1
|
Bostan IS, Mihaila M, Roman V, Radu N, Neagu MT, Bostan M, Mehedintu C. Landscape of Endometrial Cancer: Molecular Mechanisms, Biomarkers, and Target Therapy. Cancers (Basel) 2024; 16:2027. [PMID: 38893147 PMCID: PMC11171255 DOI: 10.3390/cancers16112027] [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: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Endometrial cancer is one the most prevalent gynecological cancers and, unfortunately, has a poor prognosis due to low response rates to traditional treatments. However, the progress in molecular biology and understanding the genetic mechanisms involved in tumor processes offers valuable information that has led to the current classification that describes four molecular subtypes of endometrial cancer. This review focuses on the molecular mechanisms involved in the pathogenesis of endometrial cancers, such as genetic mutations, defects in the DNA mismatch repair pathway, epigenetic changes, or dysregulation in angiogenic or hormonal signaling pathways. The preclinical genomic and molecular investigations presented allowed for the identification of some molecules that could be used as biomarkers to diagnose, predict, and monitor the progression of endometrial cancer. Besides the therapies known in clinical practice, targeted therapy is described as a new cancer treatment that involves identifying specific molecular targets in tumor cells. By selectively inhibiting these targets, key signaling pathways involved in cancer progression can be disrupted while normal cells are protected. The connection between molecular biomarkers and targeted therapy is vital in the fight against cancer. Ongoing research and clinical trials are exploring the use of standard therapy agents in combination with other treatment strategies like immunotherapy and anti-angiogenesis therapy to improve outcomes and personalize treatment for patients with endometrial cancer. This approach has the potential to transform the management of cancer patients. In conclusion, enhancing molecular tools is essential for stratifying the risk and guiding surgery, adjuvant therapy, and cancer treatment for women with endometrial cancer. In addition, the information from this review may have an essential value in the personalized therapy approach for endometrial cancer to improve the patient's life.
Collapse
Affiliation(s)
| | - Mirela Mihaila
- Stefan S. Nicolau Institute of Virology, Center of Immunology, Romanian Academy, 030304 Bucharest, Romania; (M.M.); (V.R.)
- Faculty of Pharmacy, Titu Maiorescu University, 040314 Bucharest, Romania
| | - Viviana Roman
- Stefan S. Nicolau Institute of Virology, Center of Immunology, Romanian Academy, 030304 Bucharest, Romania; (M.M.); (V.R.)
| | - Nicoleta Radu
- Department of Biotechnology, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 011464 Bucharest, Romania;
- Biotechnology Department, National Institute for Chemistry and Petrochemistry R&D of Bucharest, 060021 Bucharest, Romania
| | - Monica Teodora Neagu
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania;
| | - Marinela Bostan
- Stefan S. Nicolau Institute of Virology, Center of Immunology, Romanian Academy, 030304 Bucharest, Romania; (M.M.); (V.R.)
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania;
| | - Claudia Mehedintu
- Filantropia Clinical Hospital, 011132 Bucharest, Romania; (I.-S.B.); (C.M.)
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050471 Bucharest, Romania
| |
Collapse
|
2
|
Han SN, Oza A, Colombo N, Oaknin A, Raspagliesi F, Wenham RM, Braicu EI, Jewell A, Makker V, Krell J, Alía EMG, Baurain JF, Su Z, Neuwirth R, Vincent S, Sedarati F, Faller DV, Scambia G. A randomized phase 2 study of sapanisertib in combination with paclitaxel versus paclitaxel alone in women with advanced, recurrent, or persistent endometrial cancer. Gynecol Oncol 2023; 178:110-118. [PMID: 37839313 PMCID: PMC11100409 DOI: 10.1016/j.ygyno.2023.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This phase 2 study investigated sapanisertib (selective dual inhibitor of mTORC1/2) alone, or in combination with paclitaxel or TAK-117 (a selective small molecule inhibitor of PI3K), versus paclitaxel alone in advanced, recurrent, or persistent endometrial cancer. METHODS Patients with histologic diagnosis of endometrial cancer (1-2 prior regimens) were randomized to 28-day cycles on four treatment arms: 1) weekly paclitaxel 80 mg/m2 (days 1, 8, and 15); 2) weekly paclitaxel 80 mg/m2 + oral sapanisertib 4 mg on days 2-4, 9-11, 16-18, and 23-25; 3) weekly sapanisertib 30 mg, or 4) sapanisertib 4 mg + TAK-117 200 mg on days 1-3, 8-10, 15-17, and 22-24. RESULTS Of 241 patients randomized, 234 received treatment (paclitaxel, n = 87 [3 ongoing]; paclitaxel+sapanisertib, n = 86 [3 ongoing]; sapanisertib, n = 41; sapanisertib+TAK-117, n = 20). The sapanisertib and sapanisertib+TAK-117 arms were closed to enrollment after futility analyses. After a median follow-up of 14.4 (paclitaxel) versus 17.2 (paclitaxel+sapanisertib) months, median progression-free survival (PFS; primary endpoint) was 3.7 versus 5.6 months (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.58-1.15; p = 0.139); in patients with endometrioid histology (n = 116), median PFS was 3.3 versus 5.7 months (HR 0.66; 95% CI 0.43-1.03). Grade ≥ 3 treatment-emergent adverse event rates were 54.0% with paclitaxel versus 89.5% paclitaxel+sapanisertib. CONCLUSIONS Our findings support inclusion of chemotherapy combinations with investigational agents for advanced or metastatic disease. The primary endpoint was not met and toxicity was manageable. TRIAL REGISTRATION ClinicalTrials.gov number, NCT02725268.
Collapse
Affiliation(s)
- Sileny N Han
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Department of Oncology, KU Leuven, Gynaecological Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Amit Oza
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nicoletta Colombo
- Obstetrics and Gynaecology, University of Milano-Bicocca and European Institute of Oncology IRCCS, Milan, Italy
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Elena Ioana Braicu
- Department for Gynecology Campus Virchow, Charité Medical University Berlin, Berlin, Germany
| | - Andrea Jewell
- Obstetrics and Gynecology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Vicky Makker
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Jonathan Krell
- Department of Medical Oncology, Imperial College London, London, UK
| | | | - Jean-François Baurain
- Medical Oncology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Zhenqiang Su
- Computational Biology, Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Rachel Neuwirth
- Biostatistics, Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Sylvie Vincent
- Translational Medicine, Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Farhad Sedarati
- Oncology Clinical Research, Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Douglas V Faller
- Oncology Clinical Research, Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Giovanni Scambia
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| |
Collapse
|
3
|
Parker MJ, Lee H, Yao S, Irwin S, Hwang S, Belanger K, de Mare SW, Surgenor R, Yan L, Gee P, Morla S, Puyang X, Hsiao P, Zeng H, Zhu P, Korpal M, Dransfield P, Bolduc DM, Larsen NA. Identification of 2-Sulfonyl/Sulfonamide Pyrimidines as Covalent Inhibitors of WRN Using a Multiplexed High-Throughput Screening Assay. Biochemistry 2023; 62:2147-2160. [PMID: 37403936 PMCID: PMC10358344 DOI: 10.1021/acs.biochem.2c00599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/03/2023] [Indexed: 07/06/2023]
Abstract
Werner syndrome protein (WRN) is a multifunctional enzyme with helicase, ATPase, and exonuclease activities that are necessary for numerous DNA-related transactions in the human cell. Recent studies identified WRN as a synthetic lethal target in cancers characterized by genomic microsatellite instability resulting from defects in DNA mismatch repair pathways. WRN's helicase activity is essential for the viability of these high microsatellite instability (MSI-H) cancers and thus presents a therapeutic opportunity. To this end, we developed a multiplexed high-throughput screening assay that monitors exonuclease, ATPase, and helicase activities of full-length WRN. This screening campaign led to the discovery of 2-sulfonyl/sulfonamide pyrimidine derivatives as novel covalent inhibitors of WRN helicase activity. The compounds are specific for WRN versus other human RecQ family members and show competitive behavior with ATP. Examination of these novel chemical probes established the sulfonamide NH group as a key driver of compound potency. One of the leading compounds, H3B-960, showed consistent activities in a range of assays (IC50 = 22 nM, KD = 40 nM, KI = 32 nM), and the most potent compound identified, H3B-968, has inhibitory activity IC50 ∼ 10 nM. These kinetic properties trend toward other known covalent druglike molecules. Our work provides a new avenue for screening WRN for inhibitors that may be adaptable to different therapeutic modalities such as targeted protein degradation, as well as a proof of concept for the inhibition of WRN helicase activity by covalent molecules.
