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Martell K, McIntyre JB, Abedin T, Kornaga EN, Chan AMY, Enwere E, Köbel M, Dean ML, Phan T, Ghatage P, Lees-Miller SP, Doll CM. Prevalence and Prognostic Significance of PIK3CA Mutation and CNV Status and Phosphorylated AKT Expression in Patients With Cervical Cancer Treated With Primary Surgery. Int J Gynecol Pathol 2024; 43:158-170. [PMID: 37668363 DOI: 10.1097/pgp.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Currently, there are limited and conflicting reports on the prognostic utility of PIK3CA and associated pathway markers for cervical cancers treated with primary surgical management. Moreover, current studies are lacking complete characterization of adjuvant treatment with RT and/or chemotherapy. We aimed to document the prevalence, clinicopathologic, adjuvant treatment details, and prognostic value of PI3K/AKT pathway mutations and copy number variation and phosphorylated AKT status in patients with cervical cancers treated with primary surgery. A clinicopathologic review was performed on a retrospective cohort of 185 patients with cervical cancer, treated with primary surgery at a single tertiary institution. Next-generation sequencing and digital PCR was used to determine PI3K/AKT pathway mutational status and PIK3CA copy number variation, respectively, and fluorescent immunohistochemistry measured phosphorylated AKT expression. In all, 179 of 185 (96.8%) of tumors were successfully sequenced; 48 (26.8%) were positive for PI3K/AKT pathway mutations-the majority (n=37, 77.1%) PIK3CA mutations. PIK3CA mutation was associated with pathologically positive lymph nodes [12 (32%) vs. 22 (16%); P =0.022] and indication for postoperative chemoradiotherapy [17 (45.9%) vs. 32 (22.5%); P =0.004]. On multivariable analysis, PIK3CA status was not associated with overall survival ( P =0.103) or progression-free survival ( P =0.240) at 5 yrs, nor was PIK3CA copy number variation status. phosphorylated AKT ≤ median significantly predicted for progression-free survival [multivariable hazard ratio 0.39 (0.17-0.89; P =0.025)] but not overall survival ( P =0.087). The correlation of PIK3CA with pathologic positive lymph node status yet lack of association with survival outcomes may be due to the use of adjuvant postoperative therapy. PIK3CA assessment before radical hysterectomy may help identify patients with a higher risk of node-positive disease.
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Sun G, Zhang Q, Liu Y, Xie P. Role of Phosphatidylinositol 3-Kinase and Its Catalytic Unit PIK3CA in Cervical Cancer: A Mini-Review. Appl Bionics Biomech 2022; 2022:6904769. [PMID: 36046780 PMCID: PMC9420646 DOI: 10.1155/2022/6904769] [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: 06/17/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
In complicated disorders like cancer, signaling pathways form a tangled network. Targeting one gene may result in an unfavorable reaction from another off-target gene. Such entwined complexities may result in treatment resistance or failure in cancer patients. The PI3K/Akt/mTOR (phosphoinositol 3-kinase/protein kinase B/mammalian target of rapamycin) pathway is dysregulated in cervical cancer and is used as a biomarker for therapy. PI3K is a kinase that consists of a regulatory and catalytic domain and has phosphorylation capability. Class I components like the catalytic part (PIK3CA and PIK3CD) and regulatory part (like PIK3R1, PIK3R2, PIK3R3, and PIK3R5) are associated with oncogenesis and growth factors in cervical cancer. This review is aimed at discussing the involvement of the PI3K component of the PI3K/Akt/mTOR network in cervical cancer. Specifically, class I catalytic subunit PIK3CA has been identified as a pharmacological target, making it therapeutically significant. Apart from discussing the function of PI3K and PIK3CA in cervical cancer, we also discuss their inhibitors, which may be beneficial in treating cervical cancer.
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Affiliation(s)
- Guojuan Sun
- Ward Section of Home Overseas Doctors, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Qiang Zhang
- Ward Section of Home Overseas Doctors, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Yi Liu
- Maternity Rehabilitation Center, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Ping Xie
- Ward Section of Home Overseas Doctors, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
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3
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Fracasso PM, Duska LR, Thaker PH, Gao F, Zoberi I, Dehdashti F, Siegel BA, Uliel L, Menias CO, Rehm PK, Goodner SA, Creekmore AN, Lothamer HL, Rader JS. An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer. Am J Clin Oncol 2022; 45:286-293. [PMID: 35696702 PMCID: PMC9233135 DOI: 10.1097/coc.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955). PATIENTS AND METHODS Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment. RESULTS Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively. CONCLUSIONS Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
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Affiliation(s)
- Paula M. Fracasso
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Linda R. Duska
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Premal H. Thaker
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
| | - Feng Gao
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Surgery and the Division of Public Health
Sciences, Washington University School of Medicine, St. Louis, MO, 63110
| | - Imran Zoberi
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiation Oncology, Washington University
School of Medicine, St. Louis, MO, 63110
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Barry A. Siegel
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Livnat Uliel
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Christine O. Menias
- Division of Diagnostic Radiology, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Patrice K. Rehm
- Division of Nuclear Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Sherry A. Goodner
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
| | - Allison N. Creekmore
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
| | - Heather L. Lothamer
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Janet S. Rader
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
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Kashofer K, Regauer S, Reich O, Petru E, Winter E. Driver gene mutations in micro-invasive cervical squamous cancers have no prognostic significance. Gynecol Oncol 2022; 165:121-128. [PMID: 35101299 DOI: 10.1016/j.ygyno.2022.01.020] [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: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prevalence of somatic gene mutations in different stages of cervical carcinogenesis placing special emphasis on micro-invasive pT1a cervical squamous cell cancers (SCC). METHODS Micro-dissected samples of 32 micro-invasive pT1a and 55 ≥ pT1b SCC were evaluated by next generation sequencing of 50 cancer genes (cancer hot spot panel). RESULTS At primary diagnosis, 8/32 (25%) pT1a SCC, 10/28 (36%) pT1b SCC and 15/27 (56%) pT2/3 SCC carried somatic gene mutations. The most commonly affected gene was the PIK3CA gene in hot spot regions E545K and E453K in 5/8 (62%) pT1a SCC, 7/15 (70%) pT1b SCC and 10/15 (66%) pT2/3 SCC followed by FBXW7 (n = 4), KRAS and RB1 (n = 2 each). ERBB2, APC, ATM, MLP gene mutations occurred only once. Solitary activating oncogenic somatic mutations dominated over tumor suppressor mutation in 88% pT1a, 80% pT1b and 60% pT2/3 SCC. Concomitant mutations involved typically an activating oncogenic mutation and an inactivating tumor-suppressor gene mutation. All patients with pT1a SCC are alive without evidence of disease after surgical treatment, independent of mutational status or lympho-vascular space invasion. CONCLUSIONS Activating oncogenic gene mutations, in particular in the PIK3CA gene, occur early in cervical carcinogenesis. Although driver gene mutations bestow tumor cells with a growth advantage, early detection and complete removal of all cancer cells - with or without somatic gene mutations - are essential for cure. In contrast to advanced inoperable SCC, where PIK3CA driver gene mutations carry an adverse prognosis, the mutational status in surgically treated micro-invasive SCC is prognostically irrelevant.
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Affiliation(s)
- Karl Kashofer
- Diagnostic- and Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Sigrid Regauer
- Diagnostic- and Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria.
| | - Olaf Reich
- Department of Gynecology and Obstetrics, Medical University Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Medical University Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Elke Winter
- Diagnostic- and Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
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Phase II study of BKM120 in patients with advanced esophageal squamous cell carcinoma (EPOC1303). Esophagus 2022; 19:702-710. [PMID: 35904643 PMCID: PMC9436835 DOI: 10.1007/s10388-022-00928-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND PI3K/AKT/mTOR pathway is frequently overactive in esophageal squamous cell carcinoma (ESCC), making it an attractive treatment target. BKM120 is an oral pan-class I PI3K inhibitor with promising activity in several cancers. We prospectively investigated efficacy, safety, and biomarkers of BKM120 in advanced ESCC. We conducted a multicenter phase II study of BKM120 monotherapy in patients with pretreated advanced ESCC. METHODS BKM120 (100 mg/day) was administered orally in a 28-day cycle. The primary end point was disease control rate (DCR). Tumor samples for all patients were collected for gene alteration analysis in a comprehensive genomic profiling assay. RESULTS Of 42 patients enrolled, 20 had stable disease and two had confirmed partial response. One ineligible patient was excluded from the primary analysis, which met the primary end point (DCR 51.2%; 95% confidence interval [CI], 35.1-67.1). In the 42 patients, median progression-free survival and overall survival were 2.3 (95% CI 1.8-3.2) and 9.0 (95% CI 6.5-11.4) months, respectively. Common grade 3 or 4 adverse events were rash, anorexia, hyponatremia, and abnormal hepatic function; profiles of these events in this study were similar to those in previous studies of BKM120 monotherapy. No treatment-related deaths occurred. PI3K pathway activation was observed in patients with good clinical response. CONCLUSIONS BKM120 monotherapy showed promising efficacy and a manageable toxicity profile even in patients with pretreated advanced ESCC. This study showed the potential target PI3K for ESCC, and further confirmatory trial will be necessary to confirm it. Unique ID issued by UMIN: UMIN 000011217.
