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Immunotherapy: Current Status and Future Perspectives

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Abstract

Hepatocellular carcinoma (HCC) has an increasing incidence and dismal prognosis, with few systemic treatments approved, including several small molecule tyrosine kinase inhibitors. The application of immune checkpoint inhibitors (ICIs) to HCC has resulted in durable activity, and further evaluation is ongoing. In this review, we discuss the immunologic principles and the mechanism of action of the ICIs and present the relevant clinical data. Furthermore, we provide an overview of the current and emerging immunotherapeutic approaches for HCC, such as combination treatments, vaccines, and cellular therapies.

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References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians; 2018.

    Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.

    Article  PubMed  Google Scholar 

  3. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  4. Karin M. Nuclear factor-κB in cancer development and progression. Nature. 2006;441:431–436.

    Article  CAS  PubMed  Google Scholar 

  5. Llovet JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Prim. 2016;2:16018.

    Article  PubMed  Google Scholar 

  6. Makarova-Rusher OV, Altekruse SF, McNeel TS, et al. Population attributable fractions of risk factors for hepatocellular carcinoma in the United States: US HCC-attributable risk factors. Cancer. 2016;122:1757–1765.

    Article  PubMed  Google Scholar 

  7. Masuoka HC, Chalasani N. Nonalcoholic fatty liver disease: an emerging threat to obese and diabetic individuals. Ann N Y Acad Sci. 2013;1281:106–122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022.

    Article  PubMed  Google Scholar 

  9. Benson AB, D’Angelica MI, Abbott DE, et al. NCCN guidelines insights: hepatobiliary cancers, version 1.2017. J Natl Compr Canc Netw. 2017;15:563–573.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–390.

    Article  CAS  PubMed  Google Scholar 

  11. Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018;391:1163–1173.

    Article  CAS  PubMed  Google Scholar 

  12. Abou-Alfa GK, Meyer T, Cheng A-L, et al. Cabozantinib (C) versus placebo (P) in patients (pts) with advanced hepatocellular carcinoma (HCC) who have received prior sorafenib: results from the randomized phase III CELESTIAL trial. J Clin Oncol. 2018;36:207.

    Article  Google Scholar 

  13. Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373:1803–1813.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Topalian SL, Drake CG, Pardoll DM. Immune checkpoint blockade: a common denominator approach to cancer therapy. Cancer Cell. 2015;27:450–461.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Weber JS, D’Angelo SP, Minor D, et al. Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. 2015;16:375–384.

    Article  CAS  PubMed  Google Scholar 

  16. El-Khoueiry AB, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017;389:2492–2502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Knolle PA, Thimme R. Hepatic immune regulation and its involvement in viral hepatitis infection. Gastroenterology. 2014;146:1193–1207.

    Article  CAS  PubMed  Google Scholar 

  18. Makarova-Rusher OV, Medina-Echeverz J, Duffy AG, et al. The yin and yang of evasion and immune activation in HCC. J Hepatol. 2015;62:1420–1429.

    Article  CAS  PubMed  Google Scholar 

  19. Prieto J, Melero I, Sangro B. Immunological landscape and immunotherapy of hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol. 2015;12:681–700.

    Article  CAS  PubMed  Google Scholar 

  20. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12:252–264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Gao Q, Wang X-Y, Qiu S-J, et al. Overexpression of PD-L1 significantly associates with tumor aggressiveness and postoperative recurrence in human hepatocellular carcinoma. Clin Cancer Res. 2009;15:971–979.

    Article  CAS  PubMed  Google Scholar 

  22. Calderaro J, Rousseau B, Amaddeo G, et al. Programmed death ligand 1 expression in hepatocellular carcinoma: relationship with clinical and pathological features. Hepatology. 2016;64:2038–2046.

    Article  CAS  PubMed  Google Scholar 

  23. Schmidt N, Thimme R. Role of immunity in pathogenesis and treatment of hepatocellular carcinoma. Dig Dis. 2016;34:429–437.

    Article  PubMed  Google Scholar 

  24. Ormandy LA, Hillemann T, Wedemeyer H, et al. Increased populations of regulatory T cells in peripheral blood of patients with hepatocellular carcinoma. Can Res. 2005;65:2457–2464.

    Article  CAS  Google Scholar 

  25. Arihara F, Mizukoshi E, Kitahara M, et al. Increase in CD14 + HLA-DR −/low myeloid-derived suppressor cells in hepatocellular carcinoma patients and its impact on prognosis. Cancer Immunol Immunother. 2013;62:1421–1430.

