1
|
Gill RR, Richards WG, Heiling H, Mazzola E, Hung YP, Seethamraju RT, Chirieac LR, Bueno R. Predictive potential of MRI in differentiating the predominant component in biphasic pleural mesothelioma. Eur J Radiol 2024; 176:111527. [PMID: 38810438 DOI: 10.1016/j.ejrad.2024.111527] [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: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To assess the potential of apparent diffusion coefficient (ADC) values derived from diffusion weighted (DW) MRI preoperatively to predict the predominant histologic component among biphasic pleural mesothelioma (PM) tumors. METHODS ADC maps were generated from DW MRI scans. Histology and predominant component of biphasic PM were confirmed following surgical resection. Statistical analyses were done with R (R Foundation for Statistical Computing, Vienna, Austria). Average ADC values corresponding to epithelioid- and sarcomatoid-predominant tumors were compared. ADC thresholding was accomplished by recursive partitioning and confirmed with ROC analysis. RESULTS Eighty-four patients with biphasic PM's, 69 (82 %) epithelioid-predominant (BE) and 15(18 %) sarcomatoid-predominant (BS) tumors were evaluated. Thirty-eight (45 %) patients underwent extrapleural pneumonectomy (EPP), 39 (46 %) had extended pleural decortication (ePDC) and 7 (8 %) had pleural decortication (PDC). ADC values ranged between 0.696 x 10-3 to 1.921 x 10-3 mm2/s. BE tumors demonstrated significantly higher ADC values than BS tumors (p = 0.026). ADC values above 0.94 x 10-3 mm2/s were associated with a significant increase of relative risk of being in group BE over group BS (relative risk: 1.47, 95 %CI: 1.05-2.06, p = 0.027) CONCLUSION: Average ADC values of BE tumors were higher than BS tumors and the two groups can be separated by a cut off value of 0.94 X 10-3 mm2/s.
Collapse
Affiliation(s)
- Ritu R Gill
- Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | | | | | - Yin P Hung
- Masschussets General Hospital, Boston, MA, United States
| | | | | | - Raphael Bueno
- Brigham and Women's Hospital, Boston, MA, United States
| |
Collapse
|
2
|
Banks KC, Ossowski S, Hung YY, Hsu DS, Ashiku SK, Patel AR, Velotta JB, Suga JM. Comparison of Survival by Multimodal Treatment Regimen Among Malignant Pleural Mesothelioma Patients in an Integrated Health System. Clin Lung Cancer 2022; 23:694-701. [PMID: 36216742 DOI: 10.1016/j.cllc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Optimal therapy for malignant pleural mesothelioma (MPM) remains unclear. We compared overall survival in patients with MPM after various multimodal treatment regimens including combinations of immunotherapy, chemotherapy, and surgery. PATIENTS AND METHODS We examined MPM patients treated within our integrated health system from January 1, 2009 to December 31, 2020. Patients were grouped based on treatment regimen: chemotherapy alone (CT), immunotherapy with or without chemotherapy (iCT), surgery with chemotherapy (sCT), and surgery with immunotherapy and chemotherapy (siCT). We analyzed baseline characteristics and overall patient survival among these groups and several subgroups. RESULTS One hundred seventy-nine patients were included. Among the study groups, there was no difference in age, sex, race/ethnicity, Charlson Comorbidity Index, or Eastern Cooperative Oncology Group performance status. Patients treated with CT (N = 109), iCT (N = 35), sCT (N = 26), and siCT (N = 9) had median (95% confidence interval) survivals of 11.7 (9.9-16.3), 18.2 (14.5-29.8), 20.7 (11.6-37.2), and 22.6 (19.7-37.8) months, respectively (P < .001). Median survival among patients with and without immunotherapy was 19.7 (17.4-29.8) and 12.3 (10.6-17.3) months, respectively (P = .023). Median survival among patients with and without surgery was 21.7 (17.6-34.8) and 13.6 (11.5-17.3) months, respectively (P = .007). Patients with biphasic/sarcomatoid subtypes who received immunotherapy experienced 76.2% (55.8%-100.0%) 12 month survival vs. 13.6% (4.8%-39.0%) among those who did not (P < .001). CONCLUSION MPM patients receiving surgery and immunotherapy as part of multimodal treatment regimens experienced the longest survival. Surgery and immunotherapy are each associated with survival. Further investigations are warranted to assess the benefit of immunotherapy within multimodal treatment regimens for MPM.
