FDG-PET/CT for the evaluation of response to therapy of cutaneous T-cell lymphoma to vorinostat (suberoylanilide hydroxamic acid, SAHA) in a phase II trial

Total Skin Electron Beam Therapy with Rotary Dual Technique as Palliative Treatment for Mycosis Fungoides

BACKGROUND/AIM

The aim of the study was to retrospectively assess the efficacy and toxicity of total skin electron beam therapy (TSEBT) in patients with primary cutaneous T-cell lymphoma (MF, mycosis fungoides) at various stages of development.

PATIENTS AND METHODS

Treatment results of 40 patients with MF stage IB-III, treated between 2001 and 2015, were reviewed. Median total dose was 32 Gy, delivered to the entire skin surface. Median follow-up was 60 months.

RESULTS

Clinical complete response was documented in 29 and partial response in 11 patients. The clinical response significantly influenced overall survival (OS) (p=0.002) and progression-free survival (PFS) (p<0.001). Mean OS was 76 months. Mean PFS was 48.9 months and current one- and two-year PFS were 67.5% and 55%, respectively. A statistically significant correlation was found between partial and total remission time and stages of the lymphoma (p=0.015).

CONCLUSION

TSEBT is an efficient and well-tolerated palliative treatment for symptomatic primary cutaneous T-cell lymphoma.

Chidamide in FLT3-ITD positive acute myeloid leukemia and the synergistic effect in combination with cytarabine

Chidamide, a novel histone deacetylase inhibitor (HDACi), has been approved for treatment of T-cell lymphomas in multiple clinical trials. It has been demonstrated that chidamide can inhibit cell cycle, promote apoptosis and induce differentiation in leukemia cells, whereas its effect on acute myeloid leukemia (AML) patients with FLT3-ITD mutation has not been clarified. In this study, we found that chidamide specifically induced G0/G1 arrest and apoptosis in FLT3-ITD positive AML cells in a concentration and time-dependent manner. We also found chidamide had the cytotoxicity effect on FLT3-ITD positive and negative AML cells. Moreover, with respect to relapsed/refractory patients, chidamide showed the same effectiveness as that in de novo AML patients. Notably, chidamide synergistically enhanced apoptosis caused by cytarabine. Our results support chidamide alone or combine with cytarabine may be used as an alternative therapeutic choice for AML patients especially those with FLT3-ITD mutation or relapsed/refractory ones.

The utility of positron emission tomography with and without computed tomography in patients with nonmelanoma skin cancer

Combined positron emission tomography (PET) and computed tomography (CT) scans are widely used in the staging and monitoring of most malignancies. The differential for PET-positive cutaneous lesions includes primary skin cancers, infections, cutaneous metastases from distant malignancies, and benign neoplasms. In dermatology, PET/CT scans have been most widely studied in patients with melanoma and Merkel cell carcinoma. The role of PET/CT scans in the management of other cutaneous malignancies is less clear, but it has shown great promise in the management of patients with squamous cell carcinoma and cutaneous lymphoma. This review seeks to address the usefulness of PET/CT scans in nonmelanoma skin cancer and to provide guidance regarding the management of patients with incidental PET-positive nodules. Currently, there is limited experience with PET/CT scans for staging and monitoring of non-head and neck metastatic basal cell and squamous cell carcinomas, and results show limited sensitivity and specificity. We also address the evidence for management of an incidental PET-positive cutaneous nodule and recommend obtaining a biopsy specimen in patients with a known noncutaneous malignancy, a history of primary skin cancer, or a high risk of either cutaneous or noncutaneous malignancy.

Ethics of clinical trials in dermatology

The ethics of clinical trials have been the subject of numerous previous publications and mandates that are used by institutional review boards on an everyday basis. The protection of human rights and the sanctity of informed consent are critical components of clinical research monitored by human subjects investigation committees throughout our profession. In this contribution, the everyday conflicts of interest that can compromise clinical research in dermatology are presented in a case format. Of utmost importance, the primary interest of the investigating dermatologist should always be the patient at hand and those who could benefit from the research. Navigating the turbulence created by finances, academia, and corporate America is critical. By presenting several case scenarios within the relatively rare disease arena of cutaneous T-cell lymphoma, these conflicts can be appreciated. Consequently, understanding these influences in one disease setting permits generalizations to be applied to any dermatologic clinical research.

PET in T-Cell Lymphoma

Most non-Hodgkin lymphomas (NHL) are of B-cell origin; only about 10% are T-cell or NK-cell lymphomas. The clinical features of T/NK-cell lymphomas differ from those of B-cell lymphomas: advanced stage and extranodal disease are more common and the prognosis is worse. Several studies have confirmed that 2-[fluorine-18]fluoro-2-deoxy-D-glucose (18FDG) uptake varies among different subtypes of lymphoma, a disparity that can be explained by the differences in histology, proliferation of tumor cells, and the ratio of viable tumor and reactive cells in the environment. These observations are based on investigation of B-cell lymphomas. Positron emission tomography (PET)/computed tomography (CT) was found to be useful both at staging and at measuring the therapeutic outcome after two to three cycles of chemotherapy (interim PET/CT). Several meta-analyses have confirmed the role of PET in evaluating the viability of the residual tumor mass after treatment. 18FDG-PET has been proved to have an excellent negative predictive value. Conversely, only a few studies have investigated the role of FDG-PET in T/NK-cell lymphomas. This paper summarizes the current information regarding the potential use of PET/CT in patients with T-cell lymphoma.