Collapse
Affiliation(s)
- Mackenzie J. Parker
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Hyelee Lee
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Shihua Yao
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Sean Irwin
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Sunil Hwang
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Kylie Belanger
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Sofia Woo de Mare
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Richard Surgenor
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Lu Yan
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Patricia Gee
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Shravan Morla
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Xiaoling Puyang
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Peng Hsiao
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Hao Zeng
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Ping Zhu
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Manav Korpal
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Paul Dransfield
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - David M. Bolduc
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| | - Nicholas A. Larsen
- H3 Biomedicine, Inc., 300 Technology Square, Suite 5, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
4
|
Yang L, Yang H, Zhao H, Hu Z, Shen Z, Zhao L, Tan S, Zhu L, Xu R, Liu H, Ding C, Qin Y, Zhao Y. Resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, and bilateral partial external iliac arteries with artificial vessel replacement during radical endometrial cancer surgery: a case report. BMC Womens Health 2022; 22:554. [PMID: 36578004 PMCID: PMC9798542 DOI: 10.1186/s12905-022-02120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endometrial carcinoma (EC) is a common malignant tumor of the female reproductive system, often accompanied by lymph node metastasis. Artificial vascular implantation is a common surgical treatment for mediastinal tumors and abdominal aortic aneurysms but is rarely used in gynecological surgery. CASE PRESENTATION A 54-year-old female patient was first admitted to the hospital in January 2018 due to "irregular vaginal bleeding over 3 months". CT showed a mass in the uterine cavity, and several swollen lymph nodes in the retroperitoneum and pelvic cavity. The initial diagnosis was an endometrial malignant tumor. We performed radical endometrial cancer surgery with parallel resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, bilateral external iliac arteries, and artificial vessel replacement, which was successful, with good postoperative recovery and no lesion progression at 3 years postoperative follow-up. CONCLUSION This is an early case of gynecological clinical use of prostheses. Through multidisciplinary cooperation, the surgical resection rate of patients with EC in radical surgery was improved without serious fatal complications and achieved a high long-term postoperative survival rate.
Collapse
Affiliation(s)
- Linlin Yang
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Hongying Yang
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - He Zhao
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Zaoxiu Hu
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Zhenglei Shen
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Lingfeng Zhao
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Shufen Tan
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Lei Zhu
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Ruolan Xu
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Hui Liu
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Chunyan Ding
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Yan Qin
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| | - Yanfei Zhao
- grid.452826.fDepartment of Gynaecology, Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), 650118 Kunming, China
| |
Collapse
|
5
|
Quantification of Women Who Could Benefit from Hormone Therapy after Endometrial Cancer Treatment: An Analysis of SEER Data. Curr Oncol 2022; 29:9215-9223. [PMID: 36547135 PMCID: PMC9777495 DOI: 10.3390/curroncol29120721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Our primary aim was to estimate the magnitude of stage I endometrial cancer (EC) survivors that could benefit from hormonal therapy (HT). Our secondary aims were to assess EC incidence in women below 50 and below 60 over the years, and analyze the overall survival and any influencing factors. We analyzed the endometrioid EC data from the Surveillance, Epidemiology, and End Results (SEER) program according to women's age, tumor stage, and grade. We analyzed the proportions of EC survivors below 50 and below 60 years of age and stratified those age groups by race. For age distribution and survival analysis SEER, 18 registries' research data (2000-2018) were analyzed. We analyzed the SEER 12 registries' research data (1992-2019) for incidence time trends. Our investigation found a 14% and 40% cumulative prevalence of stage I EC that occurs in women below 50 or 60 years, respectively. EC's prevalence has progressively risen in recent decades, but cancer-specific mortality remains low. The increasing number of women affected by EC in premenopause or early postmenopause face an 18 years-survival rate of 96.86% and 95.73%, respectively. A significant proportion of low-grade EC survivors can potentially benefit from HT treatment, and this requires awareness of other aspects of their health or quality of life, in addition to cancer treatments.
Collapse
|
6
|
Fanaei K, Salahshourifar I, Ameli F, Esfandbod M, Irani S. High Frequency of Microsatellite Instability among Non-Metastatic Gastric Cancer. Int J Hematol Oncol Stem Cell Res 2022; 16:239-249. [PMID: 36883110 PMCID: PMC9985814 DOI: 10.18502/ijhoscr.v16i4.10882] [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: 06/05/2021] [Accepted: 09/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Microsatellite instability (MSI) is considered a key factor in carcinogenesis and a genetic alteration pattern in many types of cancers such as gastric cancer (GC). Although the role of MSI in colorectal cancer (CRC) is well known, its prognostic impact on GC has not been clearly defined. The assessment of MSI in GC has not been documented in the Iranian population yet. Therefore, this study analyzed the association of MSI status with GC in Iranian patients. Materials and Methods: We compared the frequency of MSI at 5 loci from formalin-fixed paraffin-embedded (FFPE) gastrectomy specimens, between metastatic and non-metastatic cases of GC (N = 60). A panel of five quasi-monomorphic markers and a single dinucleotide marker with linker-based fluorescent primers was used. Results: MSI was observed in 46.6% of cases, including MSI-high (H) (33.3%) and MSI-Low (L) (13.3%). Moreover, the most unstable and stable markers in our study were NR-21 and BAT-26 accordingly. MSI-H and MSI were seen more frequently in non-metastatic tumors (p= 0.028 and p= 0.019, respectively). Conclusion: The current study showed MSI status more frequently in non-metastatic GC which may reflect a good prognostic factor in GC like CRC. Although, larger and more comprehensive studies are needed to confirm this statement. A panel consisting of NR-21, BAT-25, and NR-27 mononucleotide markers appears to be reliable and useful markers for detecting MSI in GC in Iranian patients.
