Progressive but previously untreated CLL patients with greater array CGH complexity exhibit a less durable response to chemoimmunotherapy

Neue Schlüsseltechnologien führen gegenwärtig zu einem grundlegenden Wandel im klinischen Einsatz genetischer Labordiagnostik. In der Pränataldiagnostik hat die nicht invasive Abklärung von Aneuploidien im mütterliche Blut Fuß gefasst (NIPT) und dieser Ansatz wird in Zukunft auch bei anderen Chromosomenstörungen und Fragestellungen (monogene Erkrankungen) zum Einsatz kommen. Im postnatalen Bereich hat die Microarray Analyse (Array-CGH, molekulare Karyotypisierung) die konventionelle Chromosomenanalyse bei der Abklärung von Kindern mit Fehlbildungen, einer nicht-syndromalen geistigen Behinderung oder Autismusspektrumstörung abgelöst. Die neuen Hochdurchsatzsequenziermethoden erlauben die effiziente Abklärung von genetisch sehr heterogenen Krankheitsbildern wie z. B. Epilepsien, neuromuskuläre Erkrankungen und Schwerhörigkeit, durch Diagnostik-Panels, bei welchen Dutzende von Genen parallel analysiert werden können. Der Einsatz der Exom oder whole genome Sequenzierung als wissenschaftliche Methode zur Identifizierung von neuen Krankheitsgenen wird auch in der Diagnostik von schweren ungeklärten Erkrankungen oder Entwicklungsstörungen, die genetisch extrem heterogen sind, zum Einsatz kommen. Die neuen Methoden werden die klinische Diagnostik in der Pädiatrie und anderen Bereichen der Medizin über kurz oder lang verändern, indem die genetische Labordiagnostik eher früher im Abklärungsprozess zur Anwendung kommen wird (genetics first).

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A Critical Review of Second-generation anti-EGFR Monoclonal Antibodies in Metastatic Colorectal Cancer

Current Drug Targets ◽

10.2174/1389450121666200727121011 ◽

2020 ◽

Vol 21 ◽

Author(s):

Daniel Sur ◽

Andrei Havasi ◽

Alecsandra Gorzo ◽

Claudia Burz

Keyword(s):

Colorectal Cancer ◽

Drug Resistance ◽

Clinical Trials ◽

Monoclonal Antibodies ◽

Metastatic Colorectal Cancer ◽

Second Generation ◽

Current Data ◽

Braf Mutations ◽

Durable Response ◽

Ongoing Research

Background: Anti-EGFR monoclonal antibodies (mAbs) have become a relevant solution for the treatment of patients with metastatic colorectal cancer. Current anti-EGFR monoclonal antibodies face a series of problems, including resistance and non-durable response, and RAS and BRAF mutations serve as exclusion criteria for treatment with anti-EGFR mAbs. Advances in molecular tumor profiling and information on subsequent pathways responsible for disease progression and drug resistance helped develop a new generation of anti-EGFR mAbs. These second-generation mAbs have been developed to overcome existing resistance mechanisms and to limit common side effects. For the moment, existing literature suggests that these novel anti-EGFR mAbs are far from finding their way to clinical practice soon. Objective: In this review, we summarize and evaluate current data regarding ongoing research and completed clinical trials for different second-generation anti-EGFR monoclonal antibodies. Conclusion: Anti-EGFR mAbs exhibit efficacy in advanced colorectal cancer, but second-generation mAbs failed to prove their benefit in the treatment of metastatic colorectal cancer. Understanding the biological basis of primary and acquired drug resistance could allow scientists to design better clinical trials and develop improved second-generation mAbs.

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Bilateral Phyllodes Giant Tumor. A Case Report Analyzed by Array-CGH

Diagnostics ◽

10.3390/diagnostics10100825 ◽

2020 ◽

Vol 10 (10) ◽

pp. 825

Author(s):

Francesco Fortarezza ◽

Federica Pezzuto ◽

Gerardo Cazzato ◽

Clelia Punzo ◽

Antonio d’Amati ◽

...

Keyword(s):

