[Outcome of postoperative adjuvant chemotherapy and surgery alone for patients with stage pT1b-3N0M0 squamous cell carcinoma of the thoracic esophagus]

Objective: To compare the outcome of postoperative adjuvant chemotherapy and surgery alone for stage pT1b-3N0M0 squamous cell carcinoma (SCC) of the thoracic esophagus. Methods: Two hundred and thirty-eight patients who underwent esophagectomy for stage pT1b-3N0M0 SCC of the thoracic esophagus in Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University between January 2008 and February 2011 were analyzed retrospectively. These included postoperative adjuvant chemotherapy for 118 patients and surgery alone for 120 patients. In postoperative adjuvant chemotherapy arm, 3 or 4 cycles of taxol+ cisplatin (TP, n=33) or fluorouracil+ cisplatin (FP, n=85) regimens were given commencing from 4 to 6 weeks after surgery. Survival analysis was performed using Kaplan-Meier method. Univariate analysis for prognostic factors was performed by Log-rank test and multivariate by Cox regression model. Results: The 3- and 5-year disease-free survival (DFS) rates were 57.9% and 53.8%, respectively for postoperative adjuvant chemotherapy patients, compared to 40.4% and 32.5% for patients who underwent surgery alone (χ²=11.973, P=0.001). The 3- and 5-year overall survival (OS) rates were 64.4% and 55.9% in postoperative adjuvant chemotherapy patients, and 46.7% and 33.5% in surgery alone patients (χ²=13.110, P=0.000). Stratification analysis showed that there was significant difference in stage T3 patients (χ²=7.895, P=0.006), but not in stage T1b (χ²=0.762, P=0.383) and T2 (χ²=1.259, P=0.262) patients between adjuvant chemotherapy and surgery alone. Both DFS rate (χ²=1.748, P=0.186) and OS rate (χ²=2.200, P=0.138) of TP group were similar with FP group. Conclusion: In lymph node negative esophageal SCC patients, postoperative adjuvant chemotherapy shows survival benefits in stage T3 patients.

Epigenetic Reprogramming Strategies to Reverse Global Loss of 5-Hydroxymethylcytosine, a Prognostic Factor for Poor Survival in High-grade Serous Ovarian Cancer

Purpose: A major challenge in platinum-based cancer therapy is the clinical management of chemoresistant tumors, which have a largely unknown pathogenesis at the level of epigenetic regulation.Experimental Design: We evaluated the potential of using global loss of 5-hydroxymethylcytosine (5-hmC) levels as a novel diagnostic and prognostic epigenetic marker to better assess platinum-based chemotherapy response and clinical outcome in high-grade serous tumors (HGSOC), the most common and deadliest subtype of ovarian cancer. Furthermore, we identified a targetable pathway to reverse these epigenetic changes, both genetically and pharmacologically.Results: This study shows that decreased 5-hmC levels are an epigenetic hallmark for malignancy and tumor progression in HGSOC. In addition, global 5-hmC loss is associated with a decreased response to platinum-based chemotherapy, shorter time to relapse, and poor overall survival in patients newly diagnosed with HGSOC. Interestingly, the rescue of 5-hmC loss restores sensitivity to platinum chemotherapy in vitro and in vivo, decreases the percentage of tumor cells with cancer stem cell markers, and increases overall survival in an aggressive animal model of platinum-resistant disease.Conclusions: Consequently, a global analysis of patient 5-hmC levels should be included in future clinical trials, which use pretreatment with epigenetic adjuvants to elevate 5-hmC levels and improve the efficacy of current chemotherapies. Identifying prognostic epigenetic markers and altering chemotherapeutic regimens to incorporate DNMTi pretreatment in tumors with low 5-hmC levels could have important clinical implications for newly diagnosed HGSOC disease. Clin Cancer Res; 24(6); 1389-401. ©2017 AACR.

[Revision of Schatzker type Ⅵ tibial plateau fracture failure focus on the recovery of lower limb alignment]

Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ(2) test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing. Results: Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ(2)=22.000, P=0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale(P>0.01). Conclusions: Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone cutting and joint surface height can bring benefits to the postoperative knee function.Revision surgery patients have greater psychological pressure, more early psychological intervention is necessary.

Safety and efficacy of sofosbuvir-based treatment of acute hepatitis C in end-stage renal disease patients undergoing haemodialysis

BACKGROUND

Hepatitis C virus (HCV) infection in patients undergoing haemodialysis is prevalent and aggressive. The treatment of chronic hepatitis C has been revolutionised by the advent of direct-acting antivirals (DAAs). However, the safety, efficacy, and tolerance of DAAs in the treatment of acute HCV infection in patients with end-stage renal disease who are on haemodialysis are unknown.

AIM

To evaluate the safety and efficacy of sofosbuvir plus daclatasvir in this specific, difficult-to-treat population.

METHODS

We conducted a prospective and observational study of end-stage renal disease patients who were undergoing haemodialysis and were acutely infected with HCV. Patients received a half dose of sofosbuvir (200 mg) and a full dose of daclatasvir (60 mg) daily. The primary endpoint was the proportion of patients with sustained virological responses (SVRs); the other primary outcomes were safety and tolerability.

RESULTS

Thirty-three patients were enrolled in the study. The median HCV RNA viral load at baseline was 6.8 log₁₀ IU/mL. Twenty-four patients were infected with HCV genotype 2a, seven patients with 1b, and two patients with 2a+1b. All patients achieved a SVR at 12 weeks after the end of treatment. The treatment was well tolerated, and there were no drug-related serious adverse events.