Collapse
Affiliation(s)
- Khadijeh Fanaei
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Iman Salahshourifar
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fereshteh Ameli
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Esfandbod
- Department of Hematology and Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Irani
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
7
|
How JA, Jazaeri AA, Fu S, Rodon Ahnert J, Gong J, Stephen B, Ferreira Dalla Pria H, Bhosale P, Johnson A, Yuan Y, Meric-Bernstam F, Naing A. Clinical Outcomes of Patients with Recurrent Microsatellite-Stable Endometrial Cancer in Early-Phase Immunotherapy Clinical Trials. Cancers (Basel) 2022; 14:cancers14153695. [PMID: 35954359 PMCID: PMC9367373 DOI: 10.3390/cancers14153695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary There is a crucial need to improve treatment regimens in patients with recurrent endometrial cancer. Although immunotherapy treatments have shown impressive benefit in microsatellite instability-high endometrial cancer, they have been less predictable in the majority of endometrial cancers, which are microsatellite stable. Our aim was to characterize clinical outcomes in patients with recurrent microsatellite stable endometrial cancer treated in early-phase immunotherapy clinical trials in order unravel treatment regimens that would improve response and survival. Our findings suggest that utilizing immunotherapy in combination with other non-immunotherapy agents resulted in greater duration of disease control and improved survival outcomes compared to immunotherapy only (monotherapy) or in combination with other immunotherapy agents. Future studies are needed to validate these findings. Abstract Recurrent microsatellite stable (MSS) endometrial cancer has poor response to conventional therapy and limited efficacy with immune checkpoint monotherapy. We conducted a retrospective study of recurrent MSS endometrial cancer patients enrolled in immunotherapy-based clinical trials at MD Anderson Cancer Center between 1 January 2010 and 31 December 2019. Patients were evaluated for radiologic response using RECIST 1.1 criteria, progression-free survival (PFS), and overall survival (OS). Thirty-five patients were treated with immune checkpoint inhibitors: 8 with monotherapy, 17 with immunotherapy (IO) in combination with another IO-only, and 10 with IO in combination with non-IO therapy. Among those treated with combination IO plus non-IO therapy, one had a partial response but 50% had clinical benefit. Patients who received combination IO plus non-IO therapy had improved PFS compared to those who received monotherapy (HR 0.56, 95% CI 0.33–0.97; p = 0.037) or combination IO-only therapy (HR 0.36, 95% CI 0.15–0.90; p = 0.028) and had improved OS when compared to monotherapy after adjusting for prior lines of therapy (HR 0.50, 95% CI 0.27–0.95; p = 0.036). The potential beneficial clinical outcomes of combination IO plus non-IO therapy in MSS endometrial cancer should be validated in a larger study.
Collapse
Affiliation(s)
- Jeffrey A. How
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.H.); (A.A.J.)
| | - Amir A. Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.H.); (A.A.J.)
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
| | - Jordi Rodon Ahnert
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
| | - Bettzy Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
| | - Hanna Ferreira Dalla Pria
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (H.F.D.P.); (P.B.)
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (H.F.D.P.); (P.B.)
| | - Amber Johnson
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.F.); (J.R.A.); (J.G.); (B.S.); (F.M.-B.)
- Correspondence:
| |
Collapse
|
8
|
Ali R, Aouida M, Alhaj Sulaiman A, Madhusudan S, Ramotar D. Can Cisplatin Therapy Be Improved? Pathways That Can Be Targeted. Int J Mol Sci 2022; 23:ijms23137241. [PMID: 35806243 PMCID: PMC9266583 DOI: 10.3390/ijms23137241] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Cisplatin (cis-diamminedichloroplatinum (II)) is the oldest known chemotherapeutic agent. Since the identification of its anti-tumour activity, it earned a remarkable place as a treatment of choice for several cancer types. It remains effective against testicular, bladder, lung, head and neck, ovarian, and other cancers. Cisplatin treatment triggers different cellular responses. However, it exerts its cytotoxic effects by generating inter-strand and intra-strand crosslinks in DNA. Tumour cells often develop tolerance mechanisms by effectively repairing cisplatin-induced DNA lesions or tolerate the damage by adopting translesion DNA synthesis. Cisplatin-associated nephrotoxicity is also a huge challenge for effective therapy. Several preclinical and clinical studies attempted to understand the major limitations associated with cisplatin therapy, and so far, there is no definitive solution. As such, a more comprehensive molecular and genetic profiling of patients is needed to identify those individuals that can benefit from platinum therapy. Additionally, the treatment regimen can be improved by combining cisplatin with certain molecular targeted therapies to achieve a balance between tumour toxicity and tolerance mechanisms. In this review, we discuss the importance of various biological processes that contribute to the resistance of cisplatin and its derivatives. We aim to highlight the processes that can be modulated to suppress cisplatin resistance and provide an insight into the role of uptake transporters in enhancing drug efficacy.
Collapse
Affiliation(s)
- Reem Ali
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Education City, Qatar Foundation, Doha P.O. Box 34110, Qatar; (M.A.); (A.A.S.)
- Correspondence: (R.A.); (D.R.)
| | - Mustapha Aouida
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Education City, Qatar Foundation, Doha P.O. Box 34110, Qatar; (M.A.); (A.A.S.)
| | - Abdallah Alhaj Sulaiman
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Education City, Qatar Foundation, Doha P.O. Box 34110, Qatar; (M.A.); (A.A.S.)
| | - Srinivasan Madhusudan
- Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham NG7 3RD, UK;
| | - Dindial Ramotar
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Education City, Qatar Foundation, Doha P.O. Box 34110, Qatar; (M.A.); (A.A.S.)
- Correspondence: (R.A.); (D.R.)
| |
Collapse
|
9
|
Bellone S, Roque DM, Siegel ER, Buza N, Hui P, Bonazzoli E, Guglielmi A, Zammataro L, Nagarkatti N, Zaidi S, Lee J, Silasi DA, Huang GS, Andikyan V, Damast S, Clark M, Azodi M, Schwartz PE, Tymon-Rosario JR, Harold JA, Mauricio D, Zeybek B, Menderes G, Altwerger G, Ratner E, Alexandrov LB, Iwasaki A, Kong Y, Song E, Dong W, Elvin JA, Choi J, Santin AD. A phase 2 evaluation of pembrolizumab for recurrent Lynch-like versus sporadic endometrial cancers with microsatellite instability. Cancer 2022; 128:1206-1218. [PMID: 34875107 PMCID: PMC9465822 DOI: 10.1002/cncr.34025] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Microsatellite instability-high (MSI-H)/mismatch repair deficiency (dMMR) is a biomarker for responses to immune checkpoint inhibitors (ICIs). Whether mechanisms underlying microsatellite instability alter responses to ICIs is unclear. This article reports data from a prospective phase 2 pilot study of pembrolizumab in patients with recurrent MSI-H endometrial cancer (EC) analyzed by whole exome sequencing (WES) and potential mechanisms of primary/secondary ICI resistance (NCT02899793). METHODS Patients with measurable MSI-H/dMMR EC confirmed by polymerase chain reaction/immunohistochemistry were evaluated by WES and received 200 mg of pembrolizumab every 3 weeks for ≤2 years. The primary end point was the objective response rate (ORR). Secondary end points included progression-free survival (PFS) and overall survival (OS). RESULTS Twenty-five patients (24 evaluable) were treated. Six patients (25%) harbored Lynch/Lynch-like tumors, whereas 18 (75%) had sporadic EC. The tumor mutation burden was higher in Lynch-like tumors (median, 2939 mutations/megabase [Mut/Mb]; interquartile range [IQR], 867-5108 Mut/Mb) than sporadic tumors (median, 604 Mut/Mb; IQR, 411-798 Mut/Mb; P = .0076). The ORR was 100% in Lynch/Lynch-like patients but only 44% in sporadic patients (P = .024). The 3-year PFS and OS proportions were 100% versus 30% (P = .017) and 100% versus 43% (P = .043), respectively. CONCLUSIONS This study suggests prognostic significance of Lynch-like cancers versus sporadic MSI-H/dMMR ECs for ORR, PFS, and OS when patients are treated with pembrolizumab. Larger confirmatory studies in ECs and other MSI-H/dMMR tumors are necessary. Defective antigen processing/presentation and deranged induction in interferon responses serve as mechanisms of resistance in sporadic MSI-H ECs. Oligoprogression in MSI-H/dMMR patients appears salvageable with surgical resection and/or local treatment and the continuation of pembrolizumab off study. Clinical studies evaluating separate MSI-H/dMMR EC subtypes treated with ICIs are warranted.