Array Cgh ◽

Phyllodes Tumor ◽

Molecular Classification ◽

Left Breast ◽

Comparative Genomic ◽

Fish Analysis ◽

Molecular Tests ◽

Giant Tumor ◽

Metastatic Risk ◽

The Right

The breast phyllodes tumor is a biphasic tumor that accounts for less than of 1% of all breast neoplasms. It is classified as benign, borderline, or malignant, and can mimic benign masses. Some recurrent alterations have been identified. However, a precise molecular classification of these tumors has not yet been established. Herein, we describe a case of a 43-year-old woman that was admitted to the emergency room for a significant bleeding from the breast skin. A voluminous ulcerative mass of the left breast and multiple nodules with micro-calcifications on the right side were detected at a physical examination. A left total mastectomy and a nodulectomy of the right breast was performed. The histological diagnosis of the surgical specimens reported a bilateral giant phyllodes tumor, showing malignant features on the left and borderline characteristics associated with a fibroadenoma on the right. A further molecular analysis was carried out by an array-Comparative Genomic Hybridization (CGH) to characterize copy-number alterations. Many losses were detected in the malignant mass, involving several tumor suppressor genes. These findings could explain the malignant growth and the metastatic risk. In our study, genomic profiling by an array-CGH revealed a greater chromosomal instability in the borderline mass (40 total defects) than in the malignant (19 total defects) giant phyllodes tumor, reflecting the tumor heterogeneity. Should our results be confirmed with more sensitive and specific molecular tests (DNA sequencing and FISH analysis), they could allow a better selection of patients with adverse pathological features, thus optimizing and improving patient’s management.

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TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

Journal of Allergy ◽

10.1155/2013/130905 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 13

Author(s):

Freja Lærke Sand ◽

Simon Francis Thomsen

Keyword(s):

Side Effects ◽

Chronic Urticaria ◽

Treatment Options ◽

Significant Proportion ◽

Response Duration ◽

Immunosuppressive Drugs ◽

Tnf Alpha ◽

High Dose ◽

Duration Of Treatment ◽

Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

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Biomarkers and Gene Signatures to Predict Durable Response to Pembrolizumab in Non-Small Cell Lung Cancer

Cancers ◽

10.3390/cancers13153828 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3828

Author(s):

Anello Marcello Poma ◽

Rossella Bruno ◽

Iacopo Pietrini ◽

Greta Alì ◽

Giulia Pasquini ◽

...

Keyword(s):

Lung Cancer ◽

T Cells ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Immune Cell ◽

Small Cell ◽

Small Cell Lung ◽

First Line ◽

Durable Response ◽

Nsclc Patients

Pembrolizumab has been approved as first-line treatment for advanced Non-small cell lung cancer (NSCLC) patients with tumors expressing PD-L1 and in the absence of other targetable alterations. However, not all patients that meet these criteria have a durable benefit. In this monocentric study, we aimed at refining the selection of patients based on the expression of immune genes. Forty-six consecutive advanced NSCLC patients treated with pembrolizumab in first-line setting were enrolled. The expression levels of 770 genes involved in the regulation of the immune system was analysed by the nanoString system. PD-L1 expression was evaluated by immunohistochemistry. Patients with durable clinical benefit had a greater infiltration of cytotoxic cells, exhausted CD8, B-cells, CD45, T-cells, CD8 T-cells and NK cells. Immune cell scores such as CD8 T-cell and NK cell were good predictors of durable response with an AUC of 0.82. Among the immune cell markers, XCL1/2 showed the better performance in predicting durable benefit to pembrolizumab, with an AUC of 0.85. Additionally, CD8A, CD8B and EOMES showed a high specificity (>0.86) in identifying patients with a good response to treatment. In the same series, PD-L1 expression levels had an AUC of 0.61. The characterization of tumor microenvironment, even with the use of single markers, can improve patients’ selection for pembrolizumab treatment.

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Genetik und Diagnostik des primären Lymphödems

Phlebologie ◽

10.1055/a-1383-5360 ◽

2021 ◽

Author(s):

Charlotte Kemper ◽

Magdalena Danyel ◽

Claus-Eric Ott ◽

René Hägerling

Keyword(s):

Array Cgh ◽

Late Onset ◽

Hydrops Fetalis ◽

Genetische Diagnostik ◽

Genetische Varianten

Zusammenfassung Einleitung Das primäre Lymphödem ist eine genetisch bedingte, angeborene Erkrankung, die durch einen unzureichenden Abtransport von Lymphflüssigkeit aufgrund einer Fehlbildung oder Fehlfunktion des Lymphgefäßsystems entsteht. Dabei tragen periphere und systemische Manifestationen zum letztendlichen Phänotyp bei. Neben peripheren Manifestationen des primären Lymphödems, v. a. Schwellungen der unteren Extremität, können auch systemische Manifestationen, wie z. B. Aszites, intestinale und pleurale Lymphangiektasien, Chylothorax, Pleura- und Perikarderguss oder auch der Hydrops fetalis, auftreten. In Abhängigkeit vom ursächlichen Gen und der zugrunde liegenden genetischen Veränderung unterscheiden sich sowohl die klinischen Manifestationen als auch der Ausprägungsgrad des Lymphödems. Klassifikation Die Krankheitsbilder, die mit einem primären Lymphödem einhergehen, lassen sich in 5 Kategorien aufteilen: (1) Erkrankungen, die mit einer segmentalen Wachstumsstörung assoziiert sind und auf einem somatischen Mosaik beruhen, (2) syndromale Erkrankungen, (3) Erkrankungen, bei denen das primäre Lymphödem eine systemische Beteiligung aufweist, (4) kongenitale Krankheitsbilder und (5) nach dem ersten Lebensjahr auftretende (Late Onset) Krankheitsbilder. Genetische Diagnostik Basierend auf der Klinik des Patienten und der Zuordnung zu einer der 5 Kategorien kann eine zielgerichtete genetische Diagnostik erfolgen, zunächst beginnend mit einer konventionellen zytogenetischen Untersuchung (Chromosomenanalyse) sowie einer molekularzytogenetischen Methode (Array-CGH). Anschließend kann eine molekulargenetische Untersuchung im Rahmen von Einzelgenanalysen, Panel-Untersuchungen oder Exom- sowie Ganzgenomsequenzierung durchgeführt werden, durch die genetische Varianten oder Mutationen aufgedeckt werden können, die als kausal für die Symptomatik identifiziert werden können. Fazit Betroffene eines primären Lymphödems profitieren von einer gezielten genetischen Diagnostik, da die verschiedenen Krankheitsbilder meistens nur durch die Detektion einer assoziierten genetischen Veränderung diagnostiziert werden können und somit eine Aussage über Vererbung und Wiederholungsrisiko möglich ist.

