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Johnson HR, Gunder LC, Leverson GE, Carchman EH. The Use of the Protease Inhibitor, Saquinavir, to Treat Anal Cancer Spheroids Derived From Human Papillomavirus Transgenic Mice. Dis Colon Rectum 2023; 66:360-365. [PMID: 36599112 PMCID: PMC9931656 DOI: 10.1097/dcr.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anal cancer is associated with high-risk human papillomavirus infection and oncoprotein expression. We have identified several protease inhibitors, used to treat HIV, that decrease oncogene expression. OBJECTIVE The aim of this project is to determine whether saquinavir, a protease inhibitor, results in a treatment response in anal cancer spheroids. DESIGN K14E6/E7 transgenic mice (n = 5), which express human papillomavirus 16 oncoproteins E6 and E7 in their epithelium, were treated topically at the anus with a carcinogen, 7,12-dimethylbenz[a]anthracene, to promote anal tumor growth. Tumors were excised and digested, and cells were plated. The tumor cells form 3D multicellular aggregates known as spheroids. SETTINGS This study was performed in an American Association for Accreditation of Laboratory Animal Care-approved facility. INTERVENTIONS Spheroids were placed in treatment groups: no treatment, vehicle (dimethyl sulfoxide), and 15 μM saquinavir. Spheroids were imaged immediately pretreatment and 24 hours posttreatment. MAIN OUTCOME MEASURES Spheroid diameters were measured using ImageJ and mean percent reduction was calculated for each spheroid to determine treatment effect on spheroid growth. Analysis of variance using pairwise comparisons was performed with Fisher protected least significant difference tests. RESULTS The no-treatment (n = 119 spheroids) and vehicle (n = 126 spheroids) groups demonstrated an increase in spheroid diameter during the treatment period. In contrast, spheroids treated with saquinavir (n = 151 spheroids) demonstrated a statistically significant percent reduction compared to the no-treatment ( p < 0.0001) and vehicle ( p = 0.002) groups. LIMITATIONS A limitation of these data is that some human error is likely present given that images were analyzed by 3 different scientists. CONCLUSIONS Saquinavir leads to a statistically significant percent reduction in mice anal tumor spheroid growth ex vivo compared to control groups. Protease inhibitor therapy may be an effective treatment or adjuvant therapy to the Nigro protocol to promote anal cancer tumor regression. See Video Abstract at http://links.lww.com/DCR/C82 . EL USO DEL INHIBIDOR DE LA PROTEASA, SAQUINAVIR, PARA TRATAR LOS ESFEROIDES DEL CNCER ANAL DERIVADOS DE RATONES TRANSGNICOS PARA EL VPH ANTECEDENTES:El cáncer anal está asociado con la infección por el virus del papiloma humano de alto riesgo y la expresión de oncoproteínas. Hemos identificado varios inhibidores de la proteasa, utilizados para tratar el VIH, que disminuyen la expresión del oncogén.OBJETIVO:El objetivo de este proyecto es determinar si los esferoides de cáncer anal responden al tratamiento con inhibidor de la proteasa, Saquinavir.DISEÑO:Ratones transgénicos K14E6/E7 (n = 5), que expresan las oncoproteínas E6 y E7 del VPH16 en su epitelio, fueron tratados tópicamente en el ano con carcinógeno, 7,12 dimetilbenz[a]antraceno, para promover el crecimiento del tumor anal. Los tumores se extirparon y digirieron, y las células se sembraron en placas. Las células tumorales forman agregados multicelulares tridimensionales, conocidos como esferoides.ESCENARIO:Este estudio se realizó en un centro aprobado por la Asociación Estadounidense para la Acreditación de Cuidado de Animales de Laboratorio.INTERVENCIONES:Se colocaron esferoides en grupos de tratamiento: sin tratamiento, vehículo (sulfóxido de dimetilo) y saquinavir 15 μM. Se tomaron imágenes de los esferoides inmediatamente antes del tratamiento y 24 horas después del tratamiento.PRINCIPALES MEDIDAS DE RESULTADO:Los diámetros de los esferoides se midieron con ImageJ y se calculó el porcentaje medio de reducción de cada esferoide para determinar el efecto