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Lee NY, Harris J, Kim J, Garden A, Mechalakos J, Pfister DG, Chan AT, Hu K, Colevas AD, Frank S, Shenouda G, Bar-Ad V, Waldron JN, Harari PM, Raben A, Torres-Saavedra P, Le QT. Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma: A Nonrandomized Controlled Trial. JAMA Netw Open 2023; 6:e2316094. [PMID: 37266942 PMCID: PMC10238946 DOI: 10.1001/jamanetworkopen.2023.16094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/13/2023] [Indexed: 06/03/2023] Open
Abstract
Importance The long-term outcomes associated with adding bevacizumab, a vascular endothelial growth factor inhibitor, to standard chemoradiation have continued to be favorable for a group of patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Objective To assess long-term toxic effects and clinical outcomes associated with chemotherapy, radiation therapy (RT), and bevacizumab for NPC. Design, Setting, and Participants This single-arm phase II nonrandomized controlled trial was conducted by the National Cancer Trials Network group and NRG Oncology (formerly Radiation Therapy Oncology Group), with accrual from December 13, 2006, to February 5, 2009, and data analysis from June 26 to July 1, 2019. The study was conducted at 19 cancer centers with a median (IQR) follow-up of 9.0 (7.7-9.3) years. Included patients were adults (aged ≥18 years) with NPC that was World Health Organization (WHO) histologic grade I to IIb or III, American Joint Committee on Cancer stage IIB or greater, and with or without lymph node involvement. Interventions Patients received 3 cycles of bevacizumab (15 mg/kg) concurrently with standard cisplatin (100 mg/m2) and RT (69.96 Gy) followed by 3 cycles of adjuvant bevacizumab (15 mg/kg) given concurrently with cisplatin (80 mg/m2) and fluorouracil (1000 mg/m2/d). Main Outcomes and Measures The primary end point was grade 4 hemorrhage or grade 5 adverse events in the first year. Secondary end points were locoregional progression-free (LRPF) interval, distant metastasis-free (DMF) interval, progression-free survival (PFS), overall survival (OS), and other adverse events. Long-term toxic effects and clinical outcomes were reported due to the limited follow-up in the initial report for this trial and the importance of long-term outcomes when combining bevacizumab with chemoradiation. Results Among 46 patients with NPC who were enrolled, 44 patients were analyzed (29 males [65.9%]; 23 Asian [52.3%], 2 Black [4.5%], and 16 White [36.4%]; 38 not Hispanic [86.4%]; median [IQR] age, 48.5 [39.0-56.0] years). There were 33 patients with a Zubrod performance status of 0, indicating that they were fully functional and asymptomatic (75.0%); 32 patients with a WHO histologic grade of IIb or III (72.7%); and 39 patients with stage III or IVB disease (88.6%). Among analyzed patients, 42 individuals received radiation therapy of 69.96 Gy or greater (95.5%; dose range, 65.72-70.00 Gy); 30 patients received 3 cycles of cisplatin (68.2%) with RT, and 31 patients received 3 cycles of bevacizumab with RT (70.5%); this was followed by 3 cycles of adjuvant cisplatin in 21 patients (47.7%), fluorouracil in 24 patients (54.5%), and bevacizumab in 23 patients (52.3%). No grade 4 hemorrhage or grade 5 AEs were reported in the first year or thereafter. Late grade 3 AEs occurred in 16 patients (36.4%), including 7 patients with dysphagia (15.9%), 6 patients with hearing impairment (13.6%), and 2 patients with dry mouth (4.5%). The 1- and 5-year rates of feeding tube use were 5 of 41 patients (12.2%) and 0 of 27 patients, respectively. There were 19 patients (43.2%) who progressed or died without disease progression (6 patients with locoregional progression [13.6%], 8 patients with distant progression [18.2%], and 5 patients who died without progression [11.4%]). The 5- and 7-year rates were 79.5% (95% CI, 67.6%-91.5%) and 69.7% (95% CI, 55.9%-83.5%) for OS, 61.2% (95% CI, 46.8%-75.6%) and 56.3% (95% CI, 41.5%-71.1%) for PFS, 74.9% (95% CI, 61.4%-86.6%) and 72.3% (95% CI, 58.4%-84.7%) for LRPF interval, and 79.5% (95% CI,66.4%-90.0%) for both times for DMF interval. Among 13 patients who died, death was due to disease in 8 patients (61.5%). Conclusions and Relevance In this nonrandomized controlled trial, no grade 4 hemorrhage or grade 5 AEs were reported in the first year or thereafter among patients with NPC receiving bevacizumab combined with chemoradiation. The rate of distant metastasis was low although 89% of patients had stage III to IVB disease, suggesting that further investigation may be warranted. Trial Registration ClinicalTrials.gov Identifier: NCT00408694.
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Affiliation(s)
- Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Harris
- Statistics and Data Management Center, NRG Oncology, American College of Radiology, Philadelphia, Pennsylvania
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adam Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David G. Pfister
- Department of Medicine Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony T.C. Chan
- Department of Clinical Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kenneth Hu
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York
- Accrual for State University of New York Health Science Center, Brooklyn, New York
| | - A Dimitrios Colevas
- Department of Medicine, Stanford University, Stanford, California
- Accruals for University of California, San Francisco
| | - Steven Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John N. Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Adam Raben
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Delaware
| | - Pedro Torres-Saavedra
- Statistics and Data Management Center, NRG Oncology, American College of Radiology, Philadelphia, Pennsylvania
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
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Liao LJ, Hsu WL, Chen CJ, Chiu YL. Feature Reviews of the Molecular Mechanisms of Nasopharyngeal Carcinoma. Biomedicines 2023; 11:1528. [PMID: 37371623 DOI: 10.3390/biomedicines11061528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is rare in most parts of the world but endemic in southern Asia. Here, we describe the molecular abnormalities in NPC and point out potential molecular mechanisms for future therapy. This article provides a brief up-to-date review focusing on the molecular pathways of NPC, which may improve our knowledge of this disease, and we also highlight some issues for further research. In brief, some heritable genes are related to NPC; therefore, people with a family history of NPC have an increased risk of this disease. Carcinogenic substances and Epstein-Barr virus (EBV) exposure both contribute to tumorigenesis through the accumulation of multiple genomic changes. In recent years, salted fish intake has decreased the impact on NPC, which implies that changing exposure to carcinogens can modify the risk of NPC. Eradication of cancer-associated viruses potentially eradicates cancer, and EBV vaccines might also prevent this disease in the future. Screening patients by using an EBV antibody is feasible in the high-risk group; plasma EBV DNA measurement could also be conducted for screening, prognosis, and monitoring of this disease. Understanding the molecular mechanisms of NPC can further provide novel information for health promotion, disease screening, and precision cancer treatment.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Wan-Lun Hsu
- Master Program of Big Data Analysis in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chi-Ju Chen
- Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yen-Ling Chiu
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Graduate Institute of Medicine and Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan 320, Taiwan
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Lin Y, Yu X, Lu L, Chen H, Wu J, Chen Y, Lin Q, Wang X, Chen X, Chen X. Age is a significant biomarker for the selection of neoadjuvant chemotherapy plus radiotherapy versus concurrent chemoradiotherapy in patients with advanced nasopharyngeal carcinoma. Cancer Biomark 2023; 37:1-11. [PMID: 36938724 DOI: 10.3233/cbm-210357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The optimal timing of combined chemotherapy with radiotherapy for locally advanced nasopharyngeal carcinoma (LA-NPC) is undetermined. OBJECTIVE This study aimed to compare the therapeutic efficacy of neoadjuvant chemotherapy (NACT) followed by radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). METHODS Five hundred and thirty-eight patients diagnosed with LA-NPC and treated with NACT + RT or CCRT alone were enrolled in the study. Restricted cubic spline regression (RCS) was used to determine the relationship between age and the hazard Ratio of death. A Kaplan-Meier analysis was performed to evaluate overall survival (OS) related to NACT + RT or CCRT alone. Cox proportional hazards models were used to adjust for potential confounding factors. RESULTS Compared with the CCRT alone regimen, the NACT + RT regimen showed a significantly better OS rate with a 62% decreased risk of death in a subgroup of patients aged ⩾ 45 years (hazard ratio, HR: 0.38; 95% confidence interval, CI: 0.24-0.61). In patients aged < 45 years, the risk of death was significantly increased when NACT + RT was chosen compared with CCRT (HR: 4.10; 95% CI: 2.09-8.07). CONCLUSIONS Age is a significant biomarker when selecting NACT + RT or CCRT alone in patients with advanced NPC.
