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Hoke ATK, Takahashi Y, Padget MR, Gomez J, Amit M, Burks J, Bell D, Xie T, Soon-Shiong P, Hodge JW, Hanna EY, London NR. Targeting sinonasal undifferentiated carcinoma with a combinatory immunotherapy approach. Transl Oncol 2024; 44:101943. [PMID: 38593586 PMCID: PMC11024348 DOI: 10.1016/j.tranon.2024.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy of the sinonasal cavity with poor prognosis and limited treatment options. To investigate the potential for SNUC sensitivity to combinatory immunotherapy, we performed in vitro studies with SNUC cell lines and used multi-spectral immunofluorescence to characterize the in vivo patient SNUC tumor immune microenvironment (TIME). EXPERIMENTAL DESIGN Human-derived SNUC cell lines were used for in vitro studies of tumor cell susceptibility to natural killer (NK) cell-based immunotherapeutic strategies. Tumor samples from 14 treatment naïve SNUC patients were examined via multi-spectral immunofluorescence and clinical correlations assessed. RESULTS Anti-PD-L1 blockade enhanced NK cell lysis of SNUC cell lines ∼5.4 fold (P ≤ 0.0001). This effect was blocked by a CD16 neutralizing antibody demonstrating activity through an antibody-dependent cellular cytotoxicity (ADCC) mediated pathway. ADCC-dependent lysis of SNUC cells was further enhanced by upregulation of PD-L1 on tumor cells by exogenous interferon-gamma (IFN-γ) administration or interleukin-15 (IL-15) stimulated IFN-γ release from NK cells. Combination treatment with anti-PD-L1 blockade and IL-15 superagonism enhanced NK-cell killing of SNUC cells 9.6-fold (P ≤ 0.0001). Untreated SNUC patient tumor samples were found to have an NK cell infiltrate and PD-L1+ tumor cells at a median of 5.4 cells per mm2. A striking 55.7-fold increase in CKlow tumor cell/NK cell interactions was observed in patients without disease recurrence after treatment (P = 0.022). Patients with higher CD3+CD8+ in the stroma had a significantly improved 5-year overall survival (P = 0.0029) and a significant increase in CKlow tumor cell/CD8+ cytotoxic T cell interactions was noted in long-term survivors (P = 0.0225). CONCLUSION These data provide the pre-clinical rationale for ongoing investigation into combinatory immunotherapy approaches for SNUC.
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Affiliation(s)
- Austin T K Hoke
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michelle R Padget
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Javier Gomez
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Moran Amit
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jared Burks
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diana Bell
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, United States
| | - Tongxin Xie
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - James W Hodge
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nyall R London
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Sideris G, Solomos P, Gogoulos P, Margaris I, Panagoulis E, Vlastarakos P, Karamagkiolas S, Tzagkaroulakis M, Nikolopoulos T, Delides A. Neuroendocrine and undifferentiated sinonasal and skull base tumors: An up-to-date narrative review. Oral Maxillofac Surg 2024:10.1007/s10006-024-01240-3. [PMID: 38502274 DOI: 10.1007/s10006-024-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/17/2024] [Indexed: 03/21/2024]
Abstract
Tumors located in the nasal cavity, paranasal sinuses and the skull base comprise a wide range of histologic subtypes. Among them, neuroendocrine and undifferentiated tumors are rare but noteworthy, because of their distinctive features, aggressive nature, and diagnostic complexities. A literature search was conducted in the PubMed/MEDLINE and the Scopus databases from 2019 until inception. The keywords "neuroendocrine", "undifferentiated", "nose", "sinonasal", "paranasal", "skull base" were used. Thirty-eight articles referring to neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base were finally included and analyzed. Neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base are infrequent malignancies, most commonly affecting middle-aged men. They usually present with non-specific symptoms, even though ocular or neurologic manifestations may occur. Prognosis is generally poor; however, novel targeted and immunological therapies have shown promising results. Sinonasal Neuroendocrine Carcinomas (SNECs) carry distinct histological and immunohistochemical features. Management consists of surgical resection coupled with systematic therapy. Sinonasal Undifferentiated Carcinomas (SNUCs) lack specific squamous or glandular features. They typically stain positive for pancytokeratin and INI1 antibody. Treatment includes induction chemotherapy, followed by a combination of chemotherapy and radiotherapy. Olfactory neuroblastomas (ONBs) have neuroepithelial or neuroblastic features. They show diffuse positivity for various markers, including synaptophysin, chromogranin, and neuron-specific enolase (NSE). Surgical resection plus radiotherapy is considered the treatment of choice. In conclusion, neuroendocrine and undifferentiated tumors arising from the nose, paranasal sinuses and the skull base represent a unique group of malignancies. A thorough understanding of their clinical features, molecular changes, diagnostic approaches, treatment modalities, and prognostic factors is critical for providing optimal patient care. Still, continued research efforts and multidisciplinary collaboration are warranted, in order to improve outcomes for patients diagnosed with these rare and aggressive tumors.
