Biologists discover process that neutralizes tumors July 10, 2018, University of California - San Diego The molecular "brake" known as PD-1 can bind and neutralize the same tumor cell, instead of an opposing tumor cell. Credit: Hui Lab, UC San Diego Researchers from the University of California San Diego have identified an unexpected mechanism that could help determine whether a cancer patient will respond to immunotherapy. Ideally, the immune system identifies tumors as threatening elements and deploys immune cells (T cells) to find and kill them. However, tumor cells have evolved to employ a protein called PD-L1 to blind T cells from carrying out their functions and evade immune defenses. PD-L1 protects tumor cells by activating a "molecular brake" known as PD-1 to stop T cells. In important therapeutic progress, antibodies developed to block PD-L1/PD-1 have been clinically proven to benefit certain cancer patients. Yet why some patients don't respond to such therapy has remained a mystery. Now, UC San Diego's Yunlong Zhao, Enfu Hui and their colleagues at the University of Chicago and the Nanjing Medical School in China have uncovered some clues. As described July 10 in the journal Cell Reports, the researchers discovered an unexpected twist in the tumor versus T cell battle. Some tumor cells display not only their PD-L1 weapon, but also the PD-1 "brake." This simultaneous expression leads PD-1 to bind and neutralize PD-L1 on the same tumor cell. Thus, the PD-L1 on these tumor cells can no longer engage the PD-1 brake on T cells."It's a very exciting finding," said Hui. "Our study uncovered an unexpected role of PD-1 and another dimension of PD-1 regulation with important therapeutic implications."This study suggests that patients with high levels of PD-1 on tumor cells may not respond well to the blocking antibodies because the PD-1 pathway is self-canceled. In these patients, mechanisms other than PD-L1/PD-1 are likely employed by the tumors to escape from immune destruction. Looking to extend the immunotherapy potential of the finding, Hui and his colleagues are now seeking to determine additional mechanisms of "self-cancellation" at the