Prospect of combination of anti-PD-1/PD-L1 therapy and other therapeutics for treatment of lung cancer

Lung cancer is the leading cause of cancer death worldwide, mainly because it has no obvious symptoms at the early stage and it is usually diagnosed at the advanced stage. Surgery and chemotherapy are the main common treatment options for lung cancer patients. During the past 25 years, great progress has been made in the treatment of lung cancer. Novel materials such as nanoparticles have shown therapeutic potential for lung cancer as they can selectively enter tumor cells due to their small size and surface modifiability. However,the prognosis of patients with lung cancer is still unsatisfactory. Targeted immunotherapy has shown potential for the treatment of lung cancer. The anti-tumor immunotherapy has been widely concerned as immune escape plays an important role in the occurrence and development of tumors. In particular, agents targeting PD-1/PD-L1 have been widely studied and some anti-PD-1/PD-L1 agents have been approved for the treatment of lung cancer by FDA since they have shown significant anti-tumor activity in lung cancer patients. Nevertheless, not all patients response to this therapy and the immune-related adverse events have emerged. The immune-related adverse events mainly involve the gut, skin, endocrine glands, liver,lung and other tissues. With the development of this field, combination therapy has been regarded as a promising strategy to improve the safety and efficacy of antiPD-1/PD-L1 therapy. Studies have shown that the radiotherapy, chemotherapy, oncolytic virus, antiangiogenic agents and indoleamine 2,3-dioxygenase(IDO) inhibitors may improve the efficacy and reduce the incidence of adverse events of anti-PD-1/PD-L1 therapy. Radiotherapy can not only kill tumor cells, but also stimulate the immune system by releasing tumor antigens. Chemotherapy may induce the tumor-specific adaptive immune response.Oncolytic virotherapy, which is a form of immunotherapy,can kill tumors directly and induce the host immune response to tumour cells. Angiogenic factors have immunosuppressive effect, thus the antiangiogenic drugs may improve anti-tumor activity of anti-PD-1/PD-L1 agents in the treatment of lung cancer. Researches on IDO inhibitors in combined with other therapies are active and this combination may have good safety. In this review, we summarized the mechanisms and advantages of the combination therapy based on anti-PD-1/PD-L1 therapy,providing basis for its further clinical application.     

PD-1/PD-L1与CTLA-4联合治疗实体瘤患者有效性和安全性的Meta分析

目的: 系统评价PD-1/PD-L1与CTLA-4联合治疗对比PD-1/PD-L1单药治疗实体瘤患者的有效性和安全性,旨在为临床用药提供循证参考。方法: 计算机检索PubMed、Embase、Cochrane Library、中国知网、CBM、维普和万方数据,检索时限均为各数据库建库至2021年11月。根据纳入与排除标准筛选文献后,采用Cochrane 系统评价员手册 5.1.0 推荐的偏倚风险评估工具对纳入文献质量进行评价;采用Rev Man 5.4软件进行Meta分析;采用倒漏斗图进行发表偏倚分析。结果: 共纳入22项研究,共计8 535例患者。Meta分析结果显示,从生存指标方面分析,PD-1/PD-L1与CTLA-4联合治疗显著改善实体瘤患者的客观反应率(ORR)、疾病控制率(DCR)和无进展生存期(PFS),但总生存期(OS)改善无统计学差异。亚组分析结果显示,PD-1/PD-L1与CTLA-4联合治疗能显著改善黑色素瘤患者的ORR和PFS,而OS改善无统计学差异;能显著改善肺癌患者的PFS,而ORR和OS改善无统计学差异;显著改善其他实体瘤患者的ORR和DCR,而PFS和OS改善无统计学差异。从安全指标方面分析,PD-1/PD-L1与CTLA-4联合治疗显著增加实体瘤患者的所有级别和3~4级不良反应发生率、死亡率以及中止治疗率。亚组分析结果显示,PD-1/PD-L1与CTLA-4联合治疗能显著增加黑色素瘤和其他实体瘤患者的3~4级不良反应发生率和中止治疗率,显著增加肺癌患者所有级别和3~4级不良反应发生率、死亡率以及中止治疗率。结论: PD-1/PD-L1和CTLA-4联合治疗与PD-1/PD-L1单药治疗相比,能显著改善实体瘤患者的PFS、DCR和ORR,但是也显著增加实体瘤患者治疗相关不良反应发生率。     

