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Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Immunology and Immunotherapy".

Deadline for manuscript submissions: closed (15 April 2023) | Viewed by 26158

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Special Issue Editors

Prof. Dr. Nicola Silvestris

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Department of Human Pathology of the Adult and the Developmental Age “G. Barresi”, University of Messina, Messina, Italy
Interests: gastrointestinal tumors; translational research; clinical trials
Special Issues, Collections and Topics in MDPI journals

Dr. Mariacarmela Santarpia

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1. Medical Oncology Unit, AOU Policlinico "G.Martino", 98125 Messina, Italy
2. Department of Human Pathology “G. Barresi”, University of Messina, 98122 Messina, Italy
Interests: lung cancer; targeted therapy; immunotherapy; personalized medicine; biomarkers
Special Issues, Collections and Topics in MDPI journals

Dr. Tindara Franchina

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Medical Oncology Unit, Department of Human Pathology ‘G. Barresi’, University of Messina, Messina, Italy
Interests: thoracic oncology; cancer immunotherapy; precision oncology; translational research

Special Issue Information

Dear Colleagues,

A deeper understanding of the mechanisms involved in antitumor immunity has led to the development of a number of immunotherapies, including immune checkpoint inhibitors (ICIs), which have markedly changed the treatment scenario of hematological malignancies and solid tumors. Immune checkpoint inhibitors, including monoclonal antibodies directed against the programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) pathway or the cytotoxic T-lymphocyte antigen-4 (CTLA-4) pathway, currently represent the standard of care for the treatment of a large number of metastatic tumors and have also proven to be effective as part of multimodality therapeutic approaches to locally advanced and early-stage tumors. However, despite demonstration of significant clinical efficacy, initial objective responses to ICIs are still unsatisfactory, and almost all patients ultimately develop acquired resistance to treatment over time. Moreover, the development of immune-related adverse events can limit the use of these beneficial agents in the clinical setting. Hence, it is of crucial importance to identify predictive biomarkers to select those patients most likely benefiting from immunotherapy to improve patient outcomes while potentially avoiding toxicities with these drugs.

In this Special Issue, we will include research articles and reviews covering current knowledge and outlooks on predictive biomarkers in tissue and liquid biopsy and combinatorial therapeutic strategies integrating immunotherapy with radiotherapy, chemotherapy, and targeted agents, in different tumor types and settings of disease. Mechanisms and management of immune-related toxicities will also be discussed.

Prof. Dr. Nicola Silvestris
Dr. Mariacarmela Santarpia
Dr. Tindara Franchina
Guest Editors

Manuscript Submission Information

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Keywords

immunotherapy
immune checkpoint inhibitors (ICIs)
predictive biomarkers
multidisciplinary treatments
immune-related toxicity

Published Papers (11 papers)

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Research

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10 pages, 2900 KiB

Open AccessCommunication

Immunotherapy in Urothelial Cancer: Stop When Achieving a Response, Restart upon Disease Progression

by Youssra Salhi, Ronald De Wit and Debbie Robbrecht

Cancers 2023, 15(14), 3654; https://doi.org/10.3390/cancers15143654 - 18 Jul 2023

Cited by 2 | Viewed by 1227

Abstract

Background: Since there is no clear consensus on optimal treatment duration of PD-(L)1 targeting checkpoint inhibitors in the setting of urothelial cancer (UC) patients, even patients with durable responses are often treated up to 2 years. It is questionable whether this is necessary and whether quality of life improves when treatment is discontinued earlier and restarted when necessary. Methods: We collected available data from locally advanced or metastatic UC patients within the Netherlands between September 2017 and December 2019 treated with first or second-line pembrolizumab, to evaluate treatment duration, reasons for discontinuation, subsequent treatments and survival outcomes. Results: Data were available from 74 patients: 85% (63/74) of patients had a treatment duration of 12 months or shorter, and in seven out of them, treatment was discontinued for another reason than progressive disease. Two patients (3%) had a treatment duration between 12 and 24 months, and eight patients (11%) completed 24 months of treatment. Survival at data cut-off (1 July 2020) with a median follow-up of 35 months was 100% in patients with partial or complete response (6/7 patients) and treatment duration ≤ 12 months, and 100% in patients treated for 24 months. In total, three patients were re-treated with pembrolizumab upon progressive disease during follow-up. Conclusions: In patients who reach partial or complete response during treatment with a PD-(L)1 targeting checkpoint inhibitor, early discontinuation of treatment with pembrolizumab and restart if necessary seems to be reasonable with preserved favorable outcomes. This article should drive further efforts to optimize the treatment duration for patients who respond to treatment with pembrolizumab. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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20 pages, 6136 KiB