interface of the tumor and immune cells."We think that our finding is the tip of the iceberg," said Hui, recently named a Pew Biomedical Scholar and Searle Scholar. "We speculate that self-cancellation is a general mechanism to regulate immune cell function. Understanding these processes more clearly will help develop better immunotherapy strategies and more reliably predict whether a patient will respond or not."
Showing posts with label PD-L1/ PD-1. Show all posts
Showing posts with label PD-L1/ PD-1. Show all posts
Saturday, July 14, 2018
Friday, July 13, 2018
綠葉 抗腫瘤核心: 紫杉醇脂質體(力撲素) _2016年採購金額17.89億 !!
港股上市的綠葉製藥則以其國際化而聞名 綠葉製藥的抗腫瘤核心產品為注射用紫杉醇脂質體(力撲素)和注射用甘氨雙唑鈉(希美納),力撲素2016年終端採購金額為17.89億元,同比增長19%,是綠葉製藥最大單品,占綠葉製藥終端採購總額的48%。綠葉製藥目前專注的研發項目包括腫瘤科的核心領域,其國外在研抗腫瘤產品包括治療前列腺癌的LY01005注射用戈舍瑞林緩釋微球。國內主要在研抗腫瘤產品包括:治療急性淋巴細胞白血病的注射用硫酸長春新堿脂質體;治療前列腺癌的注射用醋酸曲普瑞林緩釋微球;治療前列腺癌、乳腺癌的注射用醋酸戈舍瑞林緩釋微球;Poziotinib片。而這兩年風波頗多的海正藥業(600267,SH),其抗腫瘤產品線包含24個品種,幾乎覆蓋了所有類別。2016 年,海正藥業抗腫瘤藥終端採購金額為7.1億元,旗下抗腫瘤藥以細胞毒素類抗生素為核心產品,2016年終端市場採購金額約20.66億元。在研方面,海正藥業擁有firtecan pegol、埃博黴素B、卡巴他賽等,覆蓋前列腺癌、惡性腫瘤、乳腺癌等。此外不得不提的是被稱為A股"抗癌第一股"的貝達藥業。2011年,貝達藥業自主研發的國家1類新藥埃克替尼(凱美納),獲得新藥證書和生產批文並開始上市銷售,成為公司收入及利潤的主要來源。埃克替尼是我國第一個擁有自主智慧財產權的小分子靶向抗癌藥,並作為中國創新藥,首次被納入國際權威的醫藥臨床試驗資料提供商Citeline的《2012年藥物研發年度報告》之全球新藥研發目錄。品種儲備上,貝達藥業擁有BPI-7711、BPI-9016M、伏立諾他等十餘抗腫瘤在研藥物,主要面對非小細胞肺癌與淋巴瘤等。
研發紮堆PD-1 在研發上,目前PD-1被認為是抗腫瘤治療的明星品種,廣泛應用於各類治療領域,包括腫瘤、自身免疫系統疾病、神經科及眼科。2017年單克隆抗體(包括融合蛋白)的全球銷售收入為1038億美元。截至2018年5月10日,全球共5種已上市的PD-1及PD-L1抗體,包括PD-1抗體Keytruda及Opdivo,PD- L1抗體Tecentriq、Bavencio及Imfinzi。今年6月百時美施貴寶PD-1單抗Opdivo(納武單抗)在華獲批,成為第一個在中國上市的PD-1抑制劑。目前約有20餘款國產PD-(L)1單抗正在研發,研發藥企包括君實生物、信達生物、恒瑞醫藥和百濟神州。今年3月9日,君實生物宣佈JS001的新藥上市申請獲CDE正式受理,適應症為黑色素瘤。JS001是國內企業首個獲得CFDA臨床試驗批件的PD-1單抗,除了申報的黑色素瘤外,JS001膀胱癌臨床試驗已到II期,鼻咽癌、胃癌、肺癌、食管癌、尿路上皮癌等也已進行到臨床I期。剛申請擬掛牌港交所的信達生物的PD-1單抗信迪單抗注射液(IBI308)于去年年底向CDE提交申請,適應症是霍奇金淋巴瘤,不過隨後該申請已被信達生物撤回,根據此前媒體報導,此次是信達生物主動撤回,將在補充材料後重新提交申請。恒瑞的PD-1單抗SHR-1210則是國內最早進入三期臨床試驗的PD-(L)1單抗,其適應症包括非小細胞肺癌、食道癌和肝細胞癌,此外其肝細胞癌與霍奇金淋巴瘤已到臨床II期,黑色素瘤與鼻咽癌到臨床I期。百濟神州的PD-1單抗產品BGB-A317處於III期試驗階段,適應症為非小細胞肺癌、食道癌和肝細胞癌,同時還有II期臨床適應症霍奇金淋巴瘤、胃癌、小細胞肺癌等。此外,試圖在PD-1上取得突破的還包括基石藥業、嘉和生物、正大天晴、科倫藥業、麗珠集團、海正藥業與複宏漢霖等。在國內藥企與資本紮堆的同時,對PD-1研發是否已有泡沫的質疑聲也開始出現。
Labels:
China Pharma,
China Technology,
Formulation,