Collapse
Affiliation(s)
- Stefania Bellone
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Dana M Roque
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Natalia Buza
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Bonazzoli
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Adele Guglielmi
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Luca Zammataro
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Nupur Nagarkatti
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Samir Zaidi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jungsoo Lee
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Dan-Arin Silasi
- Division of Gynecologic Oncology, Mercy Clinic, St. Louis, Missouri
| | - Gloria S Huang
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Vaagn Andikyan
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Shari Damast
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Mitchell Clark
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Joan R Tymon-Rosario
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Justin A Harold
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Mauricio
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Burak Zeybek
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Gary Altwerger
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Ratner
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, California
| | - Akiko Iwasaki
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Yong Kong
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Eric Song
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Weilai Dong
- Laboratory of Human Genetics and Genomics, Rockefeller University, New York, New York
| | - Julia A Elvin
- Cancer Genomics Research, Foundation Medicine, Cambridge, Massachusetts
| | - Jungmin Choi
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Alessandro D Santin
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
10
|
AlSemari MA, Strianese D, Abu Safieh L, Al Hussain H, Abedalthagafi M, Edward DP. Expression of Programmed Cell Death-L1 (PD-L1) Protein and Mismatch Repair Mutations in Orbital Tumours-a Pilot Study. Eur J Ophthalmol 2021; 32:3097-3102. [PMID: 34931541 DOI: 10.1177/11206721211066203] [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: 11/16/2022]
Abstract
PURPOSE Programmed cell death protein 1 (PD-1) and DNA mismatch repair (MMR) deficiency play an important role in tumour progression and response to treatment.Both markers have been studied in some ocular tumours but little is known about these markers in orbital tumours. This pilot study reports on PD-L1 expression and MMR mutations using next generation sequencing (NGS) in specific orbital tumours. METHODS We reviewed surgical specimens from patients with rhabdomyosarcoma, adenoid cystic carcinoma (ACC), pleomorphic adenoma (PA) and biopsy negative tissue from orbital tumours used as a control. immunohistochemistry (IHC) was performed on Formalin fixed paraffin embedded tissue using a PD-L1 antibody. DNA was extracted for targeted gene panel NGS of the MMR genes PMS2, MLH1, MSH6 and MSH2. RESULTS The study included 17 orbital specimens. Scattered membrane PD-L1 staining was noted in 3/6 rhabdomyosarcoma specimens without an accompanying lymphocytic infiltrate. PD-L1 immunostaining was absent in 3/3 ACC, and 5/6 PA specimens. PD-L1 immunostaining was not detected in 2/2 control specimens. 4/17 samples shared the same pathogenic mutation in the MLH1 gene, including 3/6 rhabdomyosarcoma and 1/3 ACC samples. 1/6 PA samples had a mutation in MSH6. CONCLUSIONS Our study demonstrated scattered, non-quantifiable or absent PD-L1 staining in a limited sample of orbital tumours suggesting that PD-1/PD-L1 inhibitor therapy may not be useful in treatment of malignant orbital tumours (rhabdomyosarcoma and ACC) when refractory to conventional therapy. Our pilot study suggest that PD-L1/MMR axis might not play a major role in the pathogenesis of primary orbital tumour.
Collapse
Affiliation(s)
| | - Diego Strianese
- 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Neuroscience, University of Naples Federico II School of Medicine and Surgery, Italy
| | - Leen Abu Safieh
- Genomic Research Department, 37849King Fahad Medical City, Riyadh, Saudi Arabia.,Saudi Human Genome Project, 83527King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | | | - Malak Abedalthagafi
- Genomic Research Department, 37849King Fahad Medical City, Riyadh, Saudi Arabia.,Saudi Human Genome Project, 83527King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Deepak P Edward
- 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine12247, Chicago, USA
| |
Collapse
|
11
|
Song Y, Gu Y, Hu X, Wang M, He Q, Li Y. Endometrial Tumors with MSI-H and dMMR Share a Similar Tumor Immune Microenvironment. Onco Targets Ther 2021; 14:4485-4497. [PMID: 34429613 PMCID: PMC8379685 DOI: 10.2147/ott.s324641] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Microsatellite instability (MSI) and mismatch repair deficiency (dMMR) are important biomarkers for predicting responses to immune checkpoint inhibitor (ICI) therapies. Although PCR-based tests for high MSI (MSI-H) and dMMR yield highly concordant results in endometrial cancer (EC), it is unclear whether this is true for MSI-H and MMR detected by next-generation sequencing (NGS) and immunohistochemistry (IHC), respectively. This study investigated whether EC with MSI-H identified by NGS and dMMR identified by IHC have similar tumor immune microenvironments. Patients and Methods EC tissue and corresponding peripheral blood lymphocyte samples were collected from 99 randomly selected patients. MSI status and tumor mutation burden (TMB) were examined by NGS. MMR protein and programmed death ligand (PD-L)1 expression and tumor-infiltrating lymphocyte (TIL) abundance were evaluated by IHC. Results Of the 99 EC samples, 29 (29%) had dMMR by IHC, while 18 (18%) had MSI-H by NGS. MSI and MMR status identified by the two methods were discordant in the 99 EC patients, and 2/18 NGS-identified MSI-H patients (11%) retained MMR protein expression. MSI-H and dMMR endometrial tumors had similar numbers of cluster of differentiation (CD)3+ TILs (T cells) and CD8+ TILs (cytotoxic T cells) in the tumor center and periphery, which differed from those in microsatellite stable (MSS) and mismatch repair-proficient (pMMR) EC; they also showed similar TMB, PD-L1 expression, and TIL counts with higher TMB and PD-L1 expression than MSS and pMMR ECs. The abundance of CD3+ and CD8+ TILs was increased in PD-L1-positive EC. Conclusion NGS-identified MSI status and IHC-identified MMR status were inconsistent in EC, and 11% of NGS-identified MSI-H tumors retained MMR protein expression. Conversely, MSI and MMR status determined by the two methods provided similar data on TMB, PD-L1 expression, and TIL abundance, which can guide treatment decisions with ICIs.
