonstrated a manageable safety profile in this analysis of patients with advanced HCC. A majority of sTRAEs resolved with treatment.
    Nivolumab is a viable treatment option for patients with previously treated advanced hepatocellular carcinoma as it has demonstrated durable tumor responses and promising survival. Nivolumab has a manageable safety profile. The most common select treatment-related adverse events (sTRAEs) in this analysis were skin related (35%). Gastrointestinal and hepatic sTRAEs were observed in approximately 14% of patients. The majority of sTRAEs resolved (68%). Safety events are easier to manage if addressed early. Patient education on signs and symptoms to watch out for and the importance of early reporting and consultation should be emphasized.
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  • 文章类型: Case Reports
    Pembrolizumab is an immune checkpoint inhibitor with antitumor activity in other organ malignancies. We present this case -demonstrating multiple inflammatory adverse events associated with Pembrolizumab (in a single patient), in order to increase awareness and facilitate earlier identification of the wide-ranging cutaneous side effects associated with immunotherapy.
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  • 文章类型: Journal Article
    Although classical Hodgkin lymphoma (cHL) is highly curable, 20%-30% of patients will not be cured with conventional treatments. The programmed death-1 (PD-1) inhibitors (PD-1i) nivolumab and pembrolizumab have been Food and Drug Administration-approved for relapsed/refractory (R/R) cHL. There is limited data on the real-world experience with PD-1i in cHL and it is unknown whether fewer selected patients treated with PD-1i derive benefits similar to those observed in published trials.
    We performed a multicenter, retrospective analysis of R/R cHL patients treated with PD-1i in the nontrial setting. The primary objective was to describe progression-free survival (PFS) and overall survival (OS) in this population. Secondary objectives were to characterize response rates, toxicities, discontinuation patterns, and post-PD-1i therapies.
    The study included 53 patients from nine U.S. centers. Overall response rate (ORR), complete response (CR), and partial response (PR) to PD-1i were 68%, 45%, and 23%, respectively. Twelve-month OS and PFS were 89% and 75%, respectively; median PFS was 29 months. Ninety-six percent of patients with CR continue to respond at a median follow-up of 20 months. Toxicities were similar to those previously described. Seventy percent of patients treated with systemic therapy after PD-1i demonstrated objective responses.
    To our knowledge, this analysis is the first describing real-world experience with PD-1i in cHL patients in the U.S. Here, we demonstrate similar response rates compared to prior studies. The toxicity profile of PD-1i was similar to that seen in previous studies; we further describe toxicity patterns in those with prior autoimmune disease or allogeneic transplant. Post-PD-1i systemic therapies appear active. These results support the effectiveness and tolerability of PD-1i therapy in R/R cHL in a real-world setting.
    Two PD-1 inhibitors have recently been approved for patients with relapsed/refractory classical Hodgkin lymphoma based on results from nonrandomized clinical trials. However, to date, there have been no studies evaluating the effectiveness and toxicity profile of these drugs in the real-world setting in the U.S. The present study demonstrates that patients treated in a real-world context experience similar rates of overall effectiveness compared with published clinical trials. Patients who discontinue PD-1 inhibitors may experience clinical responses to subsequent treatment with systemic chemotherapy or targeted therapy. This study provides clinicians with further insight into the effectiveness and tolerability of PD-1 inhibitors and suggests that when patients progress while on these drugs, conventional systemic chemotherapy may be an effective treatment option.
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