Immune Therapy,
Luye Pharma,
PD-L1/ PD-1,
綠葉製藥
Thursday, July 12, 2018
(講授3招 成功腫瘤免疫治療) : 腫瘤免疫正常化/ 靶向微環境/ 重置微環境免疫 by 耶魯 癌症中心主任 陳列平教授
陳列平教授:探索腫瘤免疫治療新靶點,以抗PD療法中的免疫學原理為指導 丁雨竹中國醫學論壇報今日腫瘤6月30日~31日,由中國食品藥品國際交流中心主辦、藥品審評中心、美國華裔血液及腫瘤專家學會(CAHON)、清華大學醫學院協辦的2018中國腫瘤免疫治療研討會在北京召開。美國聯合技術公司癌症研究教授,耶魯大學醫學院免疫學、皮膚病學和腫瘤內科學教授,美國耶魯大學癌症中心癌症免疫學研究項目聯合主任陳列平教授,以《探索腫瘤免疫新靶點:以抗PD療法中的免疫學原理為指導》為題,為與會者帶來一場精彩演講,介紹了腫瘤免疫療法的過去、現在與未來發展方向。《中國醫學論壇報》編輯將現場演講內容整理成文,希望能幫助臨床腫瘤醫生更好地理解和應用腫瘤免疫治療,並對腫瘤免疫治療未來發展方向有更清晰的瞭解。
陳列平教授腫瘤免疫治療發展現狀 陳列平教授首先回顧了I/O藥物的變遷。從FDA已批療法的數量和種類看,過去4年間抗PD療法(包括抗PD和抗PD-1)爆發式湧現,占新療法的絕大部分,覆蓋適應證包括黑色素瘤、肺癌、腎癌、膀胱癌、頭頸癌、胃腸腫瘤、肝癌、Merkel細胞瘤、宮頸癌、霍奇金淋巴瘤和大B細胞淋巴瘤。特別是有高度微衛星不穩定性(MSI-hi)或錯配修復基因缺陷(dMMR)的腫瘤已經於2017年獲批作為抗PD適應證,涵蓋結直腸癌、胰腺癌、前列腺癌和乳腺癌等。這是首次根據突變而非突變發生部位進行批准,是非常重要的第一次。
抗PD療法中的免疫學原理 陳教授總結了抗PD療法成功背後的三大免疫學原理,也是未來腫瘤免疫治療研究方向。
使腫瘤免疫正常化(normalization of tumor immunity)正常情況下人體對腫瘤產生免疫反應,效應T細胞、抗原呈遞細胞等被調動起來,但T細胞在識別腫瘤抗原後,會啟動PD-1表達,釋放IFN-γ,誘導腫瘤細胞表達PD-L1(B7-H1),而PD-1與受體PD-L1的結合會抑制T細胞抗腫瘤能力,從而使腫瘤細胞避免免疫攻擊。這種現象是適應性免疫耐受(adaptive immune resistance)。因此,抑制PD通路能夠恢復免疫系統對腫瘤的殺傷力。但假如機體對腫瘤細胞根本沒有免疫反應,例如腫瘤缺乏T細胞浸潤,那麼抗PD療法效果就很有限。因此能否將腫瘤免疫正常化將決定抗PD療法有效性。
靶向腫瘤微環境[targeting tumor microenvironment ]既往某些腫瘤浸潤淋巴細胞(TIL)療效不佳,從免疫學上看是腫瘤微環境(TME)出了問題。例如,PD-L1或TIL缺失即可導致靶點缺失性耐藥。根據腫瘤免疫微環境(TIME),按照PD-L1和TIL的表達對晚期腫瘤進行分類。在幾種實體瘤中,任意一種靶點缺失占比55%~83%不等。另外,腫瘤浸潤淋巴細胞缺失(TIL陰性)比例約占30%~70%(代表缺乏炎症反應,機制尚不清楚),進一步強調拆解TIL治療失效原因的重要性。對此,免疫學者著重解決兩大問題:① 為什麼TIL在TME中無效:原因之一是發生適應性免疫耐受(如PD通路啟動),另外約70%人體實體瘤並非通過PD通路逃避免疫攻擊;② 為什麼TME中沒有T細胞表達。針對上述問題,陳教授提出相應的三步策略:① 鑒別免疫調控通路,找到相應分子;② 聚焦TME中的缺陷通路(defective pathway),比如:哪些分子僅在TME中表達、而在正常組織器官裡無表達?是否存在功能異常(functionally aberrant)?並排除正常免疫功能也需要的通路。③ 開發藥物。陳教授通過幾個具體的研究介紹了上述研發策略的實踐方式。比如,可以通過建構T細胞活性探針,在基因組水準尋找T細胞協同刺激/抑制分子。另外,在TME中除了T細胞還有其他需要深入研究的細胞,包括啟動的CD8+T細胞、初始CD4/8+T細胞、調節T細胞、樹突狀細胞、巨噬細胞、中性粒細胞、NK細胞和NKT細胞。陳教授著重分享了其團隊對跨膜蛋白Siglec-15的研究進展。Siglec-15是唾液酸結合Ig樣凝集素(Siglecs)家族的一員,在M2型巨噬細胞、髓系細胞(MDSC)、樹突狀細胞、B細胞與破骨細胞中表達。結果顯示,對Siglec-15的調控既能調控TME,同時可使腫瘤免疫正常化。目前由耶魯大學領銜,抗Siglec-15抗體已在包括非小細胞肺癌、卵巢癌在內的多種實體瘤中進行Ⅰ/Ⅱ期臨床研究,另有基於生物標誌物的回顧性與前瞻性研究在開展。
重置微環境中的免疫反應(reset of immune response in TME)免疫環境的問題可以糾正。一部分患者只要改善了其中一條通路,其免疫系統存在的所有問題就實現了自我糾正(鏈反應)。關鍵分子目前還在探索中。 整理、編輯 | 丁雨竹
Monday, July 9, 2018
肺癌 免疫治療如何精準治療: PD-L1 高低不重要?!癌突變壓力(Tumor mutation burden) 成關鍵?