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Choi S, Kim SW, Kim HS. Invasive Stratified Mucin-producing Carcinoma (ISMC) of the Uterine Cervix: Clinicopathological and Molecular Characteristics With Special Emphasis on the First Description of Consistent Programmed Death-ligand 1 (PD-L1) Over-expression. Cancer Genomics Proteomics 2021; 18:685-698. [PMID: 34479920 DOI: 10.21873/cgp.20290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIM Invasive stratified mucin-producing carcinoma (ISMC) of the uterine cervix has been reported to be more aggressive than other subtypes of endocervical adenocarcinoma. We investigated the clinicopathological and molecular characteristics of eight ISMCs. PATIENTS AND METHODS We reviewed the electronic medical records and pathology slides of eight patients with ISMC and conducted programmed death-ligand 1 (PD-L1) immunostaining and targeted sequencing. RESULTS The patients were between 31 and 54 years. Six tumors were pure ISMCs, and two showed co-existing squamous cell carcinoma and usual-type endocervical adenocarcinoma. Lymph node metastases were detected in three cases. Three patients developed distant metastases to the adnexa, lungs, inguinal lymph nodes, and small intestine. Two patients experienced disease progression, and three developed postoperative local recurrences. All tumors showed PD-L1 over-expression, with a mean combined positive score of 73.8 (range=30-100). One tumor harbored erb-b2 receptor tyrosine kinase 2 amplification. CONCLUSION ISMC of the uterine cervix exhibits a high risk of recurrence, metastasis, and resistance to chemoradiation therapy. PD-L1 over-expression was consistently observed in all ISMCs. This finding raises the possibility that patients with ISMC may benefit from PD-L1 immunotherapy.
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Affiliation(s)
- Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So-Woon Kim
- Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;
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7
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Sud S, Weiner AA, Wang AZ, Gupta GP, Shen CJ. Prognostic and Predictive Clinical and Biological Factors in HPV Malignancies. Semin Radiat Oncol 2021; 31:309-323. [PMID: 34455986 DOI: 10.1016/j.semradonc.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Human papillomavirus (HPV) causes the majority of oropharyngeal, cervical, and anal cancers, among others. These HPV-associated cancers cause substantial morbidity and mortality despite ongoing vaccination efforts. Aside from the earliest stage tumors, chemoradiation is used to treat most HPV-associated cancers across disease sites. Response rates are variable, and opportunities to improve oncologic control and reduce toxicity remain. HPV malignancies share multiple commonalities in oncogenesis and tumor biology that may inform personalized methods of screening, diagnosis, treatment and surveillance. In this review we discuss the current literature and identify promising molecular targets, prognostic and predictive clinical factors and biomarkers in HPV-associated oropharyngeal, cervical and anal cancer.
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Affiliation(s)
- Shivani Sud
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ashley A Weiner
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC.
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9
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Beaty BT, Moon DH, Shen CJ, Amdur RJ, Weiss J, Grilley-Olson J, Patel S, Zanation A, Hackman TG, Thorp B, Blumberg JM, Patel SN, Weissler MC, Yarbrough WG, Sheets NC, Parker JS, Neil Hayes D, Weck KE, Ramkissoon LA, Mendenhall WM, Dagan R, Tan X, Gupta GP, Chera BS. PIK3CA Mutation in HPV-Associated OPSCC Patients Receiving Deintensified Chemoradiation. J Natl Cancer Inst 2021; 112:855-858. [PMID: 31747025 DOI: 10.1093/jnci/djz224] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/14/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
PIK3CA is the most frequently mutated gene in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). Prognostic implications of such mutations remain unknown. We sought to elucidate the clinical significance of PIK3CA mutations in HPV-associated OPSCC patients treated with definitive chemoradiation (CRT). Seventy-seven patients with HPV-associated OPSCC were enrolled on two phase II clinical trials of deintensified CRT (60 Gy intensity-modulated radiotherapy with concurrent weekly cisplatin). Targeted next-generation sequencing was performed. Of the 77 patients, nine had disease recurrence (two regional, four distant, three regional and distant). Thirty-four patients had mutation(s) identified; 16 had PIK3CA mutations. Patients with wild-type-PIK3CA had statistically significantly higher 3-year disease-free survival than PIK3CA-mutant patients (93.4%, 95% confidence interval [CI] = 85.0% to 99.9% vs 68.8%, 95% CI = 26.7% to 89.8%; P = .004). On multivariate analysis, PIK3CA mutation was the only variable statistically significantly associated with disease recurrence (hazard ratio = 5.71, 95% CI = 1.53 to 21.3; P = .01). PIK3CA mutation is associated with worse disease-free survival in a prospective cohort of newly diagnosed HPV-associated OPSCC patients treated with deintensified CRT.
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Affiliation(s)
- Brian T Beaty
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Dominic H Moon
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC.,University of North Carolina, Chapel Hill, NC.,Department of Medical Oncology, University of Tennessee, Memphis, TN
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | | | | | | | | | | | - Brian Thorp
- Department of Otolaryngology/Head and Neck Surgery
| | | | | | | | | | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | | | | | | | | | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | | | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC
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Sharmin S, Zohura FT, Islam MS, Shimonty A, Khan MAAK, Parveen R, Sharmin F, Ahsan CR, Islam ABMMK, Yasmin M. Mutational profiles of marker genes of cervical carcinoma in Bangladeshi patients. BMC Cancer 2021; 21:289. [PMID: 33736612 PMCID: PMC7977314 DOI: 10.1186/s12885-021-07906-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background Cervical cancer is a gynecologic cancer type that develops in the cervix, accounting for 8% mortality of all female cancer patients. Infection with specific human papillomavirus (HPV) types is considered the most severe risk factor for cervical cancer. In the context of our socioeconomic conditions, an increasing burden of this disease and high mortality rate prevail in Bangladesh. Although several researches related to the epidemiology, HPV vaccination, and treatment modalities were conducted, researches on the mutation profiles of marker genes in cervical cancer in Bangladesh remain unexplored. Methods In this study, five different genomic regions within the top three most frequently mutated genes (EGFR, KRAS and PIK3CA) in COSMIC database with a key role in the development of cervical cancers were selected to study the mutation frequency in Bangladeshi patients. In silico analysis was done in two steps: nucleotide sequence analysis and its corresponding amino acid analysis. Results DNA from 46 cervical cancer tissue samples were extracted and amplified by PCR, using 1 set of primers designed for EGFR and 2 sets of primers designed for two different regions of both PIK3CA and KRAS gene. In total, 39 mutations were found in 26 patient samples. Eleven different mutations (23.91%), twenty-four different mutations (52.17%) and four mutations (8.7%) were found in amplified EGFR, PIK3CA and KRAS gene fragments, respectively; among which 1 (EGFR) was common in seven patient samples and 2 (PIKCA) were found in more than 1 patient. Our study shows that except for KRAS, the frequency of observed mutations in our patients is higher than those reported earlier in other parts of the world. Most of the exonic mutations were found only in the PIK3CA and EGFR genes. Conclusions The study can be used as a basis to build a mutation database for cervical cancer in Bangladesh with the possibility of targetable oncogenic mutations. Further explorations are needed to establish future diagnostics, personalized medicine decisions, and other pharmaceutical applications for specific cancer subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07906-5.
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Affiliation(s)
- Shahana Sharmin
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | - Fatima Tuj Zohura
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh.,Current Affiliation: Internal Medicine OPD, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh
| | - Md Sajedul Islam
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh.,Current Affiliation: Department of Biochemistry and Biotechnology, University of Barisal, Barisal, Bangladesh
| | - Anika Shimonty
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | - Md Abdullah-Al-Kamran Khan
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh.,Current Affiliation Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | | | - Foujia Sharmin
- Department of Gynecological Oncology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | | | | | - Mahmuda Yasmin
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.
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Patrono MG, Calvo MF, Franco JVA, Garrote V, Vietto V. A systematic review and meta-analysis of the prevalence of therapeutic targets in cervical cancer. Ecancermedicalscience 2021; 15:1200. [PMID: 33889209 PMCID: PMC8043690 DOI: 10.3332/ecancer.2021.1200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Indexed: 02/04/2023] Open
Abstract
Cervical Cancer (CC) is a significantly prevalent disease in developing countries. Currently, targeted therapies are not a primary standard of care in CC. This information could be crucial for developing directed therapies and patient screening for biomarkers that would allow personalised treatment of CC. This systematic review aimed to estimate the prevalence of potential therapeutic targets such as the epidermal growth factor receptor (EGFR) and the PI3K/Akt/mTOR and Ras/Raf/MAPK pathways in patients with CC, identified through genomic and non-genomic testing. Studies were identified through an ad-hoc search strategy from the available on MEDLINE (Ovid), CENTRAL, LILACS, SCOPUS, through the Clinical Trial registry on Clinicaltrials.gov, International Clinical Trials Registry Platform, RENIS (Argentine National Registry of Health Research) and grey literature sources. We included 74 studies which represented a total pool of 7,862 participants. Forty-five studies informed mutations of EGFR, with a combined positivity rate of 53% (95%CI: 45%-60%; I2 = 95%). Twenty studies informed the presence of mutations in PIK3CA with a combined positivity rate of 30% (95%CI: 21%-39%; I2 = 96%). Twenty-three studies reported a mutation in Ras, with a combined positivity rate of 14% (95%CI: 8%-21%; I2 = 95%). Raf mutations were informed in six studies. Six studies informed the presence of Akt mutations, two studies informed mTOR mutations and only one study reported mutations of MAPK. The most frequently described therapeutic targets were EGFR, and the PIK3CA and Ras pathways, though inconsistency in positivity rates was significant. Our study did not allow the identification of any specific clinical characteristics that might explain the observed heterogeneity. Despite the overall good quality of the included studies, the applicability of these results to patients' general population with CC is still unclear.
