IL FUTURO DELLINIBIZIONE DI PD 1 E PD L1 NELLA NEOPLASIA POLMONARE - - PowerPoint PPT Presentation
IL FUTURO DELLINIBIZIONE DI PD 1 E PD L1 NELLA NEOPLASIA POLMONARE - - PowerPoint PPT Presentation
IL FUTURO DELLINIBIZIONE DI PD 1 E PD L1 NELLA NEOPLASIA POLMONARE PD L1 NELLA NEOPLASIA POLMONARE NON A PICCOLE CELLULE Istituto Nazionale Tumori Regina Elena Istituto Nazionale Tumori Regina Elena Michele Milella Roma Dr Michele
Dr Michele Milella
- Dr. Michele Milella
In ottemperanza alla normativa ECM ed al principio di trasparenza delle fonti di finanziamento e In ottemperanza alla normativa ECM ed al principio di trasparenza delle fonti di finanziamento e dei rapporti con soggetti portatori di interessi commerciali in campo sanitario, si informano i discenti che negli ultimi due anni si sono avuti i seguenti rapporti anche di finanziamento con soggetti portatori di interessi commerciali in campo sanitario: Pfizer, Novartis, AstraZeneca, Merck‐Serono, Celgene, BMS
Back to where it all started…
(for me at least!!!) (for me at least!!!)
ASCO 2015: Immunotherapy py strikes back!
David A. Karnofsky Memorial Award and Lecture:
PD 1 Pathway Blockade A Common Denominator for Cancer Therapy Denominator for Cancer Therapy
Plenary Session including the Science of Oncology Plenary Session including the Science of Oncology Award and Lecture:
I Ch k i t Bl k d i C Immune Checkpoint Blockade in Cancer Therapy: New Insights, Opportunities, py g pp and Prospects for a Cure
Slide 51
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
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Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 4
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Immune checkpoints
- Various ligand-receptor interactions
Immune checkpoints
between T cells and APCs can regulate T-cell responses to antigen
- These responses can occur upon
initiation of a T-cell response in the LN or tumour microenvironment
- CTLA 4 modulates peripheral
- CTLA-4 modulates peripheral
T-cell expansion post antigen presentation in the LN
- PD1 modulates T-cell responses in
the periphery
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Mercury: 1506HQ13NP08597 -01-IT Approved Oct 2013; Expires Oct 2015
the periphery
Pardoll DM. Nat Rev Cancer 2012;12(4):252–64.
Ipilimumab Blocks Negative Signaling From CTLA-4
CTLA 4 blocks co stimulation: Ipilimumab blocks CTLA 4: Co stimulation via CD28: CTLA-4 blocks co-stimulation: No T-cell activation Ipilimumab blocks CTLA-4: T-cell activation Co-stimulation via CD28: T-cell activation
T cell T cell T cell TCR CTLA4 TCR CTLA4
i ili b
TCR CD28 APC MHC CD28 B7 CD28 APC MHC B7
ipilimumab
APC MHC CD28 B7 APC APC APC
Adapted from Lebbé et al. ESMO 2008 APC, antigen-presenting cell; CTLA-4, cytotoxic T-lymphocyte antigen-4; MHC, major histocompatibility complex; TCR, T-cell receptor.
Adapted from Dooms C., 2012 PILC
Nivolumab mechanism of action
R iti f t b T ll th h P i i d ti ti f T ll th h
Nivolumab mechanism of action
Recognition of tumour by T cell through MHC/antigen interaction mediates IFNγ release and PD-L1/2 upregulation on tumour Priming and activation of T cells through MHC/antigen and CD28/B7 interactions with antigen-presenting cells
T-cell receptor T cell receptor IFNγ IFNγR MHC PD L1 receptor MHC CD28 B7
NFκB Other PI3K
Dendritic ll Tumour cell
PD-L1 PD-1 PD-1 PD-L1 PD-L2
T cell cell
Shp-2 Shp-2
PD-1 PD-1
Nivolumab
PD-L2
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Mercury: 1506HQ13NP08597 -01-IT Approved Oct 2013; Expires Oct 2015
PD1 Receptor Blocking Ab
Blocking CTLA 4 and PD1 Blocking CTLA-4 and PD1
Tumour microenvironment
Activation Activation (cytokines, lysis, proliferation, migration to tumour)
MHC TCR
D d iti
MHC TCR
+++ +++
T cell Tumour cell
PD-L1 PD1
- - -
T cell Dendritic cell
CD28 B7 CTLA-4 - - - B7
+++
anti-CTLA-4 anti-PD1
+++
PD-L2 PD1
anti-PD1
- - -
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Mercury: 1506HQ13NP08597 -01-IT Approved Oct 2013; Expires Oct 2015
CTLA-4 blockade (ipilimumab) PD1 blockade (nivolumab)
Ribas A. N Engl J Med 2012;366(26):2517–9.