CheckMate 227 trial in advanced lung cancer by Dr. Borghaei.
Tumor mutation burden matters than PD-L1:
1, regardless of the level of PD-L1 expression or histology, patients who had this biomarker of a high tumor mutational burden above a certain threshold had a better outcome compared to patients with a relatively low tumor mutational burden, in terms of PFS and response rate, with the combination of ipilimumab plus nivolumab compared to chemotherapy alone.
2, even in this population of PD-L1–negative patients, a high tumor mutational burden was associated with better PFS and better duration of response with ipilimumab plus nivolumab than either chemotherapy alone or nivolumab plus chemotherapy.
3, patients have PD-L1–negative tumors and a low tumor mutational burden, the addition of nivolumab to chemo or ipilimumab to nivolumab didn’t really provide additional benefit over chemotherapy alone.
Side effects: add nivolumab to chemotherapy there are more side effects compared to chemotherapy alone. But interestingly, in this analysis, the group of patients that got ipilimumab plus nivolumab had a lower percentage of the grade 3 and 4 severe side effects. In the chemotherapy-plus-nivolumab group, the grade 3 and 4 toxicities were close to 50%—but only 25% and 35% of patients in the ipilimumab-plus-nivolumab group and chemotherapy-alone group experienced these toxicities.
*Ipilimumab is a monoclonal antibody that works to activate the immune system by targeting CTLA-4, a protein receptor that downregulates the immune system.
* Nivolumab binds to and blocks the activation of PD-1, an Ig superfamily transmembrane protein, by its ligands programmed cell death ligand 1 (PD-L1), overexpressed on certain cancer cells, and programmed cell death ligand 2 (PD-L2), which is primarily expressed on APCs. This results in the activation of T-cells and cell-mediated immune responses against tumor cells or pathogens. Activated PD-1 negatively regulates T-cell activation and and plays a key role in in tumor evasion from host immunity.
Wednesday, May 16, 2018
(NEJM) 27 種腫瘤TMB對 PD-1 Inhibition療效/ (Cancer Cell) nivolumab+ipilimumab 適用 SCLC小細胞肺癌 TMB腫瘤突變負荷高/
TMB標誌物顯神威!可增加小細胞肺癌I-O治療有效性 腫瘤資訊2018-05-15 編譯:月下荷花 來源:腫瘤資訊 CheckMate032研究表明,小細胞肺癌(SCLC)可獲益於免疫檢查點抑制治療,但哪些患者在免疫治療中獲益更多並不清楚。近日美國Hellmann教授在Cancer Cell雜誌發表了CheckMate032的回顧性研究,結果表明高腫瘤突變負荷(TMB)SCLC患者從納武利尤單抗(nivolumab)聯合伊匹木單抗(ipilimumab)治療中獲益最大。
研究背景 小細胞肺癌占所有肺癌10%–15%,大約75%患者為廣泛期。標準一線治療為含鉑化療,一旦疾病進展則缺少有效治療,預後極差。納武利尤單抗為免疫檢查點抑制劑,無論是單藥還是與伊匹木單抗聯合治療既往接受過治療的SCLC,均可獲得持續治療反應,延長生存。CheckMate 032研究中,納武利尤單抗單藥治療進展期SCLC的2年生存率14%,與伊匹木單抗聯合為26%,因此NCCN指南推薦納武利尤單抗±伊匹木單抗作為SCLC的二線或二線以上治療。然而一直缺少有效預測SCLC免疫檢查點抑制治療有效性的標誌。與其它腫瘤不同,SCLC較少表達程式化死亡配體1(PD-L1),而且無論有無PD-L1表達,納武利尤單抗±伊匹木單抗治療均可能有效。多數SCLC與吸煙有關,因此SCLC特徵之一是高體突變負荷。其它實體腫瘤中已顯示高TMB與免疫檢查點抑制治療有效性相關,但在SCLC中是否也存在這種關係並不清楚。
