Summary
Background
Squamous cell carcinoma of the anal canal (SCCA) is a rare malignancy associated with infection by human papillomavirus (HPV). No consensus treatment approach exists for the treatment of metastatic disease. Because intratumoral HPV oncoproteins upregulate immune checkpoint proteins such as PD-1 to evade immune-mediated cytotoxicity, we did a trial of the anti-PD-1 antibody nivolumab for patients with metastatic SCCA.
Methods
We did this single-arm, multicentre, phase 2 trial at ten academic centres in the USA. We enrolled patients with treatment-refractory metastatic SCCA, who were given nivolumab every 2 weeks (3 mg/kg). The primary endpoint was response according to Response Evaluation Criteria in Solid Tumors, version 1.1, in the intention-to-treat population. At the time of data cutoff, the study was ongoing, with patients continuing to receive treatment. The study is registered with ClinicalTrials.gov, number NCT02314169.
Findings
We screened 39 patients, of whom 37 were enrolled and received at least one dose of nivolumab. Among the 37 patients, nine (24% [95% CI 15–33]) had responses. There were two complete responses and seven partial responses. Grade 3 adverse events were anaemia (n=2), fatigue (n=1), rash (n=1), and hypothyroidism (n=1). No serious adverse events were reported.
Interpretation
To our knowledge, this is the first completed phase 2 trial of immunotherapy for SCCA. Nivolumab is well tolerated and effective as a monotherapy for patients with metastatic SCCA. Immune checkpoint blockade appears to be a promising approach for patients with this orphan disease.
Funding
National Cancer Institute/Cancer Therapy Evaluation Program, the HPV and Anal Cancer Foundation, the E B Anal Cancer Fund, The University of Texas MD Anderson Moon Shots Program, and an anonymous philanthropic donor.
The solubilities and diffusion coefficients of hydrogen sulfide and carbon dioxide gases in the ionic liquid (IL) 1-(2-hydroxyethyl)-3-methylimidazolium tetrafluoroborate ([hemim][BF 4 ]), at temperatures ranging from (303.15 to 353.15) K and pressures up to 1.1 MPa, were determined. The solubility data were correlated using the Krichevsky-Kasarnovsky equation, and Henry's law constants at different temperatures were obtained. From the solubility data, the partial molar thermodynamic functions of solution such as Gibbs energy, enthalpy, and entropy were calculated. The diffusion coefficients were obtained for H 2 S and CO 2 using a semi-infinite volume approach, and a correlation equation with temperature is presented for each gas. A comparison showed that the solubility of H 2 S was about three times its magnitude, and its diffusion coefficient is of the same order of magnitude as that of CO 2 in the IL studied in this work.
Gaseous solubilities of carbon dioxide (1), hydrogen sulfide (2), and their binary mixture (x(2) ≈ 0.2, 0.5, 0.8) have been measured in the ionic liquid 1-octyl-3-methylimidazolium bis(trifluoromethyl)sulfonylimide ([C(8)mim][Tf(2)N]) at temperatures ranging from (303.15 to 353.15) K and at pressures under 2 MPa. The observed PTx solubility data were used to obtain Henry's law constants and correlated by three models: (1) the simple Krichevsky-Kasarnovsky (KK) equation, (2) a model comprised of the extended Henry's law and the Pitzer's virial expansion for the excess Gibbs free energy, and (3) the generic Redlich-Kwong (RK) cubic equation of state proposed for gas-ionic liquid systems. The correlations from the three models show quite good consistency with the experimental data for IL/CO(2) and IL/H(2)S binary mixtures within experimental uncertainties. For IL/CO(2)/H(2)S ternary mixtures, the RK model shows the best correlation with the experimental data. The comparison showed that the solubility of H(2)S is about two times as great as that of CO(2) in the ionic liquid studied in this work. It was further found, by comparison of the experimental data of this study with those of previous reports, that the solubility of H(2)S in [C(n)mim][Tf(2)N] ILs increases as the number of carbon atoms in the alkyl substituent of methylimidazolium cation, n, increases. In addition, quantum chemical calculations at DFT/B3LYP level of theory using 6-311+G(d) and 6-311++G(2d,2p) basis sets were performed on the isolated systems studied in this work to provide explanations from a molecular point of view for the observed experimental trends.
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