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Affiliation(s)
- Yihong Lin
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiongbin Yu
- Department of Oncology, Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Medical University, Fuqing, Fujian, China
| | - Linbin Lu
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Hong Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Junxian Wu
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yaying Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Qin Lin
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xuewen Wang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiong Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
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Zhu GL, Fang XL, Yang KB, Tang LL, Ma J. Development and validation of a joint model for dynamic prediction of overall survival in nasopharyngeal carcinoma based on longitudinal post-treatment plasma cell-free Epstein-Barr virus DNA load. Oral Oncol 2022; 134:106140. [PMID: 36183501 DOI: 10.1016/j.oraloncology.2022.106140] [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: 06/02/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To develop and validate a joint model for dynamic prediction of overall survival (OS) in nasopharyngeal carcinoma (NPC) based on longitudinal post-treatment plasma cell-free Epstein-Barr virus (cfEBV) DNA load. PATIENTS AND METHODS We analyzed 695 patients with non-metastatic NPC and detectable post-treatment cfEBV DNA load who did not receive adjuvant therapy. We fitted the trajectories of post-treatment cfEBV DNA load as a function of time into a linear mixed-effect model and fitted a Cox regression model with covariates including age, T and N stages, and lactate dehydrogenase level. Finally, we combined both via joint modeling to develop and validate our dynamic model. RESULTS A strong positive correlation was found between the individual longitudinal post-treatment cfEBV DNA load and the risk of death from any cause (P < 0.001). We developed a joint model capable of providing subject-specific dynamic prediction of conditional OS based on the evolution of the individual plasma cfEBV DNA load trajectory. The joint model showed reliable performance in both training and validation cohorts, with a large area under the curve (interquartile range [IQR]: training cohort, 0.775-0.850; validation cohort, 0.826-0.900) and low prediction errors (IQR: training cohort, 0.017-0.078; validation cohort, 0.034 -0.071). An increasing amount of data on cfEBV DNA load was associated with better model performance. CONCLUSION Our model provided reliable subject-specific dynamic prediction of conditional OS, which could help guide individualized post-treatment surveillance, risk stratification, and management of NPC in the future.
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Affiliation(s)
- Guang-Li Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China; Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, PR China
| | - Xue-Liang Fang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China; Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Kai-Bin Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.
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5
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Chen L, Yao W, Ding L. Effects of Self-Care plus Forecasting Nursing on the Treatment Outcomes and Emotions in Patients with Nasopharyngeal Carcinoma after Radiotherapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5751903. [PMID: 35832531 PMCID: PMC9273378 DOI: 10.1155/2022/5751903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/29/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
Objective To explore the effects of self-care plus forecasting nursing on the treatment outcomes and emotions in nasopharyngeal carcinoma patients undergoing radiotherapy. Methods Eighty nasopharyngeal carcinoma patients after radiotherapy admitted to our hospital from February 2020 to August 2021 were selected. The patients were allocated into an observation group (n = 40) and an experimental group (n = 40) according to different nursing protocols. The observation group received traditional nursing intervention, whereas the experimental group received self-care plus forecasting nursing intervention. The levels of the indexes (quality of life, score on the Zung Self-Rating Anxiety Scale (SAS), score on the Zung Self-Rating Depression Scale (SDS), and adverse reaction) were compared between the two groups. Results The score of the experimental group for the quality of life was significantly higher than that of the observation group (P < 0.05); the SAS and SDS scores of the experimental group after nursing intervention were significantly lower than those of the observation group (P < 0.05); the incidence of adverse reactions in the experimental group during radiotherapy was significantly lower than that of the observation group (P < 0.05). Conclusion The self-care plus forecasting nursing intervention is effective in postradiotherapy patients with nasopharyngeal carcinoma. The technique is proved effective to improve the quality of life, reduce anxiety and depression, and decrease the incidence of adverse reactions in patients during treatment. These features make the technique worthy of a wider clinical application.
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Affiliation(s)
- Liqun Chen
- Department of Otorhinolaryngology Surgery, Qingdao Municipal Hospital East, Qingdao 266071, Shandong Province, China
| | - Wei Yao
- Department of Outpatient, Qingdao Municipal Hospital East, Qingdao 266071, Shandong Province, China
| | - Lili Ding
- Department of Outpatient, Qingdao Municipal Hospital East, Qingdao 266071, Shandong Province, China
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A systematic review and recommendations on the use of plasma EBV DNA for nasopharyngeal carcinoma. Eur J Cancer 2021; 153:109-122. [PMID: 34153713 DOI: 10.1016/j.ejca.2021.05.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Nasopharyngeal carcinoma (NPC) is an endemic malignancy in Southeast Asia, particularly Southern China. The classical non-keratinising cell type is almost unanimously associated with latent Epstein-Barr virus (EBV) infection. Circulating plasma EBV DNA can be a useful biomarker in various clinical aspects, but comprehensive recommendations and international guidelines are still lacking. We conducted a systematic review of all original articles on the clinical application of plasma EBV DNA for NPC; we further evaluated its strengths and limitations for consideration as standard recommendations. METHODS The search terms 'nasopharyngeal OR nasopharynx', and 'plasma EBV DNA OR cell-free EBV OR cfEBV' were used to identify full-length articles published up to December 2020 in the English literature. Three authors independently reviewed the article titles, removed duplicates and reviewed the remaining articles for eligibility. RESULTS A total of 81 articles met the eligibility criteria. Based on the levels of evidence and grades of recommendation assessed, it is worth considering the inclusion of plasma EBV DNA in screening, pre-treatment work-up for enhancing prognostication and tailoring of treatment strategy, monitoring during radical treatment, post-treatment surveillance for early detection of relapse, and monitoring during salvage treatment for recurrent or metastatic NPC. One major limitation is the methodology of measurement requiring harmonisation for consistent comparability. CONCLUSIONS The current comprehensive review supports the inclusion of plasma EBV DNA in international guidelines in the clinical aspects listed, but methodological issues must be resolved before global application.
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Smith C, McGrath M, Neller MA, Matthews KK, Crooks P, Le Texier L, Panizza B, Porceddu S, Khanna R. Complete response to PD-1 blockade following EBV-specific T-cell therapy in metastatic nasopharyngeal carcinoma. NPJ Precis Oncol 2021; 5:24. [PMID: 33742086 PMCID: PMC7979738 DOI: 10.1038/s41698-021-00162-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is an Epstein–Barr virus (EBV)-associated heterogeneous disease and is characterized by peritumoral immune infiltrate. Adoptive T-cell therapy (ACT) has emerged as a potential therapeutic strategy for NPC. However, the tumor microenvironment remains a major roadblock for the successful implementation of ACT in clinical settings. Expression of checkpoint molecules by malignant cells can inhibit the effector function of adoptively transferred EBV-specific T cells. Here we present a novel case report of a patient with metastatic NPC who was successfully treated with a combination of EBV-specific ACT and programmed cell death-1 blockade therapy. Following combination immunotherapy, the patient showed complete resolution of metastatic disease with no evidence of disease relapse for 22 months. Follow-up immunological analysis revealed dramatic restructuring of the global T-cell repertoire that was coincident with the clinical response. This case report provides an important platform for translating these findings to a larger cohort of NPC patients.
