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
City of Hope National Medical Center, Duarte.
Oregon Health and Science University, Portland.
Haematologica. 2025 Jul 3. doi: 10.3324/haematol.2024.286945.
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.
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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