del tratamiento sobre el crecimiento de los esferoides. El análisis de varianza mediante comparaciones por pares se realizó con las pruebas de diferencia mínima significativa protegida de Fisher.RESULTADOS:Los grupos sin tratamiento (n =119 esferoides) y vehículo (n=126 esferoides) demostraron un aumento en el diámetro del esferoide durante el período de tratamiento. Por el contrario, los esferoides tratados con saquinavir (n =151 esferoides) demostraron una reducción porcentual estadísticamente significativa en comparación con los grupos sin tratamiento ( p < 0,0001) y con vehículo (p = 0,002).LIMITACIONES:una limitación de estos datos es que es probable que haya algún error humano dado que las imágenes fueron analizadas por tres científicos diferentes.CONCLUSIONES:Saquinavir conduce a una reducción porcentual estadísticamente significativa en el crecimiento de esferoides de tumores anales en ratones ex-vivo en comparación con los grupos de control. La terapia con inhibidores de la proteasa puede ser un tratamiento eficaz o una terapia adyuvante del protocolo Nigro para promover la regresión del tumor del cáncer anal. Consulte Video Resumen en http://links.lww.com/DCR/C82 . (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Hillary R Johnson
- Division of Colorectal Surgery, Department of Surgery, University of Wisconsin-Madison, Department of Surgery, Madison, Wisconsin
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Henson CE, Morton DJ, Mayadev JS, Wong SJ, Zamarin D. Cancer trials as opportunities to serve and learn from individuals with human immunodeficiency virus. Cancer 2023; 129:664-667. [PMID: 36576320 PMCID: PMC10427029 DOI: 10.1002/cncr.34598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology, Stephenson Cancer Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Daniel J. Morton
- Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jyoti S. Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, San Diego, California, USA
| | - Stuart J. Wong
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
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Capistrano I R, Paul S, Boere I, Pantziarka P, Chopra S, Nout RA, Bouche G. Drug repurposing as a potential source of innovative therapies in cervical cancer. Int J Gynecol Cancer 2022; 32:ijgc-2022-003585. [PMID: 36137575 PMCID: PMC9664115 DOI: 10.1136/ijgc-2022-003585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Drug repurposing is an alternative development pathway that utilizes the properties of drugs approved for other diseases and builds on available safety and pharmacological data to develop the drug as a potential treatment for other diseases. A literature-based approach was performed to identify drug repurposing opportunities in cervical cancer to inform future research and trials. METHODS We queried PubMed for each drug included in two databases (ReDO_DB and CDcervix_DB, which include 300+ non-cancer drugs and 200+ cancer drugs not used in cervical cancer, respectively) and manually assessed all abstracts for relevance and activity in cervix cancer, and type of evidence. Subsequently, we also performed a search of clinical trial databases where we generated a list of registered trials in cervical cancer with all drugs from our databases. RESULTS Of the 534 drugs from both databases, 174 (33%) had at least one relevant abstract or registered trial in cervical cancer. 94 (18%) drugs had at least human data available, and 52 (10%) drugs were evaluated in registered trials. To prioritize drugs to consider for future trials, all 174 drugs were further assessed for strength of scientific rationale, feasibility for integration in cervical cancer standard of care, evidence of radiosensitization, and potential mechanism of action. Out of the 174 drugs, 38 (22%) potential drug candidates were selected. CONCLUSION This study resulted in a list of candidate drugs for potential evaluation in cervical cancer. Many drugs might warrant additional (pre)clinical investigation, which could be done in a coordinated manner using platform trials.