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Affiliation(s)
- Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Margaret McGrath
- Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michelle A Neller
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Katherine K Matthews
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Pauline Crooks
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Laetitia Le Texier
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Benedict Panizza
- Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sandro Porceddu
- Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rajiv Khanna
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Tumour Immunology Laboratory, Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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Hui EP, Ma BBY, Lam WKJ, Chan KCA, Mo F, Ai QYH, King AD, Wong CH, Wong KCW, Lam DCM, Tong M, Poon DMC, Li L, Lau TKH, Wong KH, Lo YMD, Chan ATC. Dynamic Changes of Post-Radiotherapy Plasma Epstein-Barr Virus DNA in a Randomized Trial of Adjuvant Chemotherapy Versus Observation in Nasopharyngeal Cancer. Clin Cancer Res 2021; 27:2827-2836. [PMID: 33692028 DOI: 10.1158/1078-0432.ccr-20-3519] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the dynamic changes in plasma Epstein-Barr virus (pEBV) DNA after radiotherapy in nasopharyngeal cancer (NPC). EXPERIMENTAL DESIGN We conducted a randomized controlled trial of adjuvant chemotherapy versus observation in patients with NPC who had detectable pEBV DNA at 6 weeks post-radiotherapy. Randomized patients had a second pEBV DNA checked at 6 months post-randomization. The primary endpoint was progression-free survival (PFS). RESULTS We prospectively enrolled 789 patients. Baseline post-radiotherapy pEBV DNA was undetectable in 573 (72.6%) patients, and detectable in 216 (27.4%) patients, of whom 104 (13.2%) patients were eligible for randomization to adjuvant chemotherapy (n = 52) versus observation (n = 52). The first post-radiotherapy pEBV DNA had a sensitivity of 0.48, specificity of 0.81, area under receiver-operator characteristics curve (AUC) of 0.65, false positive (FP) rate of 13.8%, and false negative (FN) rate of 14.4% for disease progression. The second post-radiotherapy pEBV DNA had improved sensitivity of 0.81, specificity of 0.75, AUC of 0.78, FP rate of 14.3%, and FN rate of 8.1%. Patients with complete clearance of post-radiotherapy pEBV DNA (51%) had survival superior to that of patients without post-radiotherapy pEBV DNA clearance (5-year PFS, 85.5% vs. 23.3%; HR, 9.6; P < 0.0001), comparable with patients with initially undetectable post-radiotherapy pEBV DNA (5-year PFS, 77.1%), irrespective of adjuvant chemotherapy or observation. CONCLUSIONS Patients with NPC with detectable post-radiotherapy pEBV DNA who experienced subsequent pEBV DNA clearance had superior survival comparable with patients with initially undetectable post-radiotherapy pEBV DNA. Post-radiotherapy pEBV DNA clearance may serve as an early surrogate endpoint for long-term survival in NPC.
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Affiliation(s)
- Edwin Pun Hui
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Brigette B Y Ma
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W K Jacky Lam
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K C Allen Chan
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Frankie Mo
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Qi-Yong Hemis Ai
- Department of Imaging and Interventional Radiology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ann D King
- Department of Imaging and Interventional Radiology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Hang Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kenneth C W Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daisy C M Lam
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Macy Tong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Darren M C Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leung Li
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas K H Lau
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwan Hung Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Y M Dennis Lo
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anthony T C Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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9
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Wei ZG, Hu XL, He Y, Guan H, Wang JJ, He L, Mu XL, Liu ZR, Li RD, Peng XC. Clinical and survival analysis of nasopharyngeal carcinoma with consistently negative Epstein-Barr virus DNA. Head Neck 2021; 43:1465-1475. [PMID: 33421240 DOI: 10.1002/hed.26608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/01/2020] [Accepted: 12/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To assess the clinical and survival features of nasopharyngeal carcinoma (NPC) with consistently negative Epstein-Barr virus (EBV) DNA level. METHODS Propensity score matching (PSM) method was used to create well-balanced cohorts. Kaplan-Meier method and Cox proportional hazards models were performed to conduct survival analysis. RESULTS Four hundred and eighty patients were enrolled. Patients with consistently negative plasma EBV DNA level had a greater chance to present a relatively earlier T and N classification compared with those with positive EBV DNA level (p < .001; p = .015). And patients with consistently negative EBV level were significantly associated with preferable 3-year DFS (95.0% vs. 84.4%, p = .004), DMFS (98.3% vs. 89.4%, p = .009), and OS (100% vs. 97.6%, p = .004). CONCLUSIONS NPC patients with consistently negative EBV DNA level performed an earlier clinical stage and negative EBV DNA level was related to preferable survival outcomes.
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Affiliation(s)
- Zhi-Gong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiao-Lin Hu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Hui Guan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jing-Jing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiao-Li Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhe-Ran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Rui-Dan Li
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Xing-Chen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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10
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Chen YP, Ismaila N, Chua MLK, Colevas AD, Haddad R, Huang SH, Wee JTS, Whitley AC, Yi JL, Yom SS, Chan ATC, Hu CS, Lang JY, Le QT, Lee AWM, Lee N, Lin JC, Ma B, Morgan TJ, Shah J, Sun Y, Ma J. Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. J Clin Oncol 2021; 39:840-859. [PMID: 33405943 DOI: 10.1200/jco.20.03237] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2020. Outcomes of interest included survival, distant and locoregional disease control, and quality of life. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 108 relevant studies to inform the evidence base for this guideline. Five overarching clinical questions were addressed, which included subquestions on radiotherapy (RT), chemotherapy sequence, and concurrent, induction, and adjuvant chemotherapy options. RECOMMENDATIONS Evidence-based recommendations were developed to address aspects of care related to chemotherapy in combination with RT for the definitive-intent treatment of stage II to IVA NPC.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
- Yu-Pei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | | | - Melvin L K Chua
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | | | - Shao Hui Huang
- Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Joseph T S Wee
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | - Jun-Lin Yi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Chao-Su Hu
- Fudan University Shanghai Cancer Center, Shanghai, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jin-Yi Lang
- Sichuan Cancer Hospital & Institute, Chengdu, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Quynh-Thu Le
- Stanford University School of Medicine, Stanford, CA
| | - Anne W M Lee
- The University of Hong Kong-Shenzhen Hospital, People's Republic of China, and The University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Nancy Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Brigette Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | | | - Jatin Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
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11
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Wuerdemann N, Jain R, Adams A, Speel EJM, Wagner S, Joosse SA, Klussmann JP. Cell-Free HPV-DNA as a Biomarker for Oropharyngeal Squamous Cell Carcinoma-A Step Towards Personalized Medicine? Cancers (Basel) 2020; 12:cancers12102997. [PMID: 33076524 PMCID: PMC7602702 DOI: 10.3390/cancers12102997] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is a distinct tumor entity with relatively favorable overall survival. Nevertheless, up to 25% of HPV-related OPSCC patients develop recurrent or metastatic disease with a fatal outcomes. Biomarkers to enable early diagnosis and to monitor this disease are not established. Liquid biopsy presents a promising minimally invasive method to monitor the cell-free DNA of oncogenic HPV and to enable personalized therapy concepts. Few studies have investigated the role of cell-free HPV DNA (cfHPV-DNA) as a diagnostic marker in patients with OPSCC with variable outcomes. To emphasize the importance of cfHPV-DNA, we performed a literature review and meta-analysis. Our results demonstrate that cfHPV-DNA in patients with OPSCC presents a promising diagnostic tool with high specificity. Nevertheless, further studies with homogeneous inclusion criteria will be necessary to strengthen the role of cfHPV-DNA as a biomarker in the future. Abstract Global incidences of oropharyngeal squamous cell carcinoma (OPSCC) are rising due to an association with high-risk human papillomavirus (HPV). Although there is an improved overall survival of HPV-related OPSCC; up to 25% of the patients develop recurrent or distant metastatic disease with a fatal outcomes. Biomarkers to monitor this disease are not established. This meta-analysis reviews the role of cell-free HPV DNA in liquid biopsy (LB) as a biomarker for HPV-related OPSCC. Pubmed, Livivo, and Cochrane Library databases were searched from inception to August, 2020. All studies were analyzed by Meta-DiSc 1.4 and Stata 16.0 statistical software. In total, 16 studies were considered for systematic review, whereas 11 studies met inclusion criteria for meta-analysis, respectively. Pooled sensitivity of cfHPV-DNA at first diagnosis and during follow-up was 0.81 (95% CI; 0.78–0.84) and 0.73 (95% CI; 0.57–0.86), while pooled specificity was 0.98 (95% CI; 0.96–0.99) and 1 (95% CI; 0.99–1). The diagnostic odds ratio (DOR) at first diagnosis was 200.60 (95% CI; 93.31–431.22) and 300.31 (95% CI; 60.94–1479.88) during follow-up. The area under the curve (AUC) of summary receiver operating characteristic (SROC) was 0.99 at first diagnosis and 1.00 during follow-up, respectively. In conclusion, cfHPV-DNA presents a potential biomarker with high specificity in patients with HPV-related OPSCC.