    Article  CAS  PubMed  Google Scholar 

  26. Greten TF, Wang XW, Korangy F. Current concepts of immune based treatments for patients with HCC: from basic science to novel treatment approaches. Gut. 2015;64:842–848.

    Article  CAS  PubMed  Google Scholar 

  27. Hoechst B, Ormandy LA, Ballmaier M, et al. A new population of myeloid-derived suppressor cells in hepatocellular carcinoma patients induces CD4 + CD25 + Foxp3 + T cells. Gastroenterology. 2008;135:234–243.

    Article  CAS  PubMed  Google Scholar 

  28. Llovet JM, Sala M, Castells L, et al. Randomized controlled trial of interferon treatment for advanced hepatocellular carcinoma. Hepatology. 2000;31:54–58.

    Article  CAS  PubMed  Google Scholar 

  29. Sangro B, Mazzolini G, Ruiz J, et al. Phase I trial of intratumoral injection of an adenovirus encoding interleukin-12 for advanced digestive tumors. J Clin Oncol. 2004;22:1389–1397.

    Article  CAS  PubMed  Google Scholar 

  30. Mazzolini G, Alfaro C, Sangro B, et al. Intratumoral injection of dendritic cells engineered to secrete interleukin-12 by recombinant adenovirus in patients with metastatic gastrointestinal carcinomas. J Clin Oncol. 2005;23:999–1010.

    Article  CAS  PubMed  Google Scholar 

  31. Faivre SJ, Santoro A, Kelley RK, et al. A phase 2 study of a novel transforming growth factor-beta (TGF-β1) receptor I kinase inhibitor, LY2157299 monohydrate (LY), in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol. 2014;32:LBA173.

    Article  Google Scholar 

  32. Faivre SJ, Santoro A, Gane E, et al. A phase 2 study of galunisertib, a novel transforming growth factor-beta (TGF-β) receptor I kinase inhibitor, in patients with advanced hepatocellular carcinoma (HCC) and low serum alpha fetoprotein (AFP). J Clin Oncol. 2016;34:4070.

    Article  Google Scholar 

  33. Wing K, Onishi Y, Prieto-Martin P, et al. CTLA-4 control over Foxp3 + regulatory T cell function. Science. 2008;322:271–275.

    Article  CAS  PubMed  Google Scholar 

  34. Barber DL, Wherry EJ, Masopust D, et al. Restoring function in exhausted CD8 T cells during chronic viral infection. Nature. 2006;439:682–687.

    Article  CAS  PubMed  Google Scholar 

  35. Sangro B, Gomez-Martin C, de la Mata M, et al. A clinical trial of CTLA-4 blockade with tremelimumab in patients with hepatocellular carcinoma and chronic hepatitis C. J Hepatol. 2013;59:81–88.

    Article  CAS  PubMed  Google Scholar 

  36. Duffy AG, Ulahannan SV, Makorova-Rusher O, et al. Tremelimumab in combination with ablation in patients with advanced hepatocellular carcinoma. J Hepatol. 2017;66:545–551.

    Article  CAS  PubMed  Google Scholar 

  37. Zhu AX, Finn RS, Edeline J, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol. 2018;. https://doi.org/10.1016/s1470-2045(18)30351-6.

    Article  PubMed  Google Scholar 

  38. Wainberg ZA, Segal NH, Jaeger D, et al. Safety and clinical activity of durvalumab monotherapy in patients with hepatocellular carcinoma (HCC). J Clin Oncol. 2017;35:4071.

    Article  Google Scholar 

  39. Vogelstein B, Papadopoulos N, Velculescu VE, et al. Cancer genome landscapes. Science. 2013;339:1546–1558.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Snyder A, Makarov V, Merghoub T, et al. Genetic basis for clinical response to CTLA-4 blockade in melanoma. N Engl J Med. 2014;371:2189–2199.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Gopalakrishnan V, Spencer CN, Nezi L, et al. Gut microbiome modulates response to anti-PD-1 immunotherapy in melanoma patients. Science. 2017;359:97–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Routy B, Chatelier EL, Derosa L, et al. Gut microbiome influences efficacy of PD-1—based immunotherapy against epithelial tumors. Science. 2018;359:91–97.

    Article  CAS  PubMed  Google Scholar 

  43. Ma C, Han M, Heinrich B, et al. Gut microbiome-mediated bile acid metabolism regulates liver cancer via NKT cells. Science. 2018;360:eaan5931.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sahin U, Türeci Ö. Personalized vaccines for cancer immunotherapy. Science. 2018;359:1355–1360.