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Affiliation(s)
| | - Sonz Paul
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ingrid Boere
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pan Pantziarka
- Anticancer Fund, Meise, Belgium
- The George Pantziarka TP53 Trust, London, UK
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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Chopra S, Goda JS, Mittal P, Mulani J, Pant S, Pai V, Kannan S, Deodhar K, Krishnamurthy MN, Menon S, Charnalia M, Shah S, Rangarajan V, Gota V, Naidu L, Sawant S, Thakkar P, Popat P, Ghosh J, Rath S, Gulia S, Engineer R, Mahantshetty U, Gupta S. Concurrent chemoradiation and brachytherapy alone or in combination with nelfinavir in locally advanced cervical cancer (NELCER): study protocol for a phase III trial. BMJ Open 2022; 12:e055765. [PMID: 35387819 PMCID: PMC8987785 DOI: 10.1136/bmjopen-2021-055765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In locally advanced cervical cancer, nodal, local and distant relapse continue to be significant patterns of relapse. Therefore, strategies to improve the efficacy of chemoradiation are desirable such as biological pathway modifiers and immunomodulating agents. This trial will investigate the impact of nelfinavir, a protease inhibitor that targets the protein kinase B (AKT) pathway on disease-free survival (DFS). METHODS AND ANALYSIS Radiosensitising effect of nelfinavir in locally advanced carcinoma of cervix is a single-centre, open-label, parallel-group, 1:1 randomised phase-III study. Patients aged over 18 years with a diagnosis of carcinoma cervix stage III are eligible for the study. After consenting, patients will undergo randomisation to chemoradiation and brachytherapy arm or nelfinavir with chemoradiation and brachytherapy arm. The primary aim of the study is to compare the difference in 3-year DFS between the two arms. Secondary aims are locoregional control, overall survival, toxicity and quality of life between the two arms. Pharmacokinetics of nelfinavir and its impact on tumour AKT, programmed cell death ligand 1, cluster of differentiation 4, cluster of differentiation 8 and natural killer 1.1 expression will be investigated. The overall sample size of 348 with 1 planned interim analysis achieves 80% power at a 0.05 significance level to detect a HR of 0.66 when the proportion surviving in the control arm is 0.65. The planned study duration is 8 years. ETHICS AND DISSEMINATION The trial is approved by the Institutional Ethics Committee-I of Tata Memorial Hospital, Mumbai (reference number: IEC/0317/1543/001) and will be monitored by the data safety monitoring committee. The study results will be disseminated via peer-reviewed scientific journals, and conference presentations. Study participants will be accrued after obtaining written informed consent from them. The confidentiality and privacy of study participants will be maintained. TRIAL REGISTRATION NUMBER The trial is registered with Clinical Trials Registry-India (CTRI/2017/08/009265) and ClinicalTrials.gov (NCT03256916).
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaahid Mulani
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sidharth Pant
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Venkatesh Pai
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Department of Biostatistics, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mayuri Charnalia
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Bio-Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Bio-Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, India
| | - Lavanya Naidu
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sheela Sawant
- Department of General Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Praffula Thakkar
- Department of General Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
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Gurram L, Mohanty S, Chopra S, Grover S, Engineer R, Gupta S, Ghosh J, Gulia S, Sawant S, Daddi A, Deodhar K, Menon S, Rekhi B, Shylasree TS, Maheshwari A, Mahantshetty U. Outcomes of Cervical Cancer in HIV-Positive Women Treated With Radiotherapy at a Tertiary Care Center in India. JCO Glob Oncol 2022; 8:e2100312. [PMID: 35324255 PMCID: PMC9071252 DOI: 10.1200/go.21.00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
There are limited data on management of cervical cancer in women living with HIV in the modern antiretroviral therapy era. The study aimed to evaluate outcomes and toxicities of these patients treated with radiotherapy.