Open AccessArticle

Immune Pathways with Aging Characteristics Improve Immunotherapy Benefits and Drug Prediction in Human Cancer

by Xinyue Wang, Shuang Guo, Hanxiao Zhou, Yue Sun, Jing Gan, Yakun Zhang, Wen Zheng, Caiyu Zhang, Xiaoxi Zhao, Jiebin Xiao, Li Wang, Yue Gao and Shangwei Ning

Cancers 2023, 15(2), 342; https://doi.org/10.3390/cancers15020342 - 04 Jan 2023

Cited by 1 | Viewed by 1766

Abstract

(1) Background: Perturbation of immune-related pathways can make substantial contributions to cancer. However, whether and how the aging process affects immune-related pathways during tumorigenesis remains largely unexplored. (2) Methods: Here, we comprehensively investigated the immune-related genes and pathways among 25 cancer types using genomic and transcriptomic data. (3) Results: We identified several pathways that showed aging-related characteristics in various cancers, further validated by conventional aging-related gene sets. Genomic analysis revealed high mutation burdens in cytokines and cytokines receptors pathways, which were strongly correlated with aging in diverse cancers. Moreover, immune-related pathways were found to be favorable prognostic factors in melanoma. Furthermore, the expression level of these pathways had close associations with patient response to immune checkpoint blockade therapy in melanoma and non-small cell lung cancer. Applying a net-work-based method, we predicted immune- and aging-related genes in pan-cancer and utilized these genes for potential immunotherapy drug discovery. Mapping drug target data to our top-ranked genes identified potential drug targets, FYN, JUN, and SRC. (4) Conclusions: Taken together, our systematic study helped interpret the associations among immune-related pathways, aging, and cancer and could serve as a resource for promoting clinical treatment. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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15 pages, 3427 KiB

Open AccessArticle

Large-Scale Profiling of Extracellular Vesicles Identified miR-625-5p as a Novel Biomarker of Immunotherapy Response in Advanced Non-Small-Cell Lung Cancer Patients

by Francesco Pantano, Francesca Zalfa, Michele Iuliani, Sonia Simonetti, Paolo Manca, Andrea Napolitano, Simone Tiberi, Marco Russano, Fabrizio Citarella, Simone Foderaro, Elisabetta Vulpis, Alessandra Zingoni, Laura Masuelli, Roberto Bei, Giulia Ribelli, Marzia Del Re, Romano Danesi, Bruno Vincenzi, Giuseppe Perrone, Giuseppe Tonini and Daniele Santini Show full author list Hide full author list

Cancers 2022, 14(10), 2435; https://doi.org/10.3390/cancers14102435 - 14 May 2022

Cited by 16 | Viewed by 2313

Abstract

Immune checkpoint inhibitors (ICIs) are largely used in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Novel biomarkers that provide biological information that could be useful for clinical management are needed. In this respect, extracellular vesicles (EV)-associated microRNAs (miRNAs) that are the principal vehicle of intercellular communication may be important sources of biomarkers. We analyzed the levels of 799 EV-miRNAs in the pretreatment plasma of 88 advanced NSCLC patients who received anti-PD-1 therapy as single agent. After data normalization, we used a two-step approach to identify candidate biomarkers associated to both objective response (OR) by RECIST and longer overall survival (OS). Univariate and multivariate analyses including known clinicopathologic variables and new findings were performed. In our cohort, 24/88 (27.3%) patients showed OR by RECIST. Median OS in the whole cohort was 11.5 months. In total, 196 EV-miRNAs out 799 were selected as expressed above background. After multiplicity adjustment, abundance of EV-miR-625-5p was found to be correlated with PD-L1 expression and significantly associated to OR by RECIST (p = 0.0366) and OS (p = 0.0031). In multivariate analysis, PD-L1 staining and EV-miR-625-5p levels were constantly associated to OR and OS. Finally, we showed that EV-miR-625-5p levels could discriminate patients with longer survival, in particular in the class expressing PD-L1 ≥50%. EV-miRNAs represent a source of relevant biomarkers. EV-miR-625-5p is an independent biomarker of response and survival in ICI-treated NSCLC patients, in particular in patients with PD-L1 expression ≥50%. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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Review