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Affiliation(s)
- Giorgos Sideris
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece.
| | - Panagiotis Solomos
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Panagiotis Gogoulos
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Ioannis Margaris
- 4Th Department of Surgery, "Attikon" University Hospital National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Panagoulis
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Petros Vlastarakos
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Sotirios Karamagkiolas
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Michael Tzagkaroulakis
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Thomas Nikolopoulos
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Alexander Delides
- 2Nd Otolaryngology Department, "Attikon" University Hospital, National & Kapodistrian University of Athens, School of Medicine, Rimini 1, 12462, Chaidari, Athens, Greece
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Ferrari M, Mattavelli D, Schreiber A, Gualtieri T, Rampinelli V, Tomasoni M, Taboni S, Ardighieri L, Battocchio S, Bozzola A, Ravanelli M, Maroldi R, Piazza C, Bossi P, Deganello A, Nicolai P. Does Reorganization of Clinicopathological Information Improve Prognostic Stratification and Prediction of Chemoradiosensitivity in Sinonasal Carcinomas? A Retrospective Study on 145 Patients. Front Oncol 2022; 12:799680. [PMID: 35720015 PMCID: PMC9203696 DOI: 10.3389/fonc.2022.799680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The classification of sinonasal carcinomas (SNCs) is a conundrum. Consequently, prognosis and prediction of response to non-surgical treatment are often unreliable. The availability of prognostic and predictive measures is an unmet need, and the first logical source of information to be investigated is represented by the clinicopathological features of the disease. The hypothesis of the study was that clinicopathological information on SNC could be exploited to better predict prognosis and chemoradiosensitivity. Methods All patients affected by SNC who received curative treatment, including surgery, at the Unit of Otorhinolaryngology—Head and Neck Surgery of the University of Brescia between October 1998 and February 2019 were included in the analysis. The institutional series was reviewed and a survival analysis was performed. Machine learning and multivariable statistical methods were employed to develop, analyze, and test 3 experimental classifications (classification #1, based on cytomorphological, histomorphological, and differentiation information; classification #2, based on differentiation information; and classification #3, based on locoregional extension) of SNC, based on the inherent clinicopathological information. The association of experimental classifications with prognosis and chemoradiosensitivity was tested. Results The study included 145 patients. From a prognostic standpoint, the machine learning-generated classification of SNC provided better prediction than the current World Health Organization classification. However, the prediction of the chemoradiosensitivity of SNC was not achievable. Conclusions Reorganization of clinicopathological information, with special reference to those related to tumor differentiation, can improve the reliability of prognosis of SNC. Prediction of chemoradiosensitivity remains an unmet need and further research is required.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy.,Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Guided Therapeutics Program International Scholar, University Health Network, Toronto, Canada
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy.,Guided Therapeutics Program International Scholar, University Health Network, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Ardighieri
- Unit of Pathology, "ASST Spedali Civili di Brescia", Brescia, Italy
| | | | - Anna Bozzola
- Unit of Pathology, "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy
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Turri-Zanoni M, Gravante G, Castelnuovo P. Molecular Biomarkers in Sinonasal Cancers: New Frontiers in Diagnosis and Treatment. Curr Oncol Rep 2022; 24:55-67. [PMID: 35059992 PMCID: PMC8831338 DOI: 10.1007/s11912-021-01154-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
Purpose of Review Sinonasal tumors are rare and heterogeneous diseases which pose challenges in diagnosis and treatment. Despite significant progress made in surgical, oncological, and radiotherapy fields, their prognosis still remains poor. Therefore, alternative strategies should be studied in order to refine diagnosis and improve patient care. Recent Findings In recent years, in-depth molecular studies have identified new biological markers, such as genetic abnormalities and epigenetic variations, which have allowed to refine diagnosis and predict prognosis. As a consequence, new histological entities have been described and specific subgroup stratifications within the well-known histotypes have been made possible. These discoveries have expanded indications for immunotherapy and targeted therapies in order to reduce tumor spread, thus representing a valuable implementation of standard treatments. Summary Recent findings in molecular biology have paved the way for better understanding and managing such rare and aggressive tumors. Although further efforts need to be made in this direction, expectations are promising.
