Prof. Rossana Berardi E-Mail
Professor in Medical Oncology and Director of the Postgraduate School of Medical Oncology at Università Politecnica Marche; Director of Department of Medical Oncology, Director of “Genetic Cancer” Center and Breast Unit Coordinator at Ospedali Riuniti of Ancona, Italy
Research Keywords: thoracic cancer; breast cancer; neuroendocrine tumors; innovative therapies; COVID-19 and cancer
Immunotherapy in the last years improved outcome of cancer patients, inducing durable tumour responses, in particular in patients affected by NSCLC and melanoma. Immune checkpoint inhibitors regulate and stimulate the immune system to recognize and attack tumour cells. It is commonly better tolerated than chemotherapy and targeted therapy with a unique toxicity profile depending on their different of mechanism of activity.
These toxicities, despite rare, can be sometimes disabling.
However, some patients do not benefit from immunotherapy. Several original researches investigated the potential predictive role of clinical, pathological, laboratoristic factors to select responder patients.
Notwithstanding, a validated predictive parameters do not detected.
Immunotoxicity could involve all organs and systems requiring a specific management including steroids, immunomodulating therapy in multidisciplinary approach. Pathophysiology of immune-toxicity is still unclear. Parameters potentially associated with increased risk of immune-related adverse events are still under investigation.
This special issue focus on predictive factors of response and toxicity in cancer patients treated with immunotherapy in order to improve the management of those subjects.
Women for Oncology – Italy supports this special issue.
Keywords: immunotherapy; immune-related toxicity; multidisciplinary approach
Hyperprogressive disease (HPD) is a novel pattern of response during immunotherapy treatment. Several retrospective studies have evaluated its prevalence among various cancer types and, in particular, in non-small cell lung cancer patients, based on different definition criteria. If HPD is a just a typical phenomenon of immunotherapy is still an unsolved concern. This paper summarized the available data about HPD in other cancer treatments.
Although breast cancer is not traditionally considered an immunogenic type of tumor, the combination of immunotherapy and chemotherapy has recently emerged as a novel treatment option in triple-negative subtype in the advanced setting and other similar combinations of immune checkpoint inhibitors with chemotherapy are expected to become part of the neoadjuvant management in the near future. In addition, encouraging results have been observed with the combination of immune checkpoint blockade with diverse biological agents, including anti-HER2 agents, CDK 4/6 inhibitors, PARP-inhibitors. The present review summarized the available evidence coming from clinical trials on the role of immune checkpoint inhibitors in the management of breast cancer, both in advanced and early setting.
Immunotherapy dramatically changed the management of several malignancies including non-small cell lung cancer (NSCLC). Since immune checkpoint inhibitors have a different mechanism of action from cytotoxic agents or small molecules against NSCLC, also tumor response may present with atypical features. Pseudoprogression (PP) is a distinct response pattern defined by a transient enlargement of the tumor burden, sustained by inflammatory cells and usually not associated with worsening of performance status (PS). Here the authors describe the case of a lung adenocarcinoma patient treated with pembrolizumab, who developed an early symptomatic PP with a dramatic global worsening of PS. Subsequently an improvement in general condition and a brilliant tumor response were observed. Tumor re-biopsy was collected after the treatment in order to support the identification of PP and to describe microenvironment modifications induce by immunotherapy.