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41 pages, 3907 KiB

Open AccessReview

Targeting the Interplay of Independent Cellular Pathways and Immunity: A Challenge in Cancer Immunotherapy

by Angela Lauriola, Pierpaola Davalli, Gaetano Marverti, Spartaco Santi, Andrea Caporali and Domenico D’Arca

Cancers 2023, 15(11), 3009; https://doi.org/10.3390/cancers15113009 - 31 May 2023

Cited by 2 | Viewed by 1493

Abstract

Immunotherapy is a cancer treatment that exploits the capacity of the body’s immune system to prevent, control, and remove cancer. Immunotherapy has revolutionized cancer treatment and significantly improved patient outcomes for several tumor types. However, most patients have not benefited from such therapies yet. Within the field of cancer immunotherapy, an expansion of the combination strategy that targets independent cellular pathways that can work synergistically is predicted. Here, we review some consequences of tumor cell death and increased immune system engagement in the modulation of oxidative stress and ubiquitin ligase pathways. We also indicate combinations of cancer immunotherapies and immunomodulatory targets. Additionally, we discuss imaging techniques, which are crucial for monitoring tumor responses during treatment and the immunotherapy side effects. Finally, the major outstanding questions are also presented, and directions for future research are described. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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22 pages, 1193 KiB

Open AccessEditor’s ChoiceReview

Hope and Hype around Immunotherapy in Triple-Negative Breast Cancer

by Flavia Jacobs, Elisa Agostinetto, Chiara Miggiano, Rita De Sanctis, Alberto Zambelli and Armando Santoro

Cancers 2023, 15(11), 2933; https://doi.org/10.3390/cancers15112933 - 26 May 2023

Cited by 4 | Viewed by 2520

Abstract

Triple-negative breast cancer (TNBC) holds a poor prognosis compared to other breast cancer subtypes, and the development of new effective treatment strategies is an unmet medical need. TNBC has traditionally been considered not amenable to treatment with targeted agents due to a lack of actionable targets. Therefore, chemotherapy has remained the mainstay of systemic treatment for many decades. The advent of immunotherapy raised very hopeful expectations in TNBC, possibly due to higher levels of tumor-infiltrating lymphocytes, PD-L1 expression and tumor mutational burden compared to other breast cancer subtypes, that predict an effective anti-tumor immune-engagement. The results of clinical trials testing immunotherapy in TNBC led to the approval of the combination of immune checkpoint inhibitors and chemotherapy in both early and advanced settings. However, some open questions about the use of immunotherapy in TNBC still exist. These include a deeper understanding of the heterogeneity of the disease, identification of reliable predictive biomarkers of response, determination of the most appropriate chemotherapy backbone and appropriate management of potential long-term immune-related adverse events. In this review we aim to examine the available evidence on the use of immunotherapy strategies in both early and advanced TNBC, to critically discuss some of the limitations encountered in clinical research and to summarize data on novel promising immunotherapeutic strategies beyond PD-(L)1 blockade that have been investigated in the most recent trials. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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17 pages, 1400 KiB

Open AccessReview

The Melanoma-Associated Antigen Family A (MAGE-A): A Promising Target for Cancer Immunotherapy?

by Alaa Alsalloum, Julia A. Shevchenko and Sergey Sennikov

Cancers 2023, 15(6), 1779; https://doi.org/10.3390/cancers15061779 - 15 Mar 2023

Cited by 9 | Viewed by 3584

Abstract

Early efforts to identify tumor-associated antigens over the last decade have provided unique cancer epitopes for targeted cancer therapy. MAGE-A proteins are a subclass of cancer/testis (CT) antigens that are presented on the cell surface by MHC class I molecules as an immune-privileged site. This is due to their restricted expression to germline cells and a wide range of cancers, where they are associated with resistance to chemotherapy, metastasis, and cancer cells with an increasing potential for survival. This makes them an appealing candidate target for designing an effective and specific immunotherapy, thereby suggesting that targeting oncogenic MAGE-As with cancer vaccination, adoptive T-cell transfer, or a combination of therapies would be promising. In this review, we summarize and discuss previous and ongoing (pre-)clinical studies that target these antigens, while bearing in mind the benefits and drawbacks of various therapeutic strategies, in order to speculate on future directions for MAGE-A-specific immunotherapies. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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15 pages, 787 KiB