Collapse
Affiliation(s)
- Yunfeng Song
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ye Gu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiang Hu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mengfei Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Qizhi He
- Department of Pathology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yiran Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
12
|
Sychevskaya KA, Risinskaya NV, Kravchenko SK, Nikulina EE, Misyurina AE, Magomedova AU, Sudarikov AB. Pitfalls in mononucleotide microsatellite repeats instability assessing (MSI) in the patients with B-cell lymphomas. Klin Lab Diagn 2021; 66:181-186. [PMID: 33793119 DOI: 10.51620/0869-2084-2021-66-3-181-186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Analysis of microsatellite instability (MSI) is a routine study in the diagnostics of solid malignancies. The standard for determining MSI is a pentaplex PCR panel of mononucleotide repeats: NR-21, NR-24, NR-27, BAT-25, BAT-26. The presence of MSI is established based on differences in the length of markers in the tumor tissue and in the control, but due to the quasimonomorphic nature of standard mononucleotide loci the use of a control sample is not necessary in the diagnosis of MSI-positive solid tumors. The significance of the MSI phenomenon in oncohematology has not been established. This paper presents the results of a study of MSI in B-cell lymphomas: follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL). We have shown that aberrations of mononucleotide markers occur in these diseases, but the nature of the changes does not correspond to the classical MSI in solid neoplasms. This fact requires further study of the pathogenesis of such genetic disorders. Due to the possibility of ambiguous interpretation of the results of the MSI study for previously uncharacterized diseases, strict compliance with the methodology of parallel analysis of the tumor tissue and the control sample is mandatory.
Collapse
|
13
|
Siemanowski J, Schömig-Markiefka B, Buhl T, Haak A, Siebolts U, Dietmaier W, Arens N, Pauly N, Ataseven B, Büttner R, Merkelbach-Bruse S. Managing Difficulties of Microsatellite Instability Testing in Endometrial Cancer-Limitations and Advantages of Four Different PCR-Based Approaches. Cancers (Basel) 2021; 13:1268. [PMID: 33809329 PMCID: PMC8000432 DOI: 10.3390/cancers13061268] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Microsatellite instability (MSI), a common alteration in endometrial cancers (EC) is known as a biomarker for immune checkpoint therapy response alongside screening for Lynch Syndrome (LS). However, former studies described challenging MSI profiles in EC hindering analysis by using MSI testing methods intensively validated for colorectal cancer (CRC) only. In order to reduce false negatives, this study examined four different PCR-based approaches for MSI testing using 25 EC samples already tested for mismatch repair deficiency (dMMR). In a follow up validation set of 75 EC samples previously tested both for MMR and MSI, the efficiency of a seven-marker system corresponding to the Idylla system was further analyzed. Both Bethesda and Promega marker panels require trained operators to overcome interpretation complexities caused by either hardly visible additional peaks of one and two nucleotides, or small shifts in microsatellite repeat length. Using parallel sequencing adjustment of bioinformatics is needed. Applying the Idylla MSI assay, an evaluation of input material is more crucial for reliable results and is indispensable. Following MMR deficiency testing as a first-line screening procedure, additional testing with a PCR-based method is necessary if inconclusive staining of immunohistochemistry (IHC) must be clarified.
Collapse
Affiliation(s)
- Janna Siemanowski
- Institute of Pathology, University Hospital Cologne, D-50924 Cologne, Germany; (B.S.-M.); (T.B.); (R.B.); (S.M.-B.)
| | - Birgid Schömig-Markiefka
- Institute of Pathology, University Hospital Cologne, D-50924 Cologne, Germany; (B.S.-M.); (T.B.); (R.B.); (S.M.-B.)
| | - Theresa Buhl
- Institute of Pathology, University Hospital Cologne, D-50924 Cologne, Germany; (B.S.-M.); (T.B.); (R.B.); (S.M.-B.)
| | - Anja Haak
- Institute of Pathology, University Hospital Halle (Saale), D-06112 Halle, Germany; (A.H.); (U.S.)
| | - Udo Siebolts
- Institute of Pathology, University Hospital Halle (Saale), D-06112 Halle, Germany; (A.H.); (U.S.)
| | - Wolfgang Dietmaier
- Institute of Pathology, University Regensburg, D-93053 Regensburg, Germany;
| | - Norbert Arens
- Center for Histology, Cytology and Molecular Diagnostics Trier, D-54296 Trier, Germany;
| | - Nina Pauly
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, D-45136 Essen, Germany; (N.P.); (B.A.)
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, D-45136 Essen, Germany; (N.P.); (B.A.)
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, D-81377 Munich, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, D-50924 Cologne, Germany; (B.S.-M.); (T.B.); (R.B.); (S.M.-B.)
| | - Sabine Merkelbach-Bruse
- Institute of Pathology, University Hospital Cologne, D-50924 Cologne, Germany; (B.S.-M.); (T.B.); (R.B.); (S.M.-B.)
| |
Collapse
|
14
|
Favier A, Rocher G, Larsen AK, Delangle R, Uzan C, Sabbah M, Castela M, Duval A, Mehats C, Canlorbe G. MicroRNA as Epigenetic Modifiers in Endometrial Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13051137. [PMID: 33800944 PMCID: PMC7961497 DOI: 10.3390/cancers13051137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Endometrial cancer (EC) is the 2nd most common gynecologic cancer worldwide. MicroRNAs (miRNAs) are small noncoding RNAs that contribute to epigenetic regulation. The objective of this systematic review is to summarize our current knowledge on the role of miRNAs in the epigenetic deregulation of tumor-related genes in EC. It includes all miRNAs reported to be involved in EC including their roles in DNA methylation and RNA-associated silencing. This systematic review should be useful for development of novel strategies to improve diagnosis and risk assessment as well as for new treatments aimed at miRNAs, their target genes or DNA methylation. Abstract The objective of this systematic review is to summarize our current knowledge on the influence of miRNAs in the epigenetic deregulation of tumor-related genes in endometrial cancer (EC). We conducted a literature search on the role of miRNAs in the epigenetic regulation of EC applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following terms were used: microRNA, miRNA, miR, endometrial cancer, endometrium, epigenetic, epimutation, hypermethylation, lynch, deacetylase, DICER, novel biomarker, histone, chromatin. The miRNAs were classified and are presented according to their function (tumor suppressor or onco-miRNA), their targets (when known), their expression levels in EC tissue vs the normal surrounding tissue, and the degree of DNA methylation in miRNA loci and CpG sites. Data were collected from 201 articles, including 190 original articles, published between November 1, 2008 and September 30, 2020 identifying 313 different miRNAs implicated in epigenetic regulation of EC. Overall, we identified a total of 148 miRNAs with decreased expression in EC, 140 miRNAs with increased expression in EC, and 22 miRNAs with discordant expression levels. The literature implicated different epigenetic phenomena including altered miRNA expression levels (miR-182, -230), changes in the methylation of miRNA loci (miR-34b, -129-2, -130a/b, -152, -200b, -625) and increased/decreased methylation of target genes (miR-30d,-191). This work provides an overview of all miRNAs reported to be involved in epigenetic regulation in EC including DNA methylation and RNA-associated silencing. These findings may contribute to novel strategies in diagnosis, risk assessment, and treatments aimed at miRNAs, their target genes or DNA methylation.