程序性死亡受体1的检测方法及其在乳腺癌中表达的研究进展

近年来,肿瘤的免疫治疗已成为继传统手术、放疗、化疗、内分泌治疗和靶向药物治疗手段之后新的治疗方法,尤其以程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)位靶点的免疫检查点抑制治疗使得非小细胞肺癌、黑色素瘤等恶性实体肿瘤患者获得了有效持久的临床获益。PD-L1的检测是免疫检查点抑制剂治疗的关键环节,但在乳腺癌中的其检测方法和判定标准尚未统一。就PD-L1的检测方法以及其在乳腺癌各分子分型中的表达进行综述。     

Gemcitabine and checkpoint blockade exhibit synergistic anti-tumor effects in a model of murine lung carcinoma

Lung cancer is leading cause of cancer death in the world. Chemotherapy is currently one of the standard treatments for lung cancer. Gemcitabine is a pyrimidine nucleoside drug which has been approved by FDA to treat lung cancer. However, acquired resistance inevitable develops after Gemcitabine treatment, limiting clinical efficacy. Lewis lung carcinoma (LLC) cells were treated with Gemcitabine and cell apoptosis and programmed cell death-ligand 1 (PD-L1) expression were analyzed by flow cytometry. LLC mouse model was established to analysis the proportion and programmed cell death-1 (PD-1) expression of CD8 + T cells. Anti-tumor effect by treating with Gemcitabine and anti-PD-1 antibody was measured through in vivo LLC mouse model. Gemcitabine treatment induces tumor cell apoptosis and PD-L1 expression. Further study showed that Gemcitabine treatment also increases CD8⁺ and CD4⁺ T cells proportion, PD-1 and PD-L1 expression in LLC mouse model. Combination therapy with Gemcitabine and αPD-1 not only has strong anti-tumor effect, but also could inhibit postsurgical recurrence of LLC. Our findings demonstrated that the combination therapy of Gemcitabine and αPD-1 is an effective therapeutic strategy for lung cancer.     

Effectivity and safety of PD-1/PD-L1 inhibitors for different level of PD-L1-positive,advanced NSCLC: A meta-analysis of 4939 patients from randomized controlled trials

BackgroundEffective improvement for the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors had been shown in advanced non-small cell lung cancer (NSCLC) patients compared with traditional therapy. However, we do not have ample evidences to demonstrate the safety and effectivity in the treatment of PD-L1-positive, advanced NSCLC. The relation was controversial about the expression of PD-L1 and survival outcomes of PD-1/PD-L1 inhibitors.Materials and methodsElectronic databases (PubMed, EMBASE, and the Cochrane library) and major conference proceedings were systematically searched for all clinical trials in NSCLC using PD-1/PD-L1 inhibitors. Randomized controlled trials (RCTs) were included to compare PD-1/PD-L1 inhibitors with chemotherapy in advanced NSCLC patients reporting adverse events (AEs) and immune-related AEs (irAEs). The incidence, Hazard Ratio (HR), Odds Ratio (OR), and corresponding 95% confidence interval (CI) of outcomes were calculated.ResultsA total of 4939 patients from 10RCTs were included. In the group of PD-L1 ≥ 1%, PD-L1 ≥ 5%, PD-L1 ≥ 10%, PD-L1 ≥ 50%, the HR of OS is 0.31(95%CI 0.38–0.23; p < 0.0001), 0.47(95%CI 0.82–0.12; p = 0.008), 0.85(95%CI 1.17–0.53; p < 0.0001), 0.47(95%CI 0.59–0.36; p < 0.0001) respectively. The HR of PFS is 0.13(95%CI 0.01–0.24; p = 0.027), 0.31(95%CI 0.00–0.62; p < 0.0001), 0.62(95%CI 0.30–0.93; p < 0.0001), 0.40(95% CI 0.20–0.59; p < 0.0001) respectively. In terms of summary adverse events, PD-1/PD-L1 inhibitors groups had a significant lower risks in any treat-realated AEs than chemotherapy. About irAEs, PD-1/PD-L1 inhibitors groups had a significant higher risks in irAEs than chemotherapy.ConclusionPD-1/PD-L1 inhibitors are generally effected and safer than chemotherapy for patients with PD-L1-positive, advanced NSCLC. However, PD-1/PD-L1 inhibitors can generate a unique spectrum of irAEs, and even life-threatening.     

