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Bartemes KR, Gochanour BR, Routman DM, Ma DJ, Doering KA, Burger KN, Foote PH, Taylor WR, Mahoney DW, Berger CK, Cao X, Then SS, Haller TJ, Larish AM, Moore EJ, Garcia JJ, Graham RP, Bakkum-Gamez JN, Kisiel JB, Van Abel KM. Assessing the capacity of methylated DNA markers of cervical squamous cell carcinoma to discriminate oropharyngeal squamous cell carcinoma in human papillomavirus mediated disease. Oral Oncol 2023; 146:106568. [PMID: 37717549 PMCID: PMC10591712 DOI: 10.1016/j.oraloncology.2023.106568] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Early identification of human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) is challenging and novel biomarkers are needed. We hypothesized that a panel of methylated DNA markers (MDMs) found in HPV(+) cervical squamous cell carcinoma (CSCC) will have similar discrimination in HPV(+)OPSCC tissues. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded tissues were obtained from patients with primary HPV(+)OPSCC or HPV(+)CSCC; control tissues included normal oropharynx palatine tonsil (NOP) and cervix (NCS). Using a methylation-specific polymerase chain reaction, 21 previously validated cervical MDMs were evaluated on tissue-extracted DNA. Discrimination between case and control cervical and oropharynx tissue was assessed using area under the curve (AUC). RESULTS 34 HPV(+)OPSCC, 36 HPV(+)CSCC, 26 NOP, and 24 NCS patients met inclusion criteria. Within HPV(+)CSCC, 18/21 (86%) of MDMs achieved an AUC ≥ 0.9 and all MDMs exhibited better than chance classifications relative to control cervical tissue (all p < 0.001). In contrast, within HPV(+)OPSCC only 5/21 (24%) MDMs achieved an AUC ≥ 0.90 but 19/21 (90%) exhibited better than chance classifications relative to control tonsil tissue (all p < 0.001). Overall, 13/21 MDMs had statistically significant lower AUCs in the oropharyngeal cohort compared to the cervical cohort, and only 1 MDM exhibited a statistically significant increase in AUC. CONCLUSIONS Previously validated MDMs exhibited robust performance in independent HPV(+)CSCC patients. However, most of these MDMs exhibited higher discrimination for HPV(+)CSCC than for HPV(+)OPSCC. This suggests that each SCC subtype requires a unique set of MDMs for optimal discrimination. Future studies are necessary to establish an MDM panel for HPV(+)OPSCC.
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Affiliation(s)
- Kathleen R Bartemes
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J Ma
- Department of Radiation Oncology, Rochester, MN, USA
| | | | - Kelli N Burger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Douglas W Mahoney
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoming Cao
- Department of Gastroenterology, Rochester, MN, USA
| | - Sara S Then
- Department of Gastroenterology, Rochester, MN, USA
| | - Travis J Haller
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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El Khoury LY, Lin WH, Smadbeck JB, Barrett MT, Sadeghian D, McCune AF, Karagouga G, Cheville JC, Harris FR, Kinsella LM, Feathers RW, Schafer Klein JL, Walther-Antonio MR, Johnson SH, Penheiter AR, Cucinella G, Schivardi G, Bhagwate A, Borad MJ, Mansfield AS, Murphy SJ, Mariani A, Vasmatzis G, Anastasiadis PZ, Weroha SJ, Larish AM. Epigenomics may begin to explain in vitro differential response to hypomethylating agents in MMR-D hypermethylated endometrial cancer. Epigenomics 2023; 15:283-292. [PMID: 37212177 DOI: 10.2217/epi-2023-0026] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
This work examines differences in chromatin accessibility, methylation, and response to DNA hypomethylating agents between mismatch repair-deficient and non-mismatch repair-deficient endometrial cancer. Next-generation sequencing of a stage 1B, grade 2 endometrioid endometrial cancer tumor revealed microsatellite instability and a variant of unknown significance in POLE along with global and MLH1 hypermethylation. Inhibition of viability by decitabine in the study and comparison tumors was minimal, as shown by an inhibitory effect of 0 and 17.9, respectively. Conversely, the inhibitory effect of azacitidine on the study tumor was more pronounced, at 72.8 versus 41.2. In vitro, mismatch repair-deficient endometrial cancer with MLH1 hypermethylation respond better to DNA methyltransferase inhibition by azacytidine (DNA/RNA inhibition), than to decitabine (DNA-only inhibition). Additional large studies are needed to substantiate our findings.
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Affiliation(s)
- Louis Y El Khoury
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - Wan Hsin Lin
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - James B Smadbeck
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael T Barrett
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Dorsay Sadeghian
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Alexa F McCune
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Giannoula Karagouga
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - John C Cheville
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Faye R Harris
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Ryan W Feathers
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Janet L Schafer Klein
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Sarah H Johnson
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Alan R Penheiter
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Giuseppe Cucinella
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Gabriella Schivardi
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Aditya Bhagwate
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Mitesh J Borad
- Department of Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | - Stephen J Murphy
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrea Mariani
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - George Vasmatzis
- Biomarker Discovery Group, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Saravut J Weroha
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Alyssa M Larish
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN 55905, USA
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Ghoniem K, Larish AM, Dinoi G, Zhou XC, Alhilli M, Wallace S, Wohlmuth C, Baiocchi G, Tokgozoglu N, Raspagliesi F, Buda A, Zanagnolo V, Zapardiel I, Jagasia N, Giuntoli R, Glickman A, Peiretti M, Lanner M, Chacon E, Di Guilmi J, Pereira A, Laas E, Fishman A, Nitschmann CC, Parker S, Joehlin-Price A, Lees B, Covens A, De Brot L, Taskiran C, Bogani G, Paniga C, Multinu F, Hernandez-Gutierrez A, Weaver AL, McGree ME, Mariani A. Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study. Gynecol Oncol 2021; 162:590-598. [PMID: 34274133 DOI: 10.1016/j.ygyno.2021.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 03/09/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs). METHODS Patients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded. RESULTS Of 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%-85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2-41.5) months. At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50-9.99; P < .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45-7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44-9.54; P = .007) were independent predictors of recurrence. Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months). CONCLUSIONS In patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.
