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Adibi A, Tokat ÜM, Özgü E, Mamyrov N, Aydın E, Bilgiç ŞN, Tutar O, Demiray M. Durable radiologic and molecular complete response following nivolumab in an HNSCC patient with UV signature and HIV. Oral Oncol 2024; 154:106859. [PMID: 38781626 DOI: 10.1016/j.oraloncology.2024.106859] [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: 04/30/2024] [Revised: 05/07/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
Cancer patients living with HIV (CPLWH) may experience increased mortality risk. Furthermore, they have been historically excluded from clinical trials due to safety concerns. Our patient with squamous cell carcinoma of the lower lip received radiotherapy and platinum-based chemotherapy but declined by multiple centers due to his accidental HIV status. Genomic profiling revealed CDKN2A/B, PBRM1, TP53, and TERT alterations corresponding to UV signature, and high tumor mutational burden with positive PD-L1 staining. Accordingly, we report a durable radiologic and molecular complete response upon nivolumab plus IVC and antiretroviral therapy (ART). We demonstrated the safety and efficacy of ICIs, and feasibility of managing adverse events caused by antitumor, antiviral, and integrative therapies.
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Affiliation(s)
- Ashkan Adibi
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye; Istanbul University, Institute of Oncology, Department of Basic Oncology, Division of Cancer Genetics, Istanbul, Turkiye
| | - Ünal Metin Tokat
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye
| | - Eylül Özgü
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye
| | - Nurseit Mamyrov
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye
| | - Esranur Aydın
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye
| | | | - Onur Tutar
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkiye
| | - Mutlu Demiray
- Medicana Health Group, Precision Oncology Center, Istanbul, Turkiye.
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Adibi A, Tokat ÜM, Özgü E, Aydın E, Demiray İ, Demiray M. PARP inhibitor combinations with high-dose vitamin C in the treatment of Ewing sarcoma: two case reports and mechanistic overview. Ther Adv Med Oncol 2023; 15:17588359231213841. [PMID: 38107827 PMCID: PMC10725144 DOI: 10.1177/17588359231213841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023] Open
Abstract
Ewing's sarcoma (ES) is a bone and soft tissue tumor that mainly occurs at a young age. The underlying cause of Ewing's sarcoma is the formation of fusion proteins between FET family genes and ETS family genes. Tumors with FET/ETS fusion genes can have defects in the DNA damage response and are sensitive to PARP inhibitors (PARPi). However, several studies have shown that PARPi alone is not sufficient to induce a meaningful antitumor response and that combinations of DNA-damaging agents with PARPi are required to achieve efficacy. Accordingly, preclinical studies have reported dramatic responses to PARPi treatment in combination with DNA-damaging agents such as temozolomide or irinotecan. Similarly, it has been previously reported that by generating reactive oxygen species, high-dose intravenous vitamin C (IVC) can induce DNA damage. This suggests that the combination of IVC with PARPi may increase genotoxic stress and enhance the antitumor response. In addition, unlike chemotherapeutic agents, IVC induces DNA damage selectively in cancer cells, and the side effects are significantly milder than those of chemotherapy. As ETS fusion-positive ES is deficient in faithful DNA repair, partly due to the interaction between ETS fusion products and PARP1, a PARPi plus IVC seems to be a logical and effective combination for the treatment of ETS fusion-positive ES. This paper reports significant responses to IVC (1-1.5 g/kg) in combination with PARPi (olaparib 300 mg BID or talazoparib 1 mg/day) in two patients with metastatic Ewing's sarcoma. The observations highlight an unmet therapeutic need for patients with advanced metastatic ES. The combination of PARPi with a selective DNA-damaging agent was effective in these cases. This case experience suggests that IVC may be incorporated into PARPi-based therapeutic strategies. Further studies are needed to confirm the efficacy of this combination in the treatment of Ewing sarcoma with ETS fusions.