    Article  CAS  PubMed  Google Scholar 

  45. Butterfield LH, Ribas A, Meng WS, et al. T-cell responses to HLA-A*0201 immunodominant peptides derived from alpha-fetoprotein in patients with hepatocellular cancer. Clin Cancer Res. 2003;9:5902–5908.

    CAS  PubMed  Google Scholar 

  46. Butterfield LH, Economou JS, Gamblin T, et al. Alpha fetoprotein DNA prime and adenovirus boost immunization of two hepatocellular cancer patients. J Transl Med. 2014;12:86.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Nakagawa H, Mizukoshi E, Kobayashi E, et al. Association between high-avidity T-cell receptors, induced by α-fetoprotein-derived peptides, and anti-tumor effects in patients with hepatocellular carcinoma. Gastroenterology. 2017;152:e10.

    Article  CAS  Google Scholar 

  48. Feng M, Gao W, Wang R, et al. Therapeutically targeting glypican-3 via a conformation-specific single-domain antibody in hepatocellular carcinoma. Proc Natl Acad Sci. 2013;110:E1083–E1091.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Gao H, Li K, Tu H, et al. Development of T cells redirected to glypican-3 for the treatment of hepatocellular carcinoma. Clin Cancer Res. 2014;20:6418–6428.

    Article  CAS  PubMed  Google Scholar 

  50. Acloque H, Adams MS, Fishwick K, et al. Epithelial-mesenchymal transitions: the importance of changing cell state in development and disease. J Clin Investig. 2009;119:1438–1449.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Sun CK, Chua M-S, He J, et al. Suppression of glypican 3 inhibits growth of hepatocellular carcinoma cells through up-regulation of TGF-β2. Neoplasia. 2011;13:735–747.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Wu Y, Liu H, Weng H, et al. Glypican-3 promotes epithelial-mesenchymal transition of hepatocellular carcinoma cells through ERK signaling pathway. Int J Oncol. 2015;46:1275–1285.

    Article  CAS  PubMed  Google Scholar 

  53. Sawada Y, Yoshikawa T, Nobuoka D, et al. Phase I trial of a glypican-3-derived peptide vaccine for advanced hepatocellular carcinoma: immunologic evidence and potential for improving overall survival. Clin Cancer Res. 2012;18:3686–3696.

    Article  CAS  PubMed  Google Scholar 

  54. Sawada Y, Yoshikawa T, Shimomura M, et al. Programmed death-1 blockade enhances the antitumor effects of peptide vaccine-induced peptide-specific cytotoxic T lymphocytes. Int J Oncol. 2015;46:28–36.

    Article  CAS  PubMed  Google Scholar 

  55. Sawada Y, Yoshikawa T, Ofuji K, et al. Phase II study of the GPC3-derived peptide vaccine as an adjuvant therapy for hepatocellular carcinoma patients. OncoImmunology. 2016;5:e1129483.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Nakano K, Ishiguro T, Konishi H, et al. Generation of a humanized anti-glypican 3 antibody by CDR grafting and stability optimization. Anticancer Drugs. 2010;21:907.

    Article  CAS  PubMed  Google Scholar 

  57. Zhu AX, Gold PJ, El-Khoueiry AB, et al. First-in-man phase I study of GC33, a novel recombinant humanized antibody against Glypican-3, in patients with advanced hepatocellular carcinoma. Clin Cancer Res. 2013;19:920–928.

    Article  CAS  PubMed  Google Scholar 

  58. Greten TF, Forner A, Korangy F, et al. A phase II open label trial evaluating safety and efficacy of a telomerase peptide vaccination in patients with advanced hepatocellular carcinoma. BMC Cancer. 2010;10:209.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Park B-H, Hwang T, Liu T-C, et al. Use of a targeted oncolytic poxvirus, JX-594, in patients with refractory primary or metastatic liver cancer: a phase I trial. Lancet Oncol. 2008;9:533–542.

    Article  CAS  PubMed  Google Scholar 

  60. Heo J, Reid T, Ruo L, et al. Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer. Nat Med. 2013;19:329–336.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Postow MA, Chesney J, Pavlick AC, et al. Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. N Engl J Med. 2015;372:2006–2017.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Kelley RK, Abou-Alfa GK, Bendell JC, et al. Phase I/II study of durvalumab and tremelimumab in patients with unresectable hepatocellular carcinoma (HCC): phase I safety and efficacy analyses. J Clin Oncol. 2017;35:4073.