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Affiliation(s)
- Maria Guadalupe Patrono
- Department of Gynecology, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- https://orcid.org/0000-0002-1309-2114
| | - Maria Florencia Calvo
- Department of Gynecology, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- https://orcid.org/0000-0002-2224-1564
| | - Juan Victor Ariel Franco
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Potosí 4265, Buenos Aires C1199ABB, Argentina
- https://orcid.org/0000-0003-0411-899X
| | - Virginia Garrote
- Central Library, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Tte. J. D. Perón 4190, 1º floor, stair J. C1199ABB, Argentina
- https://orcid.org/0000-0002-7328-6228
| | - Valeria Vietto
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Potosí 4265, Buenos Aires C1199ABB, Argentina
- https://orcid.org/0000-0003-4619-9812
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12
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Targeted inhibition of cooperative mutation- and therapy-induced AKT activation in AML effectively enhances response to chemotherapy. Leukemia 2020; 35:2030-2042. [PMID: 33299144 DOI: 10.1038/s41375-020-01094-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 11/09/2022]
Abstract
Most AML patients exhibit mutational activation of the PI3K/AKT signaling pathway, which promotes downstream effects including growth, survival, DNA repair, and resistance to chemotherapy. Herein we demonstrate that the inv(16)/KITD816Y AML mouse model exhibits constitutive activation of PI3K/AKT signaling, which was enhanced by chemotherapy-induced DNA damage through DNA-PK-dependent AKT phosphorylation. Strikingly, inhibitors of either PI3K or DNA-PK markedly reduced chemotherapy-induced AKT phosphorylation and signaling leading to increased DNA damage and apoptosis of inv(16)/KITD816Y AML cells in response to chemotherapy. Consistently, combinations of chemotherapy and PI3K or DNA-PK inhibitors synergistically inhibited growth and survival of clonogenic AML cells without substantially inhibiting normal clonogenic bone marrow cells. Moreover, treatment of inv(16)/KITD816Y AML mice with combinations of chemotherapy and PI3K or DNA-PK inhibitors significantly prolonged survival compared to untreated/single-treated mice. Mechanistically, our findings implicate that constitutive activation of PI3K/AKT signaling driven by mutant KIT, and potentially other mutational activators such as FLT3 and RAS, cooperates with chemotherapy-induced DNA-PK-dependent activation of AKT to promote survival, DNA repair, and chemotherapy resistance in AML. Hence, our study provides a rationale to select AML patients exhibiting constitutive PI3K/AKT activation for simultaneous treatment with chemotherapy and inhibitors of DNA-PK and PI3K to improve chemotherapy response and clinical outcome.
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13
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Watanabe T, Nanamiya H, Kojima M, Nomura S, Furukawa S, Soeda S, Tanaka D, Isogai T, Imai JI, Watanabe S, Fujimori K. Clinical implication of oncogenic somatic mutations in early-stage cervical cancer with radical hysterectomy. Sci Rep 2020; 10:18734. [PMID: 33127935 PMCID: PMC7599240 DOI: 10.1038/s41598-020-72518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
It is well known that tumour initiation and progression are primarily an accumulation of genetic mutations. The mutation status of a tumour may predict prognosis and enable better selection of targeted therapies. In the current study, we analysed a total of 55 surgical tumours from stage IB-IIB cervical cancer (CC) patients who had undergone radical hysterectomy including pelvic lymphadenectomy, using a cancer panel covering 50 highly mutated tumorigenesis-related genes. In 35 patients (63.6%), a total 52 mutations were detected (58.3% in squamous cell carcinoma, 73.7% in adenocarcinoma), mostly in PIK3CA (34.5%) and KRAS and TP53 (9.1%). Being mutation-positive was significantly correlated with pelvic lymph node (PLN) metastasis (P = 0.035) and tended to have a worse overall survival (P = 0.076). In particular, in the patients with squamous cell carcinoma, there was a significant association between being mutation-positive and relapse-free survival (P = 0.041). The patients with PLN metastasis had a significantly worse overall survival than those without (P = 0.006). These results indicate that somatic mutation status is a predictive biomarker for PLN metastasis in early-stage CC, and is consequently related to poor prognosis. Therefore, comprehensive genetic mutations, rather than a single genetic mutation, should be examined widely in order to identify novel genetic indicators with clinical usefulness.
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Affiliation(s)
- Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
| | - Hideaki Nanamiya
- Medical-Industrial Translational Research Center, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Manabu Kojima
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shinji Nomura
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Daisuke Tanaka
- Medical-Industrial Translational Research Center, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Takao Isogai
- Medical-Industrial Translational Research Center, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Jun-Ichi Imai
- Medical-Industrial Translational Research Center, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shinya Watanabe
- Medical-Industrial Translational Research Center, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
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14
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Rashmi R, Jayachandran K, Zhang J, Menon V, Muhammad N, Zahner M, Ruiz F, Zhang S, Cho K, Wang Y, Huang X, Huang Y, McCormick ML, Rogers BE, Spitz DR, Patti GJ, Schwarz JK. Glutaminase Inhibitors Induce Thiol-Mediated Oxidative Stress and Radiosensitization in Treatment-Resistant Cervical Cancers. Mol Cancer Ther 2020; 19:2465-2475. [PMID: 33087507 DOI: 10.1158/1535-7163.mct-20-0271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to determine if radiation (RT)-resistant cervical cancers are dependent upon glutamine metabolism driven by activation of the PI3K pathway and test whether PI3K pathway mutation predicts radiosensitization by inhibition of glutamine metabolism. Cervical cancer cell lines with and without PI3K pathway mutations, including SiHa and SiHa PTEN-/- cells engineered by CRISPR/Cas9, were used for mechanistic studies performed in vitro in the presence and absence of glutamine starvation and the glutaminase inhibitor, telaglenastat (CB-839). These studies included cell survival, proliferation, quantification of oxidative stress parameters, metabolic tracing with stable isotope-labeled substrates, metabolic rescue, and combination studies with L-buthionine sulfoximine (BSO), auranofin (AUR), and RT. In vivo studies of telaglenastat ± RT were performed using CaSki and SiHa xenografts grown in immune-compromised mice. PI3K-activated cervical cancer cells were selectively sensitive to glutamine deprivation through a mechanism that included thiol-mediated oxidative stress. Telaglenastat treatment decreased total glutathione pools, increased the percent glutathione disulfide, and caused clonogenic cell killing that was reversed by treatment with the thiol antioxidant, N-acetylcysteine. Telaglenastat also sensitized cells to killing by glutathione depletion with BSO, thioredoxin reductase inhibition with AUR, and RT. Glutamine-dependent PI3K-activated cervical cancer xenografts were sensitive to telaglenastat monotherapy, and telaglenastat selectively radiosensitized cervical cancer cells in vitro and in vivo These novel preclinical data support the utility of telaglenastat for glutamine-dependent radioresistant cervical cancers and demonstrate that PI3K pathway mutations may be used as a predictive biomarker for telaglenastat sensitivity.
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Affiliation(s)
- Ramachandran Rashmi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kay Jayachandran
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jin Zhang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri
| | - Vishnu Menon
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, India
| | - Naoshad Muhammad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Zahner
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Fiona Ruiz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Sisi Zhang
- Department of Chemistry, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin Cho
- Department of Chemistry, Washington University School of Medicine, St. Louis, Missouri
| | - Yuting Wang
- Department of Chemistry, Washington University School of Medicine, St. Louis, Missouri
| | - Xiaojing Huang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael L McCormick
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Buck E Rogers
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas R Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Gary J Patti
- Department of Chemistry, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. .,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Center, Washington University School of Medicine, St. Louis, Missouri
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15
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Yoshimoto Y, Sasaki Y, Murata K, Noda SE, Miyasaka Y, Hamamoto J, Furuya M, Hirato J, Suzuki Y, Ohno T, Tokino T, Oike T, Nakano T. Mutation profiling of uterine cervical cancer patients treated with definitive radiotherapy. Gynecol Oncol 2020; 159:546-553. [PMID: 32951893 DOI: 10.1016/j.ygyno.2020.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To elucidate tumor mutation profiles associated with outcomes of uterine cervical cancer (UCC) patients treated with definitive radiotherapy. METHODS Ninety-eight patients with newly diagnosed and pathologically confirmed UCC (82 squamous cell carcinomas, 12 adenocarcinomas, and four adenosquamous carcinomas) who were treated with definitive radiotherapy were analyzed. DNA was extracted from pre-treatment tumor biopsy specimens. The exons of 409 cancer-related genes were sequenced using a next-generation sequencer. Genetic mutations were identified and analyzed for correlations with clinical outcome. RESULTS Recurrent mutations were observed in PIK3CA (35.7%), ARID1A (25.5%), NOTCH1 (19.4%), FGFR3 (16.3%), FBXW7 (19.4%), TP53 (13.3%), EP300 (12.2%), and FGFR4 (10.2%). The prevalence of mutations in FGFR family genes (i.e., FGFR1-4) was almost as high (24.5%) as that in PIK3CA and ARID1A, both of which are well-studied drivers of UCC. Fifty-five percent (21 of 38) of the identified FGFR mutations were located in the FGFR protein tyrosine kinase domain. Five-year progression-free survival (PFS) rates for FGFR mutation-positive patients (n = 24) were significantly worse than those for FGFR mutation-negative patients (n = 74) (43.9% vs. 68.5%, respectively; P = 0.010). Multivariate analysis identified FGFR mutations as significant predictors of worse 5 year PFS (P = 0.005), independent of clinicopathological variables. CONCLUSIONS FGFR mutations are associated with worse PFS in UCC patients treated with definitive radiotherapy. These results warrant further validation in prospective studies.
