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Vasquez-Trespalacios EM, Rivera Rivera JN, McIntyre M, Santiago-Datil W, Wenham RM, Vadaparampil ST, Buras AL, Conley CC. High Financial Hardship among Patients with Advanced Ovarian Cancer. J Soc Work End Life Palliat Care 2024:1-13. [PMID: 38635421 DOI: 10.1080/15524256.2024.2342285] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
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Affiliation(s)
| | | | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrea L Buras
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
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2
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Conley CC, Buras AL, McIntyre M, Santiago-Datil W, English D, Wenham RM, Vadaparampil ST. "It doesn't really apply to what I'm going through": a mixed-methods study of barriers to palliative care among patients with advanced ovarian cancer. Support Care Cancer 2023; 31:397. [PMID: 37326676 DOI: 10.1007/s00520-023-07832-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Palliative care aims to provide symptom relief and general support for patients with serious illness. Despite experiencing significant treatment side effects, specialty palliative care is under-utilized by patients with advanced ovarian cancer. We explored barriers to palliative care in this population. METHODS We conducted a sequential mixed-methods study. Qualitative: we interviewed patients with advanced ovarian cancer (N = 7). Guided by the Social Ecological Model (SEM), interviews assessed intrapersonal, interpersonal, organizational, and policy-level barriers to receipt of specialty palliative care. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Quantitative: patients with advanced ovarian cancer (N = 38) completed self-report surveys assessing knowledge about, attitudes towards, and prior experiences with specialty palliative care. Descriptive statistics were used to characterize survey responses. RESULTS Qualitative analysis identified barriers to specialty palliative care at each SEM level. Intrapersonal factors (e.g., knowledge, attitudes) were most frequently discussed. Other common barriers included insurance coverage and distance/travel time. Survey responses indicated most participants were aware of palliative care (74%) but had mixed attitudes towards palliative care and did not feel they needed for palliative care. No survey respondents had received a physician recommendation for palliative care, and a sizable minority (29%) thought palliative care referral should only take place when patients have no remaining treatment options. CONCLUSION Among patients with advanced ovarian cancer, barriers to specialty palliative care exist at multiple levels. Our results underscore the potential value of a multilevel intervention to support receipt of palliative care in this population.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA.
- Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA.
| | - Andrea L Buras
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Diana English
- Department of Gynecologic Oncology, Tampa General Hospital, Tampa, FL, USA
- Department of Palliative Care, Tampa General Hospital, Tampa, FL, USA
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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3
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Affiliation(s)
- Andrea L. Buras
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Clarissa Lam
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Jing-Yi Chern
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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4
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Buras AL, Wang T, Whiting J, Townsend MK, Fridley BL, Tworoger SS. Prospective Analyses of Sedentary Behavior in Relation to Risk of Ovarian Cancer. Am J Epidemiol 2022; 191:1021-1029. [PMID: 35094053 PMCID: PMC9271222 DOI: 10.1093/aje/kwac018] [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: 06/30/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 01/30/2023] Open
Abstract
We examined the association of sedentary behavior with risk of ovarian cancer overall, by tumor subtype, and by participant characteristics in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II). A total of 69,558 NHS participants (1992-2016) and 104,130 NHS II participants (1991-2015) who reported on time spent sitting at home, at work, and while watching television were included in the analysis, which included 884 histologically confirmed ovarian cancer cases. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer by sitting time (no mutual adjustment for individual sitting types in primary analyses). We examined potential heterogeneity by tumor histological type (type I or II), body mass index (weight (kg)/height (m)2; < 25 or ≥25), and total physical activity (<15 or ≥15 metabolic equivalent of task-hours/week). We observed an increased risk of ovarian cancer for women who sat at work for 10-19 hours/week (HR = 1.25, 95% CI: 1.04, 1.51) and ≥20 hours/week (HR = 1.40, 95% CI: 1.14, 1.71) versus <5 hours/week. This association did not vary by body mass index, physical activity, or histotype (P for heterogeneity ≥ 0.43). No associations were observed for overall sitting, sitting while watching television, or other sitting at home. Longer sitting time at work was associated with elevated risk of ovarian cancer. Further investigations are required to confirm these findings and elucidate underlying mechanisms.