Collapse
Affiliation(s)
- Kian C Banks
- Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA; University of California, San Francisco - East Bay, Oakland, CA.
| | - Stephanie Ossowski
- Department of Hematology/Oncology, Kaiser San Francisco Medical Center, San Francisco, CA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Diana S Hsu
- Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA; University of California, San Francisco - East Bay, Oakland, CA
| | - Simon K Ashiku
- Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA
| | - Ashish R Patel
- Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA
| | - J Marie Suga
- Department of Oncology, Kaiser Vallejo Medical Center, Vallejo, CA
| |
Collapse
|
3
|
Lorenzini E, Torricelli F, Zamponi R, Donati B, Manicardi V, Sauta E, Faria do Valle I, Reggiani F, Gugnoni M, Manzotti G, Fragliasso V, Vitale E, Piana S, Sancisi V, Ciarrocchi A. KAP1 is a new non-genetic vulnerability of malignant pleural mesothelioma (MPM). NAR Cancer 2022; 4:zcac024. [PMID: 35910692 PMCID: PMC9336180 DOI: 10.1093/narcan/zcac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and incurable cancer, which incidence is increasing in many countries. MPM escapes the classical genetic model of cancer evolution, lacking a distinctive genetic fingerprint. Omics profiling revealed extensive heterogeneity failing to identify major vulnerabilities and restraining development of MPM-oriented therapies. Here, we performed a multilayered analysis based on a functional genome-wide CRISPR/Cas9 screening integrated with patients molecular and clinical data, to identify new non-genetic vulnerabilities of MPM. We identified a core of 18 functionally-related genes as essential for MPM cells. The chromatin reader KAP1 emerged as a dependency of MPM. We showed that KAP1 supports cell growth by orchestrating the expression of a G2/M-specific program, ensuring mitosis correct execution. Targeting KAP1 transcriptional function, by using CDK9 inhibitors resulted in a dramatic loss of MPM cells viability and shutdown of the KAP1-mediated program. Validation analysis on two independent MPM-patients sets, including a consecutive, retrospective cohort of 97 MPM, confirmed KAP1 as new non-genetic dependency of MPM and proved the association of its dependent gene program with reduced patients’ survival probability. Overall these data: provided new insights into the biology of MPM delineating KAP1 and its target genes as building blocks of its clinical aggressiveness.
Collapse
Affiliation(s)
- Eugenia Lorenzini
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Cellular and Molecular Biology PhD Program, University of Bologna, 40126 Bologna , Italy
| | - Federica Torricelli
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Raffaella Zamponi
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Benedetta Donati
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Veronica Manicardi
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia , 41121 Modena , Italy
| | - Elisabetta Sauta
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Electrical, Computer and Biomedical Engineering, University of Pavi, , 27100 Pavia , Italy
| | - Italo Faria do Valle
- Department of Physics, Center for Complex Network Research, Northeastern University , Boston , MA 02115 , USA
| | - Francesca Reggiani
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Mila Gugnoni
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Gloria Manzotti
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Valentina Fragliasso
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Emanuele Vitale
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia , 41121 Modena , Italy
| | - Simonetta Piana
- Pathology Unit , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Valentina Sancisi
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research , Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| |
Collapse
|
4
|
Lapidot M, Mazzola E, Bueno R. Outcomes of Pleurectomy Decortication in Biphasic Mesothelioma. J Thorac Cardiovasc Surg 2022; 164:1340-1348.e3. [DOI: 10.1016/j.jtcvs.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/11/2021] [Accepted: 01/12/2022] [Indexed: 10/31/2022]
|
5
|
Salvage Surgery after Immunotherapy in Refractory Malignant Pleural Mesothelioma. Ann Thorac Surg 2022; 114:e357-e359. [PMID: 35104447 DOI: 10.1016/j.athoracsur.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/24/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
A 78-year old male presenting with epithelial malignant pleural mesothelioma (MPM) underwent multidisciplinary review at our institution. We offered surgical resection with adjuvant chemotherapy, but the patient declined. After six months, his disease progressed and he opted for dual immunotherapy with ipilimumab and nivolumab, however, after treatment initiation, he developed pneumonitis. Immunosuppression controlled the pneumonitis, but his MPM progressed, so salvage surgical resection was offered. Left extrapleural pneumonectomy was successfully performed with an unremarkable recovery. Final pathology revealed stage III biphasic mesothelioma. This is the first report to demonstrate feasibility of salvage resection for progression of MPM after immunotherapy.