Collapse
Affiliation(s)
- Amélia Favier
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
- Correspondence: (A.F.); (G.C.)
| | - Grégoire Rocher
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
| | - Annette K. Larsen
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
| | - Romain Delangle
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
| | - Catherine Uzan
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
| | - Michèle Sabbah
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
| | - Mathieu Castela
- Scarcell Therapeutics, 101 rue de Sèvres, 75006 Paris, France;
| | - Alex Duval
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
| | - Céline Mehats
- U1016, CNRS, UMR8104, Institut Cochin, INSERM, Université de Paris, 75014 Paris, France;
| | - Geoffroy Canlorbe
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Correspondence: (A.F.); (G.C.)
| |
Collapse
|
15
|
Elze L, Mensenkamp AR, Nagtegaal ID, van Zelst-Stams WAG, de Voer RM, Ligtenberg MJL. Somatic Nonepigenetic Mismatch Repair Gene Aberrations Underly Most Mismatch Repair-Deficient Lynch-Like Tumors. Gastroenterology 2021; 160:1414-1416.e3. [PMID: 33253688 DOI: 10.1053/j.gastro.2020.11.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Lisa Elze
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjen R Mensenkamp
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wendy A G van Zelst-Stams
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Richarda M de Voer
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
16
|
Singh AK, Talseth-Palmer B, McPhillips M, Lavik LAS, Xavier A, Drabløs F, Sjursen W. Targeted sequencing of genes associated with the mismatch repair pathway in patients with endometrial cancer. PLoS One 2020; 15:e0235613. [PMID: 32634176 PMCID: PMC7340288 DOI: 10.1371/journal.pone.0235613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/19/2020] [Indexed: 01/28/2023] Open
Abstract
Germline variants inactivating the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2 cause Lynch syndrome that implies an increased cancer risk, where colon and endometrial cancer are the most frequent. Identification of these pathogenic variants is important to identify endometrial cancer patients with inherited increased risk of new cancers, in order to offer them lifesaving surveillance. However, several other genes are also part of the MMR pathway. It is therefore relevant to search for variants in additional genes that may be associated with cancer risk by including all known genes involved in the MMR pathway. Next-generation sequencing was used to screen 22 genes involved in the MMR pathway in constitutional DNA extracted from full blood from 199 unselected endometrial cancer patients. Bioinformatic pipelines were developed for identification and functional annotation of variants, using several different software tools and custom programs. This facilitated identification of 22 exonic, 4 UTR and 9 intronic variants that could be classified according to pathogenicity. This study has identified several germline variants in genes of the MMR pathway that potentially may be associated with an increased risk for cancer, in particular endometrial cancer, and therefore are relevant for further investigation. We have also developed bioinformatics strategies to analyse targeted sequencing data, including low quality data and genomic regions outside of the protein coding exons of the relevant genes.
Collapse
Affiliation(s)
- Ashish Kumar Singh
- Department of Medical Genetics, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
| | - Bente Talseth-Palmer
- Department of Medical Genetics, St. Olavs Hospital, Trondheim, Norway
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia
- Department of Research and Development, Møre og Romsdal Hospital Trust, Molde, Norway
| | - Mary McPhillips
- NSW Health Pathology, Molecular Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | | | - Alexandre Xavier
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia
| | - Finn Drabløs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Sjursen
- Department of Medical Genetics, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
17
|
Padala SA, Patel SK, Vakiti A, Patel N, Gani I, Kapoor R, Muhammad S. Pembrolizumab-induced severe rejection and graft intolerance syndrome resulting in renal allograft nephrectomy. J Oncol Pharm Pract 2020; 27:470-476. [PMID: 32580640 DOI: 10.1177/1078155220934160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pembrolizumab is a selective anti-programmed cell death protein-1 (PD-1) humanized monoclonal antibody that inhibits PD-1 activity by binding to the PD-1 receptor that is found on activated T-cells. The goal of the treatment is to allow the immune system to target and destroy cancer cells by preventing cancer cells from binding to PD-1 receptors, leading to decreased tumor growth. The activation of T-cells by pembrolizumab not only leads to the destruction of malignant cells but also attacks the donor alloantigens that are present in a renal transplant, resulting in graft rejection. CASE REPORT We present a case of a 46-year-old African American female with history of renal transplant who was treated with pembrolizumab for stage IV B endometrial adenocarcinoma and experienced renal transplant rejection and severe graft intolerance syndrome.Management and outcome: Due to ongoing graft intolerance, a transplant nephrectomy was performed. Allograft pathology was consistent with non-viable kidney with tubulitis, interstitial fibrosis and necrosis consistent with transplant rejection without any evidence of malignancy. DISCUSSION As emphasized in our case, there is a very high risk of graft rejection in patients who need to be placed on immunomodulators such as pembrolizumab, so the risk versus benefit needs to be assessed and discussed. Our case is unique because pembrolizumab not only caused graft rejection but also severe graft intolerance syndrome which led to transplant nephrectomy. Further guidelines are needed in renal transplant patients requiring PD-1 inhibitors to establish the ideal treatment plan of immunosuppression management and anti-cancer treatments.
Collapse
Affiliation(s)
- Sandeep A Padala
- Department of Medicine, Nephrology, Augusta University, Medical College of Georgia, Augusta, USA
| | - Shivam K Patel
- Department of Medicine, Medical College of Georgia, Augusta, USA
| | - Anusha Vakiti
- Department of Medicine, Hematology-Oncology, Augusta University Medical Center, Medical College of Georgia, Augusta, USA
| | - Nikhil Patel
- Department of Pathology, Augusta University Medical Center, Medical College of Georgia, Augusta, USA
| | - Imran Gani
- Department of Medicine, Nephrology, Augusta University Medical Center, Medical College of Georgia, Augusta, USA
| | - Rajan Kapoor
- Department of Medicine, Nephrology, Augusta University Medical Center, Medical College of Georgia, Augusta, USA
| | - Saeed Muhammad
- Department of Surgery, Transplant Nephrology, Augusta University Medical Center, Medical College of Georgia, Augusta, USA
| |
Collapse
|
18
|
Heidari-Khoei H, Esfandiari F, Hajari MA, Ghorbaninejad Z, Piryaei A, Baharvand H. Organoid technology in female reproductive biomedicine. Reprod Biol Endocrinol 2020; 18:64. [PMID: 32552764 PMCID: PMC7301968 DOI: 10.1186/s12958-020-00621-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
Recent developments in organoid technology are revolutionizing our knowledge about the biology, physiology, and function of various organs. Female reproductive biology and medicine also benefit from this technology. Organoids recapitulate features of different reproductive organs including the uterus, fallopian tubes, and ovaries, as well as trophoblasts. The genetic stability of organoids and long-lasting commitment to their tissue of origin during long-term culture makes them attractive substitutes for animal and in vitro models. Despite current limitations, organoids offer a promising platform to address fundamental questions regarding the reproductive system's physiology and pathology. They provide a human source to harness stem cells for regenerative medicine, heal damaged epithelia in specific diseases, and study biological processes in healthy and pathological conditions. The combination of male and female reproductive organoids with other technologies, such as microfluidics technology, would enable scientists to create a multi-organoid-on-a-chip platform for the next step to human-on-a-chip platforms for clinical applications, drug discovery, and toxicology studies. The present review discusses recent advances in producing organoid models of reproductive organs and highlights their applications, as well as technical challenges and future directions.