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Affiliation(s)
- Yuya Yoshimoto
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan; Department of Radiation Oncology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasushi Sasaki
- Center for Medical Education, Sapporo Medical University, Sapporo, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuhei Miyasaka
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan
| | - Junko Hamamoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mio Furuya
- Department of Pathology, Maebashi Red Cross Hospital, Maebashi, Japan; Department of Pathology, Gunma University Hospital, Maebashi, Japan
| | - Junko Hirato
- Department of Pathology, Gunma University Hospital, Maebashi, Japan; Department of Pathology, Public Tomioka General Hospital, Maebashi, Japan
| | - Yoshiyuki Suzuki
- Department of Radiation Oncology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan
| | - Takashi Tokino
- Research Institute for Frontier Medicine, Sapporo Medical University, Sapporo, Japan
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan.
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma Graduate School of Medicine, Maebashi, Japan; National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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16
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Nimotuzumab with Concurrent Chemoradiation in the Treatment of Locally Advanced Cervical Cancer: A Single-Centre Experience. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Martell K, McIntyre JB, Kornaga EN, Chan AMY, Phan T, Köbel M, Enwere EK, Dean ML, Ghatage P, Lees-Miller SP, Doll CM. PIK3CA mutation and CNV status and post-chemoradiotherapy survival in patients with cervical cancer. Gynecol Oncol 2020; 158:776-784. [PMID: 32653099 DOI: 10.1016/j.ygyno.2020.06.506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/25/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to describe the prognostic value of PI3K/AKT pathway mutations in a large cohort of patients with cervical cancer. EXPERIMENTAL DESIGN Patients with pre-treatment archival specimens, diagnosed with FIGO stages IB-IVA cervical cancer between 1998 and 2014 and treated with radical, curative intent chemoradiotherapy (CRT) at a single center were identified. Mutational status was determined by next generation sequencing and PIK3CA copy number (CNV) was assessed by digital PCR. RESULTS 190 patients with available pre-treatment tumor specimens were identified. Median OS and PFS were 57.4 and 46.0 months, respectively. A total of 161 tumors were successfully sequenced; 60 (37.3%) had PI3K/AKT pathway mutations, with 50 (30.1%) having PIK3CA hotspot mutations. PIK3CA CNV gain was noted in 79 (59.2%) of the 154 successfully analyzed. On univariate analysis, PIK3CA mutation was associated with poor OS (HR 1.73; 95% CI: 1.03-2.92; p = .037) but not PFS (HR 1.38; 0.84-2.28; p = .204). Absence of any PI3K/AKT pathway mutation was associated with improved OS (HR 1.68; 1.01-2.81; p = .046) but not PFS (HR 1.50; 0.93-2.43; p = .202). Associations were not maintained when adjusting for clinical factors. On univariate analysis, PIK3CA mutation positive, CNV normal tumors were associated with poorer OS (HR 2.55; 1.18-5.50; p = .017) and trend to worse PFS (HR 1.87; 0.90-3.83; p = .094) when compared to those with CNV gain and wildtype PIK3CA. CONCLUSIONS PI3K/AKT pathway mutations are common in cervical cancer. Consideration of PIK3CA mutational status with CNV status may be important in predicting outcome in cervical cancer patients.
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Affiliation(s)
- Kevin Martell
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John B McIntyre
- Precision Oncology Hub, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Elizabeth N Kornaga
- Precision Oncology Hub, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Angela M Y Chan
- Precision Oncology Hub, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Tien Phan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Emeka K Enwere
- Precision Oncology Hub, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Michelle L Dean
- Precision Oncology Hub, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Prafull Ghatage
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan P Lees-Miller
- Department of Biochemistry and Molecular Biology, Oncology and Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Corinne M Doll
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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18
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Chargari C, Levy A, Paoletti X, Soria JC, Massard C, Weichselbaum RR, Deutsch E. Methodological Development of Combination Drug and Radiotherapy in Basic and Clinical Research. Clin Cancer Res 2020; 26:4723-4736. [PMID: 32409306 DOI: 10.1158/1078-0432.ccr-19-4155] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/14/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023]
Abstract
Newer technical improvements in radiation oncology have been rapidly implemented in recent decades, allowing an improved therapeutic ratio. The development of strategies using local and systemic treatments concurrently, mainly targeted therapies, has however plateaued. Targeted molecular compounds and immunotherapy are increasingly being incorporated as the new standard of care for a wide array of cancers. A better understanding of possible prior methodology issues is therefore required and should be integrated into upcoming early clinical trials including individualized radiotherapy-drug combinations. The outcome of clinical trials is influenced by the validity of the preclinical proofs of concept, the impact on normal tissue, the robustness of biomarkers and the quality of the delivery of radiation. Herein, key methodological aspects are discussed with the aim of optimizing the design and implementation of future precision drug-radiotherapy trials.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Xavier Paoletti
- University of Versailles St. Quentin, France
- Institut Curie INSERM U900, Biostatistics for Personalized Medicine Team, St. Cloud, France
| | | | - Christophe Massard
- Université Paris-Sud, Orsay, France
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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19
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Leblanc O, Vacher S, Lecerf C, Jeannot E, Klijanienko J, Berger F, Hoffmann C, Calugaru V, Badois N, Chilles A, Lesnik M, Krhili S, Bieche I, Le Tourneau C, Kamal M. Biomarkers of cetuximab resistance in patients with head and neck squamous cell carcinoma. Cancer Biol Med 2020; 17:208-217. [PMID: 32296588 PMCID: PMC7142836 DOI: 10.20892/j.issn.2095-3941.2019.0153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: In patients with head and neck squamous cell carcinoma (HNSCC), cetuximab [a monoclonal antibody targeting epidermal growth factor receptor (EGFR)] has been shown to improve overall survival when combined with radiotherapy in the locally advanced setting or with chemotherapy in first-line recurrent and/or metastatic (R/M) setting, respectively. While biomarkers of resistance to cetuximab have been identified in metastatic colorectal cancer, no biomarkers of efficacy have been identified in HNSCC. Here, we aimed to identify biomarkers of cetuximab sensitivity/resistance in HNSCC. Methods: HNSCC patients treated with cetuximab at the Curie Institute, for whom complete clinicopathological data and formalin-fixed paraffin-embedded (FFPE) tumor tissue collected before cetuximab treatment were available, were included. Immunohistochemistry analyses of PTEN and EGFR were performed to assess protein expression levels. PIK3CA and H/N/KRAS mutations were analyzed using high-resolution melting (HRM) and Sanger sequencing. We evaluated the predictive value of these alterations in terms of progression-free survival (PFS). Results: Hot spot activating PIK3CA and KRAS/HRAS mutations were associated with poor PFS among HNSCC patients treated with cetuximab in the first-line R/M setting, but not among HNSCC patients treated with cetuximab in combination with radiotherapy. Loss of PTEN protein expression had a negative predictive value among HNSCC patients treated with cetuximab and radiotherapy. High EGFR expression did not predict cetuximab sensitivity in our patient population. Conclusions: Hot spot activating PIK3CA and RAS mutations predicted cetuximab resistance among HNSCC patients in the first-line R/M setting, whereas loss of PTEN protein expression predicted resistance to cetuximab when combined to radiotherapy.
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Affiliation(s)
- Olivia Leblanc
- Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
| | - Sophie Vacher
- Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
| | - Charlotte Lecerf
- Department of Drug Development and Innovation (D3i), Curie Institute, PSL Research University, Paris 75005, France
| | - Emmanuelle Jeannot
- Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
- Department of Pathology, Curie Institute, PSL Research University, Paris 75005, France
| | - Jerzy Klijanienko
- Department of Pathology, Curie Institute, PSL Research University, Paris 75005, France
| | - Frédérique Berger
- Department of Biostatistics, Curie Institute, PSL Research University, Paris 75005, France
| | - Caroline Hoffmann
- Department of Surgery, Curie Institute, PSL Research University, Paris 75005, France
- INSERM U932 Research Unit, Paris 75005, France
| | - Valentin Calugaru
- Department of Radiotherapy, Curie Institute, PSL Research University, Paris 75005, France
| | - Nathalie Badois
- Department of Surgery, Curie Institute, PSL Research University, Paris 75005, France
| | - Anne Chilles
- Department of Radiotherapy, Curie Institute, PSL Research University, Paris 75005, France
| | - Maria Lesnik
- Department of Surgery, Curie Institute, PSL Research University, Paris 75005, France
| | - Samar Krhili
- Department of Surgery, Curie Institute, PSL Research University, Paris 75005, France
| | - Ivan Bieche
- Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
- EA7331, Faculty of Pharmaceutical and Biological Sciences, Paris Descartes University, Paris 75005, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Curie Institute, PSL Research University, Paris 75005, France
- INSERM U900 Research Unit, Curie Institute, Paris 75005, France
| | - Maud Kamal
- Department of Drug Development and Innovation (D3i), Curie Institute, PSL Research University, Paris 75005, France
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20
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Higher Anti-Tumor Efficacy of the Dual HER3-EGFR Antibody MEHD7945a Combined with Ionizing Irradiation in Cervical Cancer Cells. Int J Radiat Oncol Biol Phys 2020; 106:1039-1051. [PMID: 31959545 DOI: 10.1016/j.ijrobp.2019.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/23/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The outcome of locally advanced cervical cancer (LACC) is dismal. Biomarkers are needed to individualize treatments and to improve patient outcomes. Here, we investigated whether coexpression of epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 3 (HER3) could be an outcome prognostic biomarker, and whether targeting both EGFR and HER3 with a dual antibody (MEHD7945A) enhanced ionizing radiation (IR) efficacy. METHODS AND MATERIALS Expression of EGFR and HER3 was evaluated by immunohistochemistry in cancer biopsies (n = 72 patients with LACC). The antitumor effects of the MEHD7945A and IR combotherapy were assessed in 2 EGFR- and HER3-positive cervical cancer cell lines (A431 and CaSki) and in A431 cell xenografts. The mechanisms involved in tumor cell radiosensitization were also studied. The interaction of MEHD7945A, IR, and cisplatin was evaluated using dose-response matrix data. RESULTS EGFR and HER3 were coexpressed in only in 7 of the 22 biopsies of FIGO IVB cervix cancer. The median overall survival was 14.6 months and 23.1 months in patients with FIGO IVB tumors that coexpressed or did not coexpress EGFR and HER3, respectively. In mice xenografted with A431 (squamous cell carcinoma) cells, MEHD7945A significantly increased IR response by reducing tumor growth and increasing cleaved caspase-3 expression. In A431 and CaSki cells, the combotherapy increased DNA damage and cell death, particularly immunogenic cell death, and decreased survival by inhibiting the MAPK and AKT pathways. An additive effect was observed when IR, MEHD7945A, and cisplatin were combined. CONCLUSIONS Targeting EGFR and HER3 with a specific dual antibody enhanced IR efficacy. These preliminary results and the prognostic value of EGFR and HER3 coexpression should be confirmed in a larger sample.
