Despite the application of conventional therapies,the prognosis of advanced gastric cancer(GC)or gastroesophageal junction cancer(GEJC)is still poor.In recent years,immune checkpoint inhibitors(ICIs)have reshaped the ...Despite the application of conventional therapies,the prognosis of advanced gastric cancer(GC)or gastroesophageal junction cancer(GEJC)is still poor.In recent years,immune checkpoint inhibitors(ICIs)have reshaped the paradigm of cancer therapy.Emerging evidence support the feasibility of programmed cell death-1(PD-1)and its ligand(PD-L1)inhibition in chemo-refractory GC/GEJC.Nivolumab and pembrolizumab have initially been approved in Japan and United States,respectively for the third-line treatment of progressive GC or GEJC.In March 2020,nivolumab has also been licensed in China for treating advanced GC/GEJC who received≥2 lines of systemic therapies.Current studies are moving forward to the first-line application or focusing on combination strategies,though data are insufficient and disputable.In this review,we summarize the recently reported and ongoing clinical trials in ICIs for advanced GC/GEJC.Molecular characteristics and clinical implications of different tumor subtypes are also reviewed.We further discuss the safety profile and biomarkers for predicting the response of ICIs,which has guiding values in clinical practice.展开更多
Objective: Immunotherapeutic outcomes and clinical characteristics of claudin 18 isoform 2 positive(CLDN18.2-positive) gastric cancer(GC) vary in different clinical studies, making it difficult to optimize antiCLDN18....Objective: Immunotherapeutic outcomes and clinical characteristics of claudin 18 isoform 2 positive(CLDN18.2-positive) gastric cancer(GC) vary in different clinical studies, making it difficult to optimize antiCLDN18.2 therapy. We conducted a retrospective analysis to explore the association of CLDN18.2 expression with clinicopathological characteristics and immunotherapeutic outcomes in GC.Methods: A total of 536 advanced GC patients from 2019 to 2021 in the CT041-CG4006 and CT041-ST-01clinical trials were included in the analysis. CLDN18.2 expression on ≥40% of tumor cells(2+, 40%) and CLDN18.2 expression on ≥70% of tumor cells(2+, 70%) were considered the two levels of positively expressed GC. The clinicopathological characteristics and immunotherapy outcomes of GC patients were analyzed according to CLDN18.2 expression status.Results: CLDN18.2 was expressed in 57.6%(cut-off: 2+, 40%) and 48.9%(cut-off: 2+, 70%) of patients.Programmed death-ligand 1(PD-L1) and CLDN18.2 were co-expressed in 19.8% [combined positive score(CPS)≥1, CLDN18.2(cut-off: 2+, 40%)] and 17.2% [CPS≥5, CLDN18.2(cut-off: 2+, 70%)] of patients.CLDN18.2 expression positively correlated with younger age, female sex, non-gastroesophageal junction(nonGEJ), and diffuse phenotype(P<0.001). HER2 and PD-L1 expression were significantly lower in CLDN18.2-positive GC(both P<0.05). Uterine adnexa metastasis(P<0.001) was more frequent and liver metastasis(P<0.001)was less common in CLDN18.2-positive GC. Overall survival and immunotherapy-related progression-free survival(ir PFS) were inferior in the CLDN18.2-positive group.Conclusions: CLDN18.2-positive GC is associated with poor prognosis and worse immunotherapeutic outcomes. The combination of anti-CLDN18.2 therapy, anti-PD-L1/PD-1 therapy, and chemotherapy for GC requires further investigation.展开更多
Objective:Immune checkpoint inhibitors(ICIs)have achieved remarkable results in cancer treatments.However,there is no effective predictive biomarker for gastrointestinal(GI)cancer.Methods:We conducted integrative anal...Objective:Immune checkpoint inhibitors(ICIs)have achieved remarkable results in cancer treatments.However,there is no effective predictive biomarker for gastrointestinal(GI)cancer.Methods:We conducted integrative analyses of the genomic and survival data of ICI-treated GI cancer patients from the Memorial Sloan Kettering Cancer Center cohort(MSK-GI,n=227),the Janjigian cohort(n=40),and the Peking University Cancer Hospital&Institute cohort(PUCH,n=80)to determine the possible associations between DNA damage response and repair(DDR)gene mutations and clinical outcomes.Data from The Cancer Genome Atlas database were analyzed to determine the possible correlations between DDR gene mutations and the tumor microenvironment.Results:In the MSK cohort,the presence of≥2 DDR gene mutations was correlated with prolonged overall survival(OS).The Janjigian and PUCH cohorts further confirmed that subgroups with≥2 DDR gene mutations displayed a prolonged OS and a higher durable clinical benefit.Furthermore,the DDR gene mutation load could be considered as an independent prognostic factor,and exhibited a potential predictive value for survival in GI cancer patients treated with ICIs.Mechanistically,we showed that the presence of≥2 DDR gene mutations was correlated with higher levels of tumor mutation burden,neoantigen,and T cell infiltration.Conclusions:The DDR gene mutation status was correlated with favorable clinical outcomes in GI cancer patients receiving ICIs,which could serve as a potential biomarker to guide patient selection for immunotherapy.展开更多