Nano-based theranostics for chronic obstructive lung diseases: challenges and therapeutic potential

The major challenges in the delivery and therapeutic efficacy of nano-delivery systems in chronic obstructive airway conditions are airway defense, severe inflammation and mucous hypersecretion. Chronic airway inflammation and mucous hypersecretion are hallmarks of chronic obstructive airway diseases, including asthma, COPD (chronic obstructive pulmonary disease) and CF (cystic fibrosis). Distinct etiologies drive inflammation and mucous hypersecretion in these diseases, which are further induced by infection or components of cigarette smoke. Controlling chronic inflammation is at the root of treatments such as corticosteroids, antibiotics or other available drugs, which pose the challenge of sustained delivery of drugs to target cells or tissues. In spite of the wide application of nano-based drug delivery systems, very few are tested to date. Targeted nanoparticle-mediated sustained drug delivery is required to control inflammatory cell chemotaxis, fibrosis, protease-mediated chronic emphysema and/or chronic lung obstruction in COPD. Moreover, targeted epithelial delivery is indispensable for correcting the underlying defects in CF and targeted inflammatory cell delivery for controlling other chronic inflammatory lung diseases. We propose that the design and development of nano-based targeted theranostic vehicles with therapeutic, imaging and airway-defense penetrating capability, will be invaluable for treating chronic obstructive lung diseases. This paper discusses a novel nano-theranostic strategy that we are currently evaluating to treat the underlying cause of CF and COPD lung disease.

Inhibition of cervical cancer cell growth in vitro and in vivo with dual shRNAs

RNA interference (RNAi)-based gene silencing is widely used in laboratories for gene function studies and also holds a great promise for developing treatments for diseases. However, in vivo delivery of RNAi therapy remains a key issue. Lentiviral vectors have been employed for stable gene transfer and gene therapy and therefore are expected to deliver a stable and durable RNAi therapy. But this does not seem to be true in some disease models. Here, we showed that lentivirus delivered short-hairpin RNA (shRNA) against human papillomavirus (HPV) E6/E7 oncogenes were effective for only 2 weeks in a cervical cancer model. However, using this vector to carry two copies of the same shRNA or two shRNAs targeting at two different but closely related genes (HPV E6 and vascular endothelial growth factor) was more effective at silencing the gene targets and inhibiting cell or even tumor growth than their single shRNA counterparts. The cancer cells treated with dual shRNA were also more sensitive to chemotherapeutic drugs than single shRNA-treated cells. These results suggest that a multi-shRNA strategy may be a more attractive approach for developing an RNAi therapy for this cancer.

Recent advances in histone deacetylase targeted cancer therapy

Epigenetic regulators such as histone acetyltransferases (HATs) and histone deacetylases (HDACs) are known to play an important role in gene expression. Of these enzymes, HDACs have been shown to be commonly associated with many types of cancers and to affect cancer development. Consequently, HDACs have been considered as promising targets for cancer therapy. In addition, the inhibition of HDACs by histone deacetylase inhibitors (HDACIs) shifts the balance between the deacetylating activity of HDACs and the acetylating activity of HATs in the regulation of gene expression. Therefore, HDACIs are an exciting new addition in cancer therapies. Numerous HDACIs have been identified and some have recently been used in clinical trials for cancer treatment, although the mechanisms underlying the anticancer effects of HDACIs remain unclear. In this review, we examine the most recent developments in HDACIs and various aspects of HDAC-targeted cancer treatment.

Computer-assisted quantitative evaluation of therapeutic responses for lymphoma using serial PET/CT imaging

RATIONALE AND OBJECTIVES

Molecular imaging modalities such as positron emission tomography (PET)/computed tomography (CT) have emerged as an essential diagnostic tool for monitoring treatment response in lymphoma patients. However, quantitative assessment of treatment outcomes from serial scans is often difficult, laborious, and time consuming. Automatic quantization of longitudinal PET/CT scans provides more efficient and comprehensive quantitative evaluation of cancer therapeutic responses. This study develops and validates a Longitudinal Image Navigation and Analysis (LINA) system for this quantitative imaging application.

MATERIALS AND METHODS

LINA is designed to automatically construct longitudinal correspondence along serial images of individual patients for changes in tumor volume and metabolic activity via regions of interest (ROI) segmented from a given time point image and propagated into the space of all follow-up PET/CT images. We applied LINA retrospectively to nine lymphoma patients enrolled in an immunotherapy clinical trial conducted at the Center for Cell and Gene Therapy, Baylor College of Medicine. This methodology was compared to the readout by a diagnostic radiologist, who manually measured the ROI metabolic activity as defined by the maximal standardized uptake value (SUVmax).

RESULTS

Quantitative results showed that the measured SUVs obtained from automatic mapping are as accurate as semiautomatic segmentation and consistent with clinical examination findings. The average of relative squared differences of SUVmax between automatic and semiautomatic segmentation was found to be 0.02.

CONCLUSIONS

These data support a role for LINA in facilitating quantitative analysis of serial PET/CT images to efficiently assess cancer treatment responses in a comprehensive and intuitive software platform.

CT and PET/CT findings of T-cell lymphoma

OBJECTIVE

The purpose of this study was to describe the extranodal features of T-cell lymphoma at CT and PET/CT.

CONCLUSION

The extranodal features of T-cell lymphoma are not specific and usually cannot be used to differentiate T-cell lymphoma from other aggressive types of lymphoma. Noncutaneous subtypes frequently manifest with visceral involvement. The goal of CT in initial staging is to exclude visceral involvement. Evidence on the utility of PET/CT is promising, showing high diagnostic value in evaluation of occult disease and treatment response, but the role of PET/CT is evolving.