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库潘尼西与纳武单抗联合治疗里氏转化或转化型非霍奇金淋巴瘤患者的安全性和疗效:一项I期试验的结果

Safety and efficacyof the combination of copanlisib and nivolumab in patients with Richter's transformation or transformed non-Hodgkin lymphoma: results from a phase I trial.

作者信息

Shouse Geoffrey, Chen Canping, Muir Alexandra, Popplewell Leslie, Siddiqi Tanya, Zain Jasmine, Herrera Alex F, Danilova Olga, Roleder Carly, Wang Lili, Spurgeon Stephen E F, Kittai Adam S, Chen Lu, Xia Zheng, Davids Matthew S, Danilov Alexey V

机构信息

City of Hope National Medical Center, Duarte.

Oregon Health and Science University, Portland.

出版信息

Haematologica. 2025 Jul 3. doi: 10.3324/haematol.2024.286945.


DOI:10.3324/haematol.2024.286945
PMID:40605718
Abstract

Despite advances in targeted and cellular therapies, outcomes for patients with Richter's transformation (RT) and transformed non-Hodgkin lymphoma (tNHL) remain dismal. In this study we report safety and efficacy of the combination of the selective, small molecule inhibitor of phosphoinositide-3-kinase copanlisib, with the anti-PD-1 antibody nivolumab from a phase 1 multicenter investigator-sponsored study. Twenty-seven adult patients with relapsed and/or refractory RT or tNHL were treated with escalating doses of copanlisib IV on days 1, 8, and 15 (dose level [DL] 1-45 mg, DL2-60 mg) combined with nivolumab 240 mg IV on days 1 and 15 of a 28-day cycle. Three dose limiting toxicities occurred in 2 patients treated at DL2, hence 45 mg was determined the maximum tolerated dose and utilized in the expansion cohort. The most common treatment-related adverse events were diarrhea and anemia. All patients went off protocol, predominantly due to progressive disease and adverse events (67% and 26% of patients, respectively). Overall response rate (ORR) was 46%. Patients with transformed follicular lymphoma had ORR 67% (2 complete responses), with median progression free survival (PFS) 4.4 months (95% CI: 1.4-12.2). Patients with RT had ORR 31% (2 complete responses) with median PFS 2.0 months (95% CI: 0.7-4.9). Treatment resulted in downregulation of MYC and NFκB pathways in malignant B cells. Responding RT patients exhibited sustained activation of IFN-α and IFN-γ signaling pathways in CD4+ and CD8+ T cells. Overall, treatment with copanlisib and nivolumab demonstrated manageable toxicity and promising clinical efficacy in tNHL patients.

摘要

尽管在靶向治疗和细胞疗法方面取得了进展,但里氏转化(RT)和转化型非霍奇金淋巴瘤(tNHL)患者的预后仍然很差。在本研究中我们报告了一项1期多中心研究者发起的研究中,选择性小分子磷酸肌醇-3-激酶抑制剂库潘尼西与抗PD-1抗体纳武单抗联合使用的安全性和有效性。27例复发和/或难治性RT或tNHL成年患者在28天周期的第1、8和15天接受递增剂量的静脉注射库潘尼西(剂量水平[DL]1-45mg,DL2-60mg),并在第1天和第15天联合静脉注射240mg纳武单抗。在接受DL2治疗的2例患者中发生了3例剂量限制性毒性反应,因此确定45mg为最大耐受剂量并用于扩大队列。最常见的治疗相关不良事件是腹泻和贫血。所有患者均退出研究方案,主要原因是疾病进展和不良事件(分别占患者的67%和26%)。总缓解率(ORR)为46%。转化型滤泡性淋巴瘤患者的ORR为67%(2例完全缓解),中位无进展生存期(PFS)为4.4个月(95%CI:1.4-12.2)。RT患者的ORR为31%(2例完全缓解),中位PFS为2.0个月(95%CI:0.7-4.9)。治疗导致恶性B细胞中MYC和NFκB通路下调。有反应的RT患者在CD4+和CD8+T细胞中表现出IFN-α和IFN-γ信号通路的持续激活。总体而言,库潘尼西和纳武单抗治疗在tNHL患者中显示出可控的毒性和有前景的临床疗效。

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