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Tinsley E, Bredin P, Toomey S, Hennessy BT, Furney SJ. KMT2C and KMT2D aberrations in breast cancer. Trends Cancer 2024:S2405-8033(24)00029-3. [PMID: 38453563 DOI: 10.1016/j.trecan.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
KMT2C and KMT2D are histone lysine methyltransferases responsible for the monomethylation of histone 3 lysine 4 (H3K4) residues at gene enhancer sites. KMT2C/D are the most frequently mutated histone methyltransferases (HMTs) in breast cancer, occurring at frequencies of 10-20% collectively. Frequent damaging and truncating somatic mutations indicate a tumour-suppressive role of KMT2C/D in breast oncogenesis. Recent studies using cell lines and mouse models to replicate KMT2C/D loss show that these genes contribute to oestrogen receptor (ER)-driven transcription in ER+ breast cancers through the priming of gene enhancer regions. This review provides an overview of the functions of KMT2C/D and outlines the recent clinical and experimental evidence of the roles of KMT2C and KMT2D in breast cancer development.
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Affiliation(s)
- Emily Tinsley
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Philip Bredin
- Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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2
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Dowling GP, Toomey S, Bredin P, Parker I, Mulroe E, Marron J, McLoughlin O, Teiserskiene A, Power C, O'Shea AM, Greally M, Morris PG, Duke D, Hill ADK, Hennessy BT. Neoadjuvant trastuzumab deruxtecan (T-DXd) with response-directed definitive therapy in early stage HER2-positive breast cancer: a phase II study protocol (SHAMROCK study). BMC Cancer 2024; 24:91. [PMID: 38233810 PMCID: PMC10792949 DOI: 10.1186/s12885-024-11851-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The current standard of care in the neoadjuvant setting for high-risk HER2-positive (HER2 +) breast cancer is to combine systemic chemotherapy with dual HER2 blockade, trastuzumab and pertuzumab. Targeted therapies have significantly improved outcomes for patients with HER2-positive breast cancer. To improve treatment-associated toxicity, chemotherapy-sparing approaches are currently being investigated. Trastuzumab deruxtecan (T-DXd) is an HER2-directed antibody-drug-conjugate (ADC) with promising results in the metastatic setting for HER2-positive breast cancer. The SHAMROCK study investigates neoadjuvant T-DXd in early stage HER2-positive breast cancer, using pathological complete response (pCR) rate as the primary endpoint. METHODS This is a phase II open-label, single arm, adaptive multi-centre trial of T-DXd in the neoadjuvant setting in stage 2-3 HER2-positive breast cancer. Eligible patients will receive 5.4 mg/kg of T-DXd intravenously every 3 weeks for up to 6 cycles. A repeat biopsy will performed after 2 cycles for the RNA disruption index (RDI) score assessment. According to their likelihood of pCR, as determined by the RDI score, patients will either undergo 4 or 6 cycles of T-DXd prior to imaging. Patients with imaging complete response (iCR) after either 4 or 6 cycles will proceed to surgery. Patients who do not achieve iCR will either undergo further systemic therapy or proceed to surgery. DISCUSSION The SHAMROCK study is a chemotherapy-sparing approach to curative intent treatment, investigating neoadjuvant T-DXd. We hypothesise that neoadjuvant T-DXd will have a high pCR rate and be associated low toxicity in early stage HER2-positive breast cancer. TRIAL REGISTRATION EudraCT Number: 2022-002485-32; ClinicalTrials.gov identifier: NCT05710666; Cancer Trials Ireland study number: CTRIAL-IE 22-01.
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Affiliation(s)
- Gavin P Dowling
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland.
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland.
| | - Sinead Toomey
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Philip Bredin
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | | | | | | | | | - Colm Power
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Megan Greally
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Duke
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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3
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Lee CL, Cremona M, Farrelly A, Workman JA, Kennedy S, Aslam R, Carr A, Madden S, O’Neill B, Hennessy BT, Toomey S. Preclinical evaluation of the CDK4/6 inhibitor palbociclib in combination with a PI3K or MEK inhibitor in colorectal cancer. Cancer Biol Ther 2023; 24:2223388. [PMID: 37326340 PMCID: PMC10281467 DOI: 10.1080/15384047.2023.2223388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Studies have demonstrated the efficacy of Palbociclib (CDK 4/6 inhibitor), Gedatolisib (PI3K/mTOR dual inhibitor) and PD0325901 (MEK1/2 inhibitor) in colorectal cancer (CRC), however single agent therapeutics are often limited by the development of resistance. METHODS We compared the anti-proliferative effects of the combination of Gedatolisib and Palbociclib and Gedatolisib and PD0325901 in five CRC cell lines with varying mutational background and tested their combinations on total and phosphoprotein levels of signaling pathway proteins. RESULTS The combination of Palbociclib and Gedatolisib was superior to the combination of Palbociclib and PD0325901. The combination of Palbociclib and Gedatolisib had synergistic anti-proliferative effects in all cell lines tested [CI range: 0.11-0.69] and resulted in the suppression of S6rp (S240/244), without AKT reactivation. The combination of Palbociclib and Gedatolisib increased BAX and Bcl-2 levels in PIK3CA mutated cell lines. The combination of Palbociclib and Gedatolisib caused MAPK/ERK reactivation, as seen by an increase in expression of total EGFR, regardless of the mutational status of the cells. CONCLUSION This study shows that the combination of Palbociclib and Gedatolisib has synergistic anti-proliferative effects in both wild-type and mutated CRC cell lines. Separately, the phosphorylation of S6rp may be a promising biomarker of responsiveness to this combination.