CONCLUSION

A half dose of sofosbuvir (200 mg once daily) plus a full dose of daclatasvir (60 mg once daily) were suitable for the treatment of acute HCV-infected patients who were undergoing end-stage renal disease and were on haemodialysis.

Phase I study of safety and pharmacokinetics of the anti-MUC16 antibody-drug conjugate DMUC5754A in patients with platinum-resistant ovarian cancer or unresectable pancreatic cancer

BACKGROUND

MUC16 is a tumor-specific antigen overexpressed in ovarian (OC) and pancreatic (PC) cancers. The antibody-drug conjugate (ADC), DMUC5754A, contains the humanized anti-MUC16 monoclonal antibody conjugated to the microtubule-disrupting agent, monomethyl auristatin E (MMAE).

PATIENTS AND METHODS

This phase I study evaluated safety, pharmacokinetics (PK), and pharmacodynamics of DMUC5754A given every 3 weeks (Q3W, 0.3-3.2 mg/kg) or weekly (Q1W, 0.8-1.6 mg/kg) to patients with advanced recurrent platinum-resistant OC or unresectable PC. Biomarker studies were also undertaken.

RESULTS

Patients (66 OC, 11 PC) were treated with DMUC5754A (54 Q3W, 23 Q1W). Common related adverse events (AEs) in >20% of patients (all grades) over all dose levels were fatigue, peripheral neuropathy, nausea, decreased appetite, vomiting, diarrhea, alopecia, and pyrexia in Q3W patents, and nausea, vomiting, anemia, fatigue, neutropenia, alopecia, decreased appetite, diarrhea, and hypomagnesemia in Q1W patients. Grade ≥3-related AE in ≥5% of patients included neutropenia (9%) and fatigue (7%) in Q3W patients, and neutropenia (17%), diarrhea (9%), and hyponatremia (9%) in Q1W patients. Plasma antibody-conjugated MMAE (acMMAE) and serum total antibody exhibited non-linear PK across tested doses. Minimal accumulation of acMMAE, total antibody, or unconjugated MMAE was observed. Confirmed responses (1 CR, 6 PRs) occurred in OC patients whose tumors were MUC16-positive by IHC (2+ or 3+). Two OC patients had unconfirmed PRs; six OC patients had stable disease lasting >6 months. For CA125, a cut-off of ≥70% reduction was more suitable for monitoring treatment response due to the binding and clearance of serum CA125 by MUC16 ADC. We identified circulating HE4 as a potential novel surrogate biomarker for monitoring treatment response of MUC16 ADC and other anti-MUC16 therapies in OC.

CONCLUSIONS

DMUC5754A has an acceptable safety profile and evidence of anti-tumor activity in patients with MUC16-expressing tumors. Objective responses were only observed in MUC16-high patients, although prospective validation is required.

CLINICAL TRIAL NUMBER

NCT01335958.

[Study on the spatial expression of trophectoderm cells in human embryonic prenatal blastocysts]

OBJECTIVE

To study the spatial expression of trophectoderm cells in human embryonic preantral blastocysts.

METHODS

The study used Gardner score 5AA blastocysts harvested on day 6 after fertilization from assisted reproductive technology. Microcapsules were used to separate trophectoderm cells from the epidermal cells. Single-cell sequencing was performed. P<0.05 was calculated by unpaired t test, and the difference was 2 times. Here we determined, for the first time, global gene expression patterns in the polar/mural trophectoderm isolated from human blastocysts. Unsupervised hierarchical clustering analysis and gene ontology (GO) functional classification were performed using bioinformatics software. Differentially expressed genes were annotated by the Database for Annotation, Visualization and Integrated Discovery. Functions of differentially expressed genes were further annotated using encyclopedia of genes and genomes.

RESULTS

The results showed that there were up to 306 genes in the trophoblast cells and up to 75 genes in the trophoblast cells. Unsupervised cluster analysis of polar trophoblast cells and mural trophoblast cells were divided into two groups, belonging to different types and biological functions. Differences in gene function indicated that the biological functions of GO gene uptake genes were mainly transcription, energy metabolism, protein synthesis, transport, oxidative stress, ion transport, protein synthesis and transport, cell cycle regulation, actin growth, etc. They were mainly involved in ubiquitin-mediated protein hydrolysis, oxidative phosphorylation, Wnt signaling pathway, estrogen androgen metabolism and other signal pathways; wall trophoblast cells up-regulated gene GO biological function, which was mainly proteolytic metabolism, cell cycle arrest, apoptosis, activation of MAPK, carbohydrate transport, synaptic regulation, cell growth, calcium channel activation, positive B cell differentiation, T cell apoptosis and other biological functions, which were mainly involved in B cell receptor, T cell receptor, white blood cells cross-endothelial transplantation, VEGF expression, gap connection, GnRH secretion, apoptosis and other signaling pathways.

CONCLUSION

The gene expression of blastocysts trophectoderm is revealed from the spatial dimension, indicating that differentiation of polar and mural trophectoderm of blastocysts is accompanied by differences between the two cell lineages, and the polar and mural trophectoderms are coordinated with each other and the blastocyst hatching and embryo implantation processes are finely adjusted. Further data analysis is expected to find the endogenous molecular specificity of the regulation of embryo implantation.