Abrogation of HnRNP L enhances anti-PD-1 therapy efficacy via diminishing PD-L1 and promoting CD8+ T cell-mediated ferroptosis in castration-resistant prostate cancer

Owing to incurable castration-resistant prostate cancer (CRPC) ultimately developing after treating with androgen deprivation therapy (ADT), it is vital to devise new therapeutic strategies to treat CRPC. Treatments that target programmed cell death protein 1 (PD-1) and programmed death ligand-1 (PD-L1) have been approved for human cancers with clinical benefit. However, many patients, especially prostate cancer, fail to respond to anti-PD-1/PD-L1 treatment, so it is an urgent need to seek a support strategy for improving the traditional PD-1/PD-L1 targeting immunotherapy. In the present study, analyzing the data from our prostate cancer tissue microarray, we found that PD-L1 expression was positively correlated with the expression of heterogeneous nuclear ribonucleoprotein L (HnRNP L). Hence, we further investigated the potential role of HnRNP L on the PD-L1 expression, the sensitivity of cancer cells to T-cell killing and the synergistic effect with anti-PD-1 therapy in CRPC. Indeed, HnRNP L knockdown effectively decreased PD-L1 expression and recovered the sensitivity of cancer cells to T-cell killing in vitro and in vivo, on the contrary, HnRNP L overexpression led to the opposite effect in CRPC cells. In addition, consistent with the previous study, we revealed that ferroptosis played a critical role in T-cell-induced cancer cell death, and HnRNP L promoted the cancer immune escape partly through targeting YY1/PD-L1 axis and inhibiting ferroptosis in CRPC cells. Furthermore, HnRNP L knockdown enhanced antitumor immunity by recruiting infiltrating CD8⁺ T cells and synergized with anti-PD-1 therapy in CRPC tumors. This study provided biological evidence that HnRNP L knockdown might be a novel therapeutic agent in PD-L1/PD-1 blockade strategy that enhanced anti-tumor immune response in CRPC.     

PD-1/PD-L1抑制剂治疗晚期肝细胞癌的研究进展

随着肿瘤免疫治疗的不断应用,免疫检查点抑制剂(ICI)治疗肿瘤的相关临床研究开展广泛.多项研究表明,以程序性死亡受体/配体1(PD-1/PD-L1)抑制剂为代表的ICI在肝细胞癌治疗中取得了较好的疗效并改善了患者生存期;除单药治疗外,PD-1/PD-L1抑制剂还能与化疗、靶向药物及其他ICI联合治疗.但免疫治疗相关不良...     

Epigenetically silenced PD-L1 confers drug resistance to anti-PD1 therapy in gastric cardia adenocarcinoma