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Affiliation(s)
- Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Strasse 21, 50931 Cologne, Germany
- Correspondence: ; Tel.: +49-0221-478-4750
| | - Rishabh Jain
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Ernst-Jan M. Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Simon A. Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Strasse 21, 50931 Cologne, Germany
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12
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Lu T, Guo Q, Lin K, Chen H, Chen Y, Xu Y, Lin C, Su Y, Chen Y, Chen M, Zheng Y, Ye Y, Lin S, Zong J, Pan J. Circulating Epstein-Barr virus microRNAs BART7-3p and BART13-3p as novel biomarkers in nasopharyngeal carcinoma. Cancer Sci 2020; 111:1711-1723. [PMID: 32155300 PMCID: PMC7226202 DOI: 10.1111/cas.14381] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/13/2022] Open
Abstract
Epstein‐Barr virus (EBV) BamHI A rightward transcripts (BART) encoded microRNAs (EBV‐miR‐BARTs) are abnormally highly expressed in nasopharyngeal carcinoma (NPC). This study aims to investigate the diagnostic and prognostic performance of miR‐BART7‐3p and miR‐BART13‐3p. Plasma levels of EBV DNA, miR‐BART7‐3p, and miR‐BART13‐3p were examined by quantitative PCR in 483 treatment‐naïve NPC patients and 243 controls without NPC. The prognostic performance was examined by comparing plasma levels with rates of distant metastasis during follow‐up. The area under the receiver operating characteristic curve for diagnosing NPC was 0.926 for EBV DNA, 0.964 for plasma miR‐BART7‐3p, 0.973 for miR‐BART13‐3p, and 0.997 for all three indices. Among 465 NPC patients without distant metastasis, the above‐median miR‐BART7‐3p and EBV DNA were independent risk for shorter distant metastasis‐free survival (DMFS) (hazard ratio [HR] = 2.94, 95% confidence interval [CI], 1.44‐5.97, P = .003; HR = 2.27, 95% CI, 1.26‐4.10, P = .006) in multivariate Cox regression. Epstein‐Barr virus DNA, miR‐BART7‐3p, and miR‐BART13‐3p after radiotherapy were detectable in 28.6%, 17.6%, and 54.7% of patients, respectively. In multivariate Cox regression, detectable miR‐BART7‐3p and EBV DNA were independent risks for shorter DMFS (HR = 4.13, 95% CI, 1.89‐9.01, P < .001; HR = 2.14, 95% CI, 1.04‐4.42, P = .039). The 4‐year DMFS rate was 92.0% in subjects (n = 156) with neither detectable miR‐BART7‐3p nor EBV DNA, 80.0% in subjects (n = 65) with either detectable miR‐BART7‐3p or EBV DNA, and 52.9% in subjects (n = 24) with both detectable miR‐BART7‐3p and EBV DNA after radiotherapy (P < .001). Circulating levels of miR‐BART7‐3p and miR‐BART13‐3p show excellent diagnostic performance for NPC. The combination of plasma levels of miR‐BART7‐3p and EBV DNA at diagnosis and after radiotherapy could help stratify patients by risk of poor DMFS.
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Affiliation(s)
- Tianzhu Lu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Keyu Lin
- Department of Radiation Biology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Honglin Chen
- State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China
| | - Yixin Chen
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Cheng Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Ying Su
- Department of Radiation Biology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yan Chen
- Department of Clinical Laboratory, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Mengyuan Chen
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yuhong Zheng
- Department of Clinical Laboratory, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yunbin Ye
- Laboratory of Immuno-Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jingfeng Zong
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jianji Pan
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
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13
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Qu H, Huang Y, Zhao S, Zhou Y, Lv W. Prognostic value of Epstein-Barr virus DNA level for nasopharyngeal carcinoma: a meta-analysis of 8128 cases. Eur Arch Otorhinolaryngol 2019; 277:9-18. [PMID: 31659449 DOI: 10.1007/s00405-019-05699-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Plasma levels of Epstein-Barr virus (EBV) DNA have been employed to predict survival outcomes of patients with nasopharyngeal carcinoma (NPC). However, the prognostic value of subsequent EBV DNA levels (mid or post treatment) for NPC is needed to identify by a large cohort of patients. We performed a meta-analysis of studies including data from 8128 patients to evaluate the prognostic value of EBV DNA in NPC patients. METHODS We searched PubMed, Web of Science, and the Cochrane library for prospective and retrospective studies. Hazard ratios (HRs) and confidence intervals (CIs) were extracted from the studies or calculated and pooled to assess the association between EBV DNA levels pre-treatment (pre-DNA), mid-treatment (mid-DNA), and post-treatment (post-DNA) on clinical outcomes. RESULTS A total of 22 studies with 8128 patients was included for analysis. Pre-DNA levels predicted overall survival, progression-free survival, distant metastasis-free survival, and local-regional failure survival with HRs (95% CIs) of 2.70 (2.06, 3.54), 2.70 (2.12, 3.44), 3.49 (2.35, 5.17), and 2.00 (1.45, 2.76), respectively, and the corresponding HRs for post-DNA levels were 4.86 (3.30, 7.17), 6.29 (3.41, 11.60), 5.68 (2.71,11.93), respectively. Mid-DNA levels predicted overall survival and progression-free survival with an HR (95% CI) of 3.02 (1.54, 5.29) and 3.15 (2.05, 4.83). Subgroup analysis showed that the HR of post-DNA wasn't influenced by different detection time of post-DNA (P = 0.22, I2 = 33.2%). CONCLUSION The EBV DNA levels have a significant prognostic impact in patients with NPC. The effect of post-treatment EBV DNA level dominated that of pre-DNA and mid-DNA levels.