研究方法CheckMate032研究中接受納武利尤單抗單藥(3mg/kg,每2週一次)或納武利尤單抗+伊匹木單抗(1mg/kg+3mg/kg,每3週一次,共4週期,然後納武利尤單抗3mg/kg,每2週一次)聯合治療的SCLC患者進行全外顯子測序。TMB定義為錯義體突變總和,採用三分位法將TMB分為低負荷<143突變,中等負荷143-247突變,高負荷≥248突變。
研究結果 結果表明納武利尤單抗單藥和納武利尤單抗+伊匹木單抗聯合治療,高TMB患者的客觀反應率(21.3%和46.2%)高於低(4.8%和22.2%)和中(6.8%和16.0%)TMB患者,所有患者納武利尤單抗+伊匹木單抗聯合治療的客觀反應率高於納武利尤單抗單藥治療。無論是聯合還是單藥治療,獲得完全或部分反應患者的TMB高於疾病穩定或疾病進展的患者。納武利尤單抗單藥和納武利尤單抗+伊匹木單抗聯合治療,高TMB患者的1年無進展生存率(21.2%和30.0%)高於低(不能計算和6.2%)中(3.1%和8.0%)腫瘤突變患者,高TMB患者聯合治療的1年無進展生存率優於單藥治療,低中TMB患者聯合治療與單藥治療無差異,總生存結果與之相似。總之,高TMB增迦納武利尤單抗和納武利尤單抗+伊匹木單抗有效性,納武利尤單抗+伊匹木單抗的臨床獲益超過納武利尤單抗單藥。
結果討論與展望這項研究評估了SCLC的TMB與免疫檢查點抑制治療有效性的關係,結果表明高TMB 患者較低中TMB患者從納武利尤單抗和納武利尤單抗+伊匹木單抗治療中獲益更多,這與納武利尤單抗治療非小細胞肺癌(NSCLC)和尿路上皮癌、伊匹木單抗治療黑色素瘤的結果相似,因此TMB可能也是SCLC免疫檢查點治療反應的預測標誌。初始觀察發現雖然納武利尤單抗+伊匹木單抗聯合治療SCLC能增加獲益,但較納武利尤單抗單藥治療的毒性更大,因此確定單藥或聯合治療的不同預測標誌十分必要。這項研究發現,SCLC患者伴高TMB時,納武利尤單抗+伊匹木單抗聯合治療的生存遠超過歷史對照,中低TMB患者聯合治療的客觀反應率雖較單藥改善,但無進展生存和總生存並無差別。結果提示高TMB患者,聯合治療獲益優於單藥治療,而中低TMB患者單藥治療也許是最佳選擇。這項研究表明,TMB對SCLC免疫治療反應有預測作用,但尚不清楚其分子多樣性是否足以區分免疫治療反應不同的臨床亞組,目前只能得出負荷最高者免疫治療獲益最多。有人認為突變負荷分析並不可行,因為SCLC標本取材多為小標本且存在較多壞死組織。但這項研究顯示,61%患者的活檢組織足以用於全外顯子檢測,因為是回顧性研究,活檢取材時並未預先計畫全外顯子檢測,若事先計畫全外顯子檢查則取材合乎標準的患者比例可能更高。總之這項研究證實,SCLCTMB檢測可行,如若為前瞻性研究則可獲更高的成功率。目前不清楚TMB和納武利尤單抗+伊匹木單抗治療結果之間究竟如何產生聯繫。有假說認為,加入伊匹木單抗增加抗腫瘤T細胞克隆儲備,同時也降低TMB的預測相關性。但這個假說似乎與SCLC無關,因為TMB在SCLC中是納武利尤單抗+伊匹木單抗治療反應增加的預測標誌。與之相似,有研究顯示NSCLC採用納武利尤單抗+伊匹木單抗聯合治療的反應進一步改善。需要更多研究明確二者協同作用的潛在免疫學機制。研究還發現,不論是均分法、三分法還是四分法,皆顯示高TMB與結果改善相關,說明SCLC的TMB與免疫治療獲益的關係很穩定,同時也提示多個閾值均可富集獲益人群,需要進一步優化,也要更好地理解增加免疫原性的體突變分子特徵。目前另有二個評估納武利尤單抗±伊匹木單抗治療SCLC有效性的III期研究(CheckMate331和CheckMate451),這二項研究會有更多資料明確TMB與治療結果間的關係。總之,SCLC患者採用納武利尤單抗單藥或納武利尤單抗+伊匹木單抗聯合治療時,高TMB能增加治療有效性,其中以聯合治療的臨床獲益更多,聯合治療的1年生存率幾乎是單藥治療的2倍。高TMBSCLC患者接受免疫聯合治療時,無進展生存和總生存改善尤其顯著,這與NSCLC的資料相似,提示TMB可能是所有肺癌免疫治療的潛在生物學標誌。
Tumor Mutational Burden and Response Rate to PD-1 Inhibition
December 21, 2017 N Engl J Med 2017; 377:2500-2501
TO THE EDITOR: Inhibitors of programmed death 1 (PD-1) protein or its ligand (PD-L1) have shown remarkable clinical benefit in many cancers.1 One emerging biomarker of response to anti–PD-1 therapy is the tumor mutational burden (i.e., the total number of mutations per coding area of a tumor genome). This finding is supported by the clinical activity of anti–PD-1 therapy in colorectal cancer with mismatch repair deficiency, a tumor subtype with a high tumor mutational burden, as compared with the colorectal cancer subtype with mismatch repair proficiency, which has a significantly lower tumor mutational burden and a poor response to these agents.2,3