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Affiliation(s)
- Cha Len Lee
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Angela Farrelly
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Julie A. Workman
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Kennedy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Razia Aslam
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian O’Neill
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Bryan T. Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Dowling GP, Daly GR, Keelan S, Boland F, Toomey S, Hill ADK, Hennessy BT. Efficacy and Safety of Trastuzumab Deruxtecan in Breast Cancer: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2023; 23:847-855.e2. [PMID: 37775347 DOI: 10.1016/j.clbc.2023.09.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
Trastuzumab deruxtecan (T-DXd) is a novel antibody-drug-conjugate (ADC), primarily used in the treatment of HER2-positive breast cancer. This study aimed to conduct a systematic review to evaluate the efficacy and safety of T-DXd in treating breast cancer, based on clinical trials. A systematic search of the literature was conducted to identify clinical trials investigating the efficacy and safety of T-DXd in breast cancer. Clinical trials of any phase were included. Outcome measures were any adverse events and survival. Meta-analysis was conducted where possible. Pooled prevalence for each adverse event of any grade and grade 3 or greater were estimated. Progression-free survival (PFS), overall survival (OS) and objective response rates (ORRs) were also reported to evaluate the efficacy of T-DXd in breast cancer. A total of 1593 patients from 6 clinical trials were included. Common adverse events of any grade were nausea, anemia, neutropenia, vomiting, fatigue, constipation and diarrhea, occurring in greater than 30% of cases. In terms of adverse events of grade 3 or more, only anemia and neutropenia occurred at a relatively high rate. Median PFS ranged from 11.1 to 22.1 months. There was evidence of a benefit of T-DXd compared to controls in terms of both PFS (OR: 0.38; 95% CI: 0.32, 0.45) and OS (OR: 0.61; 95% CI: 0.48, 0.78). ORRs ranged from 37% to 79.9%. The present systematic review shows evidence that T-DXd is a safe and effective agent in the treatment of breast cancer based on currently available data. The most common adverse events affected the blood, lymphatic and gastrointestinal systems. Interstitial lung disease (ILD) is a notable and potentially serious adverse event.
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Affiliation(s)
- Gavin P Dowling
- Department of Molecular Medicine, Medical Oncology Lab, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Bons Secours Hospital, Dublin, Ireland.
| | - Gordon R Daly
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Stephen Keelan
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Medical Oncology Lab, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Molecular Medicine, Medical Oncology Lab, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
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Lenz L, Neff C, Solimeno C, Cogan ES, Abramson VG, Boughey JC, Falkson C, Goetz MP, Ford JM, Gradishar WJ, Jankowitz RC, Kaklamani VG, Marcom PK, Richardson AL, Storniolo AM, Tung NM, Vinayak S, Hodgson DR, Lai Z, Dearden S, Hennessy BT, Mayer EL, Mills GB, Slavin TP, Gutin A, Connolly RM, Telli ML, Stearns V, Lanchbury JS, Timms KM. Identifying homologous recombination deficiency in breast cancer: genomic instability score distributions differ among breast cancer subtypes. Breast Cancer Res Treat 2023; 202:191-201. [PMID: 37589839 PMCID: PMC10504389 DOI: 10.1007/s10549-023-07046-3] [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: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE A 3-biomarker homologous recombination deficiency (HRD) score is a key component of a currently FDA-approved companion diagnostic assay to identify HRD in patients with ovarian cancer using a threshold score of ≥ 42, though recent studies have explored the utility of a lower threshold (GIS ≥ 33). The present study evaluated whether the ovarian cancer thresholds may also be appropriate for major breast cancer subtypes by comparing the genomic instability score (GIS) distributions of BRCA1/2-deficient estrogen receptor-positive breast cancer (ER + BC) and triple-negative breast cancer (TNBC) to the GIS distribution of BRCA1/2-deficient ovarian cancer. METHODS Ovarian cancer and breast cancer (ER + BC and TNBC) tumors from ten study cohorts were sequenced to identify pathogenic BRCA1/2 mutations, and GIS was calculated using a previously described algorithm. Pathologic complete response (pCR) to platinum therapy was evaluated in a subset of TNBC samples. For TNBC, a threshold was set and threshold validity was assessed relative to clinical outcomes. RESULTS A total of 560 ovarian cancer, 805 ER + BC, and 443 TNBC tumors were included. Compared to ovarian cancer, the GIS distribution of BRCA1/2-deficient samples was shifted lower for ER + BC (p = 0.015), but not TNBC (p = 0.35). In the subset of TNBC samples, univariable logistic regression models revealed that GIS status using thresholds of ≥ 42 and ≥ 33 were significant predictors of response to platinum therapy. CONCLUSIONS This study demonstrated that the GIS thresholds used for ovarian cancer may also be appropriate for TNBC, but not ER + BC. GIS thresholds in TNBC were validated using clinical response data to platinum therapy.
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Affiliation(s)
- Lauren Lenz
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chris Neff
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Cara Solimeno
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Elizabeth S Cogan
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | | | | | - Carla Falkson
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - James M Ford
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Andrea L Richardson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anna Maria Storniolo
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nadine M Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shaveta Vinayak
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, 15. AstraZeneca, Seattle, WA, USA
| | | | | | | | | | - Erica L Mayer
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Thomas P Slavin
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexander Gutin
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | | | | | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jerry S Lanchbury
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Kirsten M Timms
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA.
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6
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Gaynor N, Blanco A, Madden SF, Moran B, Fletcher JM, Kaukonen D, Ramírez JS, Eustace AJ, McDermott MSJ, Canonici A, Toomey S, Teiserskiene A, Hennessy BT, O'Donovan N, Crown J, Collins DM. Alterations in immune cell phenotype and cytotoxic capacity in HER2+ breast cancer patients receiving HER2-targeted neo-adjuvant therapy. Br J Cancer 2023; 129:1022-1031. [PMID: 37507543 PMCID: PMC10491671 DOI: 10.1038/s41416-023-02375-y] [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: 01/09/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The phase II neo-adjuvant clinical trial ICORG10-05 (NCT01485926) compared chemotherapy in combination with trastuzumab, lapatinib or both in patients with HER2+ breast cancer. We studied circulating immune cells looking for alterations in phenotype, genotype and cytotoxic capacity (direct and antibody-dependent cell-mediated cytotoxicity (ADCC)) in the context of treatment response. METHODS Peripheral blood mononuclear cells (PBMCs) were isolated from pre- (n = 41) and post- (n = 25) neo-adjuvant treatment blood samples. Direct/trastuzumab-ADCC cytotoxicity of patient-derived PBMCs against K562/SKBR3 cell lines was determined ex vivo. Pembrolizumab was interrogated in 21 pre-treatment PBMC ADCC assays. Thirty-nine pre-treatment and 21 post-treatment PBMC samples were immunophenotyped. Fc receptor genotype, tumour infiltrating lymphocyte (TIL) levels and oestrogen receptor (ER) status were quantified. RESULTS Treatment attenuated the cytotoxicity/ADCC of PBMCs. CD3+/CD4+/CD8+ T cells increased following therapy, while CD56+ NK cells/CD14+ monocytes/CD19+ B cells decreased with significant post-treatment immune cell changes confined to patients with residual disease. Pembrolizumab-augmented ex vivo PBMC ADCC activity was associated with residual disease, but not pathological complete response. Pembrolizumab-responsive PBMCs were associated with lower baseline TIL levels and ER+ tumours. CONCLUSIONS PBMCs display altered phenotype and function following completion of neo-adjuvant treatment. Anti-PD-1-responsive PBMCs in ex vivo ADCC assays may be a biomarker of treatment response.