ObjectivesThe anti-PD-1/PD-L1 therapy has been demonstrated safe and effective for cancer patients. However, our previous data showed that it had no obvious effects on gastric cardia adenocarcinoma (GCA). Thus, we investigated how the expression level of the PD-L1 was affected by the anti-PD-1 therapy, because it has been demonstrated that the PD-L1 level affects the therapeutic efficient of the anti-PD-1 therapy.Materials and methodsThe mRNA and protein levels of PD-L1 in the GCA tissues and corresponding normal tissues were determined by qPCR and ELISA. Promoter methylation was analyzed by bisulfite sequencing. Finally the methylation of PD-L1 promoter was confirmed in the mice.ResultsThe level of PD-L1 was up-regulated in the GCA tissues when compared to the adjacent non-tumor tissues. The anti-PD1 therapy could reduce the PD-L1 levels in patients with cancer recurrence. The promoter of PD-L1 was more hypermethylated in the secondary GCA after the anti-PD-1 therapy when compared with the adjacent non-tumor tissues or the primary GCA without the anti-PD-1 therapy. Furthermore, the promoter methylation of PD-L1 could be induced by the anti-PD-1 therapy in the mice model. Finally, the anti-PD-1 plus DNA hypomethylating agent azacytidine could significantly suppressed the tumor growth better than the anti-PD-1 therapy.ConclusionsHere we demonstrated that the unresponsiveness of GCA to the anti-PD-1 therapy might result from the promoter methylation and down-regulation of PD-L1. The anti-PD-1 plus azacytidine might be a more promising approach to treat GCA.     

Development of small-molecule immune checkpoint inhibitors of PD-1/PD-L1 as a new therapeutic strategy for tumour immunotherapy

Abstract

Cancer immunotherapy has been increasingly utilised to treat advanced malignancies. The signalling network of immune checkpoints has attracted considerable attention. Immune checkpoint inhibitors are revolutionising the treatment options and expectations for patients with cancer. The reported clinical success of targeting the T-cell immune checkpoint receptors PD-1/PD-L1 has demonstrated the importance of immune modulation. Indeed, antibodies binding to PD-1 or PD-L1 have shown remarkable efficacy. However, antibody drugs have many disadvantages, such as their production cost, stability, and immunogenicity and, therefore, small-molecule inhibitors of PD-1 and its ligand PD-L1 are being introduced. Small-molecule inhibitors could offer inherent advantages in terms of pharmacokinetics and druggability, thereby providing additional methods for cancer treatment and achieving better therapeutic effects. In this review, we first discuss how PD-1/PD-L1-targeting inhibitors modulate the relationship between immune cells and tumour cells in tumour immunotherapy. Second, we discuss how the immunomodulatory potential of these inhibitors can be exploited via rational combinations with immunotherapy and targeted therapy. Third, this review is the first to summarise the current clinical and preclinical evidence regarding small-molecule inhibitors of the PD-1/PD-L1 immune checkpoint, considering features and responses related to the tumours and to the host immune system.

Trial registration: ClinicalTrials.gov identifier: NCT02812875.     

程序性死亡因子-1（PD-1）抑制药新药Nivolumab的临床研究进展

摘 要 目的： 介绍程序性死亡因子-1(PD-1)抑制药抗癌新药Nivolumab。方法: 根据文献,对Nivolumab的作用机制以及目前获批或进入III期的几个主要适应证的临床研究结果进行综述与评价。结果: Nivolumab可通过与PD-1的结合,阻断其与关键配体PD-L1和PD-L2的相互作用,恢复T细胞的抗肿瘤活性;已经完成或正在进行中的多项临床研究结果显示Nivolumab单用或者与化疗药物或CTLA-4抑制药Ipilimumab合用,对于黑色素瘤、非小细胞肺癌以及肾细胞癌的效果优于目前临床应用的化疗药物,Nivolumab总体耐受性好,3～4级的不良事件主要为免疫介导肺炎,肝功能紊乱,疲劳等。结论:Nivolumab通过肿瘤免疫效应可改善对黑色素瘤、非小细胞肺癌以及肾细胞癌等多种肿瘤的治疗效果。     

程序性细胞死亡蛋白配体-1与程序性细胞死亡蛋白配体-1抑制剂在垂体腺瘤中的研究进展

垂体腺瘤是垂体最常见的疾病,侵袭性垂体腺瘤和垂体癌对常规诊疗方式效果欠佳,是目前临床治疗的难点。免疫检查点抑制剂是肿瘤免疫治疗新的选择,在垂体腺瘤中的应用受到关注。程序性细胞死亡蛋白配体-1(PD-L1)/程序性死亡蛋白配体-1抑制剂目前研究得较为广泛,现重点阐述PD-L1/PD-L1抑制剂在侵袭性垂体腺瘤中的最新研究进展,以期为临床相关治疗提供参考。     