Collapse
|
6
|
Lapidot M, Mazzola E, Freyaldenhoven S, De León LE, Jaklitsch MT, Bueno R. Postoperative empyema after pleurectomy decortication for malignant pleural mesothelioma. Ann Thorac Surg 2021; 114:1214-1219. [PMID: 34619137 DOI: 10.1016/j.athoracsur.2021.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative empyema following pleurectomy decortication (PDC) for malignant pleural mesothelioma (MPM) is a serious complication that necessitates prolonged hospitalization. The aim of this study was to determine the incidence, risk factors and prognosis in patients who develop postoperative empyema following PDC. METHODS The background, type of PDC, neo-adjuvant treatment, date of empyema, pleural fluid cultures, post empyema treatment and prognosis from a series of consecutive 355 patients treated over 9 years at a single high-volume center were investigated. Fisher's exact test, Kaplan Meier estimators and log rank test were used to identify significant risk factors for postoperative empyema and compare the overall survival. RESULTS 355 patients underwent PDC for MPM in a 9-year period. There were 263 males and median age at surgery was 69. Neoadjuvant therapy was given to 87 and 282 received intraoperative heated chemotherapy (IOHC). During the study 24 patients (6.8%) developed empyema. The length of stay (LOS) of patients who developed postoperative empyema was significantly longer. Median survival for patients who developed postoperative empyema was 11.7 months and 21.3 months for patients without empyema (HR-1.78, p=0.009). Postoperative empyema was associated with male sex, prolonged air leak and use of prosthetic mesh. CONCLUSIONS Postoperative empyema following PDC is associated with prolonged length of stay and higher mortality. The rates of this serious postoperative complication might decrease by developing better strategies to avoid prolonged air leak after PDC.
Collapse
Affiliation(s)
- Moshe Lapidot
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA.
| | - Emanuele Mazzola
- Dana Farber Cancer Institute, T.H Chan School of Public Health Boston, Harvard Medical School Boston, MA
| | - Samuel Freyaldenhoven
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Luis E De León
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Michael T Jaklitsch
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Raphael Bueno
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| |
Collapse
|
7
|
Lococo F. Malignant Pleural Mesothelioma: Time Is Running Out. J Clin Med 2021; 10:jcm10040648. [PMID: 33567623 PMCID: PMC7914895 DOI: 10.3390/jcm10040648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Filippo Lococo
- Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
- Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| |
Collapse
|
8
|
Kantor T, Wakeam E. Landmark Trials in the Surgical Management of Mesothelioma. Ann Surg Oncol 2021; 28:2037-2047. [PMID: 33521898 DOI: 10.1245/s10434-021-09589-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
The treatment of mesothelioma has evolved slowly over the last 20 years. While surgery as a standalone treatment has fallen out of favor, the importance of multimodality treatment consisting of combinations of chemotherapy, radiotherapy, and surgery have become more common in operable, fit patients. In this review, we discuss trials in surgery, chemotherapy, and radiation that have shaped contemporary multimodality treatment of this difficult malignancy, and we touch on the new and emerging immunotherapeutic and targeted agents that may change the future treatment of this disease. We also review the multimodality treatment regimens, with particular attention to trimodality therapy and neoadjuvant hemithoracic radiation strategies.
