Stool microbiota profiling of patients with muscle invasive bladder cancer receiving neoadjuvant pembrolizumab.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4533-4533
Author(s):  
Filippo Pederzoli ◽  
Irene Locatelli ◽  
Michela Riba ◽  
Marco Bandini ◽  
Daniele Raggi ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Radical Cystectomy ◽  
Cell Activity ◽  
Response To Therapy ◽  
Smoking History ◽  
Linear Discriminant ◽  
Neoadjuvant Immunotherapy ◽  
Flat Dose ◽  
Muscle Invasive ◽  
Stool Microbiota

4533 Background: Immune checkpoint inhibitors (ICIs) showed efficacy in metastatic urothelial carcinoma (UC) and promising activity in muscle-invasive and non-muscle invasive UC of the bladder. Recent studies revealed the immunomodulatory effect of the gut microbiota on ICIs efficacy across several malignancies, identifying microbial “signatures” associated with response to therapy and effective antitumoral T-cell activity. In our study, we aimed to study the stool microbiota in patients undergoing neoadjuvant immunotherapy (IO) for muscle-invasive UC. Methods: Pre-IO stools were available for analysis from 42 patients enrolled in the PURE-01 trial (NCT02736266), testing 3x200mg flat-dose pembrolizumab every 21 days before radical cystectomy (RC). All samples were collected using Stool Nucleic Acid Collection and Preservation Tubes (Norgen) and extracted using the Stool DNA Isolation Kit (Norgen), according to the manufacturer’s protocol. 16s sequencing was performed using standardized protocols at the internal facility, using mock communities and DNA standards (ZymoBIOMICS) to control for extraction and sequencing contaminations. A QIIME-based bioinformatic pipeline was used for microbiome analyses. Complete response (CR) to neoadjuvant IO was defined as ypT0N0 at pathologic examination on radical cystectomy specimens, while partial response (PR) was defined as < ypT2N0. Concomitant antibiotic therapy (ABT) was defined as any ATB between 30 days prior to the first pembrolizumab dose and the planned RC. Results: In our study sample, 23 patients responded to IO (21 CR + 2 PR). Overall median age was 68.5 years. Among responders, 20 (87%) patients had a smoking history (vs. 15 (79%) in non-responders) and 4 (17%) underwent concomitant ABT (vs. 6 (32%) in non-responders). Alpha-diversity assessed by richness (ACE index) was higher in responders vs. non-responders (p = 0.05), while no significant diversity was found. Beta-diversity did not show clear clustering of responders vs. non-responders. LEfSe identified 16 bacterial taxa with a linear discriminant analysis (LDA) score ≥2.5 that were differently enriched between responders and non-responders. Among them, we identified the genus Sutterella enriched in responders (p = 0.02), while the species Ruminococcus bromii was enriched in non-responders (p = 0.02). Conclusions: Our analyses showed an association between response to neoadjuvant-IO and microbiome composition in an intention-to-cure population with muscle invasive UC. We found bacterial taxa specifically enriched in responders or non-responders using pre-therapy stool specimens. The identified taxa may be tested in future studies as potential indicators of therapy outcomes, alone or in combination with other IO biomarkers. These results may also inspire new strategies of gut microbiota modulation to promote response in immunotherapy-refractory patients.

scholarly journals Pembrolizumab as Neoadjuvant Therapy Before Radical Cystectomy in Patients With Muscle-Invasive Urothelial Bladder Carcinoma (PURE-01): An Open-Label, Single-Arm, Phase II Study

2018 ◽  
Vol 36 (34) ◽  
pp. 3353-3360 ◽  
Author(s):  
Andrea Necchi ◽  
Andrea Anichini ◽  
Daniele Raggi ◽  
Alberto Briganti ◽  
Simona Massa ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Radical Cystectomy ◽  
Bladder Carcinoma ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Immune Gene ◽  
Open Label ◽  
End Point ◽  
Neoadjuvant Immunotherapy ◽  
Muscle Invasive