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Affiliation(s)
- Hongling Qu
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528300, Guangdong, People's Republic of China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, People's Republic of China
| | - Shufen Zhao
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, People's Republic of China
| | - Yuanqing Zhou
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528300, Guangdong, People's Republic of China
| | - Weibiao Lv
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528300, Guangdong, People's Republic of China.
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14
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Xie X, Ren Y, Wang K, Yi B. Molecular Prognostic Value of Circulating Epstein–Barr Viral DNA in Nasopharyngeal Carcinoma: A Meta-Analysis of 27,235 Cases in the Endemic Area of Southeast Asia. Genet Test Mol Biomarkers 2019; 23:448-459. [PMID: 31199710 DOI: 10.1089/gtmb.2018.0304] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Xulin Xie
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Yupei Ren
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Kun Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Bin Yi
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, P.R. China
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15
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Le QT, Colevas AD, O’Sullivan B, Lee AWM, Lee N, Ma B, Siu LL, Waldron J, Lim CM, Riaz N, Lynn J, Malik S. Current Treatment Landscape of Nasopharyngeal Carcinoma and Potential Trials Evaluating the Value of Immunotherapy. J Natl Cancer Inst 2019; 111:655-663. [PMID: 30912808 PMCID: PMC7962891 DOI: 10.1093/jnci/djz044] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a type of head and neck cancer with a distinctive regional and racial prevalence. It is associated with Epstein-Barr virus infection and has a high propensity for regional and distant metastases, while it is very sensitive to radiation and chemotherapy. A common feature of Epstein-Barr virus-positive NPC is the dense infiltration of lymphocytes in the tumor stroma and positive programmed death-ligand 1 expression in tumor cells, making it an attractive target for immunotherapy, especially immune checkpoint inhibitors. As new immunotherapeutic agents are being rapidly adopted in many cancers, including head and neck cancer, the National Cancer Institute sponsored a clinical trial planning meeting to identify opportunities for developing phase II and III trials testing immunotherapy in different stages of NPC. The meeting started with the summary of the biology of the disease, current standards of care, and evidence of immunotherapy in this cancer. Three subcommittees were tasked to develop clinical trials: loco regionally advanced, nonmetastatic NPC; widely metastatic NPC; and either local recurrence after initial treatment or presenting with oligometastatic disease. This article summarizes the proceedings of this clinical trial planning meeting and provides a road map for future trials incorporating immune checkpoint inhibitors for therapeutic management of NPC. This road map, though specific for NPC, may also be applicable to other virally driven cancers that have similar ability to evade the host's immune system.
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Affiliation(s)
- Quynh Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brigette Ma
- Department of Clinical Oncology, The Chinese University of Hong Kong, State Key Laboratory of Translational Oncology, Hong Kong SAR, China
| | - Lillian L Siu
- Department of Clinical Oncology, Department of Medicine, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Chwee-Ming Lim
- Department of Otolaryngology, National University of Singapore, Singapore
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jean Lynn
- Clinical Investigative Branch, Cancer Therapy Evaluation Program, National Institute of Health, Bethesda, MD
| | - Shakun Malik
- Department of Thoracic Oncology Therapeutics
- Clinical Investigative Branch, Cancer Therapy Evaluation Program, National Institute of Health, Bethesda, MD
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16
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Liu L, Zuo L, Yang J, Xin S, Zhang J, Zhou J, Li G, Tang J, Lu J. Exosomal cyclophilin A as a novel noninvasive biomarker for Epstein-Barr virus associated nasopharyngeal carcinoma. Cancer Med 2019; 8:3142-3151. [PMID: 31063269 PMCID: PMC6558463 DOI: 10.1002/cam4.2185] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022] Open
Abstract
Exosomes have emerged as novel vehicles for proteins and other contents in cancer progression. Cyclophilin A (CYPA) is a pivotal member of immunophilin family. Whether CYPA can be detected in sera of nasopharyngeal carcinoma (NPC) patients remains to be explored. Epstein-Barr virus (EBV) is the first identified human tumor virus and is a causative agent of NPC. The antibody of EBV capsid antigen immunoglobulin A (EBV-VCA-IgA) is a known biomarker of NPC, with a proportion of no more than 70% being detected positively. Hence, novel biomarkers need to be discovered for early diagnosis, prognosis, and monitoring of EBV-associated NPC. A total of 110 NPC and 36 normal control serum samples were collected. Exosomes from these samples were extracted. The mRNA and protein expression levels of the above samples were validated by reverse transcription -quantitative polymerase chain reaction, Western blotting, or enzyme-linked immunosorbent assay (ELISA). Finally, the results demonstrated that both the serum and exosomal CYPA levels of NPC patients were significantly higher than that of normal cases. In addition, exosomal CYPA had a much higher level than that in the whole sera. The positive rate of EBV-VCA-IgA antibody was 68.2% in NPC sera, and noticeably, among the cases with EBV-VCA-IgA negative, 80% of them presented high levels of CYPA above the standard (cutoff value). In particular, CYPA in exosomes was uniformly with higher significance than that in whole sera. Combined analysis of CYPA protein and EBV-VCA-IgA antibody showed a greatly higher discriminatory ability in diagnosis of NPC. Moreover, exosomal CYPA level had a positive correlation with that of the EBV-encoded latent membrane protein 1 (LMP1) in exosomes. EBV-positive cancer cells secreted significantly higher levels of exosomal CYPA. This study established the utility of circulating exosomal CYPA as a potential noninvasive diagnostic biomarker for EBV-associated NPC.
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Affiliation(s)
- Lingzhi Liu
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Lielian Zuo
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Jing Yang
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Shuyu Xin
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Jing Zhang
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Jianhua Zhou
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Guiyuan Li
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
| | - Jinyong Tang
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Chenzhou, Hunan, China
| | - Jianhong Lu
- NHC Key Laboratory of Carcinogenesis, Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, China
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Liu SL, Sun XS, Li XY, Tang LQ, Chen QY, Lin HX, Liang YJ, Yan JJ, Lin C, Guo SS, Liu LT, Li Y, Xie HJ, Tang QN, Liang H, Guo L, Mai HQ. The diagnostic and prognostic values of plasma Epstein-Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study. Cancer Commun (Lond) 2019; 39:14. [PMID: 30925939 PMCID: PMC6441165 DOI: 10.1186/s40880-019-0357-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 03/19/2019] [Indexed: 01/27/2023] Open
Abstract
Background Currently, the diagnosis and treatment of nasopharyngeal carcinoma (NPC) patients with residual cervical lymphadenopathy following radical radiotherapy with or without chemotherapy are challenging. We investigated the prognosis of NPC patients with residual cervical lymphadenopathy and assessed the diagnostic and prognostic values of Epstein-Barr virus (EBV) DNA in these patients. Methods This study included 82 NPC patients who were diagnosed with suspected residual cervical lymphadenopathy following completion of antitumor therapy. Their plasma EBV DNA levels were measured using quantitative polymerase chain reaction (qPCR) before the initiation of treatment and before neck dissection. Fine needle aspiration cytology (FNAC) was performed in 21 patients. All patients had undergone neck dissection and postoperative pathological examination to identify the nature of residual cervical lymphadenopathy. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were calculated using the Kaplan–Meier method and compared using the log-rank test. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analysis was used to estimate the effect of potential prognostic factors on survival. Results Following a median follow-up of 52.6 months, compared with patients with negative postoperative pathological findings for residual cervical lymphadenopathy, the patients with positive findings had a significantly lower 3-year PFS rate (49.9% vs. 83.3%, P = 0.008). Among NPC patients with residual cervical lymphadenopathy, the patients with preoperative plasma EBV DNA > 0 copy/mL had a lower 3-year PFS rate than did those with no detectable EBV DNA (43.7% vs. 61.1%, P = 0.031). In addition, combining FNAC with preoperative EBV DNA detection improved the diagnostic sensitivity. Multivariable analysis demonstrated that residual cervical lymphadenopathy with positive postoperative pathological result was an independent prognostic factor for PFS and that detectable preoperative plasma EBV DNA was an independent prognostic factor for OS. Conclusions Using FNAC combined with preoperative EBV DNA detection improves the sensitivity in diagnosing NPC with residual cervical lymphadenopathy. Compared with patients with undetectable EBV DNA, patients with detectable preoperative plasma EBV DNA have worse prognosis and may require a more aggressive treatment strategy.