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Affiliation(s)
- Khaled Ghoniem
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Giorgia Dinoi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Universita Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Sumer Wallace
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christoph Wohlmuth
- Sunnybrook Health Sciences, University of Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | | | | | | | | | | | | | - Nisha Jagasia
- Mater Hospital Brisbane & Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Robert Giuntoli
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | | | | | | | | | - Augusto Pereira
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ami Fishman
- Meir Medical Center, Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | | | - Brittany Lees
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Allan Covens
- Sunnybrook Health Sciences, University of Toronto, Ontario, Canada
| | | | - Cagatay Taskiran
- Turkish Society of Gynecologic Oncology, Istanbul, Turkey; Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale Tumori -Milan, Milan, Italy
| | | | - Francesco Multinu
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
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Marnach ML, Larish AM, Kim SJ, Mara KC, Henry MR, Chantigian PDM. Retrospective 15-Year Review of Anal Cytology Screening in Women at Mayo Clinic Rochester, Minnesota. J Low Genit Tract Dis 2021; 24:238-242. [PMID: 32205766 DOI: 10.1097/lgt.0000000000000535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Anal cytology is a modality for anal cancer screening in high-risk women. In this retrospective study, we review risk factors associated with abnormal anal cytology and unsatisfactory anal cytology rates, and correlate findings of cytology with histological results. METHODS A retrospective cohort study of anal cytology screening in women at Mayo Clinic in Rochester, Minnesota from 2002 to 2018 was conducted. RESULTS Three hundred fifty-seven women had a total of 592 anal cytologies performed. Three hundred seventeen women had screening anal cytology, whereas 40 women had anal cytology for surveillance given a history of anal intraepithelial neoplasia (AIN) or anal cancer. An unsatisfactory anal cytology result was found in 14.7%. Risk factors, type of follow-up, and correlation with histologic specimens were also reviewed. Histologic finding of AIN 2/3 correlated with abnormal anal cytology 84% of the time in this cohort. CONCLUSIONS High-risk women should be screened on a periodic basis for anal cancer. Anal cytology is one possible modality that can be used. Further insight into AIN progression, regression, recurrence, and outcome after treatment will help direct future screening recommendations.
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Affiliation(s)
- Mary L Marnach
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Sharon J Kim
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | | | - Michael R Henry
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN
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Larish AM, Dickson RR, Kudgus RA, McGovern RM, Reid JM, Hooten WM, Nicholson WT, Vaughan LE, Burnett TL, Laughlin-Tommaso SK, Faubion SS, Green IC. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019; 16:763-766. [PMID: 31010782 DOI: 10.1016/j.jsxm.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/13/2019] [Accepted: 03/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vaginal diazepam is frequently used to treat pelvic floor tension myalgia and pelvic pain despite limited knowledge of systemic absorption. AIM To determine the pharmacokinetic and adverse event profile of diazepam vaginal suppositories. METHODS We used a prospective pharmacokinetic design with repeated assessments of diazepam levels. Eight healthy volunteers were administered a 10-mg compounded vaginal diazepam suppository in the outpatient gynecologic clinic. Serum samples were collected at 0, 45, 90, 120, and 180 minutes; 8, 24, and 72 hours; and 1 week following administration of a 10-mg vaginal suppository. The occurrence of adverse events was assessed using the alternate step and tandem walk tests, the Brief Confusion Assessment Method, and numerical ratings. Plasma concentrations of diazepam and active long-acting metabolites were measured. Pharmacokinetic parameters were calculated by standard noncompartmental methods. RESULTS The mean peak diazepam concentration (Cmax) of 31.0 ng/mL was detected at a mean time (Tmax) of 3.1 hours after suppository placement. The bioavailability was found to be 70.5%, and the mean terminal elimination half-life was 82 hours. The plasma levels of temazepam and nordiazepam peaked at 0.8 ng/mL at 29 hours and 6.4 ng/mL at 132 hours, respectively. Fatigue was reported by 3 of 8 participants. CLINICAL IMPLICATIONS Serum plasma concentrations of vaginally administered diazepam are low; however the half-life is prolonged. STRENGTHS & LIMITATIONS Strengths include use of inclusion and exclusion criteria aimed at mitigating clinical factors that could adversely impact diazepam absorption and metabolism, and the use of an ultrasensitive LC-MS/MS assay. Limitations included the lack of addressing the efficacy of vaginal diazepam in lieu of performing a pure pharmacokinetic study with healthy participants. CONCLUSION Vaginal administration of diazepam results in lower peak serum plasma concentration, longer time to peak concentration, and lower bioavailability than standard oral use. Providers should be aware that with diazepam's long half-life, accumulating levels would occur with chronic daily doses, and steady-state levels would not be reached for up to 1 week. This profile would favor intermittent use to allow participation in physical therapy and intimacy. Larish AM, Dickson RR, Kudgus RA, et al. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019;16;763-766.
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Affiliation(s)
- Alyssa M Larish
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rozalin R Dickson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rachel A Kudgus
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Renee M McGovern
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joel M Reid
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Wayne T Nicholson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa E Vaughan
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Stephanie S Faubion
- Women's Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Isabel C Green
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA.
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