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Affiliation(s)
- Nicola Gaynor
- Cancer Biotherapeutics Research Group, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Alfonso Blanco
- Flow Cytometry Core Technology, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, School of Population Heath Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Damien Kaukonen
- Data Science Centre, School of Population Heath Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Javier Sánchez Ramírez
- Cancer Biotherapeutics Research Group, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Alex J Eustace
- School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Martina S J McDermott
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Alexandra Canonici
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ausra Teiserskiene
- Cancer Trials Ireland, RCSI House, 121 St. Stephen's Green, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cancer Trials Ireland, RCSI House, 121 St. Stephen's Green, Dublin, Ireland
| | - Norma O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - John Crown
- Cancer Biotherapeutics Research Group, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Denis M Collins
- Cancer Biotherapeutics Research Group, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
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7
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Cosgrove N, Eustace AJ, O'Donovan P, Madden SF, Moran B, Crown J, Moulton B, Morris PG, Grogan L, Breathnach O, Power C, Allen M, Walshe JM, Hill AD, Blümel A, O'Connor D, Das S, Milewska M, Fay J, Kay E, Toomey S, Hennessy BT, Furney SJ. Predictive modelling of response to neoadjuvant therapy in HER2+ breast cancer. NPJ Breast Cancer 2023; 9:72. [PMID: 37758711 PMCID: PMC10533568 DOI: 10.1038/s41523-023-00572-9] [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: 12/21/2022] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
HER2-positive (HER2+) breast cancer accounts for 20-25% of all breast cancers. Predictive biomarkers of neoadjuvant therapy response are needed to better identify patients with early stage disease who may benefit from tailored treatments in the adjuvant setting. As part of the TCHL phase-II clinical trial (ICORG10-05/NCT01485926) whole exome DNA sequencing was carried out on normal-tumour pairs collected from 22 patients. Here we report predictive modelling of neoadjuvant therapy response using clinicopathological and genomic features of pre-treatment tumour biopsies identified age, estrogen receptor (ER) status and level of immune cell infiltration may together be important for predicting response. Clonal evolution analysis of longitudinally collected tumour samples show subclonal diversity and dynamics are evident with potential therapy resistant subclones detected. The sources of greater pre-treatment immunogenicity associated with a pathological complete response is largely unexplored in HER2+ tumours. However, here we point to the possibility of APOBEC associated mutagenesis, specifically in the ER-neg/HER2+ subtype as a potential mediator of this immunogenic phenotype.
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Affiliation(s)
- Nicola Cosgrove
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alex J Eustace
- School of Biotechnology, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Peter O'Donovan
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Bruce Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Brian Moulton
- Clinical Oncology Development Europe, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael Allen
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Blümel
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Darren O'Connor
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sudipto Das
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Małgorzata Milewska
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Joanna Fay
- RCSI Biobank Service, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Elaine Kay
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland.
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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8
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Richards CE, Elamin YY, Carr A, Gately K, Rafee S, Cremona M, Hanrahan E, Smyth R, Ryan D, Morgan RK, Kennedy S, Hudson L, Fay J, O'Byrne K, Hennessy BT, Toomey S. Protein Tyrosine Phosphatase Non-Receptor 11 ( PTPN11/Shp2) as a Driver Oncogene and a Novel Therapeutic Target in Non-Small Cell Lung Cancer (NSCLC). Int J Mol Sci 2023; 24:10545. [PMID: 37445722 DOI: 10.3390/ijms241310545] [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: 05/03/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
PTPN11 encodes the SHP2 protein tyrosine phosphatase that activates the mitogen-activated protein kinase (MAPK) pathway upstream of KRAS and MEK. PTPN11/Shp2 somatic mutations occur frequently in Juvenile myelomonocytic leukaemia (JMML); however, the role of mutated PTPN11 in lung cancer tumourigenesis and its utility as a therapeutic target has not been fully addressed. We applied mass-spectrometry-based genotyping to DNA extracted from the tumour and matched the normal tissue of 356 NSCLC patients (98 adenocarcinomas (LUAD) and 258 squamous cell carcinomas (LUSC)). Further, PTPN11 mutation cases were identified in additional cohorts, including TCGA, Broad, and MD Anderson datasets and the COSMIC database. PTPN11 constructs harbouring PTPN11 E76A, A72D and C459S mutations were stably expressed in IL-3 dependent BaF3 cells and NSCLC cell lines (NCI-H1703, NCI-H157, NCI-H1299). The MAPK and PI3K pathway activation was evaluated using Western blotting. PTPN11/Shp2 phosphatase activity was measured in whole-cell protein lysates using an Shp2 assay kit. The Shp2 inhibitor (SHPi) was assessed both in vitro and in vivo in a PTPN11-mutated cell line for improved responses to MAPK and PI3K targeting therapies. Somatic PTPN11 hotspot mutations occurred in 4/98 (4.1%) adenocarcinomas and 7/258 (2.7%) squamous cells of 356 NSCLC patients. Additional 26 PTPN11 hotspot mutations occurred in 23 and 3 adenocarcinomas and squamous cell carcinoma, respectively, across the additional cohorts. Mutant PTPN11 significantly increased the IL-3 independent survival of Ba/F3 cells compared to wildtype PTPN11 (p < 0.0001). Ba/F3, NCI-H1703, and NCI-H157 cells expressing mutant PTPN11 exhibited increased PTPN11/Shp2 phosphatase activity and phospho-ERK1/2 levels compared to cells expressing wildtype PTPN11. The transduction of the PTPN11 inactivating mutation C459S into NSCLC cell lines led to decreased phospho-ERK, as well as decreased phospho-AKT in the PTPN11-mutated NCI-H661 cell line. NCI-H661 cells (PTPN11-mutated, KRAS-wild type) were significantly more sensitive to growth inhibition by the PI3K inhibitor copanlisib (IC50: 13.9 ± 4.7 nM) compared to NCI-H1703 (PTPN11/KRAS-wild type) cells (IC50: >10,000 nM). The SHP2 inhibitor, in combination with the PI3K targeting therapy copanlisib, showed no significant difference in tumour development in vivo; however, this significantly prevented MAPK pathway induction in vitro (p < 0.0001). PTPN11/Shp2 demonstrated the in vitro features of a driver oncogene and could potentially sensitize NSCLC cells to PI3K inhibition and inhibit MAPK pathway activation following PI3K pathway targeting.
