Understanding and Anticipating Therapeutic and ADverse Responses in Anti-cancer Immune Checkpoint Inhibition Towards a Better Therapeutic Management of Patients

Overview

The goal of this observational study is to explore the value of blood biomarkers for the purpose of predicting irAE development in cancer patients treated with immune checkpoint inihibitors (ICI) alone or in combination with other treatments (chemotherapy, radiotherapy and targeted therapy). Data and blood samples will be collected from participants at different time points as part of routine follow-up visits. Data and blood samples will be analysed. Analysis will include the characterization of immune cells by mass and flow cytometry.

Advances in treating patients with immunotherapy have dramatically changed cancer morbidity and mortality. Immune checkpoint inhibitors (ICI), alone or combined with other treatments, are currently used both as standard of care or in experimental settings for various cancers. ICI treatment induces objective clinical responses in 20-40% of patients (varies by tumor type); however, this leaves a majority of patients that do not respond to ICI therapy. ICI drugs purposely release immune regulatory controls and consequently increase immune activities; however, this release also provokes a significant risk of immunerelated adverse events (irAEs) such as dermatitis, hepatitis, thyroiditis and colitis, and less frequently but clinically important, hypophysitis, myocarditis and pneumonia. While the incidence of irAE is highly variable and influenced by many factors, Phase I and II trials reported rates from 10% to 80% for any grade irAE while an irAE of grade 3 or higher was observed in 2.5% to 18% of subjects. Recently, Jing et al. demonstrated that 20% of patients receiving anti-PD-1/PD-L1 had at least one irAE by integrating real-world pharmacovigilance of 26 tumor types for a total of 18,706 patients. Presently, the specific immune mechanism(s) driving irAE are unknown and biomarkers that predict their onset, particularly high-grade irAE, are urgently needed. For this reason, we hypothesize that an in-depth characterization and comparisons of the cell subpopulations composing and interacting within the primary cancer lesions, the peripheral blood, and in the organs in which irAE arise could help to better understand but also predict the clinical therapeutic response or/and irAE in patients with advanced cancers treated with ICI. The research is a non-interventional monocentric prospective study of humans for the development of biological and medical knowledge, in which the procedures are performed and the products used in the usual manner, without additional or unusual diagnostic, treatment or monitoring procedures. The study includes patients monitored for their cancer at CHU of Brest and treated using Immune Checkpoint Inhibitors. Data and peripheral blood (47mL) will be collected at different time points as part of routine follow-up visits for analysis. Analysis will include the characterization of immune cells by mass and flow cytometry.