Collapse
Affiliation(s)
- Heidar Heidari-Khoei
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, P.O. Box: 16635-148, Tehran, 1665659911, Iran
| | - Fereshteh Esfandiari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, P.O. Box: 16635-148, Tehran, 1665659911, Iran
| | - Mohammad Amin Hajari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, P.O. Box: 16635-148, Tehran, 1665659911, Iran
| | - Zeynab Ghorbaninejad
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, P.O. Box: 16635-148, Tehran, 1665659911, Iran
| | - Abbas Piryaei
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4719, Tehran, Iran.
| | - Hossein Baharvand
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, P.O. Box: 16635-148, Tehran, 1665659911, Iran.
- Department of Developmental Biology, University of Science and Culture, Tehran, Iran.
| |
Collapse
|
19
|
Mettman D, Haer E, Olyaee M, Rastogi A, Madan R, O'Neil M, Kelting S, Dennis K, Fan F. The utility of immunohistochemical testing for mismatch repair proteins in fine needle aspiration specimens of pancreatic adenocarcinoma. Ann Diagn Pathol 2020; 47:151552. [PMID: 32570025 DOI: 10.1016/j.anndiagpath.2020.151552] [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: 05/04/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Microsatellite instability (MSI) testing is recommended for all colonic and endometrial carcinomas to screen for Lynch syndrome. The role of MSI testing in pancreatic adenocarcinoma has not been well-established. Screening can be done via immunohistochemical (IHC) staining for mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, PMS2). We report our experience and the clinical utility of MMR IHC on pancreatic adenocarcinomas in fine-needle aspiration (FNA) specimens. MATERIALS AND METHODS We performed a retrospective review to identify all patients diagnosed with pancreatic adenocarcinoma by FNA at our institution between December 2017 and September 2019. For cases with sufficient tumor cells for testing, the MMR results and morphology were summarized, as well as corresponding clinical information, including age, clinical stage, treatment, and concurrent other cancers. RESULTS From December 2017 to September 2019, there were a total of 184 pancreatic FNAs with a diagnosis of adenocarcinoma. Of these 184 FNAs, 65 (35%) contained sufficient material in the cell block to perform IHC for MMR. The cell block material was collected in either RPMI or CytoLyt. Poor technical quality precluded interpretation of PMS2 in 4 cases and MSH6 in 2 cases. All other cases showed intact expression of all four proteins. CONCLUSIONS IHC for MMR proteins can be done on specimens collected in RPMI or CytoLyt, but RPMI appears to be more reliable. None of the pancreatic adenocarcinomas in this study showed loss of MMR protein expression. Routine testing of MMR loss may not be indicated in pancreatic adenocarcinomas in the general patient population.
Collapse
Affiliation(s)
- Daniel Mettman
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Erin Haer
- Pathology and Laboratory Medicine Service, Kansas City VA Medical Center, Kansas City, KS, United States of America
| | - Mojtaba Olyaee
- Department of Internal Medicine, Gastrointestinal Division, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Rastogi
- Department of Internal Medicine, Gastrointestinal Division, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Rashna Madan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Maura O'Neil
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sarah Kelting
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Katie Dennis
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America.
| |
Collapse
|
20
|
Wadee R, Grayson W. Identification of possible Lynch syndrome in endometrial carcinomas at a public hospital in South Africa. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2020. [DOI: 10.1080/20742835.2020.1745461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- R Wadee
- Department of Anatomical Pathology, School of Pathology, University of the Witwatersrand/National Health Laboratory Services (NHLS), Johannesburg, Republic of South Africa
| | - W Grayson
- AMPATH National Laboratories/Department of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, Republic of South Africa
| |
Collapse
|
21
|
Ahmed AA, Adam Essa ME. Epigenetic alterations in female urogenital organs cancer: Premise, properties, and perspectives. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
22
|
Hashmi AA, Mudassir G, Hashmi RN, Irfan M, Asif H, Khan EY, Abu Bakar SM, Faridi N. Microsatellite Instability in Endometrial Carcinoma by Immunohistochemistry, Association with Clinical and Histopathologic Parameters. Asian Pac J Cancer Prev 2019; 20:2601-2606. [PMID: 31554352 PMCID: PMC6976824 DOI: 10.31557/apjcp.2019.20.9.2601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 11/25/2022] Open
Abstract
Objective: We aimed to investigate the frequency of microsatellite instability (MSI) in endometrial carcinoma in our
population and its association with clinico-pathologic features. Methods: A total of 126 cases of primary endometrial
carcinoma were included in the study that underwent surgical resections. All slides of these cases were reviewed and
representative paraffin fixed tissue blocks were selected for MLH1, MSH2, MSH6 and PMS2 IHC staining. IHC
expression was categorized into five groups: no loss of expression; loss of expression of all four antibodies; combined
loss of MLH1/PMS2; combined loss of MSH2/MSH6; and isolated loss of MLH1. Pathological records of all cases
were retrieved from patient files. Result: Abnormal expression of MSI was noted in 56 cases (44.4%) among which
16 cases showed loss of nuclear expression of all markers, 34 cases showed loss of MLH1/PMS2 expression, 4 cases
showed loss of MSH2/MSH6 while only 2 cases revealed isolated loss of MLH. Personal and family history suggestive
of inherited cancer susceptibility was revealed in 11 cases most of which were associated with MSH2/MSH6 loss.
Significant association of MSI expression was found with tumor stage and personal/family history of endometrial/
colon cancer. Conclusion: A high frequency of endometrioid cancers in our study showed abnormal expression of
MSI markers, most of which depicted MLH1/PMS2 loss and were not associated with inherited cancer susceptibility.
On the other hand, a minority of cases showed loss of all MSI markers or MSH2/MSH6 loss and were significantly
associated with family/personal history of cancer. Therefore, we suggest that epigenetic changes in MLH1 locus may
be a predominant pathway of tumorigenesis in our population rather than inherited mutation of MSI genes; however
more large scale studies with genetic testing are required to validate this observation.