Opportunities and obstacles of targeted therapy and immunotherapy in small cell lung cancer

Abstract

Small cell lung cancer (SCLC) is an aggressive malignant tumour which accounts for approximately 13–15% of all newly diagnosed lung cancer cases. To date, platinum-based chemotherapy are still the first-line treatments for SCLC. However, chemotherapy resistance and systemic toxicity limit the long-term clinical outcome of first-line treatment in SCLC. Recent years, targeted therapy and immunotherapy have made great breakthrough in cancer therapy, and researchers aim to exploit both as a single agent or in combination with chemotherapy to improve the survival of SCLC patients, but limited effectiveness and the adverse events remain the major obstacles in the treatment of SCLC. To overcome these challenges for SCLC therapies, prevention and early diagnosis for this refractory disease is very important. At the same time, we should reveal more information about the pathogenesis of SCLC and the mechanism of drug resistance. Finally, new treatment strategies should also be taken into considerations, such as repurposing drug, optimising of targets, combination therapy strategies or prognostic biomarkers to enhance therapeutic effects and decrease the adverse events rates in SCLC patients. This article will review the molecular biology characteristics of SCLC and discuss the opportunities and obstacles of the current therapy for SCLC patients.     

Gene delivery for lung cancer using nonviral gene vectors

Multiple options for the treatment of lung cancer have often been described in the past, including surgery, chemotherapy and radiation, but the therapeutic effect is typically transient and mostly absent with advanced disease. New approaches to the treatment of lung cancer are urgently needed. Gene therapy has been widely proposed as a novel strategy to improve therapy. Although progress has been made using viral vectors, rapid advances in transfection technologies employing nonviral vectors, together with their relatively low toxicity, suggest that nonviral vectors may have significant potential for clinical applications. This paper briefly reviews general principles of gene delivery with emphasis on recent developments in the arena of lung cancer using nonviral vectors (naked DNA, polycationic polymers, cationic liposomes). Employing gene transfer techniques to achieve therapeutically useful levels of expression of therapeutic genes in the lung could provide a new strategy for treatment of lung cancer.     

PD0325901, an ERK inhibitor,enhances the efficacy of PD-1 inhibitor in non-small cell lung carcinoma

ERK pathway regulated the programmed death ligand-1 (PD-L1) expression which was linked to the response of programmed death-1 (PD-1)/PD-L1 blockade therapy. So it is deducible that ERK inhibitor could enhance the efficacy of PD-1 inhibitor in cancer immunotherapy. In this study, PD0325901, an oral potent ERK inhibitor, strongly enhanced the efficacy of PD-1 antibody in vitro and in vivo models in non-small cell lung carcinoma (NSCLC) cells. Mechanistically, PD0325901 or shRNA-ERK1/2 significantly downregulated the PD-L1 expression in NSCLC cells and increased the CD3⁺ T cells infiltration and functions in tumor tissue. There was a positive correlation between the p-ERK1/2 expression and PD-L1 expression in patients with NSCLC. And the patients with low p-ERK1/2 expression were observed a high response rate of PD-1/PD-L1 blockage therapy. Our results demonstrate that PD0325901, an ERK inhibitor, can enhance the efficacy of PD-1 blockage against NSCLC in vitro and in vivo models. And the combination of ERK inhibitor such as PD0325901 and PD-1/PD-L1 blockage is a promising regimen and encouraged to be further confirmed in the treatment of patients with NSCLC.     

Cdk5 knocking out mediated by CRISPR-Cas9 genome editing for PD-L1 attenuation and enhanced antitumor immunity