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Affiliation(s)
- Cathy E Richards
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Yasir Y Elamin
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
- Department of Thoracic Head and Neck Medical Oncology, Division of Cancer Medicine, M.D. Anderson Cancer Centre, Houston, TX 77030, USA
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Kathy Gately
- Thoracic Oncology Research Group, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Hospital, D08 NHY1 Dublin, Ireland
| | - Shereen Rafee
- Thoracic Oncology Research Group, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Hospital, D08 NHY1 Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Emer Hanrahan
- Department of Medical Oncology, St. Vincent's Hospital, D04 T6F4 Dublin, Ireland
| | - Robert Smyth
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Daniel Ryan
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Ross K Morgan
- Department of Respiratory Medicine, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, St. Vincent's Hospital, D04 T6F4 Dublin, Ireland
| | - Lance Hudson
- Department of Surgery, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Joanna Fay
- RCSI Biobank Service, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | | | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, D09 YD60 Dublin, Ireland
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9
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Biswas A, Salvucci M, Connor K, Düssmann H, Carberry S, Fichtner M, King E, Murphy B, O'Farrell AC, Cryan J, Beausang A, Heffernan J, Cremona M, Hennessy BT, Clerkin J, Sweeney KJ, MacNally S, Brett F, O'Halloran P, Bacon O, Furney S, Verreault M, Quissac E, Bielle F, Ahmed MH, Idbaih A, Leenstra S, Ntafoulis I, Fabro F, Lamfers M, Golebiewska A, Hertel F, Niclou SP, Yen RTC, Kremer A, Dilcan G, Lodi F, Arijs I, Lambrechts D, Purushothama MK, Kel A, Byrne AT, Prehn JHM. Comparative analysis of deeply phenotyped GBM cohorts of 'short-term' and 'long-term' survivors. J Neurooncol 2023:10.1007/s11060-023-04341-3. [PMID: 37237151 PMCID: PMC10322749 DOI: 10.1007/s11060-023-04341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Glioblastoma (GBM) is an aggressive brain cancer that typically results in death in the first 15 months after diagnosis. There have been limited advances in finding new treatments for GBM. In this study, we investigated molecular differences between patients with extremely short (≤ 9 months, Short term survivors, STS) and long survival (≥ 36 months, Long term survivors, LTS). METHODS Patients were selected from an in-house cohort (GLIOTRAIN-cohort), using defined inclusion criteria (Karnofsky score > 70; age < 70 years old; Stupp protocol as first line treatment, IDH wild type), and a multi-omic analysis of LTS and STS GBM samples was performed. RESULTS Transcriptomic analysis of tumour samples identified cilium gene signatures as enriched in LTS. Moreover, Immunohistochemical analysis confirmed the presence of cilia in the tumours of LTS. Notably, reverse phase protein array analysis (RPPA) demonstrated increased phosphorylated GAB1 (Y627), SRC (Y527), BCL2 (S70) and RAF (S338) protein expression in STS compared to LTS. Next, we identified 25 unique master regulators (MR) and 13 transcription factors (TFs) belonging to ontologies of integrin signalling and cell cycle to be upregulated in STS. CONCLUSION Overall, comparison of STS and LTS GBM patients, identifies novel biomarkers and potential actionable therapeutic targets for the management of GBM.