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Affiliation(s)
- Sai-Lan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Xue-Song Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Xiao-Yun Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Qiu-Yan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Yu-Jing Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jin-Jie Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chao Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Shan-Shan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Li-Ting Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Yang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hao-Jun Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Qing-Nan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hu Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
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18
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Kiprian D, Czarkowska-Paczek B, Wyczalkowska-Tomasik A, Paczek L. Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy. Medicine (Baltimore) 2018; 97:e13777. [PMID: 30572533 PMCID: PMC6319793 DOI: 10.1097/md.0000000000013777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Viral infections, including cytomegalovirus (CMV) and Epstein-Barr virus (EBV), play an important role in carcinogenesis and can influence patients' prognosis and condition during cancer treatment.The goal of this study was to investigate CMV and EBV infections in patients receiving radiotherapy or radiochemotherapy due to head and neck cancers to determine the influence of these infections on the risk of death. The observation period was 2 years.Of 41 patients enrolled, 11 received radiotherapy (simultaneous-integrated boost intensity-modulated radiation therapy [SIB-IMRT], 2.25 Gy/fraction, 30 fractions, [n = 7] or IMRT, 2 Gy per fraction, 35 fractions, [n = 4]) and 30 received radiochemotherapy (cisplatin 100 mg/m and SIB-IMRT [n = 13] or IMRT [n = 17]). Plasma CMV and EBV DNA levels were assessed using real-time PCR before or during treatment or 4 weeks posttreatment.The risk of death in the group positive for plasma CMV or EBV deoxyribonucleic acid (DNA) was significantly higher compared to the group without detectable plasma CMV (odd ratio [OR]: 7.5, 95% confidence interval [CI]: 1.11-50.67) or EBV DNA (OR: 10.91, 95% CI: 1.135-104.8). Results were confirmed using the Bayesian method. Plasma positivity for CMV or EBV DNA was associated with a higher risk of death (both P = .04).Viral infections negatively affect the survival of patients with head and neck cancers. Diagnosing and treating these viral infections in patients with positive results should be considered.
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Affiliation(s)
- Dorota Kiprian
- Department of Head and Neck Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology
| | | | | | - Leszek Paczek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
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19
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Huang CY, Chang WS, Tsai CW, Hsia TC, Shen TC, Bau DT, Shui HA. The contribution of interleukin-8 genotypes and expression to nasopharyngeal cancer susceptibility in Taiwan. Medicine (Baltimore) 2018; 97:e12135. [PMID: 30200105 PMCID: PMC6133569 DOI: 10.1097/md.0000000000012135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The incidence rate of nasopharyngeal cancer (nasopharyngeal carcinoma [NPC]) is much higher in Southeast Asia than in western countries. Interleukin-8 (IL-8), a chemokine produced by macrophages, epithelial cells, airway smooth muscle cells, and endothelial cells, is an important immuno-mediator in the development and progression of many types of cancer. Genetic variations in IL-8 have been associated with the risks of NPC and other cancers. In the current study, we evaluated the role of IL-8 in NPC at the levels of DNA, RNA, and protein in a Taiwanese population. First, in a case-control study, 176 NPC patients and 352 cancer-free controls were genotyped, and the associations of IL-8 T - 251A, C + 781T, C + 1633T, and A + 2767T polymorphisms with NPC risk were evaluated. Second, the NPC tissue samples were assessed for their IL-8 mRNA and protein expression by real-time quantitative reverse transcription polymerase chain reaction (PCR) and Western blotting, respectively. Regarding the IL-8 promoter T - 251A, the TA and AA genotypes were associated with significantly decreased risks of NPC compared with the wild-type TT genotype (adjusted odds ratio = 0.61 and 0.52, 95% confidence interval = 0.47-0.93 and 0.37-0.91, P = .0415 and .0289, respectively). The mRNA and protein expression levels for NPC tissues revealed no significant associations among the 20 NPC samples with different genotypes. These findings suggest that IL-8 may play an important role in the carcinogenesis of NPC in Taiwan.
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Affiliation(s)
- Chung-Yu Huang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
- Taoyuan Armed Forces General Hospital, Taoyuan
| | - Wen-Shin Chang
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital
| | - Chia-Wen Tsai
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital
| | - Te-Chun Hsia
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital
| | - Te-Chun Shen
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital
| | - Da-Tian Bau
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital
- Graduate Institute of Biomedical Sciences, China Medical University
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
| | - Hao-Ai Shui
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
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20
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Chan ATC, Hui EP, Ngan RKC, Tung SY, Cheng ACK, Ng WT, Lee VHF, Ma BBY, Cheng HC, Wong FCS, Loong HHF, Tong M, Poon DMC, Ahuja AT, King AD, Wang K, Mo F, Zee BCY, Chan KCA, Lo YMD. Analysis of Plasma Epstein-Barr Virus DNA in Nasopharyngeal Cancer After Chemoradiation to Identify High-Risk Patients for Adjuvant Chemotherapy: A Randomized Controlled Trial. J Clin Oncol 2018; 36:JCO2018777847. [PMID: 29989858 DOI: 10.1200/jco.2018.77.7847] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Purpose The contribution of adjuvant chemotherapy after chemoradiation therapy (CRT) in nasopharyngeal cancer (NPC) remains controversial. Plasma Epstein-Barr virus (EBV) DNA is a potential biomarker of subclinical residual disease in NPC. In this prospective, multicenter, randomized controlled trial, we used plasma EBV DNA to identify patients with NPC at a higher risk of relapse for adjuvant chemotherapy. Patients and Methods Eligible patients with histologically confirmed NPC of Union for International Cancer Control stage IIB to IVB, adequate organ function, and no locoregional disease or distant metastasis were screened by plasma EBV DNA at 6 to 8 weeks after radiotherapy (RT). Patients with undetectable plasma EBV DNA underwent standard surveillance. Patients with detectable plasma EBV DNA were randomly assigned to either adjuvant chemotherapy with cisplatin and gemcitabine for six cycles (arm 1) or observation (arm 2). Patients were stratified for primary treatment (RT v CRT) and stage (II/III v IV). The primary end point was relapse-free survival (RFS). Results Seven hundred eighty-nine patients underwent EBV DNA screening. Plasma EBV DNA was undetectable in 573 (72.6%) and detectable in 216 (27.4%); 104 (13.2%) with detectable EBV DNA were randomly assigned to arms 1 (n = 52) and 2 (n = 52). After a median follow-up of 6.6 years, no significant difference was found in 5-year RFS rate between arms 1 and 2 (49.3% v 54.7%; P = .75; hazard ratio for relapse or death, 1.09; 95% CI, 0.63 to 1.89). The level of post-RT plasma EBV DNA correlated significantly with the hazards of locoregional failure, distant metastasis, and death. Conclusion In patients with NPC with detectable post-RT plasma EBV DNA, adjuvant chemotherapy with cisplatin and gemcitabine did not improve RFS. Post-RT plasma EBV DNA level should be incorporated as the selection factor in future clinical trials of adjuvant therapy in NPC.