Alpha-fetoprotein-producing gastric or gastro-esophageal junction(AFP-G/GEJ)cancer,a rare gastric cancer subtype,exhibits increased angiogenesis and more immunosuppression than non-AFP-G/GEJ cancer.The potential benef...Alpha-fetoprotein-producing gastric or gastro-esophageal junction(AFP-G/GEJ)cancer,a rare gastric cancer subtype,exhibits increased angiogenesis and more immunosuppression than non-AFP-G/GEJ cancer.The potential benefits of anti-angiogenic agents and immunotherapy for this specific subtype remain unknown.This multi-center,single-arm,phase 2 trial(ClinicalTrials.gov NCT04609176)evaluated the antitumor activity,safety,and biomarkers of camrelizumab plus apatinib and S-1 and oxaliplatin(SOX),followed by maintenance treatment with camrelizumab plus apatinib,as a first-line treatment in patients with AFP-G/GEJ adenocarcinoma.Primary endpoint was the confirmed objective response rate(ORR)per RECIST v1.1 in the full analysis set.Secondary endpoints were disease control rate(DCR),progression-free survival(PFS),overall survival(OS),duration of response,time to response,and safety.Between December 4,2020,and August 4,2023,36 patients were enrolled and treated.The trial met its primary endpoint with a confirmed ORR of 66.7%(95%Cl:49.0-81.4).The DCR was 88.9%(95%Cl:73.9-96.9).With a median follow-up of 11.7 months(range:3.2-37.9),the median PFS reached 7.8 months(95%Cl:4.9-12.3)and the median OS reached 18.0 months(95%Cl:10.5-NR).No new safety concerns were identified.In exploratory analysis,patients with durable clinical benefit exhibited higher pre-treatment(PD-1+)CD8+T cell densities and effective scores.First-line treatment with camrelizumab plus apatinib and SOX,followed by maintenance treatment with camrelizumab plus apatinib,is effective and safe in AFP-G/GEJ adenocarcinoma.Further studies are necessary to validate these findings.展开更多
To evaluate the efficacy and safety of KN026,a novel bispecific HER2(ECD2 and ECD4)antibody,plus KN046,a PD-L1,and CTLA4 bispecific antibody,in patients with advanced HER2-positive solid tumors.We conducted two sequen...To evaluate the efficacy and safety of KN026,a novel bispecific HER2(ECD2 and ECD4)antibody,plus KN046,a PD-L1,and CTLA4 bispecific antibody,in patients with advanced HER2-positive solid tumors.We conducted two sequentially designed phase Ib and Il studies with similar target populations and evaluation schedules.The primary endpoints included safety,maximum tolerated dose(MTD),the recommended phase Il dose(RP2D)for the phase Ib study,and the objective response rate(ORR)and duration of response(DoR)for the phase llstudy.Hereby,we solely report the results from 113 nonbreast cancer patients.In phase Ib,MTD was not reached.Dose 3 was confirmed to be acceptable for the phase lIl study.An objective response has been exclusively observed in HER2-positive patients.Any grade treatment-related adverse events(TRAEs)were reported in 108(95.6%)patients.The most common TRAEs were infusion reactions(38.9%),anemia(37.2%),elevated AST(31.0%),and diarrhea(30.1%).Among the 108 patients evaluated for efficacy,the overall ORR was 55.6%(95%Cl,45.7%,65.1%).In the HER2-positive GC subgroup,38 patients received this regimen as the 1st-line treatment and 30 patients achieved an objective response,with an ORR of 78.9%(95%Cl,62.7%,90.4%).Among 27 pretreated patients,the ORR was 44.4%(95%Cl,25.5%,64.7%).In the other HER2-positive solid tumor subgroup(n=34),the ORR was 52.9%(95%CI 35.1%,70.2%).Thus,KN026 plus KN04 exhibits promising efficacy and acceptable safety profiles in HER2-positive nonbreast cancer,as does the 1st-line treatment for GC.展开更多
基金the National Key Research and Development Program of China(No.2017YFC1308900)。
文摘Despite the application of conventional therapies,the prognosis of advanced gastric cancer(GC)or gastroesophageal junction cancer(GEJC)is still poor.In recent years,immune checkpoint inhibitors(ICIs)have reshaped the paradigm of cancer therapy.Emerging evidence support the feasibility of programmed cell death-1(PD-1)and its ligand(PD-L1)inhibition in chemo-refractory GC/GEJC.Nivolumab and pembrolizumab have initially been approved in Japan and United States,respectively for the third-line treatment of progressive GC or GEJC.In March 2020,nivolumab has also been licensed in China for treating advanced GC/GEJC who received≥2 lines of systemic therapies.Current studies are moving forward to the first-line application or focusing on combination strategies,though data are insufficient and disputable.In this review,we summarize the recently reported and ongoing clinical trials in ICIs for advanced GC/GEJC.Molecular characteristics and clinical implications of different tumor subtypes are also reviewed.We further discuss the safety profile and biomarkers for predicting the response of ICIs,which has guiding values in clinical practice.