Purpose To determine the activity of pembrolizumab as neoadjuvant immunotherapy before radical cystectomy (RC) for muscle-invasive bladder carcinoma (MIBC) for which standard cisplatin-based chemotherapy is poorly used. Patients and Methods In the PURE-01 study, patients had a predominant urothelial carcinoma histology and clinical (c)T≤3bN0 stage tumor. They received three cycles of pembrolizumab 200 mg every 3 weeks before RC. The primary end point in the intention-to-treat population was pathologic complete response (pT0). Biomarker analyses included programmed death-ligand 1 (PD-L1) expression using the combined positive score (CPS; Dako 22C3 pharmDx assay), genomic sequencing (FoundationONE assay), and an immune gene expression assay. Results Fifty patients were enrolled from February 2017 to March 2018. Twenty-seven patients (54%) had cT3 tumor, 21 (42%) cT2 tumor, and two (4%) cT2-3N1 tumor. One patient (2%) experienced a grade 3 transaminase increase and discontinued pembrolizumab. All patients underwent RC; there were 21 patients with pT0 (42%; 95% CI, 28.2% to 56.8%). As a secondary end point, downstaging to pT<2 was achieved in 27 patients (54%; 95% CI, 39.3% to 68.2%). In 54.3% of patients with PD-L1 CPS ≥ 10% (n = 35), RC indicated pT0, whereas RC indicated pT0 in only 13.3% of those with CPS < 10% (n = 15). A significant nonlinear association between tumor mutation burden (TMB) and pT0 was observed, with a cutoff at 15 mutations/Mb. Expression of several genes in pretherapy lesions was significantly different between pT0 and non-pT0 cohorts. Significant post-therapy changes in the TMB and evidence of adaptive mechanisms of immune resistance were observed in residual tumors. Conclusion Neoadjuvant pembrolizumab resulted in 42% of patients with pT0 and was safely administered in patients with MIBC. This study indicates that pembrolizumab could be a worthwhile neoadjuvant therapy for the treatment of MIBC when limited to patients with PD-L1–positive or high-TMB tumors.

scholarly journals PD-L1 Expression in Muscle Invasive Urothelial Carcinomas as Assessed via Immunohistochemistry: Correlations with Specific Clinical and Pathological Features, with Emphasis on Prognosis after Radical Cystectomy

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 404
Author(s):  
Ioan Alin Nechifor-Boilă ◽  
Andrada Loghin ◽  
Adela Nechifor-Boilă ◽  
Myriam Decaussin-Petrucci ◽  
Septimiu Voidăzan ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Distant Metastases ◽  
Lymph Node Involvement ◽  
Histological Variant ◽  
Node Involvement ◽  
Positive Score ◽  
Checkpoint Inhibitor Therapy ◽  
N Stage ◽  
Combined Positive Score ◽  
Muscle Invasive

In the present study, we analyzed Programmed Death Ligand-1 (PD-L1) expression in radical cystectomy (RC) specimens from patients with muscle-invasive urothelial carcinoma (UC), in order to assess any correlations with specific clinicopathological features and its potential prognostic value. A multi-institutional study was performed within the departments of urology and pathology at the Mureș County Hospital, Romania, and Centre Hospitalier Lyon Sud, France. Sixty-nine patients with MIBC were included, for whom tumor histology (conventional versus histological variant/differentiation), tumor extension (T), lymph node involvement (N), and distant metastases (M) were recorded. PD-L1 immunostaining was performed using the 22C3 clone and was interpreted using the combined positive score (CPS) as recommended (Dako Agilent, Santa Clara, CA, USA). Positive PD-L1 immunostaining was more prevalent among UCs with squamous differentiation compared to conventional UCs and trended towards an improved OS (p = 0.366). We found the T stage to be a risk factor for poor survival in PD-L1-positive patients (HR 2.9, p = 0.021), along with the N stage in PD-L1-negative patients (HR 1.98, p = 0.007). No other clinicopathological factor was found to be significantly associated with PD-L1 positivity. Thus, we confirm the need for PD-L1 immunostaining prior to initiating immune checkpoint inhibitor therapy for a more accurate assessment of the patients’ chances of responding to treatment.

Tumor Subtyping: Making Sense of Heterogeneity with a Goal Toward Treatment

2020 ◽  
pp. 1-11
Author(s):  
Joshua J. Meeks ◽  
Gottfrid Sjödahl ◽  
Seth P. Lerner ◽  
Arighno Das ◽  
David J. McConkey ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Immune Cell ◽  
Response To Therapy ◽  
Genomic Diversity ◽  
Intrinsic Resistance ◽  
Making Sense ◽  
Search Terms ◽  
Muscle Invasive ◽  
Next Generation Sequencing Ngs ◽  
Descriptive Feature