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Preclinical platform for long-term evaluation of immuno-oncology drugs using hCD34+ humanized mouse model

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001513 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001513

Author(s):

Nahee Park ◽

Kamal Pandey ◽

Sei Kyung Chang ◽

Ah-Young Kwon ◽

Young Bin Cho ◽

...

Keyword(s):

Mouse Model ◽

Humanized Mice ◽

Preclinical Models ◽

Humanized Mouse ◽

Humanized Mouse Model ◽

Durable Response ◽

Term Efficacy ◽

Nsg Mice ◽

Oncology Research

BackgroundWell-characterized preclinical models are essential for immune-oncology research. We investigated the feasibility of our humanized mouse model for evaluating the long-term efficacy of immunotherapy and biomarkers.MethodsHumanized mice were generated by injecting human fetal cord blood-derived CD34+ hematopoietic stem cells to NOD-scid IL2rγnull (NSG) mice myeloablated with irradiation or busulfan. The humanization success was defined as a 25% or higher ratio of human CD45+ cells to mice peripheral blood mononuclear cells.ResultsBusulfan was ultimately selected as the appropriate myeloablative method because it provided a higher success rate of humanization (approximately 80%) and longer survival time (45 weeks). We proved the development of functional T cells by demonstrating the anticancer effect of the programmed cell death-1 (PD-1) inhibitor in our humanized mice but not in non-humanized NSG mice. After confirming the long-lasting humanization state (45 weeks), we further investigated the response durability of the PD-1 inhibitor and biomarkers in our humanized mice. Early increase in serum tumor necrosis factor α levels, late increase in serum interleukin 6 levels and increase in tumor-infiltrating CD8+ T lymphocytes correlated more with a durable response over 60 days than with a non-durable response.ConclusionsOur CD34+ humanized mouse model is the first in vivo platform for testing the long-term efficacy of anticancer immunotherapies and biomarkers, given that none of the preclinical models has ever been evaluated for such a long duration.

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Magnetic Nanostructures as Emerging Therapeutic Tools to Boost Anti-Tumour Immunity

Cancers ◽

10.3390/cancers13112735 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2735

Author(s):

Stefano Persano ◽

Pradip Das ◽

Teresa Pellegrino

Keyword(s):

Cancer Immunotherapy ◽

Low Cost ◽

Drug Stability ◽

Adoptive Cell Therapy ◽

Magnetic Nanostructures ◽

Immune Checkpoint Blockade ◽

Therapeutic Vaccines ◽

Durable Response ◽

Tumour Immunity ◽

Therapeutic Modalities

Cancer immunotherapy has shown remarkable results in various cancer types through a range of immunotherapeutic approaches, including chimeric antigen receptor-T cell (CAR-T) therapy, immune checkpoint blockade (ICB), and therapeutic vaccines. Despite the enormous potential of cancer immunotherapy, its application in various clinical settings has been limited by immune evasion and immune suppressive mechanisms occurring locally or systemically, low durable response rates, and severe side effects. In the last decades, the rapid advancement of nanotechnology has been aiming at the development of novel synthetic nanocarriers enabling precise and enhanced delivery of immunotherapeutics, while improving drug stability and effectiveness. Magnetic nanostructured formulations are particularly intriguing because of their easy surface functionalization, low cost, and robust manufacturing procedures, together with their suitability for the implementation of magnetically-guided and heat-based therapeutic strategies. Here, we summarize and discuss the unique features of magnetic-based nanostructures, which can be opportunely designed to potentiate classic immunotherapies, such as therapeutic vaccines, ICB, adoptive cell therapy (ACT), and in situ vaccination. Finally, we focus on how multifunctional magnetic delivery systems can facilitate the anti-tumour therapies relying on multiple immunotherapies and/or other therapeutic modalities. Combinatorial magnetic-based therapies are indeed offering the possibility to overcome current challenges in cancer immunotherapy.

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