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  • Open Access

Impact of chemotherapy alone, and chemotherapy plus ipilimumab, on circulating immune cells in patients with metastatic bladder cancer

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Journal for ImmunoTherapy of Cancer20153 (Suppl 2) :P257

  • Published:


  • Gemcitabine
  • Peripheral Blood Mononuclear Cell
  • Hierarchical Cluster Analysis
  • Ipilimumab
  • Multiplex Assay


Metastatic bladder cancer (MBC) is a relatively chemosensitive neoplasm yet response durations are generally short-lived. Recently, immune checkpoint blockade has demonstrated unparalleled activity in heavily pre-treated patients (pts) with MBC. The role of standard chemotherapy on the immune system of patients with MBC, and optimal approaches to combining chemotherapy and immune checkpoint blockade, has not been comprehensively explored.


Pts with MBC were enrolled on a Phase II trial of chemotherapy + CTLA4 blockade. Patients received 2 cycles of gemcitabine + cisplatin (GC) followed by 4 cycles of GC + ipilimumab (GCI). Flow cytometry was performed on peripheral blood mononuclear cells at baseline, after GC, and after GCI to determine the impact of treatment on the frequency and phenotype of CD4+ and CD8+ T cells, regulatory T cells (CD4+CD25+CD127-CD45RA-Tregs), and myeloid-derived suppressor cells. Comparisons between time-points were made using Wilcoxon's rank test. Plasma collected from patients was assayed for the expression of 41 cytokines and chemokines by multiplex assay at these same timepoints.


The trial has completed enrollment (n=36) and flow cytometry data are available for the complete treatment sequence on 27 pts as of 5/2015 (Table). Hierarchical cluster analysis of the cytokine/chemokine panel and cellular immunophenotype demonstrated clustering of post-GC alone specimens and post-GC + ipilimumab specimens. The % of CD4+ and CD8+ T cells was significantly increased after addition of ipilimumab. The level of cytokines involved in proinflammatory and T cell activation such as IL-12, IL-7, IL-15, IFNγ, IFNα and IL-1-α and –ß was higher in the post-GC + ipilimumab than those in post-GC.

Table 1

Immune Cell Subset


Post GC

Post GC + Ipi

Wilcoxon signed-rank text (p value)


Post-GC versus Baseline

Post-GC + Ipi versus Post GC

Post-GC + Ipi verus Baseline


8.3 (5.5-13.10)

9.7 (5.1-16.4)

15.8 (9.4-27.0)





4.4 (2.6-6.7)

4.8 (3.1-7.6)

7.3 (4.2-13.5)




% Tregs

6.5 (4.1-7.4)

6.2 (5.2-8.8)

6.2 (4.4-8.0)




% Granulcytic MDSC

0.05 (0.01-.1)

0.04 (0.01-0.1)

0.04 (0.01-0.08)




% Monocytic MDSC

0.01 (0.007-0.03)

0.01 (0.004-0.02)

0.02 (0.007-0.03)





Gemcitabine plus cisplatin alone did not demonstrate significant favorable or unfavorable effects on the circulating immunocytes profiled. The addition of ipilimumab induced pharmacodynamic changes including an increase in circulating CD4+ and CD8+ T cells and modulation of the peripheral blood cytokine/chemokine milieu generally suggestive of an immunostimulatory effect. The immunomodulatory effects of treatment, interpreted in the context of the clinical outcome data, may help refine an understanding of the mechanistic basis of anticancer effects and inform subsequent rational combinations of chemotherapy plus immune checkpoint blockade.

Authors’ Affiliations

Icahn School of Medicine at Mount Sinai, New York, NY, USA
Mt. Sinai, New York, NY, USA
IU Health Goshen Center for Cancer Care, Goshen, IN, USA
Nebraska Cancer Center, Omaha, NE, USA
City of Hope, Duarte, CA, USA
Mount Sinai School of Medicine, New York, NY, USA
University of Alabama at Birmingham, Birmingham, AL, USA
Indiana University, Indianapolis, IN, USA
Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA


© Galsky et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.