基金supported by Beijing Natural Science Foundation (No. Z20J00105)the National Natural Science Foundation of China (No. 82272627)。
文摘Objective: Immunotherapeutic outcomes and clinical characteristics of claudin 18 isoform 2 positive(CLDN18.2-positive) gastric cancer(GC) vary in different clinical studies, making it difficult to optimize antiCLDN18.2 therapy. We conducted a retrospective analysis to explore the association of CLDN18.2 expression with clinicopathological characteristics and immunotherapeutic outcomes in GC.Methods: A total of 536 advanced GC patients from 2019 to 2021 in the CT041-CG4006 and CT041-ST-01clinical trials were included in the analysis. CLDN18.2 expression on ≥40% of tumor cells(2+, 40%) and CLDN18.2 expression on ≥70% of tumor cells(2+, 70%) were considered the two levels of positively expressed GC. The clinicopathological characteristics and immunotherapy outcomes of GC patients were analyzed according to CLDN18.2 expression status.Results: CLDN18.2 was expressed in 57.6%(cut-off: 2+, 40%) and 48.9%(cut-off: 2+, 70%) of patients.Programmed death-ligand 1(PD-L1) and CLDN18.2 were co-expressed in 19.8% [combined positive score(CPS)≥1, CLDN18.2(cut-off: 2+, 40%)] and 17.2% [CPS≥5, CLDN18.2(cut-off: 2+, 70%)] of patients.CLDN18.2 expression positively correlated with younger age, female sex, non-gastroesophageal junction(nonGEJ), and diffuse phenotype(P<0.001). HER2 and PD-L1 expression were significantly lower in CLDN18.2-positive GC(both P<0.05). Uterine adnexa metastasis(P<0.001) was more frequent and liver metastasis(P<0.001)was less common in CLDN18.2-positive GC. Overall survival and immunotherapy-related progression-free survival(ir PFS) were inferior in the CLDN18.2-positive group.Conclusions: CLDN18.2-positive GC is associated with poor prognosis and worse immunotherapeutic outcomes. The combination of anti-CLDN18.2 therapy, anti-PD-L1/PD-1 therapy, and chemotherapy for GC requires further investigation.
基金supported by the National Key Research and Development Program of China(Grant Nos.2018YFC1313302 and 2017YFC1308900)the Beijing Municipal Science and Technology Commission Program(Grant No.Z141107002514013)the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority(Grant No.XXT19).
文摘Objective:Immune checkpoint inhibitors(ICIs)have achieved remarkable results in cancer treatments.However,there is no effective predictive biomarker for gastrointestinal(GI)cancer.Methods:We conducted integrative analyses of the genomic and survival data of ICI-treated GI cancer patients from the Memorial Sloan Kettering Cancer Center cohort(MSK-GI,n=227),the Janjigian cohort(n=40),and the Peking University Cancer Hospital&Institute cohort(PUCH,n=80)to determine the possible associations between DNA damage response and repair(DDR)gene mutations and clinical outcomes.Data from The Cancer Genome Atlas database were analyzed to determine the possible correlations between DDR gene mutations and the tumor microenvironment.Results:In the MSK cohort,the presence of≥2 DDR gene mutations was correlated with prolonged overall survival(OS).The Janjigian and PUCH cohorts further confirmed that subgroups with≥2 DDR gene mutations displayed a prolonged OS and a higher durable clinical benefit.Furthermore,the DDR gene mutation load could be considered as an independent prognostic factor,and exhibited a potential predictive value for survival in GI cancer patients treated with ICIs.Mechanistically,we showed that the presence of≥2 DDR gene mutations was correlated with higher levels of tumor mutation burden,neoantigen,and T cell infiltration.Conclusions:The DDR gene mutation status was correlated with favorable clinical outcomes in GI cancer patients receiving ICIs,which could serve as a potential biomarker to guide patient selection for immunotherapy.