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Ackall FY, Issa K, Barak I, Teitelbaum J, Jang DW, Jung SH, Goldstein B, Carrau R, Abi Hachem R. Survival Outcomes in Sinonasal Poorly Differentiated Squamous Cell Carcinoma. Laryngoscope 2020; 131:E1040-E1048. [PMID: 32959912 DOI: 10.1002/lary.29090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Sinonasal squamous cell carcinoma (SCC) is rare with no consensus on treatment regimen. Our goal is to analyze treatment outcomes in poorly differentiated SCC (PDSCC) using a large national database. STUDY DESIGN Retrospective database study. METHODS The National Cancer Database was queried for sinonasal invasive SCC, grade 3 (poorly differentiated) from 2004 to 2014. Patient demographics and tumor and treatment characteristics were tabulated. Kaplan-Meier (KM) analysis was performed to compare overall survival (OS) between histology subtype and primary site. Multivariable Cox proportional hazards regression was performed for statistical analysis of treatment regimen on OS. RESULTS A total of 1,074 patients were identified. The maxillary sinus was the most common site (45%). T4 tumors were observed in 50% of patients, with most patients treated at high-volume facilities (77%). In KM analysis, spindle cell SCC histological subtype, primary tumors of the maxillary sinus, and poorly differentiated grade had worse OS. In our Cox-PH model, higher T stage and age were associated with worse OS. Those treated at a high-volume facility and those who underwent surgical resection followed by adjuvant radiation had improved OS. Chemotherapy within the treatment regimen did not confer survival benefit except in surgical patients when positive margins were present, and surgery with adjuvant chemoradiation trended toward improved survival. CONCLUSIONS Sinonasal PDSCC appears to be best treated at high-volume centers with surgical resection followed by adjuvant radiation. Poorly differentiated grade has worse OS compared to more differentiated tumors. Chemotherapy along with adjuvant radiation may have a role in patients with positive surgical margins. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1040-E1048, 2021.
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Affiliation(s)
- Feras Y Ackall
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Khalil Issa
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A
| | - Jordan Teitelbaum
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - David W Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Sin-H Jung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A
| | - Bradley Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Ricardo Carrau
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Medical Center, Columbus, Ohio, U.S.A
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
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Abstract
PURPOSE OF REVIEW Sinonasal cancers are a heterogenous group of rare cancers for which histopathological diagnosis can be very challenging and treatment options are limited for advanced disease in particular. Here, we review the candidacy of novel diagnostic and prognostic biomarkers, and therapeutic targets for sinonasal cancers. RECENT FINDINGS Molecular multidimensional analyses of sinonasal cancers have been lagging behind other major cancers, but there are numerous publications describing the discovery of novel candidate biomarkers, e.g. the methylation classifier, originally developed for brain cancers, and gene expression panels for the prediction of response to induction chemotherapy in sinonasal undifferentiated carcinoma. The most promising biomarkers are summarized and discussed further with regard to their clinical applicability and future potential. Many of the described novel biomarkers for sinonasal cancers will eventually overcome the pitfalls associated with the frequently non-specific immunohistological tests. With comprehensive, multidimensional molecular testing of these tumours in collaborative consortia projects, our better understanding of the molecular mechanisms of sinonasal cancers and their carcinogenesis will determine the most useful diagnostic and prognostic biomarkers, allow stringent multi-institutional validation and guide trials on targeted therapies.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, 72 Huntley Street, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, 72 Huntley Street, London, UK
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK.
- UCL Ear Institute, University College London, London, UK.
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