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Affiliation(s)
| | - Tianyi Wang
- Correspondence to Dr. Tianyi Wang, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33613 (e-mail: )
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5
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Buras AL, Barkhurst M, Rutherford TJ, Anderson ML, English DP. The Intersection of Palliative Care and Genetic Counseling in Cancer Care: A Case Discussion. J Palliat Med 2021; 25:167-171. [PMID: 34851746 DOI: 10.1089/jpm.2021.0169] [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] [Indexed: 11/13/2022] Open
Abstract
Up to 10% of cancers have a strong hereditary component. The diagnosis of a hereditary cancer may alter treatment recommendations for the patient. However, the optimal timing and best practices for integrating genetic counseling and testing into the care of women diagnosed with cancer remains unclear. In this study, we demonstrate the potential benefits of discussing genetic testing and counseling in the context of palliative care through two cases. Incorporating referrals for genetic testing into the palliative care context is important. This provides an opportunity to perform previously missed genetic testing. It is also a chance for the patient to leave a legacy while also potentially allowing for alternate targeted treatment possibilities that may be well tolerated and provide a better quality of life for the patients themselves. The benefits of referral to palliative care by the genetics team includes assisting patients with the management of not only physical but also psychological symptoms as well as conducting advanced care planning in patients and families with hereditary mutations.
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Affiliation(s)
- Andrea L Buras
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Meghan Barkhurst
- Department of Palliative Care, Chesapeake Regional Medical Center, Chesapeake, Virginia, USA
| | - Thomas J Rutherford
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Matthew L Anderson
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Diana P English
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA.,Department of Palliative Medicine, University of South Florida, Tampa, Florida, USA
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Buras AL, Chern JY, Chon HS, Shahzad MM, Wenham RM, Hoffman MS. Major vascular injury during gynecologic cancer surgery. Gynecol Oncol Rep 2021; 37:100815. [PMID: 34258355 PMCID: PMC8259293 DOI: 10.1016/j.gore.2021.100815] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Vascular injury during major gynecologic cancer surgery is a rare but potentially fatal complication. The purpose of this study was to review our experience with major vascular injury during gynecologic cancer surgery. METHODS This was a retrospective chart review of women undergoing surgery by our gynecologic oncology department from 7/1/99 to 6/30/20 who had a major vascular injury. We identified women who sustained a vascular injury by a combination of CPT code and medical record searches, fellow case logs and a list maintained for an ongoing quality assurance program. Data were expressed as median and range for continuous variables and as frequency and percentage for categorical variables. Fisher's exact test was used to analyze differences in complication rates between groups. RESULTS Major vascular injury was identified in 52 patients and procedures. The inferior vena cava was the most common site of injury, 32.7% (17/52), followed by the external iliac vein, 23.1% (12/52). Lymph node dissection was the most common time for a vascular injury to occur 51.9% (27/52). The majority of injuries required suture repair, 80.8% (42/52). Estimated blood loss in cases with vascular injury ranged from 100 mL to massive unquantifiable blood loss in the case of an aortic injury. Patients required a median of 2units of packed red blood cells. Postoperative complications included anemia requiring blood transfusion, 19.6% (9/46) and venous thromboembolism, 19.6% (9/46). CONCLUSIONS Vascular injury remains a rare but potentially morbid complication of gynecologic oncologic surgery. Prompt recognition and management are imperative in minimizing persistent bleeding and complications.