Open AccessEditor’s ChoiceReview

Tumor Infiltrating Lymphocytes across Breast Cancer Subtypes: Current Issues for Biomarker Assessment

by Carmine Valenza, Beatrice Taurelli Salimbeni, Celeste Santoro, Dario Trapani, Gabriele Antonarelli and Giuseppe Curigliano

Cancers 2023, 15(3), 767; https://doi.org/10.3390/cancers15030767 - 26 Jan 2023

Cited by 16 | Viewed by 2899

Abstract

Tumor-infiltrating lymphocytes (TILs) represent a surrogate biomarker of anti-tumor, lymphocyte-mediated immunity. In early, triple-negative breast cancer, TILs have level 1B of evidence to predict clinical outcomes. TILs represent a promising biomarker to select patients who can experience a better prognosis with de-intensified cancer treatments and derive larger benefits from immune checkpoint inhibitors. However, the assessment and the validation of TILs as a biomarker require a prospective and rigorous demonstration of its clinical validity and utility, provided reproducible analytical performance. With pending data about the prospective validation of TILs’ clinical validity to modulate treatments in early breast cancer, this review summarizes the most important current issues and future challenges related to the implementation of TILs assessments across all breast cancer subtypes and their potential integration into clinical practice. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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14 pages, 1286 KiB

Open AccessReview

Turning Tertiary Lymphoid Structures (TLS) into Hot Spots: Values of TLS in Gastrointestinal Tumors

by Daming Cai, Heng Yu, Xingzhou Wang, Yonghuan Mao, Mengjie Liang, Xiaofeng Lu, Xiaofei Shen and Wenxian Guan

Cancers 2023, 15(2), 367; https://doi.org/10.3390/cancers15020367 - 05 Jan 2023

Cited by 5 | Viewed by 3632

Abstract

Tertiary lymphoid structures (TLSs) are ectopic lymphocyte aggregation structures found in the tumor microenvironment (TME). Emerging evidence shows that TLSs are significantly correlated with the progression of gastrointestinal tumors, patients’ prognosis, and the efficacy of adjuvant therapy. Besides, there are still some immunosuppressive factors in the TLSs that may affect the anti-tumor responses of TLSs, including negative regulators of anti-tumor immune responses, the immune checkpoint molecules, and inappropriate tumor metabolism. Therefore, a more comprehensive understanding of TLSs’ responses in gastrointestinal tumors is essential to fully understand how TLSs can fully exert their anti-tumor responses. In addition, targeting TLSs with immune checkpoint inhibitors and vaccines to establish mature TLSs is currently being developed to reprogram the TME, further benefiting cancer immunotherapies. This review summarizes recent findings on the formation of TLSs, the mechanisms of their anti-tumor immune responses, and the association between therapeutic strategies and TLSs, providing a novel perspective on tumor-associated TLSs in gastrointestinal tumors. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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22 pages, 2593 KiB

Open AccessReview

Management of Endocrine and Metabolic Toxicities of Immune-Checkpoint Inhibitors: From Clinical Studies to a Real-Life Scenario

by Calogera Claudia Spagnolo, Giuseppe Giuffrida, Salvatore Cannavò, Tindara Franchina, Nicola Silvestris, Rosaria Maddalena Ruggeri and Mariacarmela Santarpia

Cancers 2023, 15(1), 246; https://doi.org/10.3390/cancers15010246 - 30 Dec 2022

Cited by 9 | Viewed by 1864

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic landscape of solid tumors. However, although ICIs are better tolerated than conventional chemotherapy, their use is associated with a peculiar toxicity profile, related to the enhancement of the immune response, affecting several organs. Among immune-related adverse events (irAEs), up to 10% involve the endocrine system. Most of them are represented by thyroid disorders (hypothyroidism and hyperthyroidism), mainly correlated to the use of anti-PD-1 and/or anti-PD-L1 agents. Less common endocrine irAEs include hypophysitis, adrenalitis, and metabolic irAEs. A deeper understanding of endocrine toxicities is a critical goal for both oncologists and endocrinologists. A strict collaboration between these specialists is mandatory for early recognition and proper treatment of these patients. In this review we will provide a comprehensive overview of endocrine and metabolic adverse events of ICIs, with particular interest in the pathogenesis, predisposing factors and clinical presentation of these irAEs, and their impact on clinical outcomes of patients. Furthermore, we will summarize the most recent studies and recommendations on the clinical approach to immune-related endocrinopathies with the purpose to optimize the diagnostic algorithm, and to help both oncologists and endocrinologists to improve the therapeutic management of these unique types of irAEs, in a real-life scenario. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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22 pages, 2620 KiB