BACKGROUND: Bladder cancers have high total mutation burdens resulting in genomic diversity and intra- and inter-tumor heterogeneity that may impact the diversity of gene expression, biologic aggressiveness, and potentially response to therapy. To compare bladder cancers among patients, an organizational structure is necessary that describes the tumor at the histologic and molecular level. These “molecular subtypes”, or “expression subtypes” of bladder cancer were originally described in 2010 and continue to evolve secondary to next generation sequencing (NGS) and an increasing public repository of well-annotated cohorts. OBJECTIVE: To review the history and methodology of expression-based subtyping of non-muscle invasive (NMIBC) and muscle invasive bladder cancer (MIBC). METHODS: A literature review was performed of primary papers from PubMed that described subtyping methods and their descriptive feature including search terms of “subtype”, and “bladder cancer”. RESULTS: 21 papers were identified for review. Tumor subtyping developed from N = 2 to N = 6 subtyping schemes with most subtypes comprised of at least luminal and basal tumors. Most NMIBCs are luminal cancers and luminal MIBCs may be associated with less aggressive features, while one study of basal tumors identified a better clinical outcome with systemic chemotherapy. Tumors with a 53-like signature may have intrinsic resistance to chemotherapy. The heterogeneity of tumors, which is likely derived from stromal components and immune cell infiltration, affect subtype calls. CONCLUSION: Subtyping, while still evolving, is ready for testing in clinical trials. Improved patient selection with tumor subtyping may help with tumor classification and potentially match patient or tumor to therapy.

scholarly journals FRI0224 IDENTIFICATION OF RISK AND PROGNOSTIC FACTORS FOR POLYARTERITIS NODOSA PATIENTS WITH DIGITAL GANGRENE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 695.2-695
Author(s):  
D. Xu ◽  
X. Tian ◽  
X. Zeng ◽  
F. Zhang ◽  
L. Zhao ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Polyarteritis Nodosa ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Response To Therapy ◽  
Smoking History ◽  
Systemic Lupus ◽  
Poor Outcomes

Background:Polyarteritis nodosa (PAN) is a segmental, necrotizing vascular disease that primarily impacts medium-sized muscle arteries. The estimated annual incidence of PAN is still lacking in China. Digital gangrene is an ischemic manifestation of the limb. However, the causes and the treatment methods vary from case to case, and the outcome is unpredictable. These features emphasize the need to identify measurable variables that accelerate digital gangrene development in PAN patients. However, little effort has been made to identify the clinical and laboratory factors that affect PAN patients with digital gangrene to anticipate their natural history and response to therapy.Objectives:Many patients with polyarteritis nodosa (PAN) complicated with digital gangrene have poor outcomes and related research information is limited. This study was carried out to identify the associated risk and prognostic factors.Methods:We conducted a retrospective study of 148 PAN patients admitted to Peking Union Medical College Hospital (PUMCH) from September 1986 to December 2018. The characteristics, therapeutic regimens, and outcome data for patients with and without gangrene were compared. The Kaplan–Meier method and Cox hazard regression model were used to evaluate the prognostic factors.Results:Forty-seven (31.8%) PAN patients had digital gangrene complications. The average age was 40.4±17.9 years and the average disease duration was 11 (4-27) months. The presence of digital gangrene was correlated with smoking history [odds ratio (OR), 4.27; 95% confidence interval (95% CI), 1.56-11.66] and eosinophil elevation (28.12; 10.30-76.8). Thirty-two (68.1%) gangrene patients received methylprednisolone pulse therapy and all of these patients were treated with cyclophosphamide. Nine patients suffered irreversible organ injury and two died. Disease duration ≥ 24 months and elevated serum C-reactive protein (CRP) were identified as hazardous factors for poor prognosis in patients with gangrene (P=0.003, HR=8.668, 95% CI 2.11, 35.55 andP=0.042, HR=27.062, 95% CI 1.13, 648.57, respectively).Conclusion:Smoking history and eosinophil elevation in PAN patients were more prone to digital gangrene and high serum CRP level predicted poor outcomes. PAN patients with smoking history and elevated eosinophils need to be seriously evaluated by clinicians. Furthermore, the CRP level should be efficiently controlled for good prognosis.References:[1]De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016;15:564-70.[2]Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616-26.[3]Xu D, You X, Wang Z, Zeng Q, Xu J, Jiang L, et al. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry VI: Effect of Cigarette Smoking on the Clinical Phenotype of Chinese Patients with Systemic Lupus Erythematosus. PLoS One. 2015;10:e0134451.Acknowledgments:NoDisclosure of Interests:Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared, Lin Zhao: None declared, Shangzhu Zhang: None declared, Jiaxin Zhou: None declared, Jiu-liang Zhao: None declared, Xiaodan Kong: None declared

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