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Affiliation(s)
- Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Samarpita Mohanty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Advanced Centre for Training, Research Education in Cancer, Navi Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sheela Sawant
- Department of Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuprita Daddi
- Department of Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Fenlon JB, Rositch AF, Dickey BL, Kimani S, Suneja G. Gynecological radiotherapy in people living with human immunodeficiency virus: a semi-systematic literature review. Int J Gynecol Cancer 2022; 32:429-35. [DOI: 10.1136/ijgc-2021-002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 11/03/2022] Open
Abstract
Appropriate diagnosis and treatment of gynecological cancers in people living with human immunodeficiency virus (HIV) remains a clinical challenge given rapid changes in both HIV and cancer management and a lack of prospective clinical trial data inclusive of the HIV population. A semi-systematic literature review was performed to identify published studies addressing risk factors, screening, treatment efficacy, treatment toxicity, and prognosis for people living with HIV diagnosed with gynecological malignancies, with a focus on radiotherapy and cervical cancer, given the relative paucity of literature on uterine, ovarian, and vulvovaginal cancers in people living with HIV. People living with HIV are more likely to be co-infected with human papilloma virus and more likely to develop human papilloma virus-associated malignancies. People living with HIV are less likely to receive cancer treatment compared with HIV-uninfected cancer patients, even after adjusting for differences in clinical features and sociodemographic variables. The literature on cervical cancer outcomes is mixed, with some studies demonstrating that people living with HIV have inferior treatment tolerability, response rates, and survival following chemoradiotherapy, and others showing no difference in these outcomes, particularly in patients receiving antiretroviral therapy. Importantly, even in the series showing inferior outcomes in people living with HIV, there were long-term survivors after administration of curative therapy. Consistent with published cancer management guidelines, people living with HIV diagnosed with gynecological cancers should be treated with standard cancer therapy. Co-management with the patient’s HIV specialist is critical to avoid overlapping toxicities and provide optimal supportive care. The morbidity and mortality caused by gynecologic cancers in this population can be mitigated by early diagnosis, appropriate treatment delivery including inclusion of people with HIV in cancer clinical trials, and diligent HIV management.
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Abstract
Cancer cells are disordered by nature and thus featured by higher internal redox level than healthy cells. Redox imbalance could trigger programmed cell death if exceeded a certain threshold, rendering therapeutic strategies relying on redox control a possible cancer management solution. Yet, various programmed cell death events have been consecutively discovered, complicating our understandings on their associations with redox imbalance and clinical implications especially therapeutic design. Thus, it is imperative to understand differences and similarities among programmed cell death events regarding their associations with redox imbalance for improved control over these events in malignant cells as well as appropriate design on therapeutic approaches relying on redox control. This review addresses these issues and concludes by bringing affront cold atmospheric plasma as an emerging redox controller with translational potential in clinics.
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Yoder AK, Lakomy DS, Dong Y, Raychaudhury S, Royse K, Hartman C, Richardson P, White DL, Kramer JR, Lin LL, Chiao E. The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study. BMC Cancer 2021; 21:776. [PMID: 34225709 PMCID: PMC8256603 DOI: 10.1186/s12885-021-08514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The incidence of anal squamous cell carcinoma has been increasing, particularly in people living with HIV (PLWH). There is concern that radiosensitizing drugs, such as protease inhibitors, commonly used in the management of HIV, may increase toxicities in patients undergoing chemoradiation. This study examines treatment outcomes and toxicities in PLWH managed with and without protease inhibitors who are receiving chemoradiation for anal cancer. METHODS Patient demographic, HIV management, and cancer treatment information were extracted from multiple Veterans Affairs databases. Patients were also manually chart reviewed. Among PLWH undergoing chemoradiation for anal carcinoma, therapy outcomes and toxicities were compared between those treated with and without protease inhibitors at time of cancer treatment. Statistical analysis was performed using chi-square, Cox regression analysis, and logistic regression. RESULTS A total of 219 PLWH taking anti-retroviral therapy undergoing chemoradiation for anal cancer were identified and included in the final analysis. The use of protease inhibitors was not associated with any survival outcome including colostomy-free survival, progression-free survival, or overall survival (all adjusted hazard ratio p-values> 0.05). Regarding toxicity, protease inhibitor use was not associated with an increased odds of hospitalizations or non-hematologic toxicities; however, protease inhibitor use was associated with increased hospitalizations for hematologic toxicities, including febrile neutropenia (p < 0.01). CONCLUSION The use of protease inhibitors during chemoradiation for anal carcinoma was not associated with any clinical outcome or increase in non-hematologic toxicity. Their use was associated with increased hospitalizations for hematologic toxicities. Further prospective research is needed to evaluate the safety and efficacy of protease inhibitors for patients undergoing chemoradiation.
