帕博利珠单抗联合二甲双胍治疗转移性头颈部癌的 II 期可行性研究
A Phase II Feasibility Study Combining Pembrolizumab and Metformin in Patients with Metastatic Head and Neck Cancer.
二甲双胍联合帕博利珠单抗耐受性良好,仅出现轻度胃肠道不良事件,并展现出有前景的活性,值得在随机试验中进一步研究。
英文原题:Exploiting the immunogenic potential of standard of care radiation or cisplatin therapy in preclinical models of HPV-associated malignancies.
在HPV相关恶性肿瘤的临床前模型中,标准治疗放疗或顺铂治疗诱导了免疫原性细胞应激,这为利用IO策略与标准治疗联合应用提供了可资利用的机会。
尽管放疗和化疗的主要目的是发挥其细胞毒性作用,但越来越多的临床前和临床证据表明,这些标准疗法具有免疫原性潜力。因此,我们试图在HPV相关恶性肿瘤的人类肿瘤模型中表征放疗和顺铂的免疫原性潜力。这些研究可能为在标准治疗基础上于临床中采用合理的联合免疫肿瘤学(IO)策略提供依据,并借此利用标准治疗的免疫原性潜力来改善HPV相关恶性肿瘤的持久缓解。
用HPV16 E7进行逆转录病毒转导,建立了一株新的HPV相关鼻腔鼻窦鳞状细胞癌(SNSCC)细胞系。还研究了三种已建立的HPV16阳性细胞系(宫颈癌和头颈部鳞状细胞癌)。在使用MTT法测定对标准治疗的敏感性后,采用流式细胞术表征亚致死剂量放疗或顺铂暴露后免疫原性细胞应激的诱导,并使用基于阻抗的实时细胞分析细胞毒性试验确定这种诱导的功能性后果,该试验使用HPV16 E7特异性细胞毒性淋巴细胞(CTL),联合或不联合N803(IL-15/IL-15-Rα超级激动剂)或外源性死亡受体配体。通过体内异种移植NSG小鼠人宫颈癌模型评估顺铂联合CTL过继性细胞转移,将体外观察结果进行了转化。
我们展示了在四种HPV相关恶性肿瘤的肿瘤模型中,存活于临床相关剂量放疗或顺铂治疗后的亚群对CTL介导的裂解更敏感,这可作为HPV治疗性疫苗或T细胞受体过继细胞转移的模型。使用N803的IL-15激动作用进一步放大了这种增强的杀伤效应。我们进一步表征了放疗或顺铂在三种细胞系中诱导了免疫原性细胞应激,并因此证明Fas和TRAIL-R2死亡受体的表面表达上调至少部分介导了增强的CTL介导的裂解。在体内,顺铂诱导的免疫原性细胞应激在HPV相关恶性肿瘤的人源模型中协同增强了CTL介导的肿瘤控制。
BACKGROUND: While radiation and chemotherapy are primarily purposed for their cytotoxic effects, a growing body of preclinical and clinical evidence demonstrates an immunogenic potential for these standard therapies. Accordingly, we sought to characterize the immunogenic potential of radiation and cisplatin in human tumor models of HPV-associated malignancies. These studies may inform rational combination immuno-oncology (IO) strategies to be employed in the clinic on the backbone of standard of care, and in so doing exploit the immunogenic potential of standard of care to improve durable responses in HPV-associated malignancies. METHODS: Retroviral transduction with HPV16 E7 established a novel HPV-associated sinonasal squamous cell carcinoma (SNSCC) cell line. Three established HPV16-positive cell lines were also studied (cervical carcinoma and head and neck squamous cell carcinoma). Following determination of sensitivities to standard therapies using MTT assays, flow cytometry was used to characterize induction of immunogenic cell stress following sublethal exposure to radiation or cisplatin, and the functional consequence of this induction was determined using impedance-based real time cell analysis cytotoxicity assays employing HPV16 E7-specific cytotoxic lymphocytes (CTLs) with or without N803 (IL-15/IL-15-Rα superagonist) or exogenous death receptor ligands. In vitro observations were translated using an in vivo xenograft NSG mouse model of human cervical carcinoma evaluating cisplatin in combination with CTL adoptive cell transfer. RESULTS: We showed that subpopulations surviving clinically relevant doses of radiation or cisplatin therapy were more susceptible to CTL-mediated lysis in four of four tumor models of HPV-associated malignancies, serving as a model for HPV therapeutic vaccine or T-cell receptor adoptive cell transfer. This increased killing was further amplified by IL-15 agonism employing N803. We further characterized that radiation or cisplatin induced immunogenic cell stress in three of three cell lines, and consequently demonstrated that upregulated surface expression of Fas and TRAIL-R2 death receptors at least in part mediated enhanced CTL-mediated lysis. In vivo, cisplatin-induced immunogenic cell stress synergistically potentiated CTL-mediated tumor control in a human model of HPV-associated malignancy. CONCLUSION: Standard of care radiation or cisplatin therapy induced immunogenic cell stress in preclinical models of HPV-associated malignancies, presenting an opportunity poised for exploitation by employing IO strategies in combination with standard of care.
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