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Affiliation(s)
- Anthony T C Chan
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Edwin P Hui
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Roger K C Ngan
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Stewart Y Tung
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Ashley C K Cheng
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Wai T Ng
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Victor H F Lee
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Brigette B Y Ma
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Hoi C Cheng
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Frank C S Wong
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Herbert H F Loong
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Macy Tong
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Darren M C Poon
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Anil T Ahuja
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Ann D King
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Ki Wang
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Frankie Mo
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Benny C Y Zee
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - K C Allen Chan
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Y M Dennis Lo
- Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Macy Tong, and Darren M.C. Poon, Prince of Wales Hospital; Roger K.C. Ngan and Hoi C. Cheng, Queen Elizabeth Hospital; Stewart Y. Tung and Frank C.S. Wong, Tuen Mun Hospital; Ashley C.K. Cheng, Princess Margaret Hospital; Wai T. Ng, Pamela Youde Nethersole Eastern Hospital; Victor H.F. Lee, Queen Mary Hospital; and Anthony T.C. Chan, Edwin P. Hui, Brigette B.Y. Ma, Herbert H.F. Loong, Anil T. Ahuja, Ann D. King, Ki Wang, Frankie Mo, Benny C.Y. Zee, K.C. Allen Chan, and Y.M. Dennis Lo, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
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21
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Alfieri S, Iacovelli NA, Marceglia S, Lasorsa I, Resteghini C, Taverna F, Mazzocchi A, Orlandi E, Guzzo M, Bianchi R, Fanti D, Pala L, Racca S, Dvir R, Quattrone P, Gloghini A, Volpi CC, Granata R, Bergamini C, Locati L, Licitra L, Bossi P. Circulating pre-treatment Epstein-Barr virus DNA as prognostic factor in locally-advanced nasopharyngeal cancer in a non-endemic area. Oncotarget 2018; 8:47780-47789. [PMID: 28562354 PMCID: PMC5564604 DOI: 10.18632/oncotarget.17822] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022] Open
Abstract
The prognostic value of pre-treatment Epstein-Barr Virus (EBV) DNA viral load for non-endemic, locally-advanced, EBV-related nasopharyngeal cancer (NPC) patients is yet to be defined. All patients with EBV encoded RNA (EBER)-positive NPC treated at our Institution from 2005 to 2014 with chemotherapy (CT) concurrent with radiation (RT) +/- induction chemotherapy (ICT) were retrospectively reviewed. Pre-treatment baseline plasma EBV DNA (b-EBV DNA) viral load was detected and quantified by PCR. Median b-EBV DNA value was correlated to potential influencing factors by univariate analysis. Significant variables were then extrapolated and included in a multivariate linear regression model. The same variables, including b-EBV DNA, were correlated with Disease Free Survival (DFS) and Overall Survival (OS) by univariate and multivariate analysis. A total of 130 locally-advanced EBER positive NPC patients were evaluated. Overall, b-EBV DNA was detected in 103 patients (79.2%). Median viral load was 554 copies/mL (range 50–151075), and was positively correlated with T stage (p=0.002), N3a-b vs N0-1-2 stage (p=0.048), type of treatment (ICT followed by CTRT, p=0.006) and locoregional and/or distant disease recurrence (p=0.034). In the overall population, DFS and OS were significantly longer in patients with pre-treatment negative EBV DNA than in positive subjects at the multivariate analysis. Negative b-EBV DNA can be considered as prognostic biomarker of longer DFS and OS in NPC in non-endemic areas. This finding needs confirmation in larger prospective series, with standardized and inter-laboratory harmonized method of plasma EBV DNA quantification.
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Affiliation(s)
- Salvatore Alfieri
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Irene Lasorsa
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Carlo Resteghini
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Taverna
- Laboratory of Immunohematology & Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arabella Mazzocchi
- Laboratory of Immunohematology & Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Guzzo
- Department of Head and Neck Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Bianchi
- Department of Head and Neck Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diana Fanti
- Laboratory of Clinical Chemistry and Microbiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Pala
- Department of Medical Oncology of Melanoma and Sarcoma, Istituto Europeo di Oncologia, Milan, Italy
| | - Sara Racca
- Laboratory of Clinical Microbiology & Virology, San Raffaele IRCCS Hospital, Milan, Italy
| | - Roee Dvir
- Laboratory of Clinical Microbiology & Virology, San Raffaele IRCCS Hospital, Milan, Italy
| | - Pasquale Quattrone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annunziata Gloghini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Costanza Volpi
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Granata
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristiana Bergamini
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Locati
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology 3, University of Milan, Milan, Italy
| | - Paolo Bossi
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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22
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Tuna M, Amos CI. Next generation sequencing and its applications in HPV-associated cancers. Oncotarget 2018; 8:8877-8889. [PMID: 27784002 PMCID: PMC5352450 DOI: 10.18632/oncotarget.12830] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/14/2016] [Indexed: 12/18/2022] Open
Abstract
Approximately 18% of all human cancers have a viral etiology, and human papillomavirus (HPV) has been identified as one of the most prevalent viruses that plays causative role in nearly all cervical cancers and, in addition, in subset of head and neck, anal, penile and vulvar cancers. The recent introduction of next generation sequencing (NGS) and other omics approaches have resulted in comprehensive knowledge on the pathogenesis of HPV-driven tumors. Specifically, these approaches have provided detailed information on genomic HPV integration sites, disrupted genes and pathways, and common and distinct genetic and epigenetic alterations in different human HPV-associated cancers. This review focuses on HPV integration sites, its concomitantly disrupted genes and pathways and its functional consequences in both cervical and head and neck cancers. Integration of NGS data with other omics and clinical data is crucial to better understand the pathophysiology of each individual malignancy and, based on this, to select targets and to design effective personalized treatment options.
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Affiliation(s)
- Musaffe Tuna
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon
| | - Christopher I Amos
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon
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23
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Guo SS, Hu W, Chen QY, Li JM, Zhu SH, He Y, Li JW, Xia L, Ji L, Lin CY, Liu LT, Tang LQ, Guo L, Mo HY, Zhao C, Guo X, Cao KJ, Qian CN, Zeng MS, Hong MH, Shao JY, Sun Y, Ma J, Fan YY, Mai HQ. Pretreatment quality of life as a predictor of survival for patients with nasopharyngeal carcinoma treated with IMRT. BMC Cancer 2018; 18:114. [PMID: 29386004 PMCID: PMC5793429 DOI: 10.1186/s12885-018-4003-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate the prognostic significance of pretreatment quality of life for patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Methods We performed a prospective, longitudinal study on 554 newly diagnosed patients with NPC from April 2011 to January 2015. A total of 501 consecutive NPC patients were included. Patients were asked to complete the EORTC QLQ-C30 (version 3.0) and QLQ-H&N35 questionnaires before treatment. Results Global health status among QLQ-C30 correlates with EBV DNA(P = 0.019). In addition, pretreatment appetite loss was significantly correlated with EBV DNA(P = 0.02). Pretreatment teeth, opening mouth, feeding tube was significantly correlated with EBV DNA, with P value of 0.003, < 0.0001, and 0.031, respectively. In multivariate analysis, pretreatment cognitive functioning of QLQ-C30 was significantly associated with LRFS, with HR of 0.971(95%CI 0.951–0.990), P = 0.004. Among scales of QLQ-H&N35 for multivariate analysis, pretreatment teeth (P = 0.026) and felt ill (P = 0.012) was significantly associated with PFS, with HR of 0.984 (95%CI 0.971–.998) and 1.004 (95%CI 1.001–1.007), respectively. Felt ill of QLQ-H&N35 was significantly associated with DMFS, with HR of 1.004(95%CI 1.000–1.007), P = 0.043. There is no QoL scale significantly associated with OS after multivariate analysis. Conclusions In conclusion, our analysis confirms that pretreatment teeth and felt ill was significantly associated with PFS in NPC patients treated with IMRT. In addition, the posttreatment EBV DNA was significantly associated with OS.