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Affiliation(s)
- Ashkan Adibi
- Center of Precision Oncology, Medicana International Hospitals, Istanbul, Türkiye
- Department of Basic Oncology, Division of Cancer Genetics, Institute of Oncology, University of Istanbul, Istanbul, Türkiye
- Institute of Health Sciences, University of Istanbul, Istanbul, Türkiye
| | - Ünal Metin Tokat
- Center of Precision Oncology, Medicana International Hospitals, Istanbul, Türkiye
| | - Eylül Özgü
- Center of Precision Oncology, Medicana International Hospitals, Istanbul, Türkiye
| | - Esranur Aydın
- Center of Precision Oncology, Medicana International Hospitals, Istanbul, Türkiye
| | - İrem Demiray
- Department of Molecular Biology and Genetics, College of Science, Koç University, Istanbul, Türkiye
| | - Mutlu Demiray
- Center of Precision Oncology, Medicana International Hospitals, Küçükbakkalköy, Vedat Günyol Cd. No: 24, Atasehir, Istanbul 34750, Türkiye
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Foster MN, Carr AC, Antony A, Peng S, Fitzpatrick MG. Intravenous Vitamin C Administration Improved Blood Cell Counts and Health-Related Quality of Life of Patient with History of Relapsed Acute Myeloid Leukaemia. Antioxidants (Basel) 2018; 7:antiox7070092. [PMID: 30012948 PMCID: PMC6070822 DOI: 10.3390/antiox7070092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 01/23/2023] Open
Abstract
A 52-year-old female presented to Integrated Health Options Clinic in October 2014 with a history of relapsed acute myeloid leukaemia (AML, diagnosed in 2009 and relapsed in 2014). Intravenous(IV) vitamin C therapy was initiated (in 2014) following completion of chemotherapy as an alternative to haematopoietic stem cell transplantation. IV vitamin C was administered twice weekly at a dose of 70 g/infusion. Within 4 weeks of initiation of IV vitamin C therapy, there was a dramatic improvement in the patient’s blood indices with platelet cell counts increasing from 25 × 109/L to 196 × 109/L and white blood cell counts increasing from 0.29 × 109/L to 4.0 × 109/L, with further improvements observed over the next 18 months. Furthermore, there was a clear and sustained improvement in the patient’s health-related quality of life scores assessed using a validated questionnaire. She has remained healthy and in complete remission until the present day. This case study highlights the benefits of IV vitamin C as a supportive therapy for previously relapsed AML.
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Affiliation(s)
- Mike N Foster
- Integrated Health Options Ltd., Auckland 1050, New Zealand.
| | - Anitra C Carr
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.
| | - Alina Antony
- Feedback Research Ltd., Auckland 1050, New Zealand.
| | - Selene Peng
- Feedback Research Ltd., Auckland 1050, New Zealand.
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No Reported Renal Stones with Intravenous Vitamin C Administration: A Prospective Case Series Study. Antioxidants (Basel) 2018; 7:antiox7050068. [PMID: 29883396 PMCID: PMC5981254 DOI: 10.3390/antiox7050068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 12/12/2022] Open
Abstract
A few cases associating high dose intravenous vitamin C (IVC) administration with renal stone formation have been reported in the literature, however, no long-term studies investigating IVC administration and reported renal stones have been carried out. Our aim was to measure the frequency of reported renal stones in patients receiving IVC therapy. We carried out a prospective case series study of 157 adult patients who commenced IVC therapy at Integrated Health Options clinic between 1 September 2011 and 31 August 2012, with follow-up for 12 months. Inquiries into the occurrence of renal stones were conducted at enrolment, 6 and 12 months, and renal function blood tests were conducted at enrolment, 4 weeks and every 12 weeks thereafter in a subgroup of patients. No renal stones were reported by any patients in the study, despite 8% of the patients having a history of renal stones. In addition, the majority of patients investigated had stable renal function during the study period as evidenced by little change in serum creatinine levels and estimated glomerular filtration rate (eGFR) following IVC. In conclusion, IVC therapy was not associated with patient-reported renal stones. Although not the primary focus of this study, it was also observed that there was no significant change in mean serum creatinine or eGFR for those who had follow-up renal function blood tests.