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Affiliation(s)
- Archita Biswas
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Manuela Salvucci
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Kate Connor
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Heiko Düssmann
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Steven Carberry
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Michael Fichtner
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Ellen King
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Brona Murphy
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Alice C O'Farrell
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Alan Beausang
- Department of Neuropathology, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | | | - Mattia Cremona
- Department of Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - James Clerkin
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Kieron J Sweeney
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Steve MacNally
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Francesca Brett
- Department of Neuropathology, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Philip O'Halloran
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Orna Bacon
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Simon Furney
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Maite Verreault
- DMU Neurosciences, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Inserm, F-75013, Paris, France
| | - Emie Quissac
- DMU Neurosciences, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Inserm, F-75013, Paris, France
| | - Franck Bielle
- DMU Neurosciences, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Inserm, F-75013, Paris, France
| | - Mohammed H Ahmed
- DMU Neurosciences, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Inserm, F-75013, Paris, France
| | - Ahmed Idbaih
- DMU Neurosciences, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Inserm, F-75013, Paris, France
| | - Sieger Leenstra
- Dept of Neurosurgery Brain Tumor Center, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Ioannis Ntafoulis
- Dept of Neurosurgery Brain Tumor Center, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Federica Fabro
- Dept of Neurosurgery Brain Tumor Center, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Martine Lamfers
- Dept of Neurosurgery Brain Tumor Center, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anna Golebiewska
- NORLUX Neuro-Oncology laboratory, Department of Cancer Research, Luxembourg Institute of Health, 6A, Rue Nicolas-Ernest Barblé, L-1210, Luxembourg, Luxembourg
| | - Frank Hertel
- NORLUX Neuro-Oncology laboratory, Department of Cancer Research, Luxembourg Institute of Health, 6A, Rue Nicolas-Ernest Barblé, L-1210, Luxembourg, Luxembourg
- Faculty of Sciences, Technology and Medicine, University of Luxembourg, L-4365, Esch-sur-Alzette, Luxembourg
| | - Simone P Niclou
- NORLUX Neuro-Oncology laboratory, Department of Cancer Research, Luxembourg Institute of Health, 6A, Rue Nicolas-Ernest Barblé, L-1210, Luxembourg, Luxembourg
- Faculty of Sciences, Technology and Medicine, University of Luxembourg, L-4365, Esch-sur-Alzette, Luxembourg
| | - Romain Tching Chi Yen
- Information Technology for Translational Medicine, 27, Rue Henri Koch - House of BioHealth, L-4354, Esch-sur-Alzette, Luxembourg
| | - Andreas Kremer
- Information Technology for Translational Medicine, 27, Rue Henri Koch - House of BioHealth, L-4354, Esch-sur-Alzette, Luxembourg
| | - Gonca Dilcan
- VIB-KU Leuven Cancer for Cancer Biology, Onderwijs en Navorsing 5, Herestraat, 49, 3000, Leuven, Belgium
| | - Francesca Lodi
- VIB-KU Leuven Cancer for Cancer Biology, Onderwijs en Navorsing 5, Herestraat, 49, 3000, Leuven, Belgium
| | - Ingrid Arijs
- VIB-KU Leuven Cancer for Cancer Biology, Onderwijs en Navorsing 5, Herestraat, 49, 3000, Leuven, Belgium
| | - Diether Lambrechts
- VIB-KU Leuven Cancer for Cancer Biology, Onderwijs en Navorsing 5, Herestraat, 49, 3000, Leuven, Belgium
| | | | - Alexander Kel
- geneXplain GmbH, Am Exer 19b, 38302, Wolfenbüttel, Germany
| | - Annette T Byrne
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Jochen H M Prehn
- Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland.
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10
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Rashed A, Fitzpatrick OM, Easty DJ, Coyne Z, Collins D, Mallet V, Milewski M, Egan K, Breathnach OS, Grogan L, Hennessy BT, Morris PG. An observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer. BMC Cancer 2023; 23:171. [PMID: 36803350 PMCID: PMC9942277 DOI: 10.1186/s12885-023-10603-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Breast cancer is one of the most prevalent malignant diseases in women. The development of dose dense chemotherapy regimens has improved clinical outcomes but has been associated with increased hematological toxicity. Currently there is a paucity of data on the use of lipegfilgrastim in dose dense AC treatment in early breast cancer. The purpose of this study was to assess the use of lipegfilgrastim in the treatment of early breast cancer and to examine the incidence of treatment-related neutropenia during the dose dense AC phase and subsequent paclitaxel treatment. METHODS This was a single arm, non-interventional, prospective study. The primary endpoint was to determine the rate of neutropenia defined as ANC of < 1.0 × 109/L, during four cycles of dose dense AC with lipegfilgrastim support. The secondary endpoints were the incidence of febrile neutropenia, (temperature > 38 °C and ANC < 1.0 × 109/L), treatment delays, premature treatment cessation and toxicity. RESULTS Forty-one participants were included in the study. Of the 160 planned dose dense AC treatments, 157 were administered, and 95% (152/160) of these were given on time. The rate of treatment delay was 5% (95% CI 2.2 to 9.9%) due to infection (4) and mucositis (1). Four (10%) patients developed febrile neutropenia. The most frequently occurring adverse event was grade 1 bone pain. CONCLUSION Lipegfilgrastim is an effective option in the prophylaxis of chemotherapy-induced neutropenia, and its use in everyday anti-cancer treatment can be considered.
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Affiliation(s)
- Ahmed Rashed
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Orla M Fitzpatrick
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland.
| | - David J Easty
- grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Zac Coyne
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Dearbhaile Collins
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Victoria Mallet
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Maciej Milewski
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Keith Egan
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Oscar S Breathnach
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Liam Grogan
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Bryan T Hennessy
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Patrick G Morris
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
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11
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Dowling GP, Keelan S, Toomey S, Daly GR, Hennessy BT, Hill ADK. Review of the status of neoadjuvant therapy in HER2-positive breast cancer. Front Oncol 2023; 13:1066007. [PMID: 36793602 PMCID: PMC9923093 DOI: 10.3389/fonc.2023.1066007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose The development of human epidermal growth factor receptor 2 (HER2)-directed therapies has revolutionized the treatment of HER2-positive breast cancer. The aim of this article is to review the continually evolving treatment strategies in the neoadjuvant setting of HER2-positive breast cancer, as well as the current challenges and future perspectives. Methods Searches were undertaken on PubMed and Clinicaltrials.gov for relevant publications and trials. Findings The current standard of care in high-risk HER2-positive breast cancer is to combine chemotherapy with dual anti-HER2 therapy, for a synergistic anti-tumor effect. We discuss the pivotal trials which led to the adoption of this approach, as well as the benefit of these neoadjuvant strategies for guiding appropriate adjuvant therapy. De-escalation strategies are currently being investigated to avoid over treatment, and aim to safely reduce chemotherapy, while optimizing HER2-targeted therapies. The development and validation of a reliable biomarker is essential to enable these de-escalation strategies and personalization of treatment. In addition, promising novel therapies are currently being explored to further improve outcomes in HER2-positive breast cancer.
