Prognosticating role of serum eosinophils on immunotherapy efficacy in patients with advanced melanoma

Aim: To evaluate serum eosinophilia (≥500 peripheral eosinophil counts/microliter) in prognosticating immunotherapy (IO) efficacy. Methodology: A retrospective study of 86 patients with advanced melanoma on PD-1 inhibitors. Results: Eosinophilia-on-IO was an independent prognosticating factor for median OS (HR :0.223; 95% CI: 0.088–0.567; p = 0.002). ‘Late eosinophilia’ (≥1 year from IO start date) group had better median OS (31.9 vs 24.1 vs 13.0 months; p = 0.002) when compared with ‘early eosinophilia’ (<1 year from IO start date) and ‘no eosinophilia’ groups, respectively. Conclusion: Eosinophilia-on-IO and its timing were associated with better IO efficacy in patients with advanced melanoma. Our findings provided insights on potential therapeutic benefit of inducing eosinophilia at certain interval time to obtain a longer durable immunotherapy response.

Targeting the IL-5 pathway in eosinophilic asthma: a comparison of mepolizumab to benralizumab in the reduction of peripheral eosinophil counts

Background Mepolizumab and benralizumab are biologics approved for severe eosinophilic asthma. Mepolizumab is an anti-interlukin-5 (IL-5) antibody while benralizumab is an anti-interleukin-5 receptor alpha (IL-5Rα) antibody targeting the IL-5 receptor on eosinophils. Both therapies reduce oral corticosteroid requirements and asthma exacerbations. However, no head-to-head studies have been published. The aim of the present study was to compare the efficacy of peripheral eosinophil reduction of mepolizumab and benralizumab. Methods A retrospective chart review was conducted on patients with severe eosinophilic asthma who were approved for either IL-5 agent. Patients with noted non-adherence or those who were on fluctuating doses of corticosteroids for non-asthma related illnesses were excluded. The last detectable eosinophil count for each patient prior to start of therapy was compared to the highest eosinophil count noted after therapy start with at least 30 days of adherence. Results Thirty-six patients taking mepolizumab and 19 patients taking benralizumab met the inclusion criteria and had both pre-treatment and post-treatment eosinophil counts. Baseline characteristics were not statistically different between those on mepolizumab and benralizumab therapy. The mean pre-therapy serum eosinophil count did not statistically differ between patients on mepolizumab (597.2 cells/µL) compared to benralizumab (521.6 cells/µL), p = 0.3769. While both therapies resulted in a significant decrease in eosinophil count (p < 0.0001); the mean decrease did not statistically differ between patients taking mepolizumab compared to those on benralizumab, p = 0.9079. Nonetheless, 100% of patients receiving benralizumab had undetectable eosinophil counts post-therapy compared to 31% of patients receiving mepolizumab (p < 0.0001). Conclusion Both mepolizumab and benralizumab are potent targets of the IL-5 pathway with the ability to significantly reduce peripheral eosinophil counts. While there is there is no statistical difference in the magnitude of eosinophil reduction offered by each agent, benralizumab is able to decrease peripheral eosinophil counts to 0 cells/µL in more patients than mepolizumab.

Abdominal Pain Relieved By A Warm Hot Water Bottle: An Atypical Presentation Of Eosinophilic Gastroenteritis

A 26-year-old woman presented with a 3-month history of worsening episodic abdominal pain, which was associated with frequent passage of watery stools, nausea and dyspepsia. Her peripheral eosinophil count was markedly elevated. This responded well to a reducing regimen of corticosteroids. Her symptoms completely resolved with a corresponding fall in eosinophil count. The patient was diagnosed with eosinophilic gastroenteritis. We have not considered steroid-sparing agents at this point, but should she have future exacerbations then this will be considered.