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Affiliation(s)
- Shan-Shan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Wen Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Qiu-Yan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jian-Mei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Shi-Heng Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Yan He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jia-Wen Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Le Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Lu Ji
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Cui-Ying Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Li-Ting Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Hao-Yuan Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Chong Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ka-Jia Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Mu-Sheng Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Ming-Huang Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Good Clinical Practice center, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jian-Yong Shao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Yu-Ying Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
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24
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Li WF, Zhang Y, Huang XB, Du XJ, Tang LL, Chen L, Peng H, Guo R, Sun Y, Ma J. Prognostic value of plasma Epstein-Barr virus DNA level during posttreatment follow-up in the patients with nasopharyngeal carcinoma having undergone intensity-modulated radiotherapy. CHINESE JOURNAL OF CANCER 2017; 36:87. [PMID: 29116021 PMCID: PMC5678814 DOI: 10.1186/s40880-017-0256-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 10/26/2017] [Indexed: 01/19/2023]
Abstract
Background The value of Epstein–Barr virus (EBV) DNA assay during posttreatment follow-up of the patients with nasopharyngeal carcinoma (NPC) presenting with different pretreatment plasma EBV DNA levels remains unclear. In the present study, we aimed to evaluate the prognostic value of plasma EBV DNA assay during posttreatment follow-up in the patients with NPC who have undergone intensity-modulated radiotherapy. Methods The medical records of 385 NPC patients treated with intensity-modulated radiotherapy between November 2009 and February 2012 were reviewed. All patients underwent plasma EBV DNA assays before treatment, within 3 months after treatment, and then every 3–12 months during posttreatment follow-up period. The recurrence rates for patients with different pretreatment and posttreatment follow-up plasma EBV DNA levels were analyzed. Results Of the 385 patients, 267 (69.4%) had detectable pretreatment plasma EBV DNA (> 0 copy/mL) and 93 (24.2%) had detectable posttreatment EBV DNA during a median follow-up of 52.8 months (range 9.3–73.8 months). Detectable EBV DNA during posttreatment follow-up was found in 14.4% (17/118) and 28.5% (76/267) of patients with undetectable and detectable pretreatment EBV DNA, respectively, and was significantly associated with tumor recurrence in both patient groups. EBV DNA was detectable in 12.8% (40/313) of patients who remained disease-free, 56.4% (22/39) of patients with locoregional recurrence alone, and 93.9% (31/33) of patients with distant metastasis as the first recurrence event (P < 0.001); 6.5% (19/292) of patients with undetectable EBV DNA and 57.0% (53/93) of patient with detectable EBV DNA during posttreatment follow-up experienced tumor recurrence. Compared with other cut-off values, the cut-off value of 0 copy/mL for EBV DNA during posttreatment follow-up had the highest area under the ROC curve (AUC) value (0.804, 95% confidence interval 0.741–0.868) for predicting tumor recurrence (sensitivity, specificity, and accuracy: 73.6%, 87.2%, and 84.7%, respectively). Conclusion Plasma EBV DNA level during posttreatment follow-up is a good marker for predicting distant metastasis but not locoregional recurrence in the patients with NPC irrespective of the pretreatment EBV DNA levels.
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Affiliation(s)
- Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Xiao-Bin Huang
- Department of Blood Source Management, Guangzhou Blood Center, Guangzhou, 510095, Guangdong, P. R. China
| | - Xiao-Jing Du
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Rui Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China.
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25
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Chen JLY, Huang YS, Kuo SH, Hong RL, Ko JY, Lou PJ, Wang CW. Intensity-modulated radiation therapy achieves better local control compared to three-dimensional conformal radiation therapy for T4-stage nasopharyngeal carcinoma. Oncotarget 2017; 8:14068-14077. [PMID: 27764778 PMCID: PMC5355163 DOI: 10.18632/oncotarget.12736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine the survival outcomes and late toxicity profiles of three-dimensional conformal radiation therapy (3DCRT) vs. intensity-modulated radiation therapy (IMRT) for patients with nasopharyngeal carcinoma (NPC). Methods Three hundred and seventy-four patients with newly diagnosed, non-metastatic, NPC who were curatively treated with 3DCRT between 2004 and 2006 and 481 patients treated with IMRT between 2007 and 2009 were analyzed. Patients were categorized as having advanced-stage disease (stage III, IVA, and IVB disease; n = 709) or early-stage disease (stage I and II; n = 146). The median follow-up time was 90.3 months for patients treated with 3DCRT and 86.3 months for patients treated with IMRT. Results For early-stage patients, the outcomes of IMRT vs. 3DCRT were similar considering locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS). For advanced-stage patients, IMRT was associated with better LRC compared with 3DCRT (5-year LRC rate: 85.6% vs. 76.6%, respectively; p = 0.035) and OS (5-year OS rate: 82.3% vs. 71.8%, respectively; p = 0.002), whereas DMFS was similar for both treatments (5-year DMFS rate: 80.9% vs. 79.0%, respectively; p = 0.324). Furthermore, the IMRT technique was more beneficial for patients with T4 disease. Late toxicities occurred more frequently in patients treated with 3DCRT than in those treated with IMRT (grade ≥3 neck fibrosis: 6.7% vs. 3.7%, respectively, p = 0.036; radiographic temporal lobe necrosis: 10.2% vs. 4.4%, respectively, p < 0.001). Conclusions Compared with 3DCRT, IMRT offered better LRC in patients with advanced-stage non-metastatic NPC, which corresponded with better OS.
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Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Radiation Oncology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan
| | - Ruey-Long Hong
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Wei Wang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Li WF, Chen L, Sun Y, Ma J. Induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma. CHINESE JOURNAL OF CANCER 2016; 35:94. [PMID: 27846913 PMCID: PMC5111216 DOI: 10.1186/s40880-016-0157-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/31/2016] [Indexed: 11/10/2022]
Abstract
The value of adding induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) for the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC) remains unclear. In our recent article entitled "Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial" published in the Lancet Oncology, we reported the results of a phase III, multicenter, randomized controlled trial comparing cisplatin, 5-fluorouracil, and docetaxel (TPF) IC plus CCRT versus CCRT alone in patients with T3-4N1/TxN2-3M0 NPC (ClinicalTrials.gov registration number NCT01245959). The IC-plus-CCRT group showed significantly higher 3-year failure-free survival, overall survival, and distant failure-free survival rates than the CCRT-alone group, with an acceptable toxicity profile. Our study suggests that adding TPF IC to CCRT could increase survival rates and reduce distant failure in patients with locoregionally advanced NPC. However, long-term follow-up is required to assess the eventual efficacy and toxicity of this strategy, and a more accurate method to determine prognosis is needed to enable better tailoring of treatment strategy for individual patients.
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Affiliation(s)
- Wen-Fei Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangdong, 510060, P. R. China
| | - Lei Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangdong, 510060, P. R. China
| | - Ying Sun
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangdong, 510060, P. R. China
| | - Jun Ma
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangdong, 510060, P. R. China.
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