[Brief introduction to the development of ancient history of paediatric diagnosis of traditional Chinese medicine]

As an important part of paediatric science, paediatric diagnosis was in the initial stage of its development before the Song Dynasty. The main measures of diagnosing diseases were observation and pulse palpation, especially the latter. The rapid development of paediatrics in the Song Dynasty necessitated thepaediatric diagnosis to develop further, emphasizing the spiritual expressions of the eyes and fingerprint, with its special features gradually developed in the period of the Jin and Yuan Dynasties.During this period, the paediatrics diagnosis was developed on the basis of the previous generations, with equal importance paid to both observation and pulse feeling. In the period of the Ming and Qing Dynasties the four paediatric diagnostics were constantly enriched with attentions paid to the use of multiple approaches and thus the diagnostics was perfected day by day.

[Tumor derived IgG suppress the proliferation of T cells in cord blood]

OBJECTIVE

To explore the function of tumor derived IgG (tIgG) and whether the tIgG can inhibit T cells activity.

METHODS

The tIgG was purified from ovarian cancer tissue. The cord blood monocyte cells (CBMC) and cord blood lymphocyte (CBL) were isolate from human umbilical cord blood. The CBMC and CBL were stimulated with phytohaemagg lutinin (PHA) in order to let the CBMC and CBL in the state of proliferation. Carboxyfluorescein succinimidyl amino ester (CFSE) was cultured with CBMC and CBL. CFSE had no cell toxicity, which could penetrate through the cell membrane and combine the intracellular protein. The fluorescence intensity decreased with the proliferation of cells step by step, so the proliferation of these cells could be detected in flow ctytometry. The tIgG which was purified from ovarian cancer tissue was divided into three groups, 1 mg/L group, 10 mg/L group, and 100 mg/L group, and the intravenous immunoglobulin (IVIG) was also divided into three groups too. The CBMC and CBL were treated by tIgG with 1 mg/L, 10 mg/L, and 100 mg/L in order to observe the proliferation of T cells. The cells were treated with IVIG as a positive control group, and the cells were treated with phosphate buffer saline (PBS) as a negative control. The proliferation of CD4⁺ or CD8⁺ T cells were detected in CBMC and CBL. The proliferation of the T cells in CBMC and CBL after 64 h and 86 h were detected.

RESULTS

In the system of CBMC, the tIgG could suppress the proliferation of CD4⁺ or CD8⁺ T cells. The results could also be found in the system of CBL. The CD4⁺ or CD8⁺ T cells in the group which were treated with PBS were more active than those in the group which were treated with tIgG and IVIG. The suppression in the group which were treated with tIgG, was stronger than that in the group treated with IVIG. In addition, the suppression of T cells in the group which were stimulated with tIgG as 100 mg/L was more effective than that in the group which were stimulated with tIgG as 10 mg/L. This could prove that tIgG had the function of immunomodulation.

CONCLUSION

The tIgG can be involved in immune escape of cancer.

[Advances in liver transplantation for patients with liver failure]

Liver transplantation is the most effective salvage treatment for advanced liver failure, but its clinical application is limited by a shortage of liver donor, strict technology admittance, and complex and diverse issues in liver damage control before transplantation. We need to better understand the indications for liver transplantation in liver failure patients, select surgical timing correctly, and develop proper surgical regimens, in order to improve the rescue and cure rate of such patients. In addition, great achievements have been made in living-donor liver transplantation, auxiliary liver transplantation, and ABO-incompatible liver transplantation, which should be taken seriously in clinical practice.

[Retrospective analysis of 117 cases of pulmonary cryptococcosis]

The clinical symptoms of PC were diverse and nonspecific. Halo sign and proximal air bronchogram are helpful for the diagnosis of PC. The outcome of most patients was satisfactory after appropriate treatment.

Systems analysis of apoptotic priming in ovarian cancer identifies vulnerabilities and predictors of drug response

The lack of effective chemotherapies for high-grade serous ovarian cancers (HGS-OvCa) has motivated a search for alternative treatment strategies. Here, we present an unbiased systems-approach to interrogate a panel of 14 well-annotated HGS-OvCa patient-derived xenografts for sensitivity to PI3K and PI3K/mTOR inhibitors and uncover cell death vulnerabilities. Proteomic analysis reveals that PI3K/mTOR inhibition in HGS-OvCa patient-derived xenografts induces both pro-apoptotic and anti-apoptotic signaling responses that limit cell killing, but also primes cells for inhibitors of anti-apoptotic proteins. In-depth quantitative analysis of BCL-2 family proteins and other apoptotic regulators, together with computational modeling and selective anti-apoptotic protein inhibitors, uncovers new mechanistic details about apoptotic regulators that are predictive of drug sensitivity (BIM, caspase-3, BCL-X_L) and resistance (MCL-1, XIAP). Our systems-approach presents a strategy for systematic analysis of the mechanisms that limit effective tumor cell killing and the identification of apoptotic vulnerabilities to overcome drug resistance in ovarian and other cancers.High-grade serous ovarian cancers (HGS-OvCa) frequently develop chemotherapy resistance. Here, the authors through a systematic analysis of proteomic and drug response data of 14 HGS-OvCa PDXs demonstrate that targeting apoptosis regulators can improve response of these tumors to inhibitors of the PI3K/mTOR pathway.