Collapse
Affiliation(s)
- Taylor Kantor
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
9
|
Pleurectomy Decortication in the Treatment of Malignant Pleural Mesothelioma: Encouraging Results and Novel Prognostic Implications Based on Experience in 355 Consecutive Patients. Ann Surg 2020; 275:1212-1220. [PMID: 33278174 DOI: 10.1097/sla.0000000000004306] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We report a series of 355 consecutive patients treated over 9 years in a single institution with intended PDC. BACKGROUND Surgery for MPM has shifted from extra-pleural pneumonectomy to PDC with the goal of MCR. METHODS Clinical and outcome data were reviewed. Kaplan-Meier estimators and log rank test were used to compare the overall survival, and logistic regression models were used. RESULTS MCR was achieved in 304. There were 223 males, median age was 69 and histology was epithelioid in 184. The 30 and 90-day mortality were 3.0% and 4.6%.Most complications were low grade. Prolonged air leak in 141, deep venous thrombosis in 64, Atrial fibrillation in 42, chylothorax in 24, Empyema in 23, pneumonia in 21, Hemothorax in 12 and pulmonary embolus in 8.Median/5-year survival were 20.7 months/17.9% in the intent-to-treat cohort and 23.2 months/21.2% in the MCR group. The survivals were best for patients with T1stage and epithelioid histology (69.8 months/54.1%). In a multivariable analysis, factors that were found to be associated with longer patient overall survival included epithelioid histology, T stage, quantitative clinical stage/tumor volume staging, adjuvant chemotherapy, intraoperative heated chemo, female sex, and length of stay shorter than 14 days. CONCLUSIONS PDC is feasible with low mortality and is associated with manageable complication rates. 5-year survival of patients undergoing PDC with MCR in multi-modality setting is approaching 25% depending on quantitative and clinical stage, sex and histological subtype and is better than PDC without- MCR.
Collapse
|
10
|
Deep Sequencing Analysis Identified a Specific Subset of Mutations Distinctive of Biphasic Malignant Pleural Mesothelioma. Cancers (Basel) 2020; 12:cancers12092454. [PMID: 32872534 PMCID: PMC7563974 DOI: 10.3390/cancers12092454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Malignant Pleural Mesothelioma (MPM) is a heterogeneous disease. Morphologically, three different phenotypes are distinguishable: epithelioid (e-), sarcomatoid (s-) and biphasic (biph-) MPM, the latest, being a mixture of e- and s-MPM cells. Being an intermediate entity, management of biph-MPM, remains debatable and controversial, with different guidelines recommending distinct approaches. Identification of biph-MPM associated genetic alterations, through deep sequencing analysis, may provide useful tools to understand these lesions. A retrospective cohort of 69 surgically resected MPMs, 39 biph-MPMs (56.5%) and 30 e-MPMs (43.5%) was selected. A separate set of 16 biph-MPM was used as validation set. Deep sequencing analysis on an MPM-specific custom panel (MPM_geneset) comprising 1041 amplicons spanning 34 genes was performed. A total of 588 variants and 5309 mutational events were detected. In total, 91.3% of MPMs showed at least one mutation and 76.8% showed co-occurrence of more than one alteration. Mutations in MXRA5 (p = 0.05) and NOD2 (p = 0.018) were significantly associated with biph-MPM both in the training and validation cohort and correlated with the extent of the sarcomatoid component. Mutations in NOD2 and XRCC6 correlated with patients’ survival. We demonstrated that biph-MPM are associated with a specific mutation set, and that genetic analysis at diagnosis may improve patients’ risk stratification.
Collapse
|
11
|
Wakeam E, Kidane B. Commentary: Picking the winners-Leaning into selection bias. J Thorac Cardiovasc Surg 2020; 159:1594-1595. [PMID: 32035644 DOI: 10.1016/j.jtcvs.2019.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Elliot Wakeam
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
12
|
Commentary: Biphasic malignant mesothelioma-Survival of the fittest. J Thorac Cardiovasc Surg 2019; 159:1596-1597. [PMID: 31619328 DOI: 10.1016/j.jtcvs.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
|