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21
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Chen W, Li T, Wang J, Liang L, Huang D, Yan G, Tian Y, Zhang X, Zhang W. Clinical study of nimotuzumab combined with concurrent radiochemotherapy for treatment of locally advanced cervical cancer. Cancer Manag Res 2019; 11:8157-8165. [PMID: 31564975 PMCID: PMC6731987 DOI: 10.2147/cmar.s191134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/11/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Nimotuzumab is a humanized monoclonal antibody that targets the epidermal growth factor receptor (EGFR) to inhibit tumor growth. Nimotuzumab has demonstrated desirable therapeutic activity in various types of tumors. However, the benefit of nimotuzumab for the treatment of cervical cancer is not entirely clear. The present study aimed to investigate the effects of nimotuzumab in the presence of CCRT in the first-line treatment of locally advanced cervical cancer (LACC). METHODS The therapeutic efficacy and side effects of nimotuzumab combined with concurrent radiochemotherapy (CCRT) were retrospectively assessed in inoperable patients with LACC (stage IIb-IIIb) who were treated using CCRT with or without nimotuzumab. RESULTS The complete response rate of study group was significantly better than control group (78.3% vs 50%, P=0.035). The difference in median progression-free survival (PFS) in the two groups was statistically significan (not reach vs 27 months, P=0.037). Multivariate comparisons of prognostic factors in the two groups indicated that both the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage and combined nimotuzumab treatment affected PFS (P<0.05). Although generally tolerable, grade 3-4 toxicities including leukopenia (P=0.025) and hemoglobin (P=0.026) reduction were more frequent in the control group than those in the study group. CONCLUSION These data suggest that combining nimotuzumab with CCRT for the treatment of LACC resulted in extended PFS and higher complete remission rates, without an increased incidence of adverse events.
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Affiliation(s)
- Wenli Chen
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Tao Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Jian Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Long Liang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Dandan Huang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Gaoshu Yan
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan610041, People’s Republic of China
| | - Ye Tian
- Department of Thoracic Tumor Surgery, The Fifth People’s Hospital of Chengdu, Chengdu611130, People’s Republic of China
| | - Xiaoli Zhang
- Department of Breast and Thyroid Surgery, The Fifth People’s Hospital of Chengdu, Chengdu611130, People’s Republic of China
| | - Wei Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu610041, People’s Republic of China
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The MITO CERV-2 trial: A randomized phase II study of cetuximab plus carboplatin and paclitaxel, in advanced or recurrent cervical cancer. Gynecol Oncol 2019; 153:535-540. [DOI: 10.1016/j.ygyno.2019.03.260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 01/08/2023]
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Clinical and genetic landscape of treatment naive cervical cancer: Alterations in PIK3CA and in epigenetic modulators associated with sub-optimal outcome. EBioMedicine 2019; 43:253-260. [PMID: 30952619 PMCID: PMC6562019 DOI: 10.1016/j.ebiom.2019.03.069] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is a lack of information as to which molecular processes, present at diagnosis, favor tumour escape from standard-of-care treatments in cervical cancer (CC). RAIDs consortium (www.raids-fp7.eu), conducted a prospectively monitored trial, [BioRAIDs (NCT02428842)] with the objectives to generate high quality samples and molecular assessments to stratify patient populations and to identify molecular patterns associated with poor outcome. METHODS Between 2013 and 2017, RAIDs collected a prospective CC sample and clinical dataset involving 419 participant patients from 18 centers in seven EU countries. Next Generation Sequencing has so far been carried out on a total of 182 samples from 377 evaluable (48%) patients, allowing to define dominant genetic alterations. Reverse phase protein expression arrays (RPPA) was applied to group patients into clusters. Activation of key genetic pathways and protein expression signatures were tested for associations with outcome. FINDINGS At a median follow up (FU) of 22 months, progression-free survival rates of this FIGO stage IB1-IV population, treated predominantly (87%) by chemoradiation, were65•4% [CI95%: 60•2-71.1]. Dominant oncogenic alterations were seen in PIK3CA (40%), while dominant suppressor gene alterations were seen in KMT2D (15%) and KMT2C (16%). Cumulative frequency of loss-of-function (LOF) mutations in any epigenetic modulator gene alteration was 47% and it was associated with PIK3CA gene alterations in 32%. Patients with tumours harboring alterations in both pathways had a significantly poorer PFS. A new finding was the detection of a high frequency of gains of TLR4 gene amplifications (10%), as well as amplifications, mutations, and non-frame-shift deletions of Androgen receptor (AR) gene in 7% of patients. Finally, RPPA protein expression analysis defined three expression clusters. INTERPRETATION Our data suggests that patient population may be stratified into four different treatment strategies based on molecular markers at the outset. FUND: European Union's Seventh Program grant agreement No 304810.
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Wang X, Gu Y, Liu H, Shi L, Sun X. Icotinib hydrochloride enhances chemo- and radiosensitivity by inhibiting EGFR signaling and attenuating RAD51 expression and function in Hela S3 cells. Onco Targets Ther 2018; 11:1245-1258. [PMID: 29551903 PMCID: PMC5843137 DOI: 10.2147/ott.s152613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Radiotherapy and cisplatin-based chemotherapy are currently considered as standard treatments employed for advanced cervical cancer (CC). However, patients with local recurrence or distant metastasis continue to have poor outcomes. EGFR overexpression correlated with chemo/radioresistance, and disease failure has been well proved in the previous studies. Hence, the aim of this study was to explore the therapeutic efficacy and underlying mechanism of the sensitization to radiation or cisplatin of icotinib hydrochloride (IH), a high-selective EGFR tyrosine kinase inhibitor (TKI), in the Hela S3 human CC cell line. Methods Cell proliferation was measured with cell counting kit-8 (CCK-8) assay. Flow cytometry analysis was performed to examine cell cycle distribution and apoptosis. The phosphorylation of EGFR and its downstream signaling molecules were measured by Western blot analysis. γ-H2AX foci and RAD51 foci in the cellular nucleus were visualized using immunofluoresence staining. Expression levels of RAD51 in the whole cells and subceullar fractions were detected to demonstrate the impact of IH on DNA repair. Results IH can significantly inhibit cell proliferation, redistribute cell cycle, enhance apoptosis and impair DNA damage response of Hela S3 cells following radiation or cisplatin treatment through suppressing the activation of the EGFR signaling pathway and attenuating the expression and function of homologous recombination (HR) protein RAD51. Conclusion This study suggests that IH is a potential sensitizer in radiotherapy and cisplatin-based chemotherapy for CC and RAD51 may serve as a prognosis biomarker for this combination treatment.
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Affiliation(s)
- Xuanxuan Wang
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanjun Gu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hai Liu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liming Shi
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaonan Sun
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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25
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Deutsch E, Haie-Meder C, Bayar MA, Mondini M, Laporte M, Mazeron R, Adam J, Varga A, Vassal G, Magné N, Chargari C, Lanoy E, Pautier P, Levy A, Soria JC. Phase I trial evaluating the antiviral agent Cidofovir in combination with chemoradiation in cervical cancer patients. Oncotarget 2018; 7:25549-57. [PMID: 27016411 PMCID: PMC5041925 DOI: 10.18632/oncotarget.8224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/06/2016] [Indexed: 01/23/2023] Open
Abstract
Purpose This phase I trial aimed to assess the safety and determine the recommended Phase II dose (RP2D) of Cidofovir combined with chemoradiotherapy in patients with stage IB2-IVA cervical cancer. Experimental design Incremental doses (1, 2.5, 5 and 6.5 mg/kg) of IV Cidofovir were administered weekly for two weeks, and then every 2 weeks from the start of chemoradiotherapy to the initiation of utero-vaginal brachytherapy. Biological expression of HPV was analyzed during treatment and tumor response was assessed according to RECIST v1.0 criteria. Results A total of 15 patients were treated with Cidofovir. Dose-limiting toxicities occurred in 2/6 patients at the 6.5 mg/kg dose level (G3 proteinuria, and G3 acute pyelonephritis with G3 febrile neutropenia). No toxicity occurred at the 5 mg/kg dose level, but only 3 patients received this dose due to trial interruption because of low accrual. The most frequent G3-4 adverse effects observed during the trial were: abdominal pain (n=3), infection (n=2), leuckoneutropenia (n=2), and others (n=6). No toxic death or major renal side effect occurred. The best response was that 8/9 evaluable patients achieved a complete response (89%). In the intention to treat population, the 2-year overall and progression-free survival rates were 93% and 76%, respectively. Biological monitoring of HPV-related markers (decreased p16 expression, and increased p53 and pRb levels) was possible on sequential tumor biopsy samples. The genomic alterations identified were PIK3CA (n=5; one also had a KRAS mutation), and HRAS (n=1) mutations. Conclusion Cidofovir at a dose of 5mg/kg combined with chemoradiotherapy appeared tolerable and yielded tumor regressions. Due to early trial interruption, the RP2D was not confirmed.