CTLA-4 vs PD1: checkpoint inhibitors CTLA-4 vs PD1: checkpoint inhibitors
CTLA-4 PD1
Migrates from intracellular stores to T cell : APC synapse upon T-cell activation1 Expressed on cell surface or induced by T cell interaction; redistributes to T cell : APC synapse on T-cell activation1 Inhibits Akt but not PI3K activity1 Inhibits PI3K and downstream Akt1 Dual ligands (B7.1; B7.2)2 Dual ligands (PD-L1; PD-L2)2 E d ti t d T ll
1 2
E d f i ll Expressed on activated T cells1,2 Expressed on a range of immune cells, including T cells Ligands broadly expressed on APCs / tiss es thro gho t the bod
1 2
Ligands expressed on tumours and imm ne cells and to a lesser e tent tissues throughout the body1,2 immune cells and, to a lesser extent, normal tissues2 Activation through association of APC and T cell in periphery followed by Activation through association of tumour and T cell at tumour site and APC and and T cell in periphery followed by distribution of activated T cells to tumor sites3 and T cell at tumour site and APC and T cell in lymph nodes3
K i ME A R I l 2008 26 677 704
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Mercury: 1506HQ13NP08597 -01-IT Approved Oct 2013; Expires Oct 2015
Keir ME. Annu Rev Immunol 2008;26:677–704. Korman AJ, et al. Adv Immunol 2006;90:297–339. Parry RV, et al. Mol Cell Biol 2005;25:9543–9553.
Slide 9
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 10
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 11
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 12
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 13
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 14
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
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Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
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Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Anti‐PD1/PD‐L1 in NSCLC: The present
Anti‐PD1/PD‐L1 in NSCLC: The (near?) future
At what price?
News from ASCO 2015: Nivo in squamous
OS and PFS by PD-L1 Expression
Presented By David Spigel at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in squamous
OS by PD-L1 Expression
Presented By David Spigel at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in squamous
ORR by PD-L1 Expression
Presented By David Spigel at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
CheckMate 057 (NCT01673867) Study Design
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
Overall Survival
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
Treatment Effect on OS in Predefined Subgroups
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
Objective Response Rate
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
Progression-free Survival
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
OS by PD-L1 Expression
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
OS and PFS Hazard Ratios by Baseline PD-L1 Expression
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
News from ASCO 2015: Nivo in non‐squamous
ORR by PD-L1 Expression
Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting
Slide 8
Presented By Marina Garassino at 2015 ASCO Annual Meeting
Slide 11
Presented By Marina Garassino at 2015 ASCO Annual Meeting
Is NIVO more effective in squamous than adenoca?
Presented By Marina Garassino at 2015 ASCO Annual Meeting
Overall Survival
Presented By Marina Garassino at 2015 ASCO Annual Meeting
News from ASCO 2015: Immuno‐Combo
Pembrolizumab and Ipilimumab Dosing
Presented By Amita Patnaik at 2015 ASCO Annual Meeting
News from ASCO 2015: Immuno‐Combo
Treatment-Related Adverse Events Observed <br />in ≥3 Patients
Presented By Amita Patnaik at 2015 ASCO Annual Meeting
News from ASCO 2015: Immuno‐Combo
Adverse Events of Special Interest (Any Frequency)
Presented By Amita Patnaik at 2015 ASCO Annual Meeting
News from ASCO 2015: Immuno‐Combo
Best Overall Response <br />(RECIST v1.1, Investigator Review)
Presented By Amita Patnaik at 2015 ASCO Annual Meeting
News from ASCO 2015: Immuno‐Combo
Change From Baseline in Tumor Size <br />(RECIST v1.1, Investigator Review)
Presented By Amita Patnaik at 2015 ASCO Annual Meeting
…and not just for NSCLC
Slide 14
Presented By Jedd Wolchok at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
Atezolizumab is a Humanized Anti-PDL1 Antibody That Inhibits the Binding of PD-L1 to PD-1 and B7.1
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
PD-L1 Expression on TC and IC is a Potential Predictive Biomarker for Atezolizumab in NSCLC
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: A Randomized All-comer Phase II Study
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: PD-L1 Expression Subgroups<br />Interim OS
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: All Patient Efficacy<br />ITT interim OS (N = 287)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: PD-L1 Expression Subgroups<br />TC3 or IC3 interim OS (n = 47)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: PD-L1 Expression Subgroups<br />TC2/3 or IC2/3 interim OS (n = 105)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: PD-L1 Expression Subgroups<br />TC1/2/3 or IC1/2/3 interim OS (n = 195)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: PD-L1 Expression Subgroups<br />TC0 and IC0 interim OS (n = 92)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
News from ASCO 2015: Atezolizumab
POPLAR: All-cause AEs (≥ 5% difference between arms)
Presented By Alexander Spira at 2015 ASCO Annual Meeting
What does the future hold?
Slide 24
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Biomarkers? Biomarkers?
Slide 31
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
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Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
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Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 34
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 35
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Genetic subsetting predicts response to anti-PD-1 therapy (Le, Diaz, et al., ASCO 2015)
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 37
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 43
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Endpoints for further clinical trials?
Slide 20
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Slide 19
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting
Are all agents created equal? Are all agents created equal?
Slide 23
Presented By Suzanne Topalian at 2015 ASCO Annual Meeting