Systems analysis of apoptotic priming in ovarian cancer identifies vulnerabilities and predictors of drug response

The lack of effective chemotherapies for high-grade serous ovarian cancers (HGS-OvCa) has motivated a search for alternative treatment strategies. Here, we present an unbiased systems-approach to interrogate a panel of 14 well-annotated HGS-OvCa patient-derived xenografts for sensitivity to PI3K and PI3K/mTOR inhibitors and uncover cell death vulnerabilities. Proteomic analysis reveals that PI3K/mTOR inhibition in HGS-OvCa patient-derived xenografts induces both pro-apoptotic and anti-apoptotic signaling responses that limit cell killing, but also primes cells for inhibitors of anti-apoptotic proteins. In-depth quantitative analysis of BCL-2 family proteins and other apoptotic regulators, together with computational modeling and selective anti-apoptotic protein inhibitors, uncovers new mechanistic details about apoptotic regulators that are predictive of drug sensitivity (BIM, caspase-3, BCL-X_L) and resistance (MCL-1, XIAP). Our systems-approach presents a strategy for systematic analysis of the mechanisms that limit effective tumor cell killing and the identification of apoptotic vulnerabilities to overcome drug resistance in ovarian and other cancers.High-grade serous ovarian cancers (HGS-OvCa) frequently develop chemotherapy resistance. Here, the authors through a systematic analysis of proteomic and drug response data of 14 HGS-OvCa PDXs demonstrate that targeting apoptosis regulators can improve response of these tumors to inhibitors of the PI3K/mTOR pathway.

[Evaluation of the modified test system for children sound localization]

Objective: To evaluate the feasibility of modified test system for sound localization (SL) in children. Methods: Modified system (6 male, 9 female) and traditional method ( 5 male, 5 female) were used for evaluation of minimum audible angle(MAA) and root-mean-square error(RMS) error of 4 to 6 years old children, and the results were compared to verify the accuracy and effectiveness of the modified test system for children sound localization.SPSS 17.0 software was used to analyze the data(t test). Results: (1) Comparison of veracity of modified system and traditional test: when tested at the positive front position using modified system, MAA and RMS error were(3.23±1.00)° and (13.68±5.18)° respectively.When using traditional method, MAA and RMS error were(3.17±0.59)°and (13.96±4.56)° respectively. No statistical differences were found between two groups(t value was 0.16, -0.14, both P>0.05). (2) Comparison of time used were as followed: when using modified system, it was (14.67±1.95) min for MAA, and (6.67±1.35) min for RMS error. When using traditional method, it was (36.30±6.81) min for MAA, and (21.00±3.50) min for RMS error. Time used were significant shorter in modified system than in traditional method (t value was-9.78, -12.37, both P<0.05). Conclusion: Modified test system for children sound localization is useful and reliable in children's horizontal SL test.The time used of modified test system is shorter than that of traditional test system.

PRKCI promotes immune suppression in ovarian cancer

Here, Sarkar et al. report that PRKCI expression, which is a key feature of high-grade serous ovarian carcinoma (HGSOC), is also up-regulated in serous tubal intraepithelial carcinoma (STIC) and early fallopian tube (FT) lesions. Using a transgenic mouse model of ovarian cancer overexpressing PRKCI, they show that PRKCI is a deregulated ovarian cancer-specific oncogene and plays a role in early stages of cancer development.

A key feature of high-grade serous ovarian carcinoma (HGSOC) is frequent amplification of the 3q26 locus harboring PRKC-ι (PRKCI). Here, we show that PRKCI is also expressed in early fallopian tube lesions, called serous tubal intraepithelial carcinoma. Transgenic mouse studies establish PRKCI as an ovarian cancer-specific oncogene. Mechanistically, we show that the oncogenic activity of PRKCI relates in part to the up-regulation of TNFα to promote an immune-suppressive tumor microenvironment characterized by an abundance of myeloid-derived suppressor cells and inhibition of cytotoxic T-cell infiltration. Furthermore, system-level and functional analyses identify YAP1 as a downstream effector in tumor progression. In human ovarian cancers, high PRKCI expression also correlates with high expression of TNFα and YAP1 and low infiltration of cytotoxic T cells. The PRKCI–YAP1 regulation of the tumor immunity provides a therapeutic strategy for highly lethal ovarian cancer.

Abstract 4033: Combined MEK and BCL-2/XL inhibition as a potential drug combination for the treatment of high-grade serous ovarian cancer

High-grade serous ovarian cancer (HGSOC) accounts for 70-80% of ovarian cancer deaths. Despite an initial response to platinum-based chemotherapy, treatment resistance eventually occurs in most patients. The overall aim of our studies is to identify synergistic drug combinations for the treatment of HGSOC and biomarkers that predict sensitivity for future translation in clinical trials. In particular, this study focuses on the vulnerabilities of patient-derived ovarian cancer cells to combined inhibition of the MEK pathway and the anti-apoptotic proteins BCL-2 and BCL-XL.