To evaluate the relationship between the tumor mutational burden and the objective response rate, we plotted the objective response rate for anti–PD-1 or anti–PD-L1 therapy against the corresponding median tumor mutational burden across multiple cancer types (Figure 1). Through an extensive literature search, we identified 27 tumor types or subtypes for which data regarding the objective response rate are available. For each tumor type, we pooled the response data from the largest published studies that evaluated the objective response rate. We included only studies of anti–PD-1 or anti–PD-L1 monotherapy that enrolled at least 10 patients who were not selected for PD-L1 tumor expression. (Details about the methods are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median tumor mutational burden for each tumor type was obtained from a validated comprehensive genomic profiling assay performed and provided by Foundation Medicine.4 We observed a significant correlation between the tumor mutational burden and the objective response rate (P<0.001). The correlation coefficient of 0.74 suggests that 55% of the differences in the objective response rate across cancer types may be explained by the tumor mutational burden. Some cancer subtypes have a response to therapy that is better than would be predicted by the tumor mutational burden (e.g., Merkel-cell carcinoma), and some have a response that is worse than would be predicted (e.g., colorectal cancer with mismatch repair proficiency). The higher-than-anticipated objective response rates for Merkel-cell carcinoma and some other cancers that have been associated with viruses suggest that the presentation of viral antigens on certain tumor types may confer an increased response rate to anti–PD-1 therapy.5
Our linear correlation formula — objective response rate=10.8×loge(X)−0.7, where "X" is the number of coding somatic mutations per megabase of DNA — can be used to make hypotheses with respect to the objective response rate in tumor types for which anti–PD-1 therapy has not been explored. For example, we anticipate a clinically meaningful objective response rate of 40.1% (95% confidence interval [CI], 31.2 to 50.6) for basal-cell carcinoma of the skin and of 20.6% (95% CI, 16.7 to 24.5) for sarcomatoid carcinoma of the lung on the basis of a median tumor mutational burden of 47.3 and 7.2, respectively.4 We anticipate a low objective response rate (<5%) for several other cancers (e.g., pilocytic astrocytoma and small-intestine carcinoid).4 A limitation of our analysis is that the sequenced tumor specimens were probably not the same ones for which clinical responses were assessed. Many different factors modulate the clinical response to an immune checkpoint inhibitor, but our findings highlight the strong relationship between the tumor mutational burden and the activity of anti–PD-1 therapies across multiple cancers.Mark Yarchoan, M.D. Alexander Hopkins, Ph.D. Elizabeth M. Jaffee, M.D. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD ejaffee@jhmi.edu
Correlation between Tumor Mutational Burden and Objective Response Rate with Anti–PD-1 or Anti–PD-L1 Therapy in 27 Tumor Types.
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