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Hosokawa Y, Saga R, Monzen S, Terashima S, Tsuruga E. Ascorbic acid does not reduce the anticancer effect of radiotherapy. Biomed Rep 2017; 6:103-107. [PMID: 28123717 PMCID: PMC5244771 DOI: 10.3892/br.2016.819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/26/2016] [Indexed: 12/21/2022] Open
Abstract
The present study hypothesized that the therapeutic use of ascorbic acid (AsA) in combination with radiation may reduce therapy-related side effects and increase the antitumor effects. The aim of the study was to examine the association between the scavenged activity of AsA and the biological anticancer effect of hydroxyl (OH) radicals generated by X-ray irradiation. Cell survival, DNA fragmentation of human leukemia HL60 cells and the amount of OH radicals were investigated following X-ray irradiation and AsA treatment. The number of living cells decreased, and DNA fragmentation increased at AsA concentrations >1 mM. Electron spin resonance spectra revealed that X-ray irradiation generated OH radicals, which were scavenged by AsA at concentrations >75 µM. The AsA concentration inside the cell was 75 µM when cells underwent extracellular treatment with 5 mM AsA, which significantly induced HL60 cell death even without irradiation. No increase in the number of viable HL60 cells was observed following AsA treatment with irradiation when compared to irradiation alone. In conclusion, the disappearance of the radiation anticancer effects with AsA treatment in combination with radiotherapy for cancer treatment is not a cause for concern.
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Affiliation(s)
- Yoichiro Hosokawa
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Ryo Saga
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Satoru Monzen
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Shingo Terashima
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Eichi Tsuruga
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
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Ascorbic acid and colon cancer: an oxidative stimulus to cell death depending on cell profile. Eur J Cell Biol 2016; 95:208-18. [DOI: 10.1016/j.ejcb.2016.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/13/2016] [Accepted: 04/05/2016] [Indexed: 12/25/2022] Open
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Moser JC, Rawal M, Wagner BA, Du J, Cullen JJ, Buettner GR. Pharmacological ascorbate and ionizing radiation (IR) increase labile iron in pancreatic cancer. Redox Biol 2013; 2:22-7. [PMID: 24396727 PMCID: PMC3881203 DOI: 10.1016/j.redox.2013.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 02/04/2023] Open
Abstract
Labile iron, i.e. iron that is weakly bound and is relatively unrestricted in its redox activity, has been implicated in both the pathogenesis as well as treatment of cancer. Two cancer treatments where labile iron may contribute to their mechanism of action are pharmacological ascorbate and ionizing radiation (IR). Pharmacological ascorbate has been shown to have tumor-specific toxic effects due to the formation of hydrogen peroxide. By catalyzing the oxidation of ascorbate, labile iron can enhance the rate of formation of hydrogen peroxide; labile iron can also react with hydrogen peroxide. Here we have investigated the magnitude of the labile iron pool in tumor and normal tissue. We also examined the ability of pharmacological ascorbate and IR to change the size of the labile iron pool. Although a significant amount of labile iron was seen in tumors (MIA PaCa-2 cells in athymic nude mice), higher levels were seen in murine tissues that were not susceptible to pharmacological ascorbate. Pharmacological ascorbate and irradiation were shown to increase the labile iron in tumor homogenates from this murine model of pancreatic cancer. As both IR and pharmacological ascorbate may rely on labile iron for their effects on tumor tissues, our data suggest that pharmacological ascorbate could be used as a radio-sensitizing agent for some radio-resistant tumors. EPR can detect chelatable iron in tissue as ferrioxamine. Chelatable iron varies widely with type of tissue. Pharmacological ascorbate increases the amount of chelatable iron in tissue.
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Affiliation(s)
- Justin C Moser
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA
| | - Malvika Rawal
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA
| | - Brett A Wagner
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA
| | - Juan Du
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA
| | - Joseph J Cullen
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA ; Department of Surgery, The University of Iowa, Iowa City, IA, USA ; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, USA
| | - Garry R Buettner
- Free Radical and Radiation Biology Program and ESR Facility, Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA ; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, USA
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