Collapse
Affiliation(s)
- Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Ghazala Mudassir
- Department of Pathology, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Muhammad Irfan
- Department of Statistics, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Huda Asif
- Medical Student, CMH Institute of Medical Sciences, Multan, Pakistan
| | - Erum Yousuf Khan
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Syed Muhammad Abu Bakar
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Naveen Faridi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| |
Collapse
|
23
|
Chan EM, Shibue T, McFarland JM, Gaeta B, Ghandi M, Dumont N, Gonzalez A, McPartlan JS, Li T, Zhang Y, Bin Liu J, Lazaro JB, Gu P, Piett CG, Apffel A, Ali SO, Deasy R, Keskula P, Ng RWS, Roberts EA, Reznichenko E, Leung L, Alimova M, Schenone M, Islam M, Maruvka YE, Liu Y, Roper J, Raghavan S, Giannakis M, Tseng YY, Nagel ZD, D'Andrea A, Root DE, Boehm JS, Getz G, Chang S, Golub TR, Tsherniak A, Vazquez F, Bass AJ. WRN helicase is a synthetic lethal target in microsatellite unstable cancers. Nature 2019; 568:551-556. [PMID: 30971823 PMCID: PMC6580861 DOI: 10.1038/s41586-019-1102-x] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
Synthetic lethality-an interaction between two genetic events through which the co-occurrence of these two genetic events leads to cell death, but each event alone does not-can be exploited for cancer therapeutics1. DNA repair processes represent attractive synthetic lethal targets, because many cancers exhibit an impairment of a DNA repair pathway, which can lead to dependence on specific repair proteins2. The success of poly(ADP-ribose) polymerase 1 (PARP-1) inhibitors in cancers with deficiencies in homologous recombination highlights the potential of this approach3. Hypothesizing that other DNA repair defects would give rise to synthetic lethal relationships, we queried dependencies in cancers with microsatellite instability (MSI), which results from deficient DNA mismatch repair. Here we analysed data from large-scale silencing screens using CRISPR-Cas9-mediated knockout and RNA interference, and found that the RecQ DNA helicase WRN was selectively essential in MSI models in vitro and in vivo, yet dispensable in models of cancers that are microsatellite stable. Depletion of WRN induced double-stranded DNA breaks and promoted apoptosis and cell cycle arrest selectively in MSI models. MSI cancer models required the helicase activity of WRN, but not its exonuclease activity. These findings show that WRN is a synthetic lethal vulnerability and promising drug target for MSI cancers.
Collapse
Affiliation(s)
- Edmond M Chan
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Nancy Dumont
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | | | - Tianxia Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yanxi Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jie Bin Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jean-Bernard Lazaro
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Peili Gu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cortt G Piett
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Annie Apffel
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Syed O Ali
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Rebecca Deasy
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Paula Keskula
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Raymond W S Ng
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Emma A Roberts
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizaveta Reznichenko
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lisa Leung
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Maria Alimova
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Mirazul Islam
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yosef E Maruvka
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Yang Liu
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jatin Roper
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC, USA
| | - Srivatsan Raghavan
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Marios Giannakis
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yuen-Yi Tseng
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Zachary D Nagel
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Alan D'Andrea
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - David E Root
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jesse S Boehm
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Gad Getz
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Sandy Chang
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
- Department of Molecular Biophysics and Biochemistry, Yale University School of Medicine, New Haven, CT, USA
| | - Todd R Golub
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Francisca Vazquez
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Adam J Bass
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
24
|
Wadee R, Grayson W. A potpourri of pathogenetic pathways in endometrial carcinoma with a focus on Lynch Syndrome. Ann Diagn Pathol 2019; 39:92-104. [PMID: 30798077 DOI: 10.1016/j.anndiagpath.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/08/2019] [Indexed: 11/27/2022]
Abstract
Endometrial carcinoma is the most frequently occurring female genital tract malignancy in developed nations, with a rising annual incidence. Endometrioid endometrial carcinoma (EEC), the most common histological variant, differs in morphologic and molecular characteristics from serous carcinomas but morphological distinction of high-grade EECs from serous carcinomas may prove difficult. Thus, molecular categorization of tumors may allow for better tumor classification with greater insight into the underlying biology of endometrial carcinomas with new therapeutic options. Microsatellite instability (MSI) is a commonly occurring molecular aberration in EECs and has been identified in most Lynch Syndrome (LS) associated tumors. This tumor syndrome predisposes afflicted individuals to a myriad of tumors including endometrial carcinoma. Herein, the molecular signature of endometrial tumors as well as LS, and its clinical manifestations are reviewed. Understanding of the pathogenetic pathways allows for greater comprehension of occurrences at a molecular level which are then appreciated at a cellular and tissue level, by the histopathologist. The molecular classification of endometrial tumors allows for further targeted therapeutic options for affected patients. Screening tests for patients with suspected LS enables surveillance of other tumors in the affected patient and her family with the potential to decrease morbidity and mortality. It is envisioned that this overview will allow for enhanced comprehension of genetic pathways by practicing pathologists, oncologists, gynecologists and other members of the multidisciplinary team, all of whom are involved in the management of the patient with an endometrial malignancy.
Collapse
Affiliation(s)
- Reubina Wadee
- University of the Witwatersrand/National Health Laboratory Services (NHLS), South Africa.
| | - Wayne Grayson
- University of the Witwatersrand, Ampath National Laboratories, South Africa.
| |
Collapse
|
25
|
Abstract
Microsatellite instability (MSI) refers to the hypermutator phenotype secondary to frequent polymorphism in short repetitive DNA sequences and single nucleotide substitution, as consequence of DNA mismatch repair (MMR) deficiency. MSI secondary to germline mutation in DNA MMR proteins is the molecular fingerprint of Lynch syndrome (LS), while epigenetic inactivation of these genes is more commonly found in sporadic MSI tumors. MSI occurs at different frequencies across malignancies, although original methods to assess MSI or MMR deficiency have been developed mostly in LS related cancers. Here we will discuss the current methods to detect MSI/MMR deficiency with a focus of new tools which are emerging as highly sensitive detector for MSI across multiple tumor types. Due to high frequencies of non-synonymous mutations, the presence of frameshift-mutated neoantigens, which can trigger a more robust and long-lasting immune response and strong TIL infiltration with tumor eradication, MSI has emerged as an important predictor of sensitivity for immunotherapy-based strategies, as showed by the recent FDA's first histology agnostic-accelerated approval to immune checkpoint inhibitors for refractory, adult and pediatric, MMR deficient (dMMR) or MSI high (MSI-H) tumors. Moreover, it is known that MSI status may predict cancer response/resistance to certain chemotherapies. Here we will describe the complex interplay between the genetic and clinical-pathological features of MSI/dMMR tumors and the cancer immunotherapy, with a focus on the predictive and prognostic role of MMR status for immune checkpoint inhibitors (ICIs) and providing some suggestions on how to conceive better predictive markers for immunotherapy in the next future.
Collapse
Affiliation(s)
- Marina Baretti
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, United States
| | - Dung T Le
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, United States.
| |
Collapse
|
26
|
Cornali T, Sammartino P, Kopanakis N, Christopoulou A, Framarino Dei Malatesta M, Efstathiou E, Spagnoli A, Ciardi A, Biacchi D, Spiliotis J. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer. Ann Surg Oncol 2017; 25:679-687. [PMID: 29282600 PMCID: PMC5814516 DOI: 10.1245/s10434-017-6307-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 01/26/2023]
Abstract
Background More information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome. Results A total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2 for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor. Conclusions For selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma.
Collapse
Affiliation(s)
- Tommaso Cornali
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy. .,Department of Surgery "Pietro Valdoni", Azienda Policlinico Umberto, Rome, Italy.
| | - Nikolaos Kopanakis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | | | | | - Elias Efstathiou
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | - Alessandra Spagnoli
- Department of Public Health and Infection Disease, Statistics Section, Sapienza University of Rome, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - John Spiliotis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| |
Collapse
|