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Affiliation(s)
- Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,Paris-Sud University, Kremlin-Bicêtre Medical University, DHU TORINO, SIRIC SOCRATES, LABEX LERMIT, Le Kremlin-Bicêtre, France.,INSERM U1030 Molecular Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France
| | - Mohamed Amine Bayar
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michele Mondini
- INSERM U1030 Molecular Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Mélanie Laporte
- Department of Medical Biology and Pathology, Translational Research Laboratory and Biobank (UMS3655 CNRS/US23 INSERM), INSERM Unit U981, Villejuif, France
| | - Renaud Mazeron
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France
| | - Julien Adam
- Department of Medical Biology and Pathology, Translational Research Laboratory and Biobank (UMS3655 CNRS/US23 INSERM), INSERM Unit U981, Villejuif, France
| | - Andrea Varga
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,INSERM U1030 Molecular Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Emilie Lanoy
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, Villejuif, France.,Inserm U1018 Centre for Research in Epidemiology and Population Health, Paris-Sud University, Villejuif, France
| | - Patricia Pautier
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,INSERM U1030 Molecular Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.,Paris-Sud University, Kremlin-Bicêtre Medical University, DHU TORINO, SIRIC SOCRATES, LABEX LERMIT, Le Kremlin-Bicêtre, France
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26
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Belin L, De Rycke Y, Broët P. A two-stage design for phase II trials with time-to-event endpoint using restricted follow-up. Contemp Clin Trials Commun 2017; 8:127-134. [PMID: 29696201 PMCID: PMC5898579 DOI: 10.1016/j.conctc.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/01/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022] Open
Abstract
In phase II oncology trials, the use of new cytostatic drugs raises some questions regarding the endpoint. Time-to-event endpoints such as Progression-Free Survival have been recommended and led to new designs. In 2003, Case and Morgan proposed a design based on the comparison of the cumulative hazards at a clinically relevant timepoint. In 2013, Kwak proposed a design based on the one-sample log-rank test. If all the patients are followed from their entry time to the analysis date, the Kwak and Jung's design leads to a smaller sample size as compared to the Case-Morgan's design. However, the Case and Morgan's design requires less information since it only needs to follow every patient during a fixed interval of time. We propose a trade-off between these two approaches that corresponds to an adaptation of Kwak and Jung's design when the follow-up is expected to be restricted. Our proposal is based on the one-sample log-rank test as the Kwak and Jung's design but it uses the same follow-up information as the Case-Morgan's design. Simulation study shows that our proposal allows reducing the sample size as compared to the Case-Morgan's design (median difference of 23% [15%-33%]). Type I and type II error rates are close to their nominal rates planned in the protocol. A real phase II clinical trial in cervical cancer illustrated the interest of this new design. Thus, our proposal can be recommended as an alternative to the Kwak's design when patients' follow-up is restricted.
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Affiliation(s)
- Lisa Belin
- Institut Curie, Service de Biométrie, Paris, 75005, France
- APHP, Hôpital Pitié Salpêtrière, CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, 75013, France
- Université Pierre et Marie Curie, Sorbonne Universités, Paris, 75013, France
| | - Yann De Rycke
- APHP, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, 75013, France
- INSERM, CIC-1421, UMR 1123, ECEVE, Paris, 75013, France
| | - Philippe Broët
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, 14-16 Avenue Paul-Vaillant Couturier, Villejuif, 94807, France
- APHP, Hôpital Paul Brousse, 14-16 Avenue Paul-Vaillant Couturier, Villejuif, 94807, France
- School of Public Health, University of Montreal, Montreal, QC, Canada
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Koncar RF, Feldman R, Bahassi EM, Hashemi Sadraei N. Comparative molecular profiling of HPV-induced squamous cell carcinomas. Cancer Med 2017; 6:1673-1685. [PMID: 28556593 PMCID: PMC5504316 DOI: 10.1002/cam4.1108] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/29/2017] [Accepted: 04/30/2017] [Indexed: 12/21/2022] Open
Abstract
Approximately 5% of all cancer incidences result from human papillomavirus (HPV) infection. HPV infection most commonly leads to cancers of the anogenital region or oropharynx. It is unknown whether different HPV-mediated cancers collectively share a molecular signature and it is important to determine if there are targetable alterations common to different types of HPV-positive tumors. We analyzed 743 p53 wild-type samples of anal, cervical, oropharyngeal, and vulvar squamous cell carcinomas which underwent multiplatform testing at a commercial molecular profiling service. Expression of 24 proteins was measured by immunohistochemistry (IHC), mutation of 48 genes was determined by next-generation and Sanger sequencing, and copy number alteration for six genes was determined by in situ hybridization. The four cohorts had remarkably similar molecular profiles. No gene had a statistically significant difference in mutation frequency or copy number change between the four different types of squamous cell carcinomas. The only significant differences between cohorts were frequency of ERCC1 and SPARC loss as determined by IHC. In all four cancer types, oncogene mutation and PD-L1 expression was relatively infrequent. The most commonly mutated gene was PIK3CA, with mutations most often affecting the helical domain of the protein and accompanied by concurrent lack of PTEN expression. Loss of MGMT and RRM1 was common among the four cohorts and may be predictive of response to cytotoxic therapies not currently being used to treat these cancer types. The similar molecular profiles of the four cohorts indicate that treatment strategies may be similarly efficacious across HPV-positive cancers.
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Affiliation(s)
- Robert F Koncar
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
| | | | - El Mustapha Bahassi
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Nooshin Hashemi Sadraei
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
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Cossar LH, Schache AG, Risk JM, Sacco JJ, Jones NJ, Lord R. Modulating the DNA Damage Response to Improve Treatment Response in Cervical Cancer. Clin Oncol (R Coll Radiol) 2017; 29:626-634. [PMID: 28336131 DOI: 10.1016/j.clon.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 01/06/2023]
Abstract
Cervical cancer is the fourth most common cause of cancer-related death in women worldwide and new therapeutic approaches are needed to improve clinical outcomes for this group of patients. Current treatment protocols for locally advanced and metastatic disease consist of ionising radiation and chemotherapy. Chemoradiation induces cytotoxic levels of DNA double-strand breaks, which activates programmed cell death via the DNA damage response (DDR). Cervical cancers are unique given an almost exclusive association with human papillomavirus (HPV) infection; a potent manipulator of the DDR, with the potential to alter tumour sensitivity to DNA-damaging agents and influence treatment response. This review highlights the wide range of therapeutic strategies in development that have the potential to modulate DDR and sensitise cervical tumours to DNA-damaging agents in the context of HPV oncogenesis.
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Affiliation(s)
- L H Cossar
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK.
| | - A G Schache
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J M Risk
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J J Sacco
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK
| | - N J Jones
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - R Lord
- Clatterbridge Cancer Centre, Wirral, UK
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29
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Jones CM, Goh V, Sebag-Montefiore D, Gilbert DC. Biomarkers in anal cancer: from biological understanding to stratified treatment. Br J Cancer 2017; 116:156-162. [PMID: 27923035 PMCID: PMC5243987 DOI: 10.1038/bjc.2016.398] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 12/27/2022] Open
Abstract
Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review.
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Affiliation(s)
- Christopher M Jones
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - David Sebag-Montefiore
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
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30
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De Rosa M, Rega D, Costabile V, Duraturo F, Niglio A, Izzo P, Pace U, Delrio P. The biological complexity of colorectal cancer: insights into biomarkers for early detection and personalized care. Therap Adv Gastroenterol 2016; 9:861-886. [PMID: 27803741 PMCID: PMC5076770 DOI: 10.1177/1756283x16659790] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer has been ranked the third and second most prevalent of all cancers in men and women, respectively, and it represents the fourth most common cause of cancer deaths. In 2012, there were 1.4 million estimated cases of colorectal cancer worldwide, and 700,000 estimated deaths, which implies significant impact on public health, especially in economically-developed countries. In recent years, there has been an increase in the number of tumors, although this has been accompanied by decreased mortality, due to more appropriate and available information, earlier diagnosis, and improvements in treatment. Colorectal cancers are characterized by great genotypic and phenotypic heterogeneity, including tumor microenvironment and interactions between healthy and cancer cells. All of these traits confer a unique peculiarity to each tumor, which can thus be considered as an individual disease. Well conducted molecular and clinical characterization of each colorectal cancer is essential with a view to the implementation of precision oncology, and thus personalized care. This last aims at standardization of therapeutic plans chosen according to the genetic background of each specific neoplasm, to increase overall survival and reduce treatment side effects. Thus, prognostic and predictive molecular biomarkers assume a critical role in the characterization of colorectal cancer and in the determination of the most appropriate therapy.