Open AccessReview

Cardiotoxicity Induced by Immune Checkpoint Inhibitors: What a Cardio-Oncology Team Should Know and Do

by Concetta Zito, Roberta Manganaro, Giuliana Ciappina, Calogera Claudia Spagnolo, Vito Racanelli, Mariacarmela Santarpia, Nicola Silvestris and Scipione Carerj

Cancers 2022, 14(21), 5403; https://doi.org/10.3390/cancers14215403 - 02 Nov 2022

Cited by 8 | Viewed by 2639

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic scenario for several malignancies. However, they can be responsible for immune-related adverse events (irAEs), involving several organs, with a pooled incidence ranging between 54% and 76%. The frequency of cardiovascular system involvement is <1%. Among the cardiovascular irAEs, myocarditis is the most common and the most dangerous but other, less common manifestations of ICI-related cardiotoxicity include pericardial disease, arrhythmias, Takotsubo-like syndrome, and acute myocardial infarction, all of which remain poorly explored. Both oncologists and cardiologists, as well as the patients, should be aware of the possible occurrence of one or more of these complications, which in some cases are fatal, in order to implement effective strategies of cardiac surveillance. In this review, we summarize the latest studies and recommendations on the pathogenesis, clinical manifestation, diagnosis, and management of ICI-related cardiotoxicity in order to realize a complete and updated overview on the main aspects of ICI-related cardiotoxicity, from surveillance to diagnosis to management, useful for both oncologists and cardiologists in their clinical practice. In particular, in the first part of the review, we realize a description of the pathogenetic mechanisms and risk factors of the main cardiovascular irAEs. Then, we focus on the management of ICI-related cardiotoxicity by analyzing five main points: (1) identifying and evaluating the type and severity of the cardiotoxicity; (2) deciding whether to withhold ICI therapy; (3) initiating steroid and immunosuppressive therapy; (4) starting conventional cardiac treatment; and (5) restarting ICI therapy. Finally, we discuss the existing evidence on surveillance for ICI-related cardiotoxicity and propose a surveillance strategy for both short- and long-term cardiotoxicity, according to the most recent guidelines. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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Other

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14 pages, 1783 KiB

Open AccessConference Report

Immune Assessment Today: Optimizing and Standardizing Efforts to Monitor Immune Responses in Cancer and Beyond

by Surya Pandey, Meghan E. Cholak, Rishita Yadali, Jeffrey A. Sosman, Marie-Pier Tetreault, Deyu Fang, Seth M. Pollack, Sacha Gnjatic, Rebecca C. Obeng, H. Kim Lyerly, Adam M. Sonabend, José A. Guevara-Patiño, Lisa H. Butterfield, Bin Zhang, Holden T. Maecker and I. Caroline Le Poole

Cancers 2024, 16(3), 475; https://doi.org/10.3390/cancers16030475 - 23 Jan 2024

Viewed by 1014

Abstract

As part of a symposium, current and former directors of Immune Monitoring cores and investigative oncologists presented insights into the past, present and future of immune assessment. Dr. Gnjatic presented a classification of immune monitoring technologies ranging from universally applicable to experimental protocols, while emphasizing the need for assay harmonization. Dr. Obeng discussed physiologic differences among CD8 T cells that align with anti-tumor responses. Dr. Lyerly presented the Soldano Ferrone lecture, commemorating the passionate tumor immunologist who inspired many, and covered a timeline of monitoring technology development and its importance to immuno-oncology. Dr. Sonabend presented recent achievements in glioblastoma treatment, accentuating the range of monitoring techniques that allowed him to refine patient selection for clinical trials. Dr. Guevara-Patiño focused on hypoxia within the tumor environment and stressed that T cell viability is not to be confused with functionality. Dr. Butterfield accentuated monitoring of dendritic cell metabolic (dys)function as a determinant for tumor vaccine success. Lectures were interspersed with select abstract presentations. To summarize the concepts, Dr. Maecker from Stanford led an informative forum discussion, pointing towards the future of immune monitoring. Immune monitoring continues to be a guiding light towards effective immunotherapeutic strategies. Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Focus on Multidisciplinary Approaches and Predictive Biomarkers)

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