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Affiliation(s)
- Gavin P Dowling
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Stephen Keelan
- The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gordon R Daly
- The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Arnold D K Hill
- The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
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12
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Aslam R, Hennessy BT, Toomey S, Richards C. Synergistic effects of alpelisib (PI3K inhibitor) and ribociclib (CDK4/6 inhibitor) combination in preclinical colorectal cancer models. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.167] [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: 01/25/2023] Open
Abstract
167 Background: Multiple activating genetic mutations in the phosphatidylinositol-3 kinase (PI3K) and the mitogen activated protein kinase (MAPK) pathways have been implicated in the development of resistance to anti-cancer therapies. Ribociclib has limited activity as a single agent in CRC. However, combining Ribociclib with targeted therapies of the MAPK and PI3K pathways may be a promising treatment strategy for CRC. Methods: We explored the in vitro efficacy of drug combinations Ribociclib (R) and Alpelisib (A) in four CRC cell lines with different mutational status; CACO2 ( PIK3CA/KRAS wild-type), LS1034 ( KRAS mutated), SNUC4 ( PIK3CA mutated) and DLD1 ( PIK3CA/KRAS mutated). Drug combination index (CI) was calculated using Calcusyn Biosoft software. We used a western immunoblotting method for protein analysis. The Chick Chorio-Allantoic Membrane (CAM) assay was used for in-vivo analysis of the effect of the drug combination. Results: IC50s for R and A were calculated for all four cell lines. CACO2 and DLD1 cells were resistant to Ribociclib (IC50 > 15µM). The cell lines had varying sensitivity to both drugs. Drug combination analysis showed that the combination of R and A has a synergistic anti-proliferative effect in all CRC cell lines tested. The combination of R and A is highly synergistic in LS1034 cells which harbour a KRAS mutation (CI = 0.16). Relative expression of the proteins Cyclin D1, E2F-1, p-BCL-2, p-AKT, p-Rb and p-S6 was determined by measuring the density of each band from the western blot experiments and normalizing to β-actin. Combined inhibition of CDK4/6 and PI3Kα caused a simultaneous reduction of p-RB, p-AKT and p-S6 and a more complete inhibition of the PI3K/AKT/mTOR pathway in all four cell lines tested. There was also an increase in the expression of the apoptotic marker pBCL2 in cells treated with the combination of R and A compared to vehicle control(VC). We observed a macroscopic reduction of visible tumour in all cell lines treated with the R and A combination in vivo as compared to VC. Microscopic examination also showed less Ki67 staining and negative cytokeratin staining in combination treated groups. Conclusions: We see a synergistic response to treatment with the combination of R and A in all cell lines and this combination may be a rational treatment strategy in colorectal cancer.
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Affiliation(s)
- Razia Aslam
- RCSI Education and Research Centre, Dublin, AL, Ireland
| | | | - Sinead Toomey
- Royal College of Surgeons in Ireland, Dublin, Ireland
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13
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Fitzpatrick OM, Murphy C, Duignan E, Egan K, Hennessy BT, Grogan L, Murphy A, Breathnach OS, Naidoo J, Morris PG. Correction to: The cost of cancer care: how far would you go for a trial? Ir J Med Sci 2023; 192:357. [PMID: 35150383 PMCID: PMC10074517 DOI: 10.1007/s11845-022-02950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Orla M Fitzpatrick
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland.
| | - Catherine Murphy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Erica Duignan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Keith Egan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Adrian Murphy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jarushka Naidoo
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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Mc Laughlin RA, Almeraikhi M, Alkaabi H, Bligh F, Cluxton C, Mcmahon D, Fitzpatrick O, Conroy MR, Hennessy BT, O'Neill B, Naidoo J, Breathnach OS, Grogan W, Murphy AG, Morris PG. Neoadjuvant chemoradiation in elderly Irish patients with esophageal cancer: A review of the clinical outcomes and toxicity. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.335] [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: 01/25/2023] Open
Abstract
335 Background: In locally advanced esophageal cancer, neoadjuvant chemo-radiotherapy improves survival compared with surgery alone. In the Chemo-Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS), the median age was 60. However, 1/3 of patients diagnosed with esophageal cancer are over 70 years. The CROSS outcomes are therefore limited in its application to older patients. The objective of this study is to report and compare the outcomes and tolerability in elderly patients (≥70 years), who underwent neoadjuvant chemo-radiation for esophageal cancer with younger patients < 70 years. Methods: A retrospective analysis of patients treated with neoadjuvant chemo-radiation for esophageal cancer between 1st January 2015 and 1st January 2021 was completed. Baseline characteristics and haematological toxicities were reported. Pathological response was reported. Survival was estimated using the Kaplan-Meier method. Results: In total 105 patients were included; 35 (33%) were ≥ 70 years and 70 (67%) patients were < 70 years. In the elderly cohort, the median age was 75 (70-86) and the younger cohort median age was 60 (29-69). 73% of patients in each cohort were male. 31 (89%) of older adults experienced any grade of anaemia compared with 45 (64%) of the younger cohort. Only one patient experienced ≥ grade 3 anaemia in each cohort. 18(51%) and 33(47%) of older and younger patients respectively experienced any grade of neutropenia. 5(14%) older and 7(10%) younger patients experienced ≥ grade 3 neutropenia. 15(43%) and 43(61%) of older and younger patients experienced any grade of thrombocytopenia. No patients experienced ≥ grade 3 thrombocytopenia. 80% of the older and 86% of the younger cohort proceeded to surgery. 3(11%) and 17(29%) of the older and younger cohorts respectively who underwent surgery achieved a complete pathological response. There was no difference in overall survival (OS) between the cohorts (p=0.48). There was also no difference in progression free survival (PFS) between the cohorts. Conclusions: In conclusion, we confirm that neoadjuvant chemo-radiation is tolerable in patients ≥ 70 when compared with patients < 70 years. Both OS and PFS is similar in both cohorts. We recommend the use of neoadjuvant therapy in appropriately selected patients ≥ 70 years.