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Affiliation(s)
- Marina De Rosa
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Valeria Costabile
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Francesca Duraturo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Antonello Niglio
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Paola Izzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Ugo Pace
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
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Abstract
PURPOSE OF REVIEW Recent peer-reviewed publications on the treatment of early, locally advanced and advanced cervical cancer patients are reviewed to gain insight into the main research done in the field. RECENT FINDINGS In early-stage patients where cure is offered to most patients, research focuses on more conservative or less morbid approaches to increase quality of life and reduce the treatment-related sexual dysfunction. No major advances have occurred for treating locally advanced disease since the introduction of concurrent chemoradiation, but efforts are directed to increase efficacy while reducing toxicity with the use of combination chemoradiation and modern radiation technologies. Molecular-targeted therapy and identification of targetable gene alterations as well as immunotherapy are actively pursued in patients with advanced disease. SUMMARY Although global statistics indicate a trend for decreased age-standardized incidence rates, social and economical factors impede the uptake of therapeutic advances achieved as many patients have no access even to basic resources for treating cancer. The adherence to quality indicators in delivery of optimized standard concurrent chemoradiation and adherence to guidelines in cervical cancer surgery must not be underestimated. Major efforts are needed in both the scientific and social aspects of cervical cancer treatment to reduce mortality.
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Mutational analysis of anal cancers demonstrates frequent PIK3CA mutations associated with poor outcome after salvage abdominoperineal resection. Br J Cancer 2016; 114:1387-94. [PMID: 27219019 PMCID: PMC4984471 DOI: 10.1038/bjc.2016.144] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A better understanding of the molecular profile of anal squamous cell carcinomas (ASCCs) is necessary to consider new therapeutic approaches, and the identification of prognostic and predictive factors for response to treatment. METHODS We retrospectively analysed tumours from ASCC patients for mutational analysis of KRAS, NRAS, HRAS, BRAF, PIK3CA, MET, TP53 and FBXW7 genes by HRM and Sanger sequencing analysis. RESULTS Specimens from 148 patients were analysed: 96 treatment-naive tumours and 52 recurrences after initial radiotherapy (RT) or chemoradiotherapy (CRT). Mutations of KRAS, PIK3CA, FBXW7 and TP53 genes were present in 3 (2.0%), 30 (20.3%), 9 (6.1%) and 7 tumours (4.7%), respectively. The distribution of the mutations was similar between treatment-naive tumours and recurrences, except for TP53 mutations being more frequent in recurrences (P=0.0005). In patients treated with abdominoperineal resection (APR) after relapse (n=38, median follow-up of 18.2 years), overall survival (OS) was significantly correlated with HPV16 status (P=0.048), gender (P=0.045) and PIK3CA mutation (P=0.037). The PIK3CA status retained its prognostic significance in Cox multivariate regression analysis (P=0.025). CONCLUSIONS Our study identified PIK3CA mutation as an independent prognostic factor in patients who underwent APR for ASCC recurrence, suggesting a potential benefit from adjuvant treatment and the evaluation of targeted therapies with PI3K/Akt/mTor inhibitors in PIK3CA-mutated patients.
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Tinhofer I, Budach V, Saki M, Konschak R, Niehr F, Jöhrens K, Weichert W, Linge A, Lohaus F, Krause M, Neumann K, Endris V, Sak A, Stuschke M, Balermpas P, Rödel C, Avlar M, Grosu A, Abdollahi A, Debus J, Belka C, Pigorsch S, Combs S, Mönnich D, Zips D, Baumann M. Targeted next-generation sequencing of locally advanced squamous cell carcinomas of the head and neck reveals druggable targets for improving adjuvant chemoradiation. Eur J Cancer 2016; 57:78-86. [DOI: 10.1016/j.ejca.2016.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 12/22/2022]
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Dirican E, Akkiprik M, Özer A. Mutation distributions and clinical correlations of PIK3CA gene mutations in breast cancer. Tumour Biol 2016; 37:7033-45. [PMID: 26921096 DOI: 10.1007/s13277-016-4924-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BCa) is the most common cancer and the second cause of death among women. Phosphoinositide 3-kinase (PI3K) signaling pathway has a crucial role in the cellular processes such as cell survival, growth, division, and motility. Moreover, oncogenic mutations in the PI3K pathway generally involve the activation phosphatidylinositol-4,5-bisphosphate 3-kinase-catalytic subunit alpha (PIK3CA) mutation which has been identified in numerous BCa subtypes. In this review, correlations between PIK3CA mutations and their clinicopathological parameters on BCa will be described. It is reported that PIK3CA mutations which have been localized mostly on exon 9 and 20 hot spots are detected 25-40 % in BCa. This relatively high frequency can offer an advantage for choosing the best treatment options for BCa. PIK3CA mutations may be used as biomarkers and have been major focus of drug development in cancer with the first clinical trials of PI3K pathway inhibitors currently in progress. Screening of PIK3CA gene mutations might be useful genetic tests for targeted therapeutics or diagnosis. Increasing data about PIK3CA mutations and its clinical correlations with BCa will help to introduce new clinical applications in the near future.
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Affiliation(s)
- Ebubekir Dirican
- Department of Medical Biology, School of Medicine, Marmara University, Başıbüyük Mah., Maltepe Başıbüyük Yolu Sok., No: 9/1, 34854, Maltepe, Istanbul, Turkey
| | - Mustafa Akkiprik
- Department of Medical Biology, School of Medicine, Marmara University, Başıbüyük Mah., Maltepe Başıbüyük Yolu Sok., No: 9/1, 34854, Maltepe, Istanbul, Turkey.
| | - Ayşe Özer
- Department of Medical Biology, School of Medicine, Marmara University, Başıbüyük Mah., Maltepe Başıbüyük Yolu Sok., No: 9/1, 34854, Maltepe, Istanbul, Turkey
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Sagae S, Monk BJ, Pujade-Lauraine E, Gaffney DK, Narayan K, Ryu SY, McCormack M, Plante M, Casado A, Reuss A, Chávez-Blanco A, Kitchener H, Nam BH, Jhingran A, Temkin S, Mileshkin L, Berns E, Scholl S, Doll C, Abu-Rustum NR, Lecuru F, Small W. Advances and Concepts in Cervical Cancer Trials: A Road Map for the Future. Int J Gynecol Cancer 2016; 26:199-207. [PMID: 26569057 PMCID: PMC4831060 DOI: 10.1097/igc.0000000000000587] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Cervical cancer is responsible for more than a quarter of a million deaths globally each year, mostly in developing countries, making therapeutic advances in all health care settings a top priority. The Gynecologic Cancer InterGroup (GCIG) is a worldwide collaboration of leading national research groups that develops and promotes multinational trials in gynecologic cancer. In recognition of the pressing need for action, the GCIG convened an international meeting with expert representation from the GCIG groups and selected large sites in low- and middle-income countries. METHODS The focus was to develop a consensus on several concepts for future clinical trials, which would be developed and promoted by the GCIG and launched with major international participation. The first half of the meeting was devoted to a resume of the current state of the knowledge and identifying the gaps in need of new evidence, validating control arms for present and future clinical trials and identifying national and international barriers for studies of cervix cancers. The second half of the meeting was concerned with achieving consensus on a path forward. RESULTS AND CONCLUSIONS There were 5 principal outcomes as follows: first, a proposal to expand fertility-preserving options with neoadjuvant chemotherapy; second, validation of the assessment of sentinel lymph nodes using minimally invasive surgery with an emphasis on identification and management of low-volume metastasis, such as isolated tumor cells and micrometastasis; third, evaluation of hypofractionation for palliative and curative radiation under the umbrella of the GCIG Cervix Cancer Research Network; fourth, adding to the advances in antiangiogenesis therapy in the setting of metastatic disease; and fifth, developing a maintenance study among women at high risk of relapse. The latter 2 systemic interventions could study PI3K (phosphatidylinositol-3-kinase) inhibitors, immunotherapy, anti-human papillomavirus approaches, or novel antiangiogenic agents/combinations.
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Affiliation(s)
- Satoru Sagae
- *Department of Gynecologic Oncology, Sapporo West Kojinkai Clinic, Sapporo, Japan; †University of Arizona Cancer Center-Phoenix, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ; ‡Hôtel-Dieu, AP-HP, Université Paris Descartes, Paris, France; §Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah Health Care, Salt Lake City, UT; ∥Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; ¶Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea; #Department of Oncology, University College Hospital London, London, United Kingdom; **Division of Gynecologic Oncology, Centre Hospitalier Universitaire de Québec, Quebec, Quebec, Canada; ††Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain; ‡‡Coordinating Center for Clinical Trials of the Phipps-University of Marburg, Marburg, Germany; §§GICOM Grupo Mexicano de Investigación en Cáncer de Ovario y Tumores Ginecológicos, A.C. México City, México; ∥∥Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, United Kingdom; ¶¶Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, South Korea; ##Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; ***Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD; †††Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; ‡‡‡Médecin - Spécialiste en Oncologie, Institut Curie, Paris, France; §§§Division of Radiation Oncology, Department Oncology, University of Calgary, Calgary, Alberta, Canada; ∥∥∥Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; ¶¶¶Chir
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36
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Lou H, Villagran G, Boland JF, Im KM, Polo S, Zhou W, Odey U, Juárez-Torres E, Medina-Martínez I, Roman-Basaure E, Mitchell J, Roberson D, Sawitzke J, Garland L, Rodríguez-Herrera M, Wells D, Troyer J, Pinto FC, Bass S, Zhang X, Castillo M, Gold B, Morales H, Yeager M, Berumen J, Alvirez E, Gharzouzi E, Dean M. Genome Analysis of Latin American Cervical Cancer: Frequent Activation of the PIK3CA Pathway. Clin Cancer Res 2015; 21:5360-70. [PMID: 26080840 PMCID: PMC4668220 DOI: 10.1158/1078-0432.ccr-14-1837] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 05/14/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Cervical cancer is one of the most common causes of cancer mortality for women living in poverty, causing more than 28,000 deaths annually in Latin America and 266,000 worldwide. To better understand the molecular basis of the disease, we ascertained blood and tumor samples from Guatemala and Venezuela and performed genomic characterization. EXPERIMENTAL DESIGN We performed human papillomavirus (HPV) typing and identified somatically mutated genes using exome and ultra-deep targeted sequencing with confirmation in samples from Mexico. Copy number changes were also assessed in the exome sequence. RESULTS Cervical cancer cases in Guatemala and Venezuela have an average age of diagnosis of 50 years and 5.6 children. Analysis of 675 tumors revealed activation of PIK3CA and other PI3K/AKT pathway genes in 31% of squamous carcinomas and 24% of adeno- and adenosquamous tumors, predominantly at two sites (E542K, E545K) in the helical domain of the PIK3CA gene. This distribution of PIK3CA mutations is distinct from most other cancer types and does not result in the in vitro phosphorylation of AKT. Somatic mutations were more frequent in squamous carcinomas diagnosed after the age of 50 years. Frequent gain of chromosome 3q was found, and low PIK3CA mutation fractions in many tumors suggest that PI3K mutation can be a late event in tumor progression. CONCLUSIONS PI3K pathway mutation is important to cervical carcinogenesis in Latin America. Therapeutic agents that directly target PI3K could play a role in the therapy of this common malignancy.