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Affiliation(s)
- Andrea L. Buras
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jing Yi Chern
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hye Sook Chon
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mian M. Shahzad
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Robert M. Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mitchel S. Hoffman
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Affiliation(s)
- Mitchel Hoffman
- Department of Gynecologic Oncology, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Andrea L. Buras
- Department of Gynecologic Oncology, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ricardo Gonzalez
- Department of Sarcoma, Moffitt Cancer Center, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Murray Shames
- Division of Vascular Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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8
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Buras AL, Mallen A, Wenham R, Montejo M. Stage IIIC endometrial cancer review: Current controversies in adjuvant therapy. Gynecol Oncol Rep 2021; 36:100754. [PMID: 33869712 PMCID: PMC8042429 DOI: 10.1016/j.gore.2021.100754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/16/2022] Open
Abstract
Stage IIIC is the most common stage of locally advanced sub-stage of endometrial cancer, nevertheless, the optimal management for these patients remains controversial. Adjuvant chemotherapy alone more effectively suppressed distant metastases but resulted in a higher rate of pelvic failure, while adjuvant radiation more effectively controlled pelvic recurrences but was associated with more frequent distant metastases. Two recent randomized trials, PORTEC3 and GOG 258, each have attempted to integrate multimodal therapy. However, heterogeneous cohorts analyzed together, including high risk stage I, stage III and stage IV, limit our ability to make conclusions specific to stage IIIC disease. Here, we review clinical evidence pertaining to management and outcomes with stage IIIC uterine carcinoma with brief discussion on evolving approaches. The studies reviewed demonstrate for stage IIIC disease radiation improves local control but does not confer an overall survival benefit and chemotherapy can improve overall survival. The data seem to suggest that aside from the possibility of defining subgroups that may confer an overall survival benefit from combined modality therapy, the future to improving survival lies in the exploration of better therapeutic regimens that will result from tailored biomarker-based therapy.
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Affiliation(s)
- Andrea L. Buras
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Adrianne Mallen
- Department of Gynecologic Oncology, Park Nicollet Methodist Hospital, Minneapolis, MN, USA
| | - Robert Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael Montejo
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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9
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Buras AL, Hathaway CA, Wang T, Townsend MK, Tworoger SS. The association of resistance training with risk of ovarian cancer. Cancer Med 2021; 10:2489-2495. [PMID: 33704932 PMCID: PMC7982607 DOI: 10.1002/cam4.3804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 01/24/2023] Open
Abstract
Background Increasing evidence, including multiple putative inflammatory risk factors (e.g., c‐reactive protein, and adiposity), supports that inflammation plays an important role in ovarian carcinogenesis. Resistance training (RT) is associated with lower levels of circulating inflammatory markers, independent of physical activity. Methods We evaluated the relationship between RT and risk of ovarian cancer accounting for other physical activity (e.g., walking) in two large prospective cohorts, the Nurses’ Health Study (NHS) and NHSII. Key Results In total, analyses included 42,005 NHS participants (2000–2016) and 67,289 NHSII participants (2001–2017) with RT assessed every 4 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of RT with ovarian cancer risk overall and by tumor subtype, adjusting for known and putative ovarian cancer risk factors. We identified a total of 609 cases over 1,748,884 person‐years. No association was observed with overall ovarian cancer risk (RT ≥60 vs 0 min/wk, HR = 0.95, 95%CI: 0.74–1.22) or by histotype (comparable HR = 0.86 and 0.98 for type I and II tumors, respectively). Results did not differ by body mass index (Pinteraction = 0.97), or other physical activity (Pinteraction = 0.31). Conclusions & Inferences We observed no evidence that moderate levels of RT were associated with risk of ovarian cancer. Further investigations are required to confirm these findings.
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Affiliation(s)
- Andrea L Buras
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Obstetrics & Gynecology, University of South Florida, Tampa, FL, USA
| | | | - Tianyi Wang
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Mary K Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Payne KK, Mine JA, Biswas S, Chaurio RA, Perales-Puchalt A, Anadon CM, Costich TL, Harro CM, Walrath J, Ming Q, Tcyganov E, Buras AL, Rigolizzo KE, Mandal G, Lajoie J, Ophir M, Tchou J, Marchion D, Luca VC, Bobrowicz P, McLaughlin B, Eskiocak U, Schmidt M, Cubillos-Ruiz JR, Rodriguez PC, Gabrilovich DI, Conejo-Garcia JR. BTN3A1 governs antitumor responses by coordinating αβ and γδ T cells. Science 2020; 369:942-949. [PMID: 32820120 DOI: 10.1126/science.aay2767] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 05/11/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
Gamma delta (γδ) T cells infiltrate most human tumors, but current immunotherapies fail to exploit their in situ major histocompatibility complex-independent tumoricidal potential. Activation of γδ T cells can be elicited by butyrophilin and butyrophilin-like molecules that are structurally similar to the immunosuppressive B7 family members, yet how they regulate and coordinate αβ and γδ T cell responses remains unknown. Here, we report that the butyrophilin BTN3A1 inhibits tumor-reactive αβ T cell receptor activation by preventing segregation of N-glycosylated CD45 from the immune synapse. Notably, CD277-specific antibodies elicit coordinated restoration of αβ T cell effector activity and BTN2A1-dependent γδ lymphocyte cytotoxicity against BTN3A1+ cancer cells, abrogating malignant progression. Targeting BTN3A1 therefore orchestrates cooperative killing of established tumors by αβ and γδ T cells and may present a treatment strategy for tumors resistant to existing immunotherapies.
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Affiliation(s)
- Kyle K Payne
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Jessica A Mine
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Subir Biswas
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Ricardo A Chaurio
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Alfredo Perales-Puchalt
- Immunology, Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Carmen M Anadon
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Tara Lee Costich
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Carly M Harro
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.,Department of Cell Biology, Microbiology, and Molecular Biology and Cancer Biology PhD Program, University of South Florida, Tampa, FL 33620, USA
| | - Jennifer Walrath
- Immunology, Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Qianqian Ming
- Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Evgenii Tcyganov
- Immunology, Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Andrea L Buras
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Kristen E Rigolizzo
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Gunjan Mandal
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | | | | | - Julia Tchou
- Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104-1693, USA
| | - Douglas Marchion
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Vincent C Luca
- Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | | | | | | | | | - Juan R Cubillos-Ruiz
- Department of Obstetrics and Gynecology, Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA
| | - Paulo C Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Dmitry I Gabrilovich
- Immunology, Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Jose R Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. .,Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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11
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Kim HI, Schultz CR, Buras AL, Friedman E, Fedorko A, Seamon L, Chandramouli GVR, Maxwell GL, Bachmann AS, Risinger JI. Ornithine decarboxylase as a therapeutic target for endometrial cancer. PLoS One 2017; 12:e0189044. [PMID: 29240775 PMCID: PMC5730160 DOI: 10.1371/journal.pone.0189044] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/19/2017] [Indexed: 12/13/2022] Open
Abstract
Ornithine Decarboxylase (ODC) a key enzyme in polyamine biosynthesis is often overexpressed in cancers and contributes to polyamine-induced cell proliferation. We noted ubiquitous expression of ODC1 in our published endometrial cancer gene array data and confirmed this in the cancer genome atlas (TCGA) with highest expression in non-endometrioid, high grade, and copy number high cancers, which have the worst clinical outcomes. ODC1 expression was associated with worse overall survival and increased recurrence in three endometrial cancer gene expression datasets. Importantly, we confirmed these findings using quantitative real-time polymerase chain reaction (qRT-PCR) in a validation cohort of 60 endometrial cancers and found that endometrial cancers with elevated ODC1 had significantly shorter recurrence-free intervals (KM log-rank p = 0.0312, Wald test p = 5.59e-05). Difluoromethylornithine (DFMO) a specific inhibitor of ODC significantly reduced cell proliferation, cell viability, and colony formation in cell line models derived from undifferentiated, endometrioid, serous, carcinosarcoma (mixed mesodermal tumor; MMT) and clear cell endometrial cancers. DFMO also significantly reduced human endometrial cancer ACI-98 tumor burden in mice compared to controls (p = 0.0023). ODC-regulated polyamines (putrescine [Put] and/or spermidine [Spd]) known activators of cell proliferation were strongly decreased in response to DFMO, in both tumor tissue ([Put] (p = 0.0006), [Spd] (p<0.0001)) and blood plasma ([Put] (p<0.0001), [Spd] (p = 0.0049)) of treated mice. Our study indicates that some endometrial cancers appear particularly sensitive to DFMO and that the polyamine pathway in endometrial cancers in general and specifically those most likely to suffer adverse clinical outcomes could be targeted for effective treatment, chemoprevention or chemoprevention of recurrence.
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Affiliation(s)
- Hong Im Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, United States of America
| | - Chad R. Schultz
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, United States of America
| | - Andrea L. Buras
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, United States of America
- Spectrum Health, Grand Rapids, Michigan, United States of America
| | | | - Alyssa Fedorko
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, United States of America
- Spectrum Health, Grand Rapids, Michigan, United States of America
| | - Leigh Seamon
- Spectrum Health, Grand Rapids, Michigan, United States of America
| | | | - G. Larry Maxwell
- Department of Obsteterics and Gynecology, Inova Fairfax Women’s Hospital, Falls Church, Virginia, United States of America
| | - André S. Bachmann
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, United States of America
- * E-mail: (JR); (AB)
| | - John I. Risinger
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, United States of America
- Spectrum Health, Grand Rapids, Michigan, United States of America
- * E-mail: (JR); (AB)
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12
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Kim HI, Schultz CR, Buras AL, Friedman E, Fedorko AM, Seamon LG, Chandramouli G, Bachmann AS, Risinger JI. Abstract 1242: Ornithine decarboxylase as a therapeutic target in endometrial cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Endometrial cancer is the 4th most common cancer and the 6th deadliest cancer in US women. The American Cancer Society estimates there will be 60,050 new endometrial cancers in 2016, an increase of more than 10% from the previous year highlighting the need for more effective treatments and prevention. Ornithine Decarboxylase (ODC) a key enzyme in polyamine synthesis is often overexpressed in cancers and contributes to cell proliferation and tumor growth. Therefore, ODC and the polyamine pathway are considered rational targets for cancer treatment or prevention. We noted ubiquitous expression of ODC1 in our previously published endometrial cancer gene array data and confirmed this in the cancer genome atlas (TCGA), finding expression in all four molecular sub-types with highest expression in copy number high cancers which have the worst clinical outcomes. Therefore, we explored the association of ODC1 gene expression with clinical outcomes of overall survival (OS) and recurrence in the TCGA cohort and noted that elevated ODC1 was significantly related to OS (Wald test p=0.001) and recurrence (p=0.01). Importantly, we confirmed these observations using QRT-PCR in a validation cohort of 60 endometrial cancers and found that endometrial cancers with elevated ODC1 had significantly shorter recurrence-free intervals (p=5.59x10-5) and elevated hazard ratio=3.72. Similar to TCGA data we also noted a strong trend to worse OS ( p=0.00014) with elevated hazard ratio 3.81. Numerous studies including clinical trials have examined the chemopreventive and anti-tumor effects of difluoromethylornithine (DFMO), a specific inhibitor of ODC. We found that DFMO treatment significantly reduced cell proliferation, cell viability, and colony formation in human cell line models derived from undifferentiated, endometrioid, serous, MMT and clear cell endometrial cancers. In contrast, immortalized uterine endometrial epithelial cells (EM E6/E7 TERT1) were less sensitive to DFMO. To confirm the significant effects of DFMO in vitro we performed an in vivo study with human endometrial cancer (ACI-98) tumor-bearing athymic nude mice. Xenografted mice were either treated with 2% (w/v) DFMO supplied in drinking water or water only (n=10/group). DFMO significantly reduced the tumor burden in mice compared to controls (p=0.0023). ODC-regulated polyamines (putrescine [Put] and spermidine [Spd]) known activators of cell proliferation were strongly decreased in response to DFMO, in both tumor tissue ([Put] (p=0.0006), [Spd] (p<0.0001)) and blood plasma ([Put] (p<0.0001), [Spd] (p=0.0049)) of treated mice. Results of these studies indicate that some endometrial cancers appear particularly sensitive to DFMO. Our findings indicate that the polyamine pathway in endometrial cancers in general and specifically those most clinically relevant endometrial cancers could be targeted for effective treatment, chemoprevention or chemoprevention of recurrence.
Citation Format: Hong Im Kim, Chad R. Schultz, Andrea L. Buras, Elizabeth Friedman, Alyssa M. Fedorko, Leigh G. Seamon, Gadisetti Chandramouli, André S. Bachmann, John I. Risinger. Ornithine decarboxylase as a therapeutic target in endometrial cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1242. doi:10.1158/1538-7445.AM2017-1242
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Affiliation(s)
- Hong Im Kim
- 1Michigan State University, Grand Rapids, MI
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Affiliation(s)
- Andrea L Buras
- Sparrow Hospital, 1322 East Michigan Avenue, Lansing, MI 48912, United States
| | - Andrea N McSwain
- Ingham Regional Medical Center, 401 West Greenlawn Avenue, Lansing, MI 48910, United States
| | - Ying Qin
- Sparrow Hospital, 1215 East Michigan Avenue, Lansing, MI 48912, United States
| | - Joseph K Meunier
- Sparrow Regional Cancer Center, 1215 East Michigan Avenue, Lansing, MI 48912, United States
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