The Ras/MAPK pathway is activated in a subset of HGSOC by gene copy alterations. However, MEK inhibitors have not been evaluated in HGSOC. In this study, we used a collection of 14 primary samples derived from ascites cells of platinum-resistant HGSOC patients (Liu JF et al. 2016). We investigated the sensitivity of these tumor cells to the MEK inhibitor cobimetinib (GDC-0973). Treatment with GDC-0973 had no effects on cell viability in vitro in any of the patient-derived models. To investigate the response to MEK inhibition, we performed Reverse Phase Protein Array of the tumor cells treated with 0.3μM of GDC-0973 in vitro. We found that MEK inhibition by GDC-0973 reduced cell cycle progression markers and upregulated the pro-apoptotic protein BIM. Since more than half of the models express high levels of anti-apoptotic BCL-2 family proteins which neutralize BIM, we examined the effects of antagonism of BCL-2 pro-survival proteins in combination with GDC-0973. Treatment with a combination of GDC-0973 and the BCL-2/XL antagonist, navitoclax (ABT-263) significantly reduced cell number and increased cell death in 10 out of 14 patient-derived models. Protein levels of BIM following treatment with GDC-0973 correlated with sensitivity to the drug combination (R2=0.8 p&lt;0.0001). Interestingly, the BIM levels after MEK inhibition correlate with BIM protein levels before the treatment, suggesting that baseline BIM levels could be used as biomarker of sensitivity. Levels of the pro-survival protein MCL-1 also played a critical role in patient-derived cells that were resistant to the drug combination. Indeed, treatment with a specific MCL-1 inhibitor, A-1210477, in combination with GDC-0973 and ABT-263 led to dramatic tumor cell killing in vitro compared to dual combination of GDC-0973 and ABT-263.

Finally, we tested the combination of GDC-0973 and ABT-263 in vivo and preliminary results indicate that the drug combination is well tolerated and is able to significantly reduce tumor growth in patient-derived xenograft models (n=4).

Our studies provide significant evidence that combined inhibition of MEK and BCL-2/XL may be an effective drug combination for treatment of HGSOC and that the pro-apoptotic protein BIM may serve as a predictive biomarker to stratify patients that can benefit from these targeted therapies

Citation Format: Claudia Iavarone, Ioannis Zervantonakis, Laura M. Selfors, Sangeetha Palakurthi, Joyce F. Liu, Ursula A. Matulonis, Ronny I. Drapkin, Gordon B. Mills, Joel D. Leverson, Deepak Sampath, Joan S. Brugge. Combined MEK and BCL-2/XL inhibition as a potential drug combination for the treatment of high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4033. doi:10.1158/1538-7445.AM2017-4033

Abstract CT008: Phase I study of the alpha specific PI3-Kinase inhibitor BYL719 and the poly (ADP-Ribose) polymerase (PARP) inhibitor olaparib in recurrent ovarian and breast cancer: Analysis of the dose escalation and ovarian cancer expansion cohort

Background: In vivo synergy with concurrent PI3-Kinase inhibition and PARP inhibition has been observed in BRCA-deficient and BRCA-proficient preclinical models of triple negative breast cancer (TNBC) and ovarian cancer (OC). A phase I trial of the oral pan-class I PI3-Kinase inhibitor BKM120 and the PARP inhibitor olaparib demonstrated anti-cancer activity in TNBC and OC, both in patients with and without germline BRCA1 and BRCA2 (BRCA) mutations. However, CNS toxicity (depression) and liver function test abnormalities limited dose escalation of BKM120 prompting evaluation of the alpha specific PI3-Kinase inhibitor BYL719 (which has no CNS toxicity) in combination with olaparib.

Methods: Olaparib was administered twice daily (tablet formulation) and BYL719 daily on a 28-day cycle, both orally. A 3 + 3 dose-escalation design was employed with primary objectives of defining the maximum tolerated dose (MTD) and recommended phase 2 dose of the combination of BYL719 and olaparib, and secondary objectives of defining toxicity, activity, and pharmacokinetic profiles of both agents. Eligibility included recurrent TNBC or high grade serous (HGS) OC, or any histology OC or breast cancer (BC) with presence of a known germline BRCA mutation, performance status of 0-1 and measurable/evaluable cancer. Patients with platinum sensitive or resistant or refractory OC were eligible and prior PARP inhibitor use was allowed. Dose-expansion cohorts at the MTD were enrolled for both BC and OC.

Results: 46 patients (16 BC and 30 OC) have been enrolled in the study; 28 patients participated in the dose escalation portion of the study (4 BC and 24 OC). Two patients with OC did not receive study drugs because of ineligibility. MTD was defined as BYL719 200mg once daily and olaparib 200mg twice daily. Dose limiting toxicities included hyperglycemia, rash and fever with decreased neutrophil count. Four patients (3 OC and 1 BC) discontinued protocol therapy because of toxicity (2 for hyperglycemia, 1 for nausea and 1 for allergic reaction). Most common toxicities included nausea, hyperglycemia, fatigue, diarrhea and vomiting. At the MTD, 6 patients with OC and 12 patients with BC were enrolled into a dose expansion cohort. The OC expansion cohort has completed enrollment, while the BC cohort is still enrolling. Among patients with OC who received study drugs (28 patients, 26 (93%) with platinum resistant disease), objective response rate (ORR) by RECIST 1.1 was 36% (10/28 patients, all partial responses (PRs)). Median duration of response was 167 days (range 16-398 days); 5 of 10 patients with PR remain on treatment. ORR was 33% for patients with germline BRCA mutations and 31% for patients without germline BRCA mutations. Among patients without germline BRCA mutations with platinum resistant OC, ORR was 29%.

Conclusions: Combined BYL719 and olaparib is feasible, and similar clinical benefit was observed in patients with and without germline BRCA mutations. The activity of this combination in OC patients without germline BRCA mutations and with platinum resistant disease was higher than expected from olaparib monotherapy and warrants further investigation. This work was funded in part by the Stand Up To Cancer Ovarian Dream Team. Clinical trial: NCT01623349.