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Affiliation(s)
- Hong Lou
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick, Maryland
| | | | - Joseph F Boland
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - Kate M Im
- Laboratory of Experimental Immunology, National Cancer Institute, Frederick, Maryland
| | - Sarita Polo
- Instituto de Cancerologia, Guatemala City, Guatemala
| | - Weiyin Zhou
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - Ushie Odey
- Hospital Central Universitario "Dr. Antonio M Pineda," Barquisimeto, Lara State, Venezuela
| | - Eligia Juárez-Torres
- Unidad de Medicina Genómica, Hospital General de México/Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F. México
| | - Ingrid Medina-Martínez
- Unidad de Medicina Genómica, Hospital General de México/Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F. México
| | | | - Jason Mitchell
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - David Roberson
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - Julie Sawitzke
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick, Maryland
| | - Lisa Garland
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick, Maryland
| | | | - David Wells
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick, Maryland
| | - Jennifer Troyer
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick, Maryland
| | | | - Sara Bass
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - Xijun Zhang
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | | | - Bert Gold
- Laboratory of Experimental Immunology, National Cancer Institute, Frederick, Maryland
| | | | - Meredith Yeager
- Cancer Genetics Research Laboratory, Division of Cancer Epidemiology and Genetics, Leidos Biomedical Research Inc.; Frederick National Laboratory for Cancer Research, Gaithersburg, Maryland
| | - Jaime Berumen
- Unidad de Medicina Genómica, Hospital General de México/Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F. México
| | - Enrique Alvirez
- Hospital Central Universitario "Dr. Antonio M Pineda," Barquisimeto, Lara State, Venezuela
| | | | - Michael Dean
- Laboratory of Experimental Immunology, National Cancer Institute, Frederick, Maryland.
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Ngo C, Samuels S, Bagrintseva K, Slocker A, Hupé P, Kenter G, Popovic M, Samet N, Tresca P, von der Leyen H, Deutsch E, Rouzier R, Belin L, Kamal M, Scholl S. From prospective biobanking to precision medicine: BIO-RAIDs - an EU study protocol in cervical cancer. BMC Cancer 2015; 15:842. [PMID: 26531748 PMCID: PMC4632364 DOI: 10.1186/s12885-015-1801-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background Cervical cancer (CC) is -second to breast cancer- a dominant cause of gynecological cancer-related deaths worldwide. CC tumor biopsies and blood samples are of easy access and vital for the development of future precision medicine strategies. Design BIO-RAIDs is a prospective multicenter European study, presently recruiting patients in 6 EU countries. Tumor and liquid biopsies from patients with previously non-treated cervical cancer (stages IB2-IV) are collected at defined time points. Patients receive standard primary treatment according to the stage of their disease. 700 patients are planned to be enrolled. The main objectives are the discovery of -dominant molecular alterations, -signalling pathway activation, and -tumor micro-environment patterns that may predict response or resistance to treatment. An exhaustive molecular analysis is performed using 1° Next generation sequencing, 2° Reverse phase protein arrays and 3° Immuno-histochemistry. Discussion The clinical study BIO-RAIDs is activated in all planned countries, 170 patients have been recruited till now. This study will make an important contribution towards precision medicine treatments in cervical cancer. The results will support the development of clinical practice guidelines for cervical cancer patients to improve their prognosis and their quality of life. Trial registration Clinicaltrials.gov: NCT02428842, registered 10 February 2015.
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Affiliation(s)
- Charlotte Ngo
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,Present address: Department of gynecological and breast oncological surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Sanne Samuels
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Ksenia Bagrintseva
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Andrea Slocker
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Philippe Hupé
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,INSERM U900, Paris, France.,Mines ParisTech, Fontainebleau, France.,CNRS UMR 144, Paris, France
| | - Gemma Kenter
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Marina Popovic
- Department of Gynecology, Institut of Oncology of Vojvodina (IOV), Put Doktora Goldmana 4, 21204, Sremska Kamenica, Serbia
| | - Nina Samet
- Department of Radiology Gynecology, Institute of Oncology of Republic of Moldova, str. N. Testemiţanu 30, MD-2025, Chişinău, Republica Moldova
| | - Patricia Tresca
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Heiko von der Leyen
- Hannover Clinical Trial Center (HCTC) GmbH, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Eric Deutsch
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Roman Rouzier
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Lisa Belin
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Maud Kamal
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Suzy Scholl
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France. .,Institut Curie, 26 rue d'Ulm 75248, Paris, Cedex 05, France.
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Xiang L, Jiang W, Li J, Shen X, Yang W, Yang G, Wu X, Yang H. PIK3CA mutation analysis in Chinese patients with surgically resected cervical cancer. Sci Rep 2015; 5:14035. [PMID: 26358014 PMCID: PMC4566086 DOI: 10.1038/srep14035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/11/2015] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to evaluate the clinicopathological and prognostic relevance of PIK3CA mutations in Chinese patients with surgically resected cervical cancer. PIK3CA mutations were screened in 771 cervical cancer specimens using reverse transcription polymerase chain reaction and Sanger sequencing. In total, 13.6% (105 of 771) of patients harbored non-synonymous PIK3CA mutations. Patients harboring PIK3CA mutations were older than patients with wild-type PIK3CA (mean age: 50.7 years vs. 47.0 years, P < 0.01). PIK3CA mutations were more commonly observed in postmenopausal patients than in premenopausal patients (19.6% vs. 10.2%, P < 0.01). PIK3CA mutations were more common in squamous cell carcinomas than in non-squamous cell tumors (15.3% vs 7.3%, of P < 0.01). The 3-year relapse-free survival was 90.2% for PIK3CA mutant patients and 80.9% for PIK3CA wild-type patients (P = 0.03). PIK3CA mutation was confirmed as an independent predictor for better treatment outcome in the multivariate analyses (HR = 0.54, 95% CI: 0.29-0.99, P = 0.048). PIK3CA mutations were significantly associated with less distant metastases (mutant-type: 8/105, wild-type: 98/666, p = 0.048). Thus, patients with mutant PIK3CA had distinct characteristics in age, menopausal status, and histological subtype and have better treatment outcome and less distant metastasis after surgery-based multimodal therapy.
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Affiliation(s)
- Libing Xiang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wei Jiang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiajia Li
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xuxia Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Wentao Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Gong Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Central Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China
| | - Xiaohua Wu
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Huijuan Yang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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Precise Classification of Cervical Carcinomas Combined with Somatic Mutation Profiling Contributes to Predicting Disease Outcome. PLoS One 2015. [PMID: 26197069 PMCID: PMC4510875 DOI: 10.1371/journal.pone.0133670] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction Squamous cell carcinoma (SCC), adenocarcinoma (AC), and adenosquamous carcinoma (ASC) are the most common histological subtypes of cervical cancer. Differences in the somatic mutation profiles of these subtypes have been suggested. We investigated the prevalence of somatic hot-spot mutations in three well-defined cohorts of SCC, AC, and ASC and determined the additional value of mutation profiling in predicting disease outcome relative to well-established prognostic parameters. Materials and Methods Clinicopathological data were collected for 301 cervical tumors classified as SCC (n=166), AC (n=55), or ASC (n=80). Mass spectrometry was used to analyze 171 somatic hot-spot mutations in 13 relevant genes. Results In 103 (34%) tumors, 123 mutations were detected (36% in SCC, 38% in AC, and 28% in ASC), mostly in PIK3CA (20%) and KRAS (7%). PIK3CA mutations occurred more frequently in SCC than AC (25% vs. 11%, P=0.025), whereas KRAS mutations occurred more frequently in AC than SCC (24% vs. 3%, P<0.001) and ASC (24% vs. 3%, P<0.001). A positive mutation status correlated with worse disease-free survival (HR 1.57, P=0.043). In multivariate analysis, tumor diameter, parametrial infiltration, and lymph node metastasis, but not the presence of a somatic mutation, were independent predictors of survival. Conclusion Potentially targetable somatic mutations occurred in 34% of cervical tumors with different distributions among histological subtypes. Precise classification of cervical carcinomas in combination with mutation profiling is valuable for predicting disease outcome and may guide the development and selection of tumor-specific treatment approaches.
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