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Affiliation(s)
| | - Majid Almeraikhi
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | - Humaid Alkaabi
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | - Fianait Bligh
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | | | | | | | | | | | - Brian O'Neill
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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Mc Laughlin RA, Devoy C, moloney C, Bennett K, Mcmahon D, Conroy MR, Fitzpatrick O, Egan K, Grogan W, Breathnach OS, Morris PG, Murphy AG, Naidoo J, Tangney M, Hennessy BT. A prospective translational study investigating the association of gut microbiome (GM) diversity with pathological complete response (pCR) after neoadjuvant treatment in early stage rectal and esophageal cancers. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps819] [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: 01/25/2023] Open
Abstract
TPS819 Background: The gut microbiome (GM) is thought to influence host immunity by modulating multiple immunologic pathways. Studies have suggested that dysbiosis of the GM confers a predisposition to certain malignancies and influences response to immune checkpoint inhibitors. However, little is known about how the GM diversity influences complete pathological response to neoadjuvant therapy in gastrointestinal (GI) tumours. We hypothesize that a more diverse GM constitution at baseline will lead to improved pathological response at the time of definitive surgery. Methods: We designed a cross-institutional multi-center translational study investigating the impact of the GM diversity on the efficacy of neoadjuvant therapy in GI cancers by assessing its association with pathological response. The study population will consist of patients with an early-stage rectal or esophageal cancer due to commence neoadjuvant therapy (including chemotherapy and chemoradiation) and planned for definitive surgery. Patients who received prior chemotherapy/monoclonal antibodies/immune checkpoint inhibitors or radiation will be excluded. The study assessments will include fecal sampling of the GM prior to neoadjuvant therapy, upon completion and again six months post completion of therapy. Fecal samples will be analysed by 16S RNA sequencing. Pathological response will be examined at time of surgery and patients will be classified as responders (complete pathological response) or non-responders. The primary endpoint of the study is to examine the association between the GM diversity and pathological response. 120 patients will be recruited over 18 months. Results: Species richness (Alpha Diversity) will be analysed using the Shannon diversity index and Jaccard similarity index to calculate beta diversity. Classification and clustering analysis will be performed with Principal Component Analysis (PCA) and Random Forest analysis. Comparison of taxa or functions between clinical cohorts will be performed using the two tailed Z test and corrected using the false discovery rate to determine Q-values. The association between GM and complete pathological response will be examined using logistic regression analysis adjusting for potential confounding factors. Adjusted odds ratios (OR) and 95% confidence intervals will be presented. Conclusions: This study will show preliminary insights into the role of GM as a potential biomarker for neoadjuvant therapy efficacy in patients with GI cancers. Recruitment is on-going.
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Affiliation(s)
| | | | | | - Kathleen Bennett
- Department of Data Science, Royal College of Surgeons of Ireland, Dublin, Ireland
| | | | | | | | - Keith Egan
- Beaumont RCSI Cancer Centre, Dublin, Ireland
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Hurley C, Lacroix L, Sheehan K, Lucas M, Buckley R, Blümel A, Toomey S, Hennessy BT, Crown J, Sautes-Fridman C, O'Connor D. Assessment of tumour infiltrating subpopulations and pathological complete response using multiplex immunohistochemistry and digital pathology in early HER2+ breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15041] [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: 11/20/2022] Open
Abstract
e15041 Background: The treatment of HER2+ breast cancer (BC) has improved substantially with the use of targeted therapies, and patients achieving pathological complete response (pCR) following neoadjuvant therapy have significantly improved disease free survival. However, there is currently no way to determine which patients are most likely to respond to neoadjuvant HER2-targeting treatment. Growing evidence indicates tumour infiltrating lymphocytes influence HER2+ BC outcome. We hypothesize that a deeper investigation of the immune landscape of HER2+ patient tumours may improve patient stratification and identify an immune profile associated with pCR. Methods: 3plex immunohistochemistry panels identifying immune cell subpopulations and tertiary lymphoid structures were applied to HER2+ BC tumors (pre-treatment N=19, post-treatment N=9) of patients of the neoadjuvant TCHL clinical trial (NCT01485926), who received HER2-targeting therapy. Quantitative analysis of CD3+, CD20+, DC-Lamp+, CD4+, and CD8+ immune cells on multi-labelled whole-slide images of TCHL tumor sections was performed using artificial intelligence image analysis models. Patient-specific densities of each cell type in tumor regions were determined to facilitate assessment of pre-treatment differences in target immune subpopulations in complete, partial, and non-responders. Results: Statistical analysis demonstrated a trend for higher densities of each immune subpopulation in pre-treatment biopsies of pCR vs. non-pCR patients. Patient categorisation based on median threshold demonstrated patients achieving pCR are more frequently high for each immune cell type assessed, while non-pCR patients are more frequently in the low category. Investigation of association of pre-treatment immune infiltrate with clinicopathological features demonstrated trends for higher levels of T-cell infiltration in later stage and hormone receptor negative patients. Conclusions: Multiplex IHC is an optimal technique for the concurrent assessment of multiple target markers in patient tissue, which can be quantitatively analyzed in a high throughput manner using AI models. The findings of this preliminary study support recent evidence regarding the role of tumor infiltrating immune cells in HER2+ BC outcome and warrant further investigation in a larger cohort.
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Affiliation(s)
| | | | | | - Mairi Lucas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Anna Blümel
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - John Crown
- NSABP/NRG Oncology, and The Irish Cooperative Oncology Research Group, Dublin, Ireland
| | | | - Darran O'Connor
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Mcmahon D, Hussein A, Mangleburg H, Nichianain A, Fitzpatrick O, McLaughlin RA, Conroy MR, Marks SJ, Naidoo J, Grogan W, Murphy AG, Breathnach OS, Hennessy BT, Morris PG. Toxicity of concurrent and adjuvant temozolomide in patients with glioblastoma multiforme (GBM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14037] [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: 11/20/2022] Open
Abstract
e14037 Background: (MGMT) promotor is prognostic and predictive of temozolomide (TMZ) benefit in newly diagnosed GBM. It has been suggested that MGMT methylation is associated with TMZ toxicity in some cancers such as melanoma but is not clearly defined in GBM. Methods: To investigate this, a retrospective electronic chart review of patients (pts) with resected GBM in a tertiary neurosurgical referral center from 1 July 2017 – 31 Dec 2020 was conducted. Hematological toxicities during TMZ with RT (concurrent) and subsequent TMZ (adjuvant) were assessed and graded by CTCAE V5.0. Toxicity was compared by MGMT methylation status. Results: In a 3.5 year period, 417 GBM resections were performed. Of these, 186 (45%) patients received at least 1 dose of TMZ in our institution: 180 pts received concurrent TMZ, 6 pts received adjuvant only. MGMT was methylated, unmethylated and unknown in 72, 97 and 17 pts respectively. In the concurrent and adjuvant phases respectively, thrombocytopenia incidence was 20%(N=14) and 52%(N=25) in the methylated group and 15%(N=15) and 51%(N=37) in the unmethylated group. In the adjuvant phase, incidence of ≥ grade 3 thrombocytopenia was 8%(N=4), in the methylated patients and 9%(N=7) for those unmethylated. Neutropenia incidence was low in the concurrent phase, however in the adjuvant phase was 29%(N=14) in the methylated group and 23%(N=17) in the unmethylated group. ≥G3 incidence was 10%(N=5) and 3%(N=2) respectively. Conclusions: In this retrospective study, a higher incidence of hematological toxicity was not seen in pts with MGMT methylated tumors. Methylation of the DNA repair enzyme O(6)-methylguanine-DNA methyltransferase.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jarushka Naidoo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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18
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Ryan DJ, Toomey S, Smyth R, Madden SF, Workman J, Cummins R, Sheehan K, Fay J, Naidoo J, Breathnach OS, Morris PG, Grogan L, O'Brien ME, Sulaiman I, Hennessy BT, Morgan RK. Exhaled Breath Condensate (EBC) analysis of circulating tumour DNA (ctDNA) using a lung cancer specific UltraSEEK oncogene panel. Lung Cancer 2022; 168:67-73. [DOI: 10.1016/j.lungcan.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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19
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O'Reilly S, Murphy V, Mulroe E, Tucker L, Carragher F, Marron J, Shannon AM, Rogan K, Connolly RM, Hennessy BT, McDermott RS. The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy. Cancers (Basel) 2022; 14:2247. [PMID: 35565375 PMCID: PMC9101172 DOI: 10.3390/cancers14092247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.