基金Capital's Funds for Health Improvement and Research(2024-1-1021)Beijing Natural Science Foundation(Z20J00105)+2 种基金National Natural Science Foundation of China(82272627)Beijing Natural Science Foundation(L234003)the Beijing Xisike Clinical Oncology Research Foundation(Y-HR2020ZD-0773)。
文摘Alpha-fetoprotein-producing gastric or gastro-esophageal junction(AFP-G/GEJ)cancer,a rare gastric cancer subtype,exhibits increased angiogenesis and more immunosuppression than non-AFP-G/GEJ cancer.The potential benefits of anti-angiogenic agents and immunotherapy for this specific subtype remain unknown.This multi-center,single-arm,phase 2 trial(ClinicalTrials.gov NCT04609176)evaluated the antitumor activity,safety,and biomarkers of camrelizumab plus apatinib and S-1 and oxaliplatin(SOX),followed by maintenance treatment with camrelizumab plus apatinib,as a first-line treatment in patients with AFP-G/GEJ adenocarcinoma.Primary endpoint was the confirmed objective response rate(ORR)per RECIST v1.1 in the full analysis set.Secondary endpoints were disease control rate(DCR),progression-free survival(PFS),overall survival(OS),duration of response,time to response,and safety.Between December 4,2020,and August 4,2023,36 patients were enrolled and treated.The trial met its primary endpoint with a confirmed ORR of 66.7%(95%Cl:49.0-81.4).The DCR was 88.9%(95%Cl:73.9-96.9).With a median follow-up of 11.7 months(range:3.2-37.9),the median PFS reached 7.8 months(95%Cl:4.9-12.3)and the median OS reached 18.0 months(95%Cl:10.5-NR).No new safety concerns were identified.In exploratory analysis,patients with durable clinical benefit exhibited higher pre-treatment(PD-1+)CD8+T cell densities and effective scores.First-line treatment with camrelizumab plus apatinib and SOX,followed by maintenance treatment with camrelizumab plus apatinib,is effective and safe in AFP-G/GEJ adenocarcinoma.Further studies are necessary to validate these findings.
基金supported by the National Natural Science Foundation of China(91959205 to L.S.)the Natural Science Foundation of Beijing Municipality(Z200015 to X.T.Z).
文摘To evaluate the efficacy and safety of KN026,a novel bispecific HER2(ECD2 and ECD4)antibody,plus KN046,a PD-L1,and CTLA4 bispecific antibody,in patients with advanced HER2-positive solid tumors.We conducted two sequentially designed phase Ib and Il studies with similar target populations and evaluation schedules.The primary endpoints included safety,maximum tolerated dose(MTD),the recommended phase Il dose(RP2D)for the phase Ib study,and the objective response rate(ORR)and duration of response(DoR)for the phase llstudy.Hereby,we solely report the results from 113 nonbreast cancer patients.In phase Ib,MTD was not reached.Dose 3 was confirmed to be acceptable for the phase lIl study.An objective response has been exclusively observed in HER2-positive patients.Any grade treatment-related adverse events(TRAEs)were reported in 108(95.6%)patients.The most common TRAEs were infusion reactions(38.9%),anemia(37.2%),elevated AST(31.0%),and diarrhea(30.1%).Among the 108 patients evaluated for efficacy,the overall ORR was 55.6%(95%Cl,45.7%,65.1%).In the HER2-positive GC subgroup,38 patients received this regimen as the 1st-line treatment and 30 patients achieved an objective response,with an ORR of 78.9%(95%Cl,62.7%,90.4%).Among 27 pretreated patients,the ORR was 44.4%(95%Cl,25.5%,64.7%).In the other HER2-positive solid tumor subgroup(n=34),the ORR was 52.9%(95%CI 35.1%,70.2%).Thus,KN026 plus KN04 exhibits promising efficacy and acceptable safety profiles in HER2-positive nonbreast cancer,as does the 1st-line treatment for GC.
