Clinical Activity of Nivolumab for Human Papilloma Virus-Related Juvenile-Onset Recurrent Respiratory Papillomatosis

The oncologist

article

Ben C. Creelan¹  M. Usman Ahmad²  Frank J. Kaszuba¹  Farah K. Khalil³  Allison W. Welsh⁴  Metin Ozdemirli⁵  Nazaneen N. Grant⁶  Deepa S. Subramaniam⁷ 

[1] Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute;Morsani College of Medicine, University of South Florida;Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute;Foundation Medicine Inc.;Department of Pathology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center;Department of Otolaryngology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center;Division of Hematology/Oncology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center

关键词: Recurrent respiratory papillomatosis;    Nivolumab;    Debulking surgical procedures;    Debridement;    Benign neoplasms;    Tracheal stenosis;    Tumor-infiltrating lymphocytes;   

DOI  :  10.1634/theoncologist.2018-0505

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Juvenile-onset recurrent respiratory papillomatosis (JO-RRP) is a human papilloma virus-mediated progressive benign neoplasm that affects children and young adults. Primary management consists of regular surgical debulking to maintain airway patency and vocal function. Like condyloma acuminata, JO-RRP is associated with immune dysregulation, and T cells isolated from papillomas express an anergic phenotype. Therefore, we hypothesized that programmed death protein 1 axis inhibition could stabilize tumor growth. Materials and Methods We treated two patients with refractory JO-RRP using nivolumab, with the primary objective of assessing clinical activity. We explored baseline papilloma features using immunohistochemistry and comprehensive genomic profiling. Results Both patients experienced symptomatic improvement, and interval laryngoscopies revealed a reduction in papillomatosis burden. One patient has not required subsequent surgical debridement for almost 2 years. On pathologic examination of pretreatment papillomas from both cases, infiltrating T cells were evident in the papilloma stroma, and papilloma programmed death ligand 1 expression was absent. Papilloma mutational load ranged between three and six mutations per megabase for each case. From on-treatment biopsy tissue, a higher amount of intraepithelial T cells and programmed death ligand 1 expression were detected in the papilloma. Conclusion Nivolumab appears to have promising activity in JO-RRP, and further clinical investigation with more patients in clinical trials is warranted. Implications for Practice To the authors' knowledge, this article is the first report describing clinical activity with a programed cell death-1 (PD-1) inhibitor to treat a rare but detrimental type of respiratory tract epithelial neoplasm that afflicts young adults. Two patients were treated, and tumor features, such as mutational load, were examined with the intent to stimulate future hypotheses for translational research. The safety and activity of PD-1 inhibitors in this population still need to be corroborated in clinical trials and should not yet be adopted into clinical practice.

【 授权许可】

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