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Title: Autoantibodies May Predict Immune-Related Toxicity: Results from a Phase I Study of IntralesionalBacillus Calmette-Guérinfollowed by Ipilimumab in Patients with Advanced Metastatic Melanoma.
Austin Authors: Da Gama Duarte, Jessica;Parakh, Sagun ;Andrews, Miles C;Woods, Katherine;Pasam, Anupama;Tutuka, Candani;Ostrouska, Simone;Blackburn, Jonathan M;Behren, Andreas;Cebon, Jonathan S 
Affiliation: Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
School of Cancer Medicine, La Trobe University, Heidelberg, Victoria, Australia
Ludwig Institute for Cancer Research, Austin Branch, Heidelberg, Victoria, Australia
MD Anderson Cancer Center, University of Texas, Houston, TX, United States
Department of Integrative Biomedical Sciences and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Sengenics Corporation, Singapore, Singapore
Issue Date: 2018 2018
Publication information: Frontiers in immunology 2018; 9: 411
Abstract: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced melanoma. The first ICI to demonstrate clinical benefit, ipilimumab, targets cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4); however, the long-term overall survival is just 22%. More than 40 years ago intralesional (IL)bacillus Calmette-Guérin(BCG), a living attenuated strain ofMycobacterium bovis, was found to induce tumor regression by stimulating cell-mediated immunity following a localized and self-limiting infection. We evaluated these two immune stimulants in combination with melanoma with the aim of developing a more effective immunotherapy and to assess toxicity. In this phase I study, patients with histologically confirmed stage III/IV metastatic melanoma received IL BCG injection followed by up to four cycles of intravenous ipilimumab (anti-CTLA-4) ( number NCT01838200). The trial was discontinued following treatment of the first five patients as the two patients receiving the escalation dose of BCG developed high-grade immune-related adverse events (irAEs) typical of ipilimumab monotherapy. These irAEs were characterized in both patients by profound increases in the repertoire of autoantibodies directed against both self- and cancer antigens. Interestingly, the induced autoantibodies were detected at time points that preceded the development of symptomatic toxicity. There was no overlap in the antigen specificity between patients and no evidence of clinical responses. Efforts to increase response rates through the use of novel immunotherapeutic combinations may be associated with higher rates of irAEs, thus the imperative to identify biomarkers of toxicity remains strong. While the small patient numbers in this trial do not allow for any conclusive evidence of predictive biomarkers, the observed changes warrant further examination of autoantibody repertoires in larger patient cohorts at risk of developing irAEs during their course of treatment. In summary, dose escalation of IL BCG followed by ipilimumab therapy was not well tolerated in advanced melanoma patients and showed no evidence of clinical benefit. Measuring autoantibody responses may provide early means for identifying patients at risk from developing severe irAEs during cancer immunotherapy.
DOI: 10.3389/fimmu.2018.00411
ORCID: 0000-0003-4289-5204
Journal: Frontiers in immunology
PubMed URL: 29552014
ISSN: 1664-3224
Type: Journal Article
Subjects: bacillus Calmette–Guerin
immune-related adverse events
protein microarrays
Appears in Collections:Journal articles

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