IL FUTURO DELLINIBIZIONE DI PD 1 E PD L1 NELLA NEOPLASIA POLMONARE - - PowerPoint PPT Presentation

il futuro dell inibizione di pd 1 e pd l1 nella neoplasia
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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


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IL FUTURO DELL’INIBIZIONE DI PD‐1 E PD L1 NELLA NEOPLASIA POLMONARE PD‐L1 NELLA NEOPLASIA POLMONARE NON A PICCOLE CELLULE

Istituto Nazionale Tumori Regina Elena Michele Milella Istituto Nazionale Tumori Regina Elena Roma

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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

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Back to where it all started…

(for me at least!!!) (for me at least!!!)

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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

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Slide 51

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

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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.

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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

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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

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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.

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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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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.

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Slide 9

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 10

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 11

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 12

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 13

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 14

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 17

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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Anti‐PD1/PD‐L1 in NSCLC: The present

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Anti‐PD1/PD‐L1 in NSCLC: The (near?) future

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At what price?

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News from ASCO 2015: Nivo in squamous

OS and PFS by PD-L1 Expression

Presented By David Spigel at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in squamous

OS by PD-L1 Expression

Presented By David Spigel at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in squamous

ORR by PD-L1 Expression

Presented By David Spigel at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in non‐squamous

CheckMate 057 (NCT01673867) Study Design

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in non‐squamous

Overall Survival

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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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

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News from ASCO 2015: Nivo in non‐squamous

Objective Response Rate

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in non‐squamous

Progression-free Survival

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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News from ASCO 2015: Nivo in non‐squamous

OS by PD-L1 Expression

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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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

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News from ASCO 2015: Nivo in non‐squamous

ORR by PD-L1 Expression

Presented By Luis Paz-Ares at 2015 ASCO Annual Meeting

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Slide 8

Presented By Marina Garassino at 2015 ASCO Annual Meeting

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Slide 11

Presented By Marina Garassino at 2015 ASCO Annual Meeting

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Is NIVO more effective in squamous than adenoca?

Presented By Marina Garassino at 2015 ASCO Annual Meeting

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Overall Survival

Presented By Marina Garassino at 2015 ASCO Annual Meeting

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News from ASCO 2015: Immuno‐Combo

Pembrolizumab and Ipilimumab Dosing

Presented By Amita Patnaik at 2015 ASCO Annual Meeting

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News from ASCO 2015: Immuno‐Combo

Treatment-Related Adverse Events Observed <br />in ≥3 Patients

Presented By Amita Patnaik at 2015 ASCO Annual Meeting

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News from ASCO 2015: Immuno‐Combo

Adverse Events of Special Interest (Any Frequency)

Presented By Amita Patnaik at 2015 ASCO Annual Meeting

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News from ASCO 2015: Immuno‐Combo

Best Overall Response <br />(RECIST v1.1, Investigator Review)

Presented By Amita Patnaik at 2015 ASCO Annual Meeting

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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

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…and not just for NSCLC

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Presented By Jedd Wolchok at 2015 ASCO Annual Meeting

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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

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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

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News from ASCO 2015: Atezolizumab

POPLAR: A Randomized All-comer Phase II Study

Presented By Alexander Spira at 2015 ASCO Annual Meeting

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News from ASCO 2015: Atezolizumab

POPLAR: PD-L1 Expression Subgroups<br />Interim OS

Presented By Alexander Spira at 2015 ASCO Annual Meeting

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News from ASCO 2015: Atezolizumab

POPLAR: All Patient Efficacy<br />ITT interim OS (N = 287)

Presented By Alexander Spira at 2015 ASCO Annual Meeting

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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

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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

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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

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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

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News from ASCO 2015: Atezolizumab

POPLAR: All-cause AEs (≥ 5% difference between arms)

Presented By Alexander Spira at 2015 ASCO Annual Meeting

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What does the future hold?

Slide 24

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Biomarkers? Biomarkers?

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Slide 31

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 32

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 33

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 34

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 35

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Genetic subsetting predicts response to anti-PD-1 therapy (Le, Diaz, et al., ASCO 2015)

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 37

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 43

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Endpoints for further clinical trials?

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Slide 20

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Slide 19

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Are all agents created equal? Are all agents created equal?

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Slide 23

Presented By Suzanne Topalian at 2015 ASCO Annual Meeting

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Combos are highly effective, but… Combos are highly effective, but… …are they always needed and can ff d h ??? we afford them???