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Affiliation(s)
- Seamus O'Reilly
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
| | | | | | - Lisa Tucker
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | | | | | | | - Ken Rogan
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | - Roisin M Connolly
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
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20
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Smith YE, Wang G, Flynn CL, Madden SF, MacEneaney O, Cruz RGB, Richards CE, Jahns H, Brennan M, Cremona M, Hennessy BT, Sheehan K, Casucci A, Sani FA, Hudson L, Fay J, Vellanki SH, O’Flaherty S, Devocelle M, Hill ADK, Brennan K, Sukumar S, Hopkins AM. Functional Antagonism of Junctional Adhesion Molecule-A (JAM-A), Overexpressed in Breast Ductal Carcinoma In Situ (DCIS), Reduces HER2-Positive Tumor Progression. Cancers (Basel) 2022; 14:cancers14051303. [PMID: 35267611 PMCID: PMC8909510 DOI: 10.3390/cancers14051303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Specific drug targets for breast ductal carcinoma in situ (DCIS) remain elusive, despite increasing disease prevalence and burden to healthcare services. Estrogen receptor (ER)-negative HER2-positive DCIS, associated with the poorest patient prognosis, is in particular need of novel therapeutic avenues. This report provides the first evidence that a cell surface protein called JAM-A is upregulated on human DCIS patient tissues and can be readily targeted by a novel JAM-A-binding peptide inhibitor in separate in vivo models of DCIS. The anti-tumor efficacy and lack of systemic toxicity of this lead inhibitor, coupled with early indications of potential signaling pathways implicated, support the value of future studies investigating JAM-A as a novel drug target in DCIS patients. Abstract Breast ductal carcinoma in situ (DCIS) is clinically challenging, featuring high diagnosis rates and few targeted therapies. Expression/signaling from junctional adhesion molecule-A (JAM-A) has been linked to poor prognosis in invasive breast cancers, but its role in DCIS is unknown. Since progression from DCIS to invasive cancer has been linked with overexpression of the human epidermal growth factor receptor-2 (HER2), and JAM-A regulates HER2 expression, we evaluated JAM-A as a therapeutic target in DCIS. JAM-A expression was immunohistochemically assessed in patient DCIS tissues. A novel JAM-A antagonist (JBS2) was designed and tested alone/in combination with the HER2 kinase inhibitor lapatinib, using SUM-225 cells in vitro and in vivo as validated DCIS models. Murine tumors were proteomically analyzed. JAM-A expression was moderate/high in 96% of DCIS patient tissues, versus 23% of normal adjacent tissues. JBS2 bound to recombinant JAM-A, inhibiting cell viability in SUM-225 cells and a primary DCIS culture in vitro and in a chick embryo xenograft model. JBS2 reduced tumor progression in in vivo models of SUM-225 cells engrafted into mammary fat pads or directly injected into the mammary ducts of NOD-SCID mice. Preliminary proteomic analysis revealed alterations in angiogenic and apoptotic pathways. High JAM-A expression in aggressive DCIS lesions and their sensitivity to treatment by a novel JAM-A antagonist support the viability of testing JAM-A as a novel therapeutic target in DCIS.
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Affiliation(s)
- Yvonne E. Smith
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Guannan Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (G.W.); (S.S.)
| | - Ciara L. Flynn
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Stephen F. Madden
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland;
| | - Owen MacEneaney
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (O.M.); (K.S.); (J.F.)
| | - Rodrigo G. B. Cruz
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Cathy E. Richards
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Hanne Jahns
- School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland;
| | - Marian Brennan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland;
| | - Mattia Cremona
- Department of Medical Oncology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (M.C.); (B.T.H.)
| | - Bryan T. Hennessy
- Department of Medical Oncology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (M.C.); (B.T.H.)
| | - Katherine Sheehan
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (O.M.); (K.S.); (J.F.)
| | - Alexander Casucci
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland; (A.C.); (F.A.S.)
| | - Faizah A. Sani
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland; (A.C.); (F.A.S.)
| | - Lance Hudson
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Joanna Fay
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (O.M.); (K.S.); (J.F.)
| | - Sri H. Vellanki
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Siobhan O’Flaherty
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland; (S.O.); (M.D.)
| | - Marc Devocelle
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland; (S.O.); (M.D.)
| | - Arnold D. K. Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Kieran Brennan
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (G.W.); (S.S.)
| | - Ann M. Hopkins
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland; (Y.E.S.); (C.L.F.); (R.G.B.C.); (C.E.R.); (L.H.); (S.H.V.); (A.D.K.H.); (K.B.)
- Correspondence: ; Tel.: +353-1-809-3858
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21
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Prior L, Keegan NM, Furney SJ, Walshe JM, Gullo G, Crown J, