Lineage specific extracellular vesicle-associated protein biomarkers for the early detection of high grade serous ovarian cancer

High grade serous ovarian carcinoma (HGSOC) accounts for ~ 70% of ovarian cancer cases. Non-invasive, highly specific blood-based tests for pre-symptomatic screening in women are crucial to reducing the mortality associated with this disease. Since most HGSOCs typically arise from the fallopian tubes (FT), our biomarker search focused on proteins found on the surface of extracellular vesicles (EVs) released by both FT and HGSOC tissue explants and representative cell lines. Using mass spectrometry, 985 EV proteins (exo-proteins) were identified that comprised the FT/HGSOC EV core proteome. Transmembrane exo-proteins were prioritized because these could serve as antigens for capture and/or detection. With a nano-engineered microfluidic platform, six newly discovered exo-proteins (ACSL4, IGSF8, ITGA2, ITGA5, ITGB3, MYOF) plus a known HGSOC associated protein, FOLR1 exhibited classification performance ranging from 85-98% in a case-control study using plasma samples representative of early (including stage IA/B) and late stage (stage III) HGSOCs. Furthermore, by linear combination of IGSF8 and ITGA5 based on logistic regression analysis, we achieved a sensitivity of 80% (99.8% specificity). These lineage-associated exo-biomarkers have potential to detect cancer while localized to the FT when patient outcomes are more favorable.

Evaluation of the Sensitivity to Endocrine Therapy Index and 21-Gene Breast Recurrence Score in the SWOG S8814 Trial

PURPOSE

Chemotherapy has not demonstrated benefit over adjuvant endocrine therapy alone for postmenopausal patients with node-positive breast cancer with a 21-gene breast recurrence score (RS) of 25 or below (RS ≤ 25). We tested whether combined results from RS and the sensitivity to endocrine therapy (SET2,3) index of endocrine-related transcription (SETER/PR) adjusted for baseline prognostic index (BPI) improve prognostic assessment, and whether SET2,3 predicted benefit from anthracycline-based chemotherapy.

METHODS

A blinded retrospective clinical validation of SET2,3 in two randomized treatment arms from the SWOG S8814 trial comparing adjuvant anthracycline-based chemotherapy followed by tamoxifen endocrine therapy for 5 years, versus tamoxifen alone. SET2,3 assay was calibrated and measured using whole-transcriptome RNA sequence of tumor samples already tested for RS. The primary end point was disease-free survival (DFS).

RESULTS

There were 106 events in 283 patients over a median follow-up of 8.99 years. Proportional hazards assumptions were met during the first 5 years only. SET2,3 index and RS were not correlated (r = -0.04) and were independently prognostic (SET2,3: hazard ratio [HR], 0.48 per unit; 95% CI, 0.34 to 0.68; P < .001; RS: HR, 1.28 per 10 units; 95% CI, 1.14 to 1.44; P < .001). SET2,3 index did not predict chemotherapy benefit (interaction P = .77). SET2,3 was high in 93/175 (53%) patients with RS ≤ 25 (concordant low-risk), with 5-year DFS 97%. SET2,3 was low in 55/108 (51%) patients with RS > 25 (concordant high-risk), with 5-year DFS 53%. Both components of SET2,3 index were prognostic after adjustment for RS: SETER/PR (HR, 0.65; 95% CI, 0.46 to 0.92) and BPI (HR, 0.45; 95% CI, 0.31 to 0.64).

CONCLUSION

SET2,3 index was not correlated with RS, demonstrated additive prognostic performance, and was not chemopredictive in this subset of patients from S8814. The SETER/PR and BPI components of SET2,3 each added prognostic information to RS.

Abstract PD9-06: Evaluation of the predicted sensitivity to endocrine therapy (SET2,3 index) and the 21-gene Breast Recurrence Score® assay in node-positive postmenopausal breast cancer: Results from an analysis in the SWOG S8814 trial

Background. SWOG trial S8814 randomized postmenopausal patients with pathologic lymph node-positive (N+) breast cancer that was hormone receptor-positive to receive adjuvant anthracycline-based chemotherapy (cyclophosphamide, doxorubicin, fluorouracil) followed by tamoxifen endocrine therapy for 5 years (CAF-T), versus tamoxifen alone (TAM). The 21-gene Breast Recurrence Score® assay was prognostic in S8814 and predicted chemotherapy benefit in patients with higher Recurrence Score® (RS) (Albain et al, Lancet Oncol 2009). Other prognostic signatures have yet to be evaluated in this cohort. The sensitivity to endocrine therapy index (SET2,3) measures non-proliferative hormone receptor-related transcription (SETER/PR) adjusted for a baseline prognosis index derived from tumor size, nodes involved and a 4-gene molecular subtype (RNA4) (Du et al, Ann Oncol 2021). SET2,3 has been shown to provide prognostic information independent from neoadjuvant chemotherapy response. We sought to evaluate the predictive and prognostic value of SET2,3 in SWOG 8814. Methods. Independently, the SET2,3 index and cut point were calibrated from their diagnostic platform to the whole transcriptome RNA sequencing (RNAseq) platform in 85 sample pairs. Expression of the 31 transcripts used for SET2,3 were provided from RNAseq data of 283 tumors in S8814 (all previously tested for RS). Blinded calculated results of SET2,3 were then merged with outcome data. The planned analysis tested whether SET2,3 (continuous index, dichotomized high/low) provided additional prognostic information to RS (overall and in pts. with RS≤25) by treatment arm, and whether low SET2,3 was associated with chemo benefit. Cox proportional hazards models of disease-free survival (DFS) included SET2,3; RS; treatment arm; and (where relevant) interaction term and reported hazard ratios (HR) and 95% confidence intervals (95%CI). Results. There were 106 events over median follow-up of 9.1 years in 283 patients. 175 patients had RS ≤25, 108 had RS &gt;25. Distribution of the SET2,3 low was similar in both RS high (51%) and low groups (47%), reflecting minimal correlation between the two. As proportional hazards assumptions were met during the first 5 years only the analysis was restricted to 5 years. Adjusting for treatment arm, high SET2,3 category was highly prognostic in this randomized trial (HR 0.27, 95% CI 0.15-0.49, p&lt;0.0001). High SET2,3 was not predictive of chemotherapy response (interaction p=0.83). In multivariable Cox models (Table), continuous RS and SET2,3 were independently prognostic in the overall population for each treatment arm (p≤0.01), whereas only SET2,3 was prognostic for patients with RS≤25 (N=175, p&lt;0.001). In patients with RS≤25, continuous SET2,3 was prognostic within the CAF-T arm (HR 0.34, p=0.006) with similar results in the TAM alone arm (HR 0.38, p=0.062). Conclusions. SET2,3 added independent prognostic information to RS results in the S8814 trial for patients with N+ disease treated with tamoxifen, though it was not predictive of benefit from adjuvant chemotherapy. When RS result ≤25, SET2,3 remained independently prognostic. Hence, SET2,3 provided independent information complementary to RS, possibly because it incorporates tumor size and number of positive nodes. SET2,3 warrants further evaluation in patients with N+ breast cancer.

Table: Multivariable Cox models in the overall population and subset with RS≤25 by treatment arm.CohortTreatment ArmContinuous Recurrence ScoreContinuous SET2,3HR (95%CI) per 10 unitsp-valueHR (95%CI)per 1 unitp-valueAll RS(N=283)CAF-TAM(N=166)1.21 (1.04-1.40)0.0120.48 (0.31-0.76)0.002TAM(N=117)1.44 (1.18-1.76)&lt; 0.0010.48 (0.27-0.88)0.017RS≤25 (N=175)CAF-TAM(N=99)1.43 (0.58-3.49)0.440.34 (0.15-0.73)0.006TAM(N=76)1.66 (0.46-5.93)0.440.38 (0.14-1.05)0.062

Citation Format: Corey W. Speers, W. Fraser Symmans, William E. Barlow, Alex Trevarton, Stephanie The, Lili Du, James M. Rae, Steven Shak, Frederick L. Baehner, Priyanka Sharma, Lajos Pusztai, Gabriel N. Hortobagyi, Daneil F Hayes, Kathy S. Albain, Andrew Godwin, Alastair Thompson. Evaluation of the predicted sensitivity to endocrine therapy (SET2,3 index) and the 21-gene Breast Recurrence Score® assay in node-positive postmenopausal breast cancer: Results from an analysis in the SWOG S8814 trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD9-06.

A framework for personalized mammogram screening

Breast cancer screening guidelines serve as crucial evidence-based recommendations in deciding when to begin regular screenings. However, due to developments in breast cancer research and differences in research interpretation, screening guidelines can vary between organizations and within organizations over time. This leads to significant lapses in adopting updated guidelines, variable decision making between physicians, and unnecessary screening for low to moderate risk patients (Jacobson and Kadiyala, 2017; Corbelli et al., 2014). For analysis, risk factors were assessed for patient screening behaviors and results. The outcome variable for the first analysis was whether the patient had undergone screening. The risk factors considered were age, marital status, education level, rural versus urban residence, and family history of breast cancer. The outcome variable for the second analysis was whether patients who had undergone breast cancer screening presented abnormal results. The risk factors considered were age, Body Mass Index, family history, smoking and alcohol status, hormonal contraceptive use, Hormone Replacement Therapy use, age of first pregnancy, number of pregnancies (parity), age of first menses, rural versus urban residence, and whether or not patients had at least one child. Logistic regression analysis displayed strong associations for both outcome variables. Risk of screening nonattendance was negatively associated with age as a continuous variable, age as a dichotomous variable, being married, any college education, and family history. Risk of one or more abnormal mammogram findings was positively associated with family history, and hormonal contraceptive use. This procedure will be further developed to incorporate additional risk factors and refine the analysis of currently implemented risk factors.

Abstract 1379: Entinostat induces PARPi sensitivity across multiple ovarian cancer models

Introduction: Ovarian cancer is a rare, but fatal disease and a leading cause of gynecologic cancer death, in the United States. Poly ADP ribose polymerase inhibitors (PARPi) are promising drugs, most effective in patients with tumors deficient in homologous recombination (HR) genes, mainly BRCA1/2. Our group has published that histone deacetylase inhibitors (HDACi) sensitized HR proficient BRCA wild-type ovarian cancer cells to PARPi, however the mechanism still remains elusive and the efficacy needed to be tested across multiple models. We recently tested Entinostat with and without Olaparib in three different ovarian cancer models, including human/mouse established cell lines, PDX derived primary cell lines and immune-competent/immune-compromised xenograft as well as PDX-derived preclinical mouse models.

Objective: To delineate the efficacy of Entinostat to sensitize ovarian tumors to Olaparib across multiple models and determine the underlying mechanism.

Methods: HR proficient BRCA wild-type ID8/SKOV3 and PDX derived primary cell lines were treated with Entinostat and Olaparib, alone or in combination and analyzed for cell proliferation. DNA damage was studied using Comet assay. Expression of cell proliferation, DNA damage and repair protein were studied using Western blot analysis and immunofluorescence. Further, ID8-treated immune-competent mouse models, SKOV3-treated immune-compromised mouse model and HGSOC patient derived PDX mouse model generated in our lab were treated with vehicle, Entinostat, Olaparib, or the combination. The mice were monitored for toxicity and body weight measured twice weekly, till tissue harvest or survival.

Results: Cell proliferation was significantly decreased (p&lt0.05) in Entinostat-Olaparib combination treated groups in all cell lines tested. Comet assay showed significantly longer comet tail length in combination treated cells compared to control (p&lt0.05). Western blot and Immunofluorescence showed that combination treatment significantly decreased BRCA1, PCNA, RAD51 and increased cleaved PARP, ΓH2AX (p&lt0.05). Further, SKOV3- xenograft mouse model showed decreased tumor burden ((p&lt0.07), ID8-xenograft mouse tumors showed decreased Ki67 (p&lt0.05) and HGSOC derived PDX model showed longer survival when treated with Entinostat-Olaparib combination therapy.

Conclusion: Entinostat in combination with Olaparib decreased cell proliferation, increased DNA damage, induced HR deficiency in vitro, reduced tumor burden, decreased Ki67 in xenograft mouse model, and improved survival of HGSOC derived PDX mice, thereby potentially sensitizing homologous recombination proficient ovarian cancer to PARPi across multiple models.

Citation Format: Vijayalaxmi G. Gupta, Shariska Petersen, Jeff Hirst, Katherine Roby, Harsh Pathak, Meghan Kusch, Andrew Wilson, Andrew Godwin, Dineo Khabele. Entinostat induces PARPi sensitivity across multiple ovarian cancer models [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1379.

Acute myeloid leukemia or myelodysplastic syndrome with chromosome 17 abnormalities and long-term outcomes with or without hematopoietic stem cell transplantation

INTRODUCTION

Chromosome 17 abnormalities, especially disorders of the 17p region and including TP53 gene mutations, result in very low rates of cure for patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) treated with conventional chemotherapy or allogeneic hematopoietic cell transplant (allo-HCT). Our retrospective study analyzed outcomes in patients with chromosome 17 (ch17) abnormalities who received conventional chemotherapy followed by allo-HCT versus those who did not receive a transplant. We analyzed whether poor outcomes extend to patients with all types of ch17 abnormalities and the impact of concomitant TP53 gene mutations assessed by next-generation sequencing (NGS) on prognosis.

METHODS

We retrospectively analyzed diagnostic and outcome data on 98 patients treated at our institution from 2012 to 2018 with AML or MDS who possessed ch17 abnormalities by cytogenetic analysis. The presence of TP53 mutations was analyzed by NGS. Primary endpoint of our study was overall survival (OS).

RESULTS

61 patients with AML and 37 with MDS were included. Complete remission (CR) with first line treatment was similar between induction chemotherapy or hypomethylating agents (HMA), 22.9 % versus 21.6 % (p = 0.33). Median OS for all patients (with or without transplant) was 10 months. Patients with abnormal ch17 in conjunction with any TP53 mutation(s) exhibited worse OS compared to patients without a TP53 mutation (10 versus 23 months, p = 0.02). 30 patients (19 AML, 11 MDS) underwent HCT, with a median OS of 11 months. For AML patients who underwent allo-HCT, 18 were in CR (13 with cytogenetic remission) and 1 had persistent disease at transplant. In the MDS cohort, 3 patients were in CR (2 with cytogenetic remission) and 8 had stable disease. Post allo-HCT survival of AML and MDS cohorts did not differ (p = 0.6), although cytogenetic CR at time of HCT trended towards improved OS (17 versus 8 months; p = 0.6).

CONCLUSIONS

AML/MDS patients with ch17 abnormalities have poor outcomes with or without HCT. Our results show that patients with ch17 abnormalities and TP53 mutations have a significantly poorer survival compared to patients who have ch17 abnormalities but no TP53 mutations. Drugs targeting abnormalities of the p53 pathway, improvement in depth of response prior to HCT, and novel maintenance strategies are needed for improved outcomes in these patients.

Abstract B29: Outcomes of DNA repair-deficient pancreatic cancers: KU Cancer Center experience

Background: DNA repair-defective pancreatic cancers are a subset that could be exploited therapeutically. BRCA 1 and 2 deficient pancreatic cancers have shown improved survival outcomes with platinum-based chemotherapy and/or PARP inhibitors. However, survival outcomes of pancreatic cancers harboring other DNA repair defects are not well understood.

Methods: We retrospectively evaluated survival outcomes of 60 metastatic pancreatic cancer patients who had their tumors profiled by standard-of-care next-generation sequencing. Patients with deficient DNA repair genes such as BRCA1 (n=2), BRCA2 (n=12), ATM (n=7), PALB2 (n=1), NBN (n=1), and BRIP1 (n=1) were grouped into DNA repair-deficient group. The remaining patients were grouped into DNA repair-proficient group. Comparative survival analysis between the two groups was performed using Kaplan-Meir methods.

Results: Demographic/baseline data for the DNA repair-deficient group (n=22) vs. the proficient group (n=38) are compared as follows: 12 vs. 20 males, 10 vs. 18 females, 20 vs. 33 with ECOG scores 0-1, 1 vs. 4 with a ECOG score 2+, 12 vs. 19 with tumors in the head, 7 vs. 6 with tumors in the body, 4 vs. 12 with tumors in the tail, 4 vs. 10 with a CA 19-9 of &lt;34, 12 vs. 24 with a CA 19-9 of &gt;34, 7 vs. 19 received initial gemcitabine-based therapy, and 15 vs. 19 received initial FOLFIRINOX chemotherapy. Survival analysis in DNA repair-deficient vs. proficient group revealed comparable median PFS of 7 months (95%CI 5-32 months) vs. 7 months (95% CI 4-30 months) [HR 0.97, p=0.9] but a longer median OS of 18 months vs. 12 months [HR 0.51, p=0.07]. Among DNA repair-deficient group, median OS was 12 months for patients who received first-line platinum-based chemo (n=15) vs. 5 months for first-line non-platinum chemo (n=7) [HR 0.57, p=0.39].

Conclusion: In addition to BRCA1/2 deficiency, pancreatic cancers that harbor other DNA repair defects also show trend towards improved OS when compared to DNA repair-proficient cancers. Treatment with first-line platinum-based chemo favored better OS in DNA repair-deficient cancers. Though median PFS appears comparable, the upper limit of 95% CI for PFS is higher for the DNA repair-deficient cancers. These findings did not meet statistical significance given our small sample size and need to be validated in a larger cohort. We currently have an ongoing clinical trial to investigate DNA repair defects in addition to BRCA1/2 in pancreatic cancers (NCT03553004).

Citation Format: Anup Kasi, Suhaib Bajwa, Mohammed Al-Jumayli, Anwaar Saeed, Andrew Godwin. Outcomes of DNA repair-deficient pancreatic cancers: KU Cancer Center experience [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr B29.

Abstract 3501: Entinostat enhances the efficacy of olaparib in preclinical models of ovarian cancer

Introduction: Ovarian cancer is a rare but often fatal disease and a leading cause of gynecologic cancer death, in the United States. Poly ADP ribose polymerase inhibitors (PARPi) are promising new drugs that are most effective in patients with tumors with altered homologous recombination (HR) DNA repair genes, particularly BRCA1/2. To expand their clinical utility, PARPi are being tested in combination with other drugs. Our group has published that histone deacetylase inhibitors (HDACi) sensitize HR proficient BRCA wild-type ovarian cancer cells to PARPi. We have developed an investigator-initiated phase 1/2 clinical trial of the PARPi olaparib combined with the HDACi entinostat in patients with recurrent, HR proficient/BRCA wild-type ovarian cancer.

Objective: To test the effects of a novel combination of olaparib and entinostat in preclinical models of BRCA wild-type ovarian cancer.

Methods: HR proficient BRCA wild-type SKOV3 and ID8 ovarian cells were treated with Entinostat followed by Olaparib alone or the combination of Entinostat and Olaparib. Treated and control cells were analyzed for cell proliferation by sulforhodamine B assays, clonogenicity, and DNA damage by Comet assays. SKOV-3-luciferase cells were injected intraperitoneally into NOD-SCID mice. Mice were randomized into 4 treatment groups and treated with vehicle, entinostat, olaparib, or the combination. The mice were monitored for toxicity and by bioluminescence imaging (BLI). At sacrifice, tumor burden was quantified.

Results: In cell culture assays, entinostat significantly enhanced the sensitivity of SKOV3 and ID8 cells to Olaparib. Entinostat combined with olaparib led to synergistic reductions in cell proliferation and clonogenicity in SKOV-3 and ID8 ovarian cancer cells, compared to each drug alone. Evidence of DNA damage was enhanced by the drug combination. In the SKOV3-luc xenograft mouse model, a significant reduction in tumor burden in the group of mice treated with the combination of entinostat and olaparib, compared to each drug alone. There was no significant toxicity with drug treatment.

Conclusion: Entinostat sensitizes ovarian cancer cells to Olaparib in vitro and in vivo. Experiments in ID-luciferase and patient-derived xenograft models are ongoing. These preclinical models are powerful tools that will be used to discover markers and mechanisms of sensitivity and resistance to inform the parallel clinical trial.

Citation Format: Vijayalaxmi G. Gupta, Yoskaly Lazo Fernandez, Katherine Roby, Harsh Pathak, Jeff Hirst, Andrew J. Wilson, Andrew Godwin, Dineo Khabele. Entinostat enhances the efficacy of olaparib in preclinical models of ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3501.

Abstract B03: Targeting the KIF11/KIF15/TPX2 axis to develop new therapies for ovarian cancer

Unlimited genetic and epigenetic diversity across the patient population, and within the tumor and among metastatic lesions of an individual patient, presents a challenge in developing targeted therapies to treat epithelial ovarian cancer (EOC). To find the Achilles heel of ovarian cancers, we designed an RNAi-based screen (&gt;6,000 genes) to identify points of molecular vulnerability. These screens identified KIF11 as essential to maintain tumor cell viability. KIF11 encodes kinesin Eg5 (KIF11), a motor protein required for microtubule antiparallel sliding during mitosis that has been targeted clinically. Although KIF11 inhibitors are well tolerated by EOC patients, clinical response rates were disappointing in heavily treated patients with advanced disease. We hypothesize one mechanism through which KIF11 inhibitors’ efficacy is muted is via functional compensation of mitotic spindle assembly by KIF15, a second motor kinesin. Using a synthetic lethal approach, we have shown that RNAi-mediated silencing of KIF15 has no effect on cell viability, but significantly sensitized cells by &gt;10- to 100-fold to a class of KIF11 inhibitors (KIF11is). TPX2-targeted siRNAs reduce cell viability by 5-fold alone, and sensitize cells by 100-fold in the presence of KIF11i. Based on these observations, we designed a high-throughput screening assay using Alpha Technology©. Informed by previous predictions of KIF15-TPX2 binding domains, we designed peptides corresponding to the appropriate domains of KIF15 (aa1149-1388, GST-tagged) and TPX2 (aa346-747, His-tagged), for use in the AlphaScreen© assay. Following several optimization steps (e.g., buffer selection, protein titration, TruHits© assay validation), we demonstrate that KIF15 binds TPX2, producing a signal &gt;30-fold greater than background signal. Further, peptides designed to mimic either KIF15 or TPX2 binding domains, but not scrambled controls, exhibited concentration-dependent disruption of the KIF15-TPX2 interaction. Next, we screened a FDA library (3,474 compounds) and bioactive (1,902 compounds) library and identified 122 hits; fresh compound stocks were tested at 4 concentrations (20, 10, 5, and 2.5 μM), resulting in 53 confirmed hits (28 FDA, 25 bioactive). To identify false positives that interfere with assay chemistry, we repeated the screen at 3 concentrations, replacing the His-TPX2 and GST-KIF15 proteins with a His-GST fusion. As an orthogonal screen, we performed a Homogenous Time Resolved Fluorescence© (HTRF)-based screen to reconfirm hit compounds at the aforementioned concentrations. From these combined data, we have identified 4 hit compounds (KU-P001 to KU-P004) that disrupt KIF15/TPX2 protein-protein interactions. To further prioritize our hits, we developed in vitro (EOC cell lines were exposed to increasing concentrations, up to 1 µM, of KIF11i for 4 months) and in vivo (patient-derived ascites xenograft models of EOC were treated with 3 cycles of either 5 mg/kg or 10 mg/kg of a KIF11i and were serially passaged and treated for 3 additional generations) models of KIF11i-resistance to evaluate their activities. In resistant EOC cells we observed a 3-fold increase in KIF15 protein expression as compared with parental cells; TPX2 protein expression remained unchanged. In vivo, both KIF15 (68% increase) and TPX2 (2-fold) protein expression was increased in resistant versus untreated PDX tumor cells. Combination studies of KU-P004 and ispinesib (KIF11i) in vitro revealed a 2- to 64-fold increase in cell death for both responsive and resistant EOC cells compared with KIF11i treatment alone. In summary, we have developed a high-throughput screening assay platform to identify inhibitors of the KIF15-TPX2 interaction and are using iterative medicinal chemistry to guide optimization and functional evaluation of hits and lead compounds to develop new combination therapies for women with ovarian cancer.

Citation Format: Rebecca J. Wates, Anuradha Roy, Frank Schoenen, John Karanicolas, Scott Weir, Andrew Godwin. Targeting the KIF11/KIF15/TPX2 axis to develop new therapies for ovarian cancer. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr B03.

Novel Tools in Determining the Physiological Demands and Nutritional Practices of Ontario FireRangers during Fire Deployments

INTRODUCTION

The seasonal profession of wildland fire fighting in Canada requires individuals to work in harsh environmental conditions that are physically demanding. The purpose of this study was to use novel technologies to evaluate the physiological demands and nutritional practices of Canadian FireRangers during fire deployments.

METHODS

Participants (n = 21) from a northern Ontario Fire Base volunteered for this study and data collection occurred during the 2014 fire season and included Initial Attack (IA), Project Fire (P), and Fire Base (B) deployments. Deployment-specific energy demands and physiological responses were measured using heart-rate variability (HRV) monitoring devices (Zephyr BioHarness3 units). Food consumption behaviour and nutrient quantity and quality were captured using audio-video food logs on iPod Touches and analyzed by NutriBase Pro 11 software.

RESULTS

Insufficient kilocalories were consumed relative to expenditure for all deployment types. Average daily kilocalories consumed: IA: 3758 (80% consumption rate); P: 2945±888.8; B: 2433±570.8. Average daily kilocalorie expenditure: IA: 4538±106.3; P: 4012±1164.8; B: 2842±649.9. The Average Macronutrient Distribution Range (AMDR) for protein was acceptable: 22-25% (across deployment types). Whereas the AMDR for fat and carbohydrates were high: 40-50%; and low: 27-37% respectively, across deployment types.

CONCLUSIONS

This study is the first to use the described methodology to simultaneously evaluate energy expenditures and nutritional practices in an occupational setting. The results support the use of HRV monitoring and video-food capture, in occupational field settings, to assess job demands. FireRangers expended the most energy during IA, and the least during B deployments. These results indicate the need to develop strategies centered on maintaining physical fitness and improving food practices.

Alteration of redox status by commonly used antimalarial drugs in the north-western region of Nigeria

This study was designed to investigate the alteration of redox status by commonly used antimalarials in Nigeria. Drugs used were artemisinin, artesunate, chloroquine, coartem and quinine at the final concentrations of 0.5–8.0 mg/mL. Blood samples were collected from malarial patients and apparently healthy humans for comparison. Reduced glutathione, catalase, superoxide dismutase (SOD) activities, protein content and lipid peroxidation were determined. All drugs significantly ( p < 0.05) increases the protein level relative to control in normal blood, whereas in the infected, a significant ( p < 0.05) reduction was observed. In normal blood, the antimalarials dose dependently decreased ( p < 0.05) SOD and catalase activities with significant ( p < 0.05) increase in the infected. The level of glutathione in normal blood significantly ( p < 0.05) increases as compared with control, whereas in the infected, similar observation was made except that the levels were less, relative to control sample. Malondialdehyde level significantly ( p < 0.05) increases with increase in drugs concentration even though less than the level in the control with few exceptions. These effects were dose dependent and more pronounced in non-malarial conditions. Commonly used antimalarials might alter the redox status in both healthy and non-healthy subjects thereby inducing oxidative stress.

Comparing para-rowing set-ups on an ergometer using kinematic movement patterns of able-bodied rowers

While numerous studies have investigated the biomechanics of able-bodied rowing, few studies have been completed with para-rowing set-ups. The purpose of this research was to provide benchmark data for handle kinetics and joint kinematics for able-bodied athletes rowing in para- rowing set-ups on an indoor ergometer. Able-bodied varsity rowers performed maximal trials in three para-rowing set-ups; Legs, Trunk and Arms (LTA), Trunk and Arms (TA) and Arms and Shoulders (AS) rowing. The handle force kinetics of the LTA stroke were comparable to the values for able-bodied literature. Lumbar flexion at the catch, extension at the finish and total range of motion were, however, greater than values in the literature for able-bodied athletes in the LTA set-up. Additionally, rowers in TA and AS set-ups utilised more extreme ranges of motion for lumbar flexion, elbow flexion and shoulder abduction than the LTA set-up. This study provides the first biomechanical values of the para-rowing strokes for researchers, coaches and athletes to use while promoting the safest training programmes possible for para-rowing.

Abstract P2-05-05: Expression profiling of in vivo DCIS progression models identified BCL9 as a molecular driver of invasive progression

Introduction: There are an estimated 60,000 new cases of ductal carcinoma in situ (DCIS) each year. At present, it is not clear why some DCIS remain non-invasive for decades while others become invasive. A lack of understanding in DCIS pathobiology has led to overtreatment of more than half of DCIS patients. To identify factors that promote DCIS invasion, we have profiled the temporal molecular changes during DCIS transition to invasive ductal carcinoma (IDC) using two in vivo models, MIND (mouse-intraductal) and DCIS/IDC tandem lesions. These studies led to the identification of B cell lymphoma-9 as a potential molecular driver of early invasion. BCL9 is a newly found co-activator of Wnt-stimulated β-catenin-mediated transcription. BCL9 has been shown to promote progression of multiple myeloma and colon carcinoma. However its role in breast cancer progression had not been recognized.

Methods: Microarray and RNA sequencing were utilized to characterize the sequential and temporal changes in mRNA expression during DCIS invasive transition. BCL9 shRNA knockdown was performed to assess the role of BCL9 in in vivo invasion, EMT and canonical Wnt signaling. Immunofluorescence of 28 patient DCIS samples was used to assess a correlation between the expression of BCL9 and biomarkers of high risk DCIS. TCGA data was analyzed to assess the status of BCL9 gene alterations in 959 human breast cancers.

Results: Analysis of BCL9, by RNA and protein showed BCL9 up-regulation to be associated with DCIS transition to IDC. Analysis of patient DCIS revealed a significant correlation between high nuclear BCL9 and pathologic characteristics associated with DCIS recurrence: ER and PR negative, high nuclear grade, and high HER2. In vivo silencing of BCL9 resulted in the inhibition of DCIS invasion and reversal of epithelial-mesenchymal transition (EMT). Analysis of the TCGA data showed BCL9 gene to be altered in 26% of breast cancers. This is a significant alteration when compared to ERBB2 (19%) and ESR1 (8%). A significantly higher proportion of basal like invasive breast cancers showed BCL9 amplification.

Conclusion: BCL9 is a molecular driver of DCIS invasive progression and may predispose to the development of basal like invasive breast cancers. As such, BCL9 has the potential to serve as a biomarker of high risk DCIS and as a therapeutic target for prevention of IDC.

Citation Format: Behbod F, Elsarraj H, Hong Y, Valdez K, Chien J, Godwin A, Fields T. Expression profiling of in vivo DCIS progression models identified BCL9 as a molecular driver of invasive progression. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-05-05.

Abstract B01: B cell lymphoma 9 mediates a cross talk between the canonical Wnt and EGFR signaling in breast cancer

Human ductal carcinoma in situ (DCIS) are the most common type of non-invasive breast cancers. The five-year survival rate for women diagnosed with non-invasive DCIS is 98% while the five-year survival plummets to 83-27% for breast cancers that have become invasive and have spread to distant sites [also referred to as invasive ductal carcinoma (IDC)]. To study DCIS pathobiology and factors that promote their transition to IDC, we have developed a novel in vivo DCIS model, MIND (mouse-intraductal), that involves intraductal injection of epithelial cells derived from primary human DCIS biopsy and surgical samples thus mimicking the entire process of DCIS to IDC transition. As a complementary approach, we have utilized human DCIS/IDC tandem lesions, which are patient DCIS that show a transition to IDC within the same breast. Analysis of RNA and protein at distinct stages of in situ to IDC using both models showed B cell lymphoma-9 (BCL9) up-regulation to be associated with DCIS transition to IDC. BCL9 is a recently identified co-activator of Wnt-stimulated beta-catenin-mediated transcription. Our studies showed that in vivo silencing of BCL9 led to inhibition of DCIS invasion and reversal of EMT. We have also demonstrated a direct binding interaction between BCL9 and beta-catenin and showed suppression of beta-catenin-mediated transcription by BCL9 knockdown. Analysis of patient DCIS samples revealed a significant correlation between high nuclear BCL9 expression and pathologic characteristics associated with DCIS recurrence: Estrogen receptor (ER) negative and Ki67. Furthermore, analysis of the TCGA data showed BCL9 gene to be upregulated in 26% of breast cancers. This is a significant gene alteration when compared to HER2 (ERBB2) gene (19%) and estrogen receptor (ESR1) gene (8%) alterations in breast cancers. Interestingly, a significantly higher proportion of basal like invasive breast cancers compared to luminal breast cancers showed BCL9 amplification suggesting that BCL9 may predispose to the development of basal breast cancers. We have performed an RPPA analysis on our DCIS cell lines KD BCL9 vs. control. This analysis indicated that BCL9 KD showed down-regulation in a number of genes in the EGFR signaling pathway including p-EGFR, p-HER2, p-STAT3, and p-Src. Conclusion: BCL9 is a molecular driver of DCIS invasive progression. The molecular mechanism for BCL9's role in breast cancer progression is through the enhancement in the canonical Wnt and EGFR signaling.

Citation Format: Hanan Elsarraj, Hong Yan, Jennifer Knapp, Anna Tsimelzon, Shixia Huang, Andrew Godwin, Sue Hilsenbeck, Dean Edwards, Fariba Behbod. B cell lymphoma 9 mediates a cross talk between the canonical Wnt and EGFR signaling in breast cancer. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research; Oct 17-20, 2015; Bellevue, WA. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(2_Suppl):Abstract nr B01.

Receptor-Interacting Protein Kinase 3 Deficiency Delays Cutaneous Wound Healing

Wound healing consists of a complex, dynamic and overlapping process involving inflammation, proliferation and tissue remodeling. A better understanding of wound healing process at the molecular level is needed for the development of novel therapeutic strategies. Receptor-interacting protein kinase 3 (RIPK3) controls programmed necrosis in response to TNF-α during inflammation and has been shown to be highly induced during cutaneous wound repair. However, its role in wound healing remains to be demonstrated. To study this, we created dorsal cutaneous wounds on male wild-type (WT) and RIPK3-deficient (Ripk3^-/-) mice. Wound area was measured daily until day 14 post-wound and skin tissues were collected from wound sites at various days for analysis. The wound healing rate in Ripk3^-/- mice was slower than the WT mice over the 14-day course; especially, at day 7, the wound size in Ripk3^-/- mice was 53% larger than that of WT mice. H&E and Masson-Trichrome staining analysis showed impaired quality of wound closure in Ripk3^-/- wounds with delayed re-epithelialization and angiogenesis and defected granulation tissue formation and collagen deposition compared to WT. The neutrophil infiltration pattern was altered in Ripk3^-/- wounds with less neutrophils at day 1 and more neutrophils at day 3. This altered pattern was also reflected in the differential expression of IL-6, KC, IL-1β and TNF-α between WT and Ripk3^-/- wounds. MMP-9 protein expression was decreased with increased Timp-1 mRNA in the Ripk3^-/- wounds compared to WT. The microvascular density along with the intensity and timing of induction of proangiogenic growth factors VEGF and TGF-β1 were also decreased or delayed in the Ripk3^-/- wounds. Furthermore, mouse embryonic fibroblasts (MEFs) from Ripk3^-/- mice migrated less towards chemoattractants TGF-β1 and PDGF than MEFs from WT mice. These results clearly demonstrate that RIPK3 is an essential molecule to maintain the temporal manner of the normal progression of wound closure.

Abstract P4-12-03: Triple-negative breast cancer: Frequency of inherited mutations in breast cancer susceptibility genes

Background: Guidelines recommend germline mutation testing of breast cancer predisposition genes in triple negative (TN) breast cancer cases with a family history of breast or ovarian cancer or when diagnosed under age 60. However, the prevalence of mutations in these genes among TN cases unselected for family history of breast or ovarian cancer is not known.

Methods: To assess the frequency of mutations in 16 predisposition genes in TN cases we screened a large cohort of TN patients (n=1824) unselected for family history of breast or ovarian cancer from 12 centers and 824 study matched unaffected controls for mutations using a panel-based sequencing approach.

Results: Deleterious mutations were identified in 15% of TN patients: 8.5% had BRCA1, 2.7% had BRCA2, and 3.6% had mutations in 12 other genes. Mutations in non-BRCA1/2 genes encoding proteins implicated in homologous recombination repair of DNA double strand breaks were detected at the same frequency as in breast cancer families. TN cases with mutations had high-grade tumors and were diagnosed at an earlier age than non-mutated cases. However, 10% of TN cases diagnosed at ≥60 years and 5% with no family history of cancer were also found to carry mutations. Inactivating mutations in non-BRCA1/2 predisposition genes were associated with moderate to high risks of TN breast cancer.

Conclusions: National Comprehensive Cancer Network (NCCN) guidelines support clinical genetic testing of breast cancer predisposition genes in 95% of TN breast cancer patients carrying mutations in susceptibility genes. In contrast, National Institute of Health and Care Excellence (NICE) guidelines in the U.K. do not support genetic testing of a substantial proportion of TN patients with predisposing alleles. Frequency tables for inherited mutations in known predisposition genes based on age of diagnosis and family history of cancer will allow for selection of TN patients most likely to carry mutations in the predisposition genes.

Citation Format: Fergus J Couch, Steven N Hart, Priyanka Sharma, Amanda Ewart Toland, Penelope Miron, Janet E Olson, Andrew Godwin, Vernon S Pankratz, Curtis Olswold, Seth Slettedahl, Lucia Guidugli, Matthias W Beckmann, Brigitte Rack, Arif B Ekici, Irene Konstantopoulou, Florentia Fostira, George Fountzilas, Liisa M Pelttari, Song Yao, Judy Garber, Angela Cox, Hiltrud Brauch, Christine Ambrosone, Heli Nevanlinna, Drakoulis Yannoukakos, Susan L Slager, Celine M Vachon, Diana M Eccles, Peter A Fasching. Triple-negative breast cancer: Frequency of inherited mutations in breast cancer susceptibility genes [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-12-03.

Conjugation of PolyPEG to interferon alpha extends serum half-life while maintaining low viscosity of the conjugate

The covalent attachment of poly(ethylene glycol) (PEG) to therapeutic proteins is a commonly used approach for extending in vivo half-lives. A potential limitation of this PEGylation strategy is the adverse effect of PEG on conjugate viscosity. Interferon-alpha (IFN) was conjugated via its N-terminal amino group by reductive amination to α-aldehyde functional comb-shaped PolyPEG polymers (50 and 70 kDa) and to linear PEG (30 kDa). In vitro potencies of the purified PEGylated IFN conjugates were measured by reporter gene assay using a HEK293P/ISRE-SEAP cell line. IFN levels were measured in rats following intravenous injection. Viscosities of various linear PEG and PolyPEG polymers along with the polymer-IFN conjugates were determined using a rotational rheometer with cone-and-plate geometry. In vitro potencies and half-lives of the PEGylated IFN conjugates were compared with those of the marketed branched PEG-IFN conjugate PEGASYS. Both PolyPEG-IFN conjugates retained a similar potency as that of the marketed comparator, whereas the linear PEG-IFN conjugate potency was greater. All conjugates showed extended half-lives compared to that of naked IFN, with the PolyPEG conjugates exhibiting the longest half-lives and the linear PEG conjugate, the shortest. Viscosity analysis showed that the linear PEG-IFN conjugate was over twice as viscous as both PolyPEG conjugates. Taken together, this work demonstrates the potential of PolyPEG conjugation to therapeutic proteins as a novel tool for optimizing pharmacokinetic profiles in a way that potentially allows administration of high-dose formulations because of lower conjugate viscosity.

Abstract 4281: Targeted or whole genome sequencing of formalin-fixed tissue samples

Background: To provide a systematic analysis of formalin fixation artifacts on Illumina sequencing libraries and results, we generated two complementary sequencing libraries (target enrichment sequencing and whole exome sequencing) from 11 pairs of matched formalin-fixed paraffin-embedded (FFPE) and fresh-frozen (FF) tumor samples and two pairs of matched FFPE and FF germline samples. We also generated whole genome sequencing data from a single pair of FF/FFPE tumor samples.

Results: The results indicate minimal variations in library fragment size, coverage, and PCR duplicates within FF/FFPE paired samples that are less than 1 year old; whereas, a large variation in these parameters were observed in FF/FFPE pairs in samples that are approximately 2 years old. No significant increase in global mismatch rates and C•G&gt;T•A substitutions were observed in FFPE samples from the former group; whereas, a discernible increase in mismatch rates and C•G&gt;T•A substitutions were observed in FFPE samples from the latter group. However, over 99.7% and 99.5% of concordant calls were observed between matched FF and FFPE pairs at reference and non-reference positions within the targeted regions, respectively. Although an increased rate of global mismatches and C•G&gt;T•A substitutions were observed in some FFPE samples, discordant rates were low (&lt;0.26) in all samples because most of the FFPE artifacts were filtered out using GATK workflow. Consistent with this analysis, C•G&gt;T•A substitutions are comparable in non-reference positions in paired FF and FFPE samples.

Conclusions: We developed upfront quality assessment and library preparation method that use low input DNA from FFPE samples to perform next-generation sequencing. The results from our studies indicate the suitability of FFPE samples in sequencing studies.

Citation Format: Sarah Munchel, Yen Hoang, Yue Zhao, Joseph Cottrell, Brandy Klotzle, Andrew Godwin, Janelle Noel, Brooke Fridley, Peter Beyerlein, Jian-Bing Fan, Marina Bibikova, Jeremy R. Chien. Targeted or whole genome sequencing of formalin-fixed tissue samples. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4281. doi:10.1158/1538-7445.AM2014-4281

Abstract 4553: Gedunin, a novel HSP-90 inhibitor, synergizes with cisplatin and paclitaxel to inhibit growth of chemoresistant ovarian cancer cell lines

High-grade serous ovarian cancer is the most lethal of all gynecological cancers. It is often not diagnosed until FIGO stage III or IV, at which point the 5-year survival rate is 15%. Although most patients initially respond to the standard of care, 70% of tumors reoccur. Of these, 70-90% are refractory to standard therapies used in the treatment of serous ovarian cancer, cisplatin and paclitaxel. These statistics reveal a need for novel therapeutics that target these tumors. Gedunin, a liminoid from the Neem tree (Azadirachta indica) has been identified as an HSP90-inhibitor. We tested whether gedunin affects the viability of five different ovarian cancer cell lines, ID8, ID8TaxR, A2870, C30 and CP70. We chose these cell lines because cisplatin (C30, CP70) and paclitaxel (ID8TaxR) resistant cells were developed from A2870 and ID8, respectively. Treatment with gedunin (0-30µM) inhibited growth of all five cell lines. In addition, combination indices revealed synergism between gedunin and the two chemotherapeutic agents. More importantly, synergism between gedunin and paclitaxel occurs even at doses (2.5µM for each) that do not have any effect on the cells when treated alone. We next determined the mechanism of gedunin action. Flow cytometry and immunofluorescence microscopy, demonstrated that gedunin induces mitotic arrest between metaphase and anaphase. This was confirmed by western blot analysis of cyclin protein levels. We also observed significant changes to expression of checkpoint kinase-1 (CHK1) and polo-like kinase-1 (PLK1) in the five cell lines. We propose that the misfolding and subsequent degradation of CHK1 and PLK1 leads to the observed mitotic halt, which eventually results in apoptosis. Following cell synchronization, gedunin-treated cells show decreased inhibitory phosphorylation (Y15) of CDK1 and increased levels of cyclin B1 compared to untreated cells. Moreover, immunofluorescence microscopy demonstrated increased monopolar spindle formation. Furthermore, gedunin treatment resulted in formation of double-strand breaks as observed by western blot analysis for gamma-H2AX. This was further verified by TUNEL staining. Finally, apoptosis was observed in gedunin treated cells as measured by increased Bcl-2 to Bax protein ratio and mitochondrial cytochrome c release. These data are in complete agreement with previous studies that show that PLK1 depletion causes spindle abnormalities, as well as increases gamma-H2AX and decreases BCL-2 protein levels. In conclusion, these data suggest that gedunin treatment results in premature mitosis followed by cell cycle arrest and apoptosis. Given that gedunin acts in synergism with both cisplatin and paclitaxel suggests that gedunin is a promising lead compound either alone or in combination with these compounds for the treatment of high-grade serous ovarian carcinoma.

Citation Format: Jessica Johnson, Anand Venugopal, Deep Kwatra, Katherine Roby, Andrew Godwin, Shrikant Anant. Gedunin, a novel HSP-90 inhibitor, synergizes with cisplatin and paclitaxel to inhibit growth of chemoresistant ovarian cancer cell lines. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4553. doi:10.1158/1538-7445.AM2014-4553

Factors associated with completion of pre-kidney transplant evaluations

This study sought to examine various factors that may prevent transplant candidates from completing their transplant workup prior to listing. We reviewed the records of 170 subjects (cases = 100, controls 70) who were either on dialysis or had less than 20 mL/min creatinine clearance and were therefore candidates for preemptive transplantation. Approximately, 56% of preemptive patients completed their workup, while only 36% of patients on dialysis completed their workup. Our data revealed that factors contributing toward completion of workup included intrinsic motivation (four times more likely), lack of specific medical comorbidities (three times more likely), and preemptive status (two times more likely). Among patients on dialysis, intrinsic motivation (five times more likely) and absence of cardiovascular complications (four times more likely) were associated with completion. When comparing patients on dialysis to patients not on dialysis, there were significant differences between the two groups in distance from home to the transplant center, level of education, and presence of medical comorbidities. We believe that targeted interventions such as timely referral, providing appropriate educational resources, and development of adequate support systems, have the potential to improve workup compliance of patients with advanced chronic kidney disease, including those on dialysis.

Internet remote control of pump settings for postoperative continuous peripheral nerve blocks: a feasibility study in 59 patients

INTRODUCTION

During continuous peripheral nerve blocks, infusion adjustments are essential for postoperative analgesia without side effects. Beside, physicians and nurse visits related to pump's settings and monitoring are time consuming and costly. We hypothesized that a remote control of pump's settings, by telemedicine transmission, adjusted to patients' feedbacks, is feasible and interesting in optimizing patient's postoperative pain management.

METHODS

Fifty-nine ASA physical status I and II patients were included. Ropivacaine 0.2% was infused during 72 h in CPNB catheters. After returning to the surgical ward, the patient was allowed to answer a 10 indicators questionnaire 3 times a day (8.00 AM, 2.00 PM, 8.00 PM), or unlimited on patient's demand. This information was transmitted from the pump to a server through the Internet. If one indicator was out of the predefined thresholds, the anesthesiologist in charge was immediately informed by texto on his cell phone. The anesthesiologist connected to the website, checked the data from the patient and modified the settings of the pump by remote control according to a written protocol. The changes need a secure access with a password and a confirmation. The number of settings changes, the time to realize the procedure and the adverse events related to the technique were noted. When the catheter was removed, the pump was unassigned to the patient and the data archived.

RESULTS

Thirty sciatic, 24 femoral and 5 interscalene catheters were inserted in 59 patients. Five catheters were accidentally removed before the end of the 72-h period. The median VAS pain values at rest and during movement were respectively at 2 and 3. Sixteen patients complained about numbness promoting 2 (0-3) changes in pump settings; 9 about motor blockade with 1 (0-2) change; 5 about difficulties for physiotherapy with 1 (0-3) change. The mean time of pump settings modification after response to questionnaire or voluntarily patient's alert was 15 ± 2.2 minutes. Early physiotherapy in the surgical ward was totally uneventful in 54 patients. The mean value of satisfaction scale of the patients was 8.4 ± 1.6. No adverse event necessitated a postoperative analgesia technique change.

CONCLUSION

Remote control pump's feedbacks and e-settings for postoperative analgesia using CPNB permitted a real adaptation to patients' needs, complaints and pain VAS values without nurse and physician physical intervention.

Shortened length of stay improves financial outcomes in living donor kidney transplantation

Kidney transplantation is the preferred clinical and most cost-effective option for end-stage renal disease. Significant advances have taken place in the care of the transplant patients with improvements in clinical outcomes. The optimization of the costs of transplantation has been a constant goal as well. We present herein the impact in financial outcomes of a shortened length of stay after kidney transplant.

Abstract 2008: Genomic medicine using NexGen sequencing to personalized treatment of metastatic adenoid cystic carcinoma (ADCC)

Background:

ADCC is a form of cancer usually originating from saliva gland. The standard treatment is surgical resection followed by adjuvant radiation if indicated. Cases of metastatic disease can behave indolently but ultimately can be fatal and there is no effective therapy. We present the results of NexGen sequencing of a 41yo caucasian female diagnosed with ADCC in 2003 who subsequently developed recurrence in 2005 and pulmonary metastases in 2006. She was treated with multiple agents including radiation. She had further progression with increase dyspnea in 2012. Commercial profiling by Caris Biosciences found expression of VEGFR, PDGFRA and PDGFRB. She was treated with Sorafenib, an oral multikinase inhibitor of the VEGFR, PDGFR, and BRAF without improvement, and she developed further dyspnea requiring oxygen. We performed NexGen sequencing of a biopsied metastatic lesion to identify somatic mutations and to determine if any targeted agent would be of further benefit. Results: NextGen sequencing was performed on DNA extracted from formalin-fixed tumor biopsy sample. Blood DNA served as control. Using Illumina TruSeq Exome Enrichment kit, 100 bp paired-end sequencing was performed on the tumor and normal exomes. Resulting sequences were mapped to the Human Reference Genome (hg19) using two bioinformatics workflows: CLC Genomics Workbench and BWA/GATK. Single nucleotide variants (SNVs) and small insertions/deletions (INDELs) were separately characterized for normal and tumor exomes. Finally, germline variants (SNVs and INDELs) were subtracted to identify putative somatic mutations in tumor exome. Concensus somatic mutations were obtained from CLC and BWA/GATK workflows. A total of 569 non-synonymous mutations and 35 stopgain mutations were observed in the tumor exome. Mutations in BRCA2, IGF1R, KDR, MTOR, TP63, XPC, RAD17, MLH1, and PTEN were observed in the tumor exome. Mutations in the components of kinase-mediated signaling (IGF1R, KDR, MTOR, PTEN) are potential targets of kinase and mTOR inhibitors whereas mutations in the DNA repair pathways (TP63, XPC, RAD17, MLH1) may be targeted with DNA alkylating agents. The result indicates that patient's tumor harbor several mutations that can be targeted by available cancer drugs. Conclusions: We found several mutated molecular pathways that can be targeted with available agents using exome sequencing. Improvement in outcome could validate the role of exome sequencing in treatment selection of advanced cancers without standard therapy.

Citation Format: Chao H. Huang, Yen Hoang, Kay Minn, Andrew Godwin, Jeremy Chien. Genomic medicine using NexGen sequencing to personalized treatment of metastatic adenoid cystic carcinoma (ADCC). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2008. doi:10.1158/1538-7445.AM2013-2008

Association of PHB 1630 C>T and MTHFR 677 C>T polymorphisms with breast and ovarian cancer risk in BRCA1/2 mutation carriers: results from a multicenter study

BACKGROUND

The variable penetrance of breast cancer in BRCA1/2 mutation carriers suggests that other genetic or environmental factors modify breast cancer risk. Two genes of special interest are prohibitin (PHB) and methylene-tetrahydrofolate reductase (MTHFR), both of which are important either directly or indirectly in maintaining genomic integrity.

METHODS

To evaluate the potential role of genetic variants within PHB and MTHFR in breast and ovarian cancer risk, 4102 BRCA1 and 2093 BRCA2 mutation carriers, and 6211 BRCA1 and 2902 BRCA2 carriers from the Consortium of Investigators of Modifiers of BRCA1 and BRCA2 (CIMBA) were genotyped for the PHB 1630 C>T (rs6917) polymorphism and the MTHFR 677 C>T (rs1801133) polymorphism, respectively.

RESULTS

There was no evidence of association between the PHB 1630 C>T and MTHFR 677 C>T polymorphisms with either disease for BRCA1 or BRCA2 mutation carriers when breast and ovarian cancer associations were evaluated separately. Analysis that evaluated associations for breast and ovarian cancer simultaneously showed some evidence that BRCA1 mutation carriers who had the rare homozygote genotype (TT) of the PHB 1630 C>T polymorphism were at increased risk of both breast and ovarian cancer (HR 1.50, 95%CI 1.10-2.04 and HR 2.16, 95%CI 1.24-3.76, respectively). However, there was no evidence of association under a multiplicative model for the effect of each minor allele.

CONCLUSION

The PHB 1630TT genotype may modify breast and ovarian cancer risks in BRCA1 mutation carriers. This association need to be evaluated in larger series of BRCA1 mutation carriers.

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.

Common alleles at 6q25.1 and 1p11.2 are associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers

Two single nucleotide polymorphisms (SNPs) at 6q25.1, near the ESR1 gene, have been implicated in the susceptibility to breast cancer for Asian (rs2046210) and European women (rs9397435). A genome-wide association study in Europeans identified two further breast cancer susceptibility variants: rs11249433 at 1p11.2 and rs999737 in RAD51L1 at 14q24.1. Although previously identified breast cancer susceptibility variants have been shown to be associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers, the involvement of these SNPs to breast cancer susceptibility in mutation carriers is currently unknown. To address this, we genotyped these SNPs in BRCA1 and BRCA2 mutation carriers from 42 studies from the Consortium of Investigators of Modifiers of BRCA1/2. In the analysis of 14 123 BRCA1 and 8053 BRCA2 mutation carriers of European ancestry, the 6q25.1 SNPs (r(2) = 0.14) were independently associated with the risk of breast cancer for BRCA1 mutation carriers [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.11-1.23, P-trend = 4.5 × 10(-9) for rs2046210; HR = 1.28, 95% CI: 1.18-1.40, P-trend = 1.3 × 10(-8) for rs9397435], but only rs9397435 was associated with the risk for BRCA2 carriers (HR = 1.14, 95% CI: 1.01-1.28, P-trend = 0.031). SNP rs11249433 (1p11.2) was associated with the risk of breast cancer for BRCA2 mutation carriers (HR = 1.09, 95% CI: 1.02-1.17, P-trend = 0.015), but was not associated with breast cancer risk for BRCA1 mutation carriers (HR = 0.97, 95% CI: 0.92-1.02, P-trend = 0.20). SNP rs999737 (RAD51L1) was not associated with breast cancer risk for either BRCA1 or BRCA2 mutation carriers (P-trend = 0.27 and 0.30, respectively). The identification of SNPs at 6q25.1 associated with breast cancer risk for BRCA1 mutation carriers will lead to a better understanding of the biology of tumour development in these women.

Genetic variation in IGF2 and HTRA1 and breast cancer risk among BRCA1 and BRCA2 carriers

BACKGROUND

BRCA1 and BRCA2 mutation carriers have a lifetime breast cancer risk of 40% to 80%, suggesting the presence of risk modifiers. We previously identified significant associations in genetic variants in the insulin-like growth factor (IGF) signaling pathway. Here, we investigate additional IGF signaling genes as risk modifiers for breast cancer development in BRCA carriers.

METHODS

A cohort of 1,019 BRCA1 and 500 BRCA2 mutation carriers were genotyped for 99 single-nucleotide polymorphisms (SNP) in 13 genes. Proportional hazards regression was used to model time from birth to diagnosis of breast cancer for BRCA1 and BRCA2 carriers separately. For linkage disequilibrium (LD) blocks with multiple SNPs, an additive genetic model was used. For an SNP analysis, no additivity assumptions were made.

RESULTS

Significant associations were found between risk of breast cancer and LD blocks in IGF2 for BRCA1 and BRCA2 mutation carriers (global P values of 0.009 for BRCA1 and 0.007 for BRCA2), HTRA1 for BRCA1 carriers (global P value of 0.005), and MMP3 for BRCA2 carriers (global P = 0.0000007 for BRCA2).

CONCLUSIONS

We identified significant associations of genetic variants involved in IGF signaling. With the known interaction of BRCA1 and IGF signaling and the loss of PTEN in a majority of BRCA1 tumors, this suggests that signaling through AKT may modify breast cancer risk in BRCA1 carriers.

IMPACT

These results suggest potential avenues for future research targeting the IGF signaling pathway in modifying risk in BRCA1and BRCA2 mutation carriers.

Evaluation of the XRCC1 gene as a phenotypic modifier in BRCA1/2 mutation carriers. Results from the consortium of investigators of modifiers of BRCA1/BRCA2

BACKGROUND

Single-nucleotide polymorphisms (SNPs) in genes involved in DNA repair are good candidates to be tested as phenotypic modifiers for carriers of mutations in the high-risk susceptibility genes BRCA1 and BRCA2. The base excision repair (BER) pathway could be particularly interesting given the relation of synthetic lethality that exists between one of the components of the pathway, PARP1, and both BRCA1 and BRCA2. In this study, we have evaluated the XRCC1 gene that participates in the BER pathway, as phenotypic modifier of BRCA1 and BRCA2.

METHODS

Three common SNPs in the gene, c.-77C>T (rs3213245) p.Arg280His (rs25489) and p.Gln399Arg (rs25487) were analysed in a series of 701 BRCA1 and 576 BRCA2 mutation carriers.

RESULTS

An association was observed between p.Arg280His-rs25489 and breast cancer risk for BRCA2 mutation carriers, with rare homozygotes at increased risk relative to common homozygotes (hazard ratio: 22.3, 95% confidence interval: 14.3-34, P<0.001). This association was further tested in a second series of 4480 BRCA1 and 3016 BRCA2 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1 and BRCA2.

CONCLUSIONS AND INTERPRETATION

No evidence of association was found when the larger series was analysed which lead us to conclude that none of the three SNPs are significant modifiers of breast cancer risk for mutation carriers.

Genetic variation at 9p22.2 and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers

BACKGROUND

Germline mutations in the BRCA1 and BRCA2 genes are associated with increased risks of breast and ovarian cancers. Although several common variants have been associated with breast cancer susceptibility in mutation carriers, none have been associated with ovarian cancer susceptibility. A genome-wide association study recently identified an association between the rare allele of the single-nucleotide polymorphism (SNP) rs3814113 (ie, the C allele) at 9p22.2 and decreased risk of ovarian cancer for women in the general population. We evaluated the association of this SNP with ovarian cancer risk among BRCA1 or BRCA2 mutation carriers by use of data from the Consortium of Investigators of Modifiers of BRCA1/2.

METHODS

We genotyped rs3814113 in 10,029 BRCA1 mutation carriers and 5837 BRCA2 mutation carriers. Associations with ovarian and breast cancer were assessed with a retrospective likelihood approach. All statistical tests were two-sided.

RESULTS

The minor allele of rs3814113 was associated with a reduced risk of ovarian cancer among BRCA1 mutation carriers (per-allele hazard ratio of ovarian cancer = 0.78, 95% confidence interval = 0.72 to 0.85; P = 4.8 × 10(-9)) and BRCA2 mutation carriers (hazard ratio of ovarian cancer = 0.78, 95% confidence interval = 0.67 to 0.90; P = 5.5 × 10(-4)). This SNP was not associated with breast cancer risk among either BRCA1 or BRCA2 mutation carriers. BRCA1 mutation carriers with the TT genotype at SNP rs3814113 were predicted to have an ovarian cancer risk to age 80 years of 48%, and those with the CC genotype were predicted to have a risk of 33%.

CONCLUSION

Common genetic variation at the 9p22.2 locus was associated with decreased risk of ovarian cancer for carriers of a BRCA1 or BRCA2 mutation.

Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress-results from a randomised clinical trial

This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individual's cognitive-affective processing system.

Plasma cell-free DNA in ovarian cancer: an independent prognostic biomarker

BACKGROUND

Cell-free DNA reflects both normal and tumor-derived DNA released into the circulation through cellular necrosis and apoptosis. The authors sought to determine the role of preoperative total plasma cell-free DNA levels in predicting clinical outcome in patients with ovarian cancer.

METHODS

After institutional review board consent, DNA was extracted from plasma of 164 women with invasive epithelial ovarian carcinoma (EOC), 49 with benign ovarian neoplasms, and 75 age-matched controls. The samples were randomly divided into training (n = 144) and validation (n = 144) sets. Quantification of cell-free DNA was performed using real-time polymerase chain reaction for beta-globin, and the number of genome equivalents (GE) per milliliter of plasma was determined. Cell-free DNA was correlated with clinicopathologic parameters.

RESULTS

The training and validation sets were similar in terms of demographic features. In the training set, EOC patients had a median preoperative cell-free DNA level of 10,113 GE/mL, compared with patients with benign ovarian neoplasms (median, 2365 GE/mL; P < .0001) and controls (median, 1912 GE/mL, P < .0001). Cell-free DNA >22,000 GE/mL was significantly associated with decreased patient survival (P < .001). After adjusting for other clinical variables, preoperative cell-free DNA >22,000 GE/mL was an independent predictor (P = .02) for disease-specific survival. Analysis of the validation set confirmed significantly higher cell-free DNA levels in EOC (median, 13,672 GE/mL) and that cell-free DNA >22,000 GE/mL was associated with a 2.83-fold increased risk of death from disease (P < .001).

CONCLUSIONS

Preoperative plasma total cell-free DNA levels are significantly elevated in patients with EOC. Elevated plasma cell-free DNA is an independent predictor for death from disease in ovarian cancer.

Abstract 310: The role of c-Jun N-terminal kinase 2alpha in non-small cell lung carcinoma tumorigenesis

c-Jun N-terminal kinases (JNKs) are members of the mitogen activated protein kinase (MAPK) family and have been implicated in tumorigenesis. One isoform in particular, JNK2alpha, has been shown to be frequently activated in primary brain tumors, to enhance several tumorigenic phenotypes, and to increase tumor formation in mice. It was reported that there is frequent activation of JNK in non-small cell lung carcinoma (NSCLC). In this study, we investigated the role of the JNK2alpha isoform in NSCLC formation by examining its expression in primary tumors and by modulating its expression in cultured cell lines. We discovered 70% of the tested primary NSCLC tumors had 2 to 3-fold higher JNK2alpha protein and mRNA expression compared to normal lung tissue indicating a possible role of JNK2alpha in NSCLC tumorigenesis. To determine the importance of JNK2alpha in NSCLC progression, we reduced JNK2α in multiple NSCLC cell lines using short hairpin RNA. Cell lines deficient in JNK2alpha had decreased cellular growth and anchorage-independent growth, and the tumors were 4-fold smaller in mass. To elucidate the mechanism by which JNK2alpha induces NSCLC growth, we analyzed the JNK substrate, STAT3. Our data show that JNK2alpha can regulate the transcriptional activity of STAT3 by phosphorylating the Ser727 residue of STAT3 thereby regulating expression of oncogenic genes, such as c-Myc protein. Our studies revealed a novel mechanism in which phosphorylation of STAT3 is mediated by a constitutively active JNK2 isoform, JNK2alpha.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 310.

Development of a multimarker assay for early detection of ovarian cancer

PURPOSE

Early detection of ovarian cancer has great promise to improve clinical outcome.

PATIENTS AND METHODS

Ninety-six serum biomarkers were analyzed in sera from healthy women and from patients with ovarian cancer, benign pelvic tumors, and breast, colorectal, and lung cancers, using multiplex xMAP bead-based immunoassays. A Metropolis algorithm with Monte Carlo simulation (MMC) was used for analysis of the data.

RESULTS

A training set, including sera from 139 patients with early-stage ovarian cancer, 149 patients with late-stage ovarian cancer, and 1,102 healthy women, was analyzed with MMC algorithm and cross validation to identify an optimal biomarker panel discriminating early-stage cancer from healthy controls. The four-biomarker panel providing the highest diagnostic power of 86% sensitivity (SN) for early-stage and 93% SN for late-stage ovarian cancer at 98% specificity (SP) was comprised of CA-125, HE4, CEA, and VCAM-1. This model was applied to an independent blinded validation set consisting of sera from 44 patients with early-stage ovarian cancer, 124 patients with late-stage ovarian cancer, and 929 healthy women, providing unbiased estimates of 86% SN for stage I and II and 95% SN for stage III and IV disease at 98% SP. This panel was selective for ovarian cancer showing SN of 33% for benign pelvic disease, SN of 6% for breast cancer, SN of 0% for colorectal cancer, and SN of 36% for lung cancer.

CONCLUSION

A panel of CA-125, HE4, CEA, and VCAM-1, after additional validation, could serve as an initial stage in a screening strategy for epithelial ovarian cancer.

Molecular Biomarkers of Columnar Cell Lesions Identified by Proteomic Approaches

The widespread increase in the use of screening mammography has led to a significant rise in the detection and diagnosis of benign breast disease (BBD), which encompasses a wide variety of non-cancerous changes including columnar cell lesions (CCL). Epidemiologic studies provide evidence for a relationship between BBD and subsequent risk of developing breast cancer. Observational studies have reported CCL are found adjacent to areas of tubular carcinoma and ductal and lobular carcinomas in situ and recently published molecular data state that genetic abnormalities frequently found in low grade ductal carcinoma in situ are also found in CCL. All these data support the hypothesis that CCL are the earliest morphologically distinguishable precursor lesions to low grade ductal carcinoma in situ and invasive carcinoma. However, BBD is heterogeneous and there is limited understanding of the biological importance associated with the spectrum of lesions. The lack of accurate molecular-based risk categories, therefore, hinders the ability of assigning prognostic significance to benign biopsy findings. The purpose of our study was to identify putative molecular markers of cancer progression from epithelial cells of BBD lesions. Regions of ductal hyperplasia (DH) and normal breast epithelium were isolated from mastectomy specimens using laser capture microdissection and extracted proteins were analyzed through proteomic approaches. Of the 1,500 total protein spots resolved by 2-dimensional electrophoresis, 98 were differentially expressed between DH and normal breast epithelial proteomes. Twenty-two proteins or related isoforms were identified using mass spectrometry. Two proteins of particular interest, NAD(P)H: quinone oxidoreductase 1 (NQO1) and galectin-3, were further investigated by immunohistochemistry (IHC) on cases diagnosed with BBD lesions. NQO1 was expressed sporadically in overtly normal epithelial cells lining breast ducts, but was overexpressed in BBD and tumor tissues. Notably, we found that a subpopulation of DH tissues with CCL stained positively for NQO1 and negatively for galectin-3. This finding has significance because CCL can only be diagnosed morphologically and the presence of CCL in biopsy specimens may indicate a precancerous lesion. However, sectioning artifacts associated with core biopsies can hinder morphological diagnosis of CCL, thus a means to additionally identify these lesions using IHC has tremendous value. Together, immunohistochemical staining of NQO1 and galectin-3 may prove to be clinically relevant in the identification of CCL in biopsy samples.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2142.

Abstract A126: Analysis of excision repair cross complementing group 1 (ERCC1) expression in squamous cell carcinoma of the head and neck (SCCHN)

Introduction: ERCC1 is a key enzyme in the nucleotide excision repair pathway and increased expression of ERCC1 is associated with cisplatin resistance in some cancers. Given the widespread use of platinum therapy for the treatment of SCCHN, we characterized the range of ERCC1 expression in SCCHN specimens using an immunofluorescence-based assay (automated quantitative analysis-tissue microarray [AQUA-TMA]). There is currently inadequate data regarding the range of ERCC1 expression in SCCHN, and how ERCC1 levels correlates with treatment outcomes, ERCC1 has been studied in SCCHN by standard immunohistochemistry, however, this method is limited by variability of techniques and subjectivity of interpretation, Therefore, there is a need for a highly quantitative technique which can be accomplished on formalin fixed paraffin embedded tissue and small samples, Our goal is to develop a reproducible assay that can eventually be incorporated into standard patient care practice.

Methods: Tissue microarrays containing head and neck squamous cell carcinoma samples obtained from patients treated at Fox Chase Cancer Center from 1999–2006 were constructed. Slides were stained by a modified indirect immunofluorescence method. Sections were incubated with ERCC1 antibody (8F1, Lab Vision) and wide-spectrum screening rabbit cytokeratin antibody (Dako Z0622). Prolong Gold mounting medium (P36931; Molecular Probes) containing 4,6-Diamidino-2-phenylindole (DAPI) was used to define tissue nuclei. A binary image (tumor mask) was created from the cytokeratin image of each histospot. ERCC1 levels were measured using fluorescent immunohistochemistry on the HistoRx PM-2000 image analysis platform and the data analyzed using AQUA algorithms. The in situ biomarker profiling system generated quantitative measurements of patient protein levels based on AQUA scores derived from fluorescent output of labeled markers. Both nuclear and non-nuclear (i.e., non-membrane/cytoplasmic) ERCC1 expression was measured

Results: 41 SCCHN specimens (24 oral cavity, 7 oropharynx, 5 glottic tumors, 3 unknown primary, 2 other) were analyzed. There were 25 males and 16 females and age at diagnosis ranged from 25 to 80 years (mean 64). The majority of patients were treated primarily by surgery. The range of AQUA scores was 33.66 to 1696.39 (mean 501.78, stnd deviation 284). The 25th percentile was 337.35, and the 75th percentile was 639.37. ERCC1 was predominantly nuclear (i.e., non-membrane/cytoplasmic) in the SCCHN tissue samples.

Conclusions: 1) It is feasible to determine a quantitative value of ERCC1 expression with AQUA. 2) There is a wide range of ERCC1 expression in SCCHN. 3) ERCC1 is predominantly localized to the nuclear compartment. 4) Ongoing work is being done to correlate ERCC1 levels with clinical features, sensitivity to platinum therapy, and survival.

Citation Information: Mol Cancer Ther 2009;8(12 Suppl):A126.

Epigenetic downregulation of the DNA repair gene MED1/MBD4 in colorectal and ovarian cancer

MED1 is a base excision repair enzyme that interacts with the mismatch repair protein MLH1 and maintains genomic integrity by binding methylated DNA and repairing spontaneous deamination events. MED1 mutations have been associated with microsatellite instability and accelerated colorectal cancer (CRC) tumorigenesis. We propose that promoter methylation may serve as an alternative epigenetic mechanism for MED1 gene suppression during sporadic CRC tumorigenesis. Methylation status of the MED1 promoter was investigated in a panel of ovarian and colorectal cancer cell lines. The MED1 promoter region was sequenced following bisulfite treatment and sequence analysis identified a CpG island within the MED1 promoter which is frequently and preferentially methylated (> or =50%) in ovarian and colorectal cancer cell lines with low/reduced MED1 expression. In vitro reversal of methylation restored MED1 expression. In colorectal cancer patients, when MED1 methylation was present, both tumor and matched mucosa were affected equally (mean frequency of methylation 24%) and there was no correlation between methylation and tumor stage. Patients without history of CRC showed significantly lower frequency of methylation (mean 14%, p < 0.05). Decreased MED1 transcript levels were observed in matched normal mucosa when compared to controls (median fold difference 8.0). Additional decreased expression was seen between mucosa and matched tumor (median fold decrease 4.4). Thus, MED1 promoter methylation and gene silencing occur in sporadic CRC patients and represent an early event in CRC tumorigenesis. Detection of MED1 methylation and gene suppression in normal colon mucosa may contribute to identifying patients at higher risk of developing CRC during screening procedures.

Using custom protein microarrays to identify autoantibody biomarkers for the early detection of breast cancer

Abstract #2003

Background: Cancer patients make antibodies to tumor-derived proteins that are potential biomarkers for early detection. To detect autoantibodies to tumor antigens in patient sera, we have adapted novel high-density custom protein microarrays (NAPPA) expressing 6,500 candidate tumor antigens for biomarker detection. These arrays are probed with sera from patients with early stage breast cancer and healthy women. Using this approach, we identified antibodies in the sera of breast cancer patients.&#x2028; Methods: 6,500 full-length human antigens were expressed using mammalian reticulocyte lysate and captured onto NAPPA protein microarrays. Protein expression (&gt;90%) was confirmed with anti-GST antibodies. Patient sera were added, and bound IgG detected with secondary antibodies. Serum samples were obtained from 103 patients with stages I-III breast cancer, and 103 age-matched control women, all undergoing routine mammography.&#x2028; Results: Using high-density protein microarrays, sera from breast cancer patients (n=53) and healthy donor sera (n=53) were screened for autoantibodies to 6,500 protein antigens. Antigens were selected for further analysis if the 95th percentile of signal of cases and controls were significantly different (p&lt;0.05) and if the number of cases with signals above the 95th percentile of controls was larger than the number expected due to random chance (p&lt;0.05). Known tumor antigens, such as p53, were detected, as well as novel antigens such as DCC1, Rab7L and USP44. In total, 768 unique antigens were selected for further analysis with an independent set of breast cancer patient (n=50) and healthy donor sera (n=50).&#x2028; Conclusions: Custom in-situ protein microarrays can be used to detect serum tumor antigen-specific antibodies and enables the rapid, simultaneous detection of immunogenic tumor antigens from patient sera. These autoantibodies are being evaluated as potential biomarkers for the early diagnosis of breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2003.

Differential methylation profile of ovarian cancer in tissues and plasma

An accurate biomarker for detection of ovarian cancer may reduce cancer-related mortality. Using a previously developed microarray-based technique, we evaluated differences in DNA methylation profiles in a panel of 56 genes using sections of serous papillary adenocarcinomas and uninvolved ovaries (n=30) from women in a high-risk group. Methylation profiles were also generated for circulating DNA from blood of patients (n=33) and healthy controls (n=33). Using the most differentially methylated genes for naïve Bayesian analysis, we identified ten of these profiles as potentially informative in tissues. Various combinations of these genes produced 69% sensitivity and 70% specificity for cancer detection as estimated under a stratified, fivefold cross-validation protocol. In plasma, five genes were identified as informative; their combination had 85% sensitivity and 61% specificity for cancer detection. These results suggest that differential methylation profiling in heterogeneous samples has the potential to identify components of a composite biomarker that may detect ovarian cancer in blood with significant accuracy.