Citation Format: Panagiotis A. Konstantinopoulos, William T. Barry, Michael Birrer, Shannon N. Westin, Sarah Farooq, Karen Cadoo, Christin Whalen, Weixiu Luo, Hui Liu, Carol Aghajanian, David B. Solit, Gordon B. Mills, Barry S. Taylor, Helen Won, Michael F. Berger, Sangeetha Palakurthi, Joyce F. Liu, Lew Cantley, Scott H. Kaufmann, Elizabeth M. Swisher, Alan D. D'Andrea, Eric Winer, Gerburg M. Wulf, Ursula A. Matulonis. Phase I study of the alpha specific PI3-Kinase inhibitor BYL719 and the poly (ADP-Ribose) polymerase (PARP) inhibitor olaparib in recurrent ovarian and breast cancer: Analysis of the dose escalation and ovarian cancer expansion cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT008. doi:10.1158/1538-7445.AM2017-CT008

STAT3 Induces Immunosuppression by Upregulating PD-1/PD-L1 in HNSCC

Head and neck cancer is one of the most prevalent cancers around the world. Head and neck squamous cell carcinoma (HNSCC) accounts for nearly 90% of head and neck cancer. In recent years, significant advances have been made in immunotherapy for HNSCC. Although some clinical trials targeting immune checkpoints have shown success, the molecular mechanism for regulation of programmed death 1 (PD-1) and its ligand (PD-L1) is partially understood. In an effort to explore the effect of activation of signal transducers and activators of transcriptions (STAT3) on PD-1/PD-L1, the expression and correlation between phosphorylation of STAT3 and PD-1/PD-L1 were determined with immunostaining of human and mouse HNSCC tissue sections. PD-1/PD-L1 overexpression was found to be significantly associated with p-STAT3 in human and mouse HNSCC. Targeting STAT3 by a small molecule effectively inhibited the expression of PD-L1 in the CAL27 cell line. Furthermore, we found that blockade of STAT3 signaling downregulated PD-1/PD-L1 in a Tgfbr1/Pten 2cKO HNSCC mouse model. These findings suggest that STAT3 signaling plays an important role in PD-1/PD-L1 regulation and the antitumor immune response of HNSCC.

Abstract NTOC-112: GENOMIC SCARS AND CLINICAL RESPONSE TO COMBINATION THERAPY OF PARP AND ANGIOGENESIS INHIBITORS IN OVARIAN CANCER

BACKGROUND: Genomic instability, frequently resulting in chromosomal allelic deletion with allelic imbalance (AI)/loss of heterozygosity (LOH), is characteristic of high-grade serous ovarian cancer (HGSOC). Frequent allelic deletion is thought to arise from deficiency in DNA repair by homologous recombination (HR) resulting in the so called “genomic scars” of HR deficiency. Quantification of AI/LOH events in the tumor genome has previously been shown to predict response to therapy using platinum compounds. Recently, PARP inhibitors have proved useful in treating a sub-set of patients with HGSOC, particularly tumors harboring BRCA1/2 mutations. Combination with an angiogenesis inhibitor significantly improved the outcome. This study explores the potential of using AI/LOH scores to predict clinical response of HGSOC to PARP inhibition alone or in combination with an angiogenesis inhibitor.

MATERIALS AND METHODS: Molecular inversion probe array data were generated using tumors from a sub-set of patients (n=37) enrolled in a clinical trial comparing the PARP inhibitor Olaparib to the combination of Olaparib with the anti-angiogenic agent Cediranib (NCT01116648). AI/LOH regions were identified using an ASCAT based algorithm. Markers of genomic instability associated with DNA repair deficiency were scored. These quantify AI regions (NAI), telomeric AI (NtAI), large scale transition (LST), fraction of LOH (FLOH), and HRD-LOH. dChip was used for copy number analysis. The best overall response to therapy was determined using the RECIST 1.1 criteria for complete and partial response (CR, n = 3 and PR, n = 18), and stable disease without objective response (SD, n = 16).

RESULTS: A high tumor NAI-score was positively correlated with the degree of clinical response to therapy (either olaparib alone or in combination with cediranib) (Chi-square test for trend, p = 0.036). This association remains statistically significant in the subgroup carrying BRCA mutations (n = 22, Chi-square test for trend, p = 0.0488). In this limited sample, the objective response rate of high NAI tumors to the combination therapy was high (7 out of 8), especially in patient carrying wild-type BRCA1/2 genes (2 out of 2, p = 0.045). The results suggest NAI may be a potential genomic marker for response to the therapy combining PARP and angiogenesis inhibitors. However, no significant association was observed between the degree of objective response and scores of other genomic measurements NtAI, LST, or HRD-LOH.

SUMMARY: High NAI-score was associated with objective response to olaparib, alone or in combination with cediranib, supporting NAI as a candidate of genomic marker for predicting response to PARP inhibitor-based therapy in HGSOC. A larger cohort would be required to further evaluate predictive value of NAI for response to the combinational therapy.

Citation Format: Zhigang C. Wang, Nicolai Juul Birkbak, William T. Barry, Thomas M. Roberts, Eric P. Winer, J Dirk Iglehart, Ursula A. Matulonis, S. Percy Ivy, and Joyce F. Liu. GENOMIC SCARS AND CLINICAL RESPONSE TO COMBINATION THERAPY OF PARP AND ANGIOGENESIS INHIBITORS IN OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr NTOC-112.