Blocking the programmed death-ligand 1 (PD-L1) on tumor cells with monoclonal antibody therapy has emerged as powerful weapon in cancer immunotherapy. However, only a minority of patients presented immune responses in clinical trials. To develop an alternative treatment method based on immune checkpoint blockade, we designed a novel and efficient CRISPR-Cas9 genome editing system delivered by cationic copolymer aPBAE to downregulate PD-L1 expression on tumor cells via specifically knocking out Cyclin-dependent kinase 5 (Cdk5) gene in vivo. The expression of PD-L1 on tumor cells was significantly attenuated by knocking out Cdk5, leading to effective tumor growth inhibition in murine melanoma and lung metastasis suppression in triple-negative breast cancer. Importantly, we demonstrated that aPBAE/Cas9-Cdk5 treatment elicited strong T cell-mediated immune responses in tumor microenvironment that the population of CD8⁺ T cells was significantly increased while regulatory T cells (Tregs) was decreased. It may be the first case to exhibit direct in vivo PD-L1 downregulation via CRISPR-Cas9 genome editing technology for cancer therapy. It will provide promising strategy for preclinical antitumor treatment through the combination of nanotechnology and genome engineering.     

PD-L1和OX40靶点肿瘤免疫疗法研究进展

恶性肿瘤作为危害人类健康最严重的疾病之一,其诱因较多、早期无明显症状且易发生转移.随着分子生物学技术的发展和对肿瘤病理机制深入研究,肿瘤免疫疗法逐渐成为人类研究的重点.其中免疫检查点PD-L1是肿瘤免疫治疗经典靶点,它可以与PD-1结合通过激活信号通路抑制T细胞活性,促进肿瘤生长.2016年,第一个PD-L1抑制剂阿特...     

PD-1/PD-L1抑制剂治疗血液恶性肿瘤综述

目的：程序性死亡受体-1（programmed death-1,PD-1）及其配体（programmed death-ligand 1,PD-L1）作为肿瘤免疫治疗的有效靶点之一,其抑制剂为血液恶性肿瘤的治愈带来了新的希望。本文旨在综述近年来PD-1/PD-L1抑制剂在血液恶性肿瘤,包括恶性淋巴瘤、白血病及多发性骨髓瘤（MM）方面的临床研究进展,并总结其对于血液恶性肿瘤的治疗效果。方法：在PubMed、Medline、The Cochrane Library、Embase、Elsevier、John Wiley等外文数据库及中国知网（CNKI）、万方、维普等中文数据库进行文献检索。结果：PD-1/PD-L1抑制剂多应用于恶性淋巴瘤的治疗,在各类白血病及MM的研究尚处于探索研究阶段。不同疾病获得的疗效存在差异,但整体较好,尤其是复发/难治经典霍奇金淋巴瘤（R/R cHL）。结论：PD-1/PD-L1抑制剂可显著提高缓解率,但仍有诸多争议有待进一步解决。     

Mitomycin C synergizes with PD-L1 blockade in treatment of non-small cell lung cancer

OBJECTIVE Programmed death 1 ligand(PD-L1) checkpoint inhibitor was a promising therapy but the response rate was only about 20%. Chemotherapy was reported to final y kil tumor cel s by triggering immune response. To improve the response of PD-L1 blockade,we tried to find chemotherapeuticaldrugs to combine with PD-L1 antibody(Ab). METHODS Non-small cell lung cancer(NSCLC) cells were pre-treated with mitomycin C(MMC) and then co-cultured with PBMCs to explore the effect of the combination of MMC with PD-L1 Ab. Lewis lung cancer(LLC) cells were used to establish xenograft model in mice and subjected to MMC or PD-L1 Ab treatment alone or combo. RESULTS MMC increased the expressions of PD-L1 and MHC-Ⅰ in NSCLC cells in vitro and in vivo and enhanced the activity of lymphocytes against NSCLC in vitro.The mice treated with combo of PD-L1 Ab with MMC showed an improved overall survival and inhibition of the tumor growth compared to monotherapy,which was linked to the increases of lymphocyte infiltration and granzyme B release in LLC cell xenograftmodels in mice. Mechanically, MMC activated the ERK pathwayand subsequently activated c-Jun that bound with PD-L1 promoter and recruited its co-factor STAT3 to enhance PD-L1 expression. Meanwhile, the ERK pathway activated P65 to promote the MHC-I expression. CONCLUSION A combination of MMC with PD-L1 blockade may improve the antitumor response and offer a promising new treatment modality against NSCLC and encourage to further study to confirm in clinic.