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Affiliation(s)
- Alison K Yoder
- University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Yongquan Dong
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Suchismita Raychaudhury
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Kathryn Royse
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
| | - Christine Hartman
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Peter Richardson
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Donna L White
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jennifer R Kramer
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Chiao
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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Garcia-Soto AE, McKenzie ND, Whicker ME, Pearson JM, Jimenez EA, Portelance L, Hu JJ, Lucci JA, Qureshi R, Kossenkov A, Schwartz L, Mills GB, Maity A, Lin LL, Simpkins F. Phase 1 trial of nelfinavir added to standard cisplatin chemotherapy with concurrent pelvic radiation for locally advanced cervical cancer. Cancer 2021; 127:2279-2293. [PMID: 33932031 PMCID: PMC8252376 DOI: 10.1002/cncr.33449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/08/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nelfinavir (NFV), an HIV-1 protease inhibitor, has been shown to sensitize cancer cells to chemoradiation (CRT). The objectives of this phase 1 trial were to evaluate safety and identify the recommended phase 2 dose of NFV added to concurrent CRT for locally advanced cervical cancer. METHODS Two dose levels of NFV were evaluated: 875 mg orally twice daily (dose level 1 [DL1]) and 1250 mg twice daily (DL2). NFV was initiated 7 days before CRT and continued through CRT completion. Toxicity, radiographic responses, and pathologic responses were evaluated. Serial tumor biopsies (baseline, after NFV monotherapy, on NFV + CRT, and posttreatment) were evaluated by immunohistochemistry, NanoString, and reverse-phase-protein-array analyses. RESULTS NFV sensitized cervical cancer cells to radiation, increasing apoptosis and tumor suppression in vivo. Patients (n = 13) with International Federation of Gynecology and Obstetrics stage IIA through IVA squamous cell cervical carcinoma were enrolled, including 7 patients at DL1 and 6 patients at DL2. At DL1, expansion to 6 patients was required after a patient developed a dose-limiting toxicity, whereas no dose-limiting toxicities occurred at DL2. Therefore, DL2 was established as the recommended phase 2 dose. All patients at DL2 completed CRT, and 1 of 6 experienced grade 3 or 4 anemia, nausea, and diarrhea. One recurrence was noted at DL2, with disease outside the radiation field. Ten of 11 evaluable patients remained without evidence of disease at a median follow-up of 50 months. NFV significantly decreased phosphorylated Akt levels in tumors. Cell cycle and cancer pathways also were reduced by NFV and CRT. CONCLUSIONS NFV with CRT is well tolerated. The response rate is promising compared with historic controls in this patient population and warrants further investigation.
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Affiliation(s)
- Arlene E Garcia-Soto
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Nathalie D McKenzie
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret E Whicker
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joseph M Pearson
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Edward A Jimenez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Lorraine Portelance
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Joseph A Lucci
- The University of Texas Health Science Center at Houston, Houston, Texas
| | | | | | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Gordon B Mills
- The Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lilie L Lin
- The University of Texas MD Anderson Cancer Center, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Fiona Simpkins
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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