Clinical activity, safety and biomarker results from a phase Ia study of atezolizumab (atezo) in advanced/recurrent endometrial cancer (rEC)

5585

Background: The prognosis for patients (pts) with rEC remains poor, with a 5-y OS of 20%-26%. We report safety, clinical activity and biomarker data from a Phase Ia study of atezo (anti–PD-L1) monotherapy in rEC. Methods: Atezo 1200 mg or 15 mg/kg IV q3w was administered until toxicity or loss of clinical benefit. Pts were initially eligible based on PD-L1 status ( > 5% of tumor-infiltrating immune cells [IC; IC2/3], VENTANA SP142 IHC assay) and then enrolled regardless of PD-L1 status. Tumor-infiltrating lymphocytes (TILs) were assessed by H&E. The FoundationOne NGS panel was used for microsatellite instability (MSI) and tumor mutation load analyses. Confirmed ORR and PFS were assessed by RECIST v1.1. Results: As of March 31, 2016, 15 pts were evaluable for safety and efficacy (minimum follow-up, 11.2 mo). The median age was 61 y (range, 20-74 y), 53% were ECOG PS 1 and 93% had ≥ 2 prior systemic therapies; 10 (67%) pts had prior RT. Pts were MSI-H (1/15), MSS (7/15) or MSI unknown (7/15). EC subtypes were endometrioid (5/15), serous (5/15), ER+ leiomyosarcoma (1/15) or unknown (4/15). Five (33%) pts were IC2/3, and 10 (67%) pts were IC0/1. Seven (47%) pts had any related AE, mainly G1-2 (5 pts). No G4-5 related AEs occurred. Two pts had related SAEs (colitis; rash). ORR was 13% (2/15) by RECIST. Both pts achieved PR and were IC2/3. ORR for IC2/3 pts was 40% (2/5). One responder was MSS and heavily infiltrated with TILs (IC3, 70% TILs, 1.8 Mut/Mb, unknown subtype); the other responder was hypermutated, MSI-H and moderately infiltrated with TILs (IC2, 10% TILs, 237 Mut/Mb, endometrioid). DOR in the 2 responders was 7.3 and 8.1+ mo. mPFS was 1.7 mo (range, 0.6-11+ mo); mOS was 9.6 mo (range, 0.6-11.8+ mo). Of the remaining pts, 2 had SD, 9 had PD and 2 were non-evaluable. DCR (PR + SD) was 27%. A trend for higher PFS and OS was seen in IC2/3 vs IC0/1 pts. Conclusions: Atezo had a favorable safety profile in rEC, with durable clinical benefit in some pts. Clinical benefit appeared to increase with higher PD-L1 expression, suggesting a link between PD-L1 status and response. Hypermutation and/or high immune infiltration may be linked to response to PD-L1 blockade, and further evaluation is merited. Clinical trial information: NCT01375842.

Overall survival and updated progression-free survival results from a randomized phase 2 trial comparing the combination of olaparib and cediranib against olaparib alone in recurrent platinum-sensitive ovarian cancer

5535

Background: We previously reported that the combination of cediranib (ced) and olaparib (olap) improved progression-free survival (PFS) and overall response rates (ORR) in women with recurrent platinum-sensitive (plat-sens) high-grade serous (HGS) or BRCA-related ovarian cancer (OvCa) (NCT 01116648). We conducted an updated PFS and overall survival (OS) analysis. Methods: Patients (pts) across 9 centers were randomized 1:1 in this Ph 2 open label study to Olap (olap 400 mg capsules BID) or Ced/Olap (olap 200 mg capsules BID; ced 30 mg daily), stratified by BRCA status and prior anti-angiogenic therapy. Eligibility included pts with recurrent plat-sens HGS or BRCA-related OvCa. Pts had measurable disease by RECIST 1.1, PS 0 or 1, and the ability to take POs. No prior anti-angiogenics in the recurrent setting or prior PARP inhibitor was allowed. PFS was defined as time from randomization to radiographic progression or death. OS was defined as time from randomization to death. Results: Pts were enrolled from Oct 2011 to Jun 2013: 46 to Olap, 44 to Ced/Olap. 48 pts were known BRCA carriers (25 Olap; 23 Ced/Olap). As of Dec 21, 2016, 67 pts had a PFS event, and 52 pts had an OS event. Updated median PFS was 8.2 mos for Olap and 16.5 mos for Ced/Olap (HR 0.50, 95% CI 0.30-0.83, p=0.007). Median OS was 33.3 mos for Olap and 44.2 mos for Ced/Olap (HR 0.64, 95% CI 0.36-1.11, p=0.11). Within known germline BRCA mut carriers, updated PFS was 16.5 vs 16.4 mos (HR 0.75, p=0.42), and OS was 40.1 vs 44.2 mos (HR 0.79, p=0.55) for Olap and Ced/Olap, respectively. In pts without known germline BRCA mut, updated PFS was 5.7 vs 23.7 mos (HR 0.32, p=0.002), and OS was 23.0 vs 37.8 mos (HR 0.48, p=0.074). Conclusions: Updated PFS results consistently demonstrated that Ced/Olap significantly extended PFS compared to Olap in the overall population of women with plat-sens OvCa. In this Phase 2 study not powered to detect OS diferences, there was a trend towards OS improvement with Ced/Olap, particularly in pts without a known germline BRCA mutation. Results from ongoing studies of this oral combination in OvCa are of clinical interest. Clinical trial information: NCT 01116648.