    Article  Google Scholar 

  63. Harding JJ, Dika IE, Abou-Alfa GK. Immunotherapy in hepatocellular carcinoma: primed to make a difference? Cancer. 2016;122:367–377.

    Article  PubMed  Google Scholar 

  64. Wallin JJ, Bendell JC, Funke R, et al. Atezolizumab in combination with bevacizumab enhances antigen-specific T-cell migration in metastatic renal cell carcinoma. Nat Commun. 2016;7:12624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Stein S, Pishvaian MJ, Lee MS, et al. Safety and clinical activity of 1L atezolizumab + bevacizumab in a phase Ib study in hepatocellular carcinoma (HCC). J Clin Oncol. 2018;36:4074.

    Article  Google Scholar 

  66. Greten TF, Sangro B. Targets for immunotherapy of liver cancer. J Hepatol. 2018;68:157–166.

    Article  CAS  Google Scholar 

  67. Rosenberg SA, Restifo NP. Adoptive cell transfer as personalized immunotherapy for human cancer. Science. 2015;348:62–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Rosenberg SA, Yang JC, Sherry RM, et al. Durable complete responses in heavily pretreated patients with metastatic melanoma using T-cell transfer immunotherapy. Clin Cancer Res. 2011;17:4550–4557.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Tran E, Turcotte S, Gros A, et al. Cancer immunotherapy based on mutation-specific CD4 + T cells in a patient with epithelial cancer. Science. 2014;344:641–645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Haruta I, Yamauchi K, Aruga A, et al. Analytical study of the clinical response to two distinct adoptive immunotherapies for advanced hepatocellular carcinoma: comparison between LAK cell and CTL therapy. J Immunother Emphas Tumor Immunol. 1996;19:218–223.

    Article  CAS  Google Scholar 

  71. Huang Z-M, Li W, Li S, et al. Cytokine-induced killer cells in combination with transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma patients. J Immunother. 2013;36:287–293.

    Article  PubMed  Google Scholar 

  72. Yu X, Zhao H, Liu L, et al. A randomized phase II study of autologous cytokine-induced killer cells in treatment of hepatocelluar carcinoma. J Clin Immunol. 2014;34:194–203.

    Article  CAS  PubMed  Google Scholar 

  73. Lee JH, Lee J-H, Lim Y-S, et al. Adjuvant immunotherapy with autologous cytokine-induced killer cells for hepatocellular carcinoma. Gastroenterology. 2015;148:e6.

    Article  Google Scholar 

  74. Kershaw MH, Westwood JA, Darcy PK. Gene-engineered T cells for cancer therapy. Nat Rev Cancer. 2013;13:525–541.

    Article  CAS  PubMed  Google Scholar 

  75. Clay TM, Custer MC, Sachs J, et al. Efficient transfer of a tumor antigen-reactive TCR to human peripheral blood lymphocytes confers anti-tumor reactivity. J Immunol. 1999;163:507–513.

    CAS  PubMed  Google Scholar 

  76. Morgan RA, Dudley ME, Yu YYL, et al. High efficiency TCR gene transfer into primary human lymphocytes affords avid recognition of melanoma tumor antigen glycoprotein 100 and does not alter the recognition of autologous melanoma antigens. J Immunol. 2003;171:3287–3295.

    Article  CAS  PubMed  Google Scholar 

  77. Gehring AJ, Xue S-A, Ho ZZ, et al. Engineering virus-specific T cells that target HBV infected hepatocytes and hepatocellular carcinoma cell lines. J Hepatol. 2011;55:103–110.

    Article  CAS  PubMed  Google Scholar 

  78. Hinrichs CS, Rosenberg SA. Exploiting the curative potential of adoptive T-cell therapy for cancer. Immunol Rev. 2014;257:56–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Zhai B, Shi D, Gao H, et al. A phase I study of anti-GPC3 chimeric antigen receptor modified T cells (GPC3 CAR-T) in Chinese patients with refractory or relapsed GPC3 + hepatocellular carcinoma (r/r GPC3 + HCC). J Clin Oncol. 2017;35:3049.

    Article  Google Scholar 

  80. Liu B, Song Y, Liu D. Clinical trials of CAR-T cells in China. J Hematol Oncol. 2017;10:166.

    Article  PubMed  PubMed Central  Google Scholar 

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Floudas, C.S., Brar, G. & Greten, T.F. Immunotherapy: Current Status and Future Perspectives. Dig Dis Sci 64, 1030–1040 (2019). https://doi.org/10.1007/s10620-019-05516-7

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