Phase 2, two-group, two-stage, open-label study of avelumab in patients with microsatellite stable, microsatellite instable and POLE-mutated recurrent or persistent endometrial cancer

TPS5615

Background: The Cancer Genome Atlas project identified 2 groups of hypermutated endometrial cancers (ECs): an ultramutated group that harbored mutations in the exonuclease domain of polymerase e ( POLE), and a hypermutated group with microsatellite instability (MSI), the majority of which harbored MLH1 promoter methylation. We (Howitt, JAMA Onc 2015) and others have shown that POLE and MSI ECs are associated with higher number of predicted neoepitopes and tumor infiltrating lymphocytes, which is counterbalanced by overexpression of PD-1/PD-L1, suggesting that they may be excellent candidates for PD-1/PD-L1 blockade. Anti-PD-1 therapy has also demonstrated promising activity in mismatch repair deficient colorectal cancers and collectively in non-colorectal cancers (Le, NEJM 2015). Methods: This is an open-label, two-cohort, two-stage, phase 2 trial, of avelumab, a fully human IgG1 antibody directed against PD-L1, in two cohorts: i) a MSI/ POLE cohort including ECs with immunohistochemical (IHC) complete loss of expression of at least one of the mismatch repair (MMR) proteins and/or documented mutation in the exonuclease domain of POLE and ii) a MSS cohort including ECs with normal IHC expression of all MMR proteins. Key eligibility criteria include measurable disease, no upper limit of prior therapies, and any EC histology. Co-primary objectives include objective response rate and rate of progression-free survival at 6 months. Avelumab is administered at 10 mg/kg as 1-hour IV infusion every 2 weeks until disease progression or unacceptable toxicity; therapy may continue at the investigator’s discretion while awaiting radiologic confirmation of disease progression 4 weeks later. Maximum target enrollment is 70 patients (35 for each cohort). In the first stage, 16 patients will be enrolled in each cohort; if there are at least two objective responses or two patients progression-free at 6 months, accrual will continue to the second stage where 19 more patients will be enrolled for each cohort. Thus far, 16 patients have been enrolled, 13 on the MSS cohort and 3 on the MSI/ POLE cohort. Clinical trial information: NCT02912572.

[Clinical application and observation of injectable modified sodium hyaluronate gel filler for facial cosmetic surgery]

Objective: To evaluate the clinical effect of injectable modified sodium hyaluronate gel filler in the treatment of facial profile modification and rejuvenation. Methods: A total of 125 patients who received facial injection of hyaluronate gel from October 2013 to October 2015 were collected. The patients included 62 cases for rhinoplasty, 28 for chin augmentation, 20 for nasolabial fold correction and 15 for lacrimal groove correction. The post-operation results, satisfaction survey and adverse reaction were observed. Results: All the injected positions improved immediately, and the instant average satisfaction score was 9.3±0.7, followed by 8.1±0.7 after 3 months, 6.9±0.8 after 6 month and 5.2±0.8 after 1 year. Thirty cases exhibited swelling, 5 cases bruised, and they all recovered within one week. Conclusions: Sodium hyaluronate is effective and stable in the treatment of facial contour modification and rejuvenation.

[Effect of cochlear implantation on sound localization for patients with unilateral sensorineural hearing loss]

The aim of this review was to examine the current literature regarding application of cochlear implantation on patients with unilateral sensorineural hearing loss (USNHL) for improvement on sound localization. The literature were searched in the PubMed database with 'cochlear implantation AND single-sided deafness' or 'cochlear implantation AND unilateral deafness' as keywords. The publication date of the articles was up to 2015-2-12. A total of 12 articles were included. The results show that the ability of sound localization for most of the USNHL subjects (90%) with cochlear implantation was significantly improved than that without CI, which suggests that CI is a superior auditory rehabilitation treatment than BAHA and CROS hearing aids for patients with USNHL, because of the re-establishment of the benefits of binaural hearing. In addition, the benefit of CI for USNHL requires a period of auditory experience or training. About 30% subjects showed significantly improvement on sound localization ability after CI worked for three months. For most of the patients (90%), the sound localization ability improved after CI worked for six months. When CI worked for nine months, all the subjects would show improvement on sound localization ability. Sound localization of the USNHL subjects with a CI is based primarily on interaural level differences (ILD) while interaural time differences (ITD) provide little advantage or probably not perceptible at all. The younger subject suffers from USNHL, the stronger the plasticity of the auditory center shows, which results in more obvious degeneration of the affected side and adaptive enhancement of the contralateral side of the auditory pathway. Similarly, the longer duration of USNHL lead to more obvious degeneration of the affected side and adaptive enhancement of the contralateral side. An adaptive enhancement of auditory pathway corresponding to the healthy ear will rely more on the monaural spatial cues that available to the intact ear to improve the sound localization in the horizontal plane. Contrarily, the degeneration of auditory pathway corresponding to the USNHL may be limited to re-reorganize from auditory deprivation even after CI, which may increase the risk that a few subjects cannot re-establish the binaural benefits after CI. Therefore, patients with USNHL should accept CI as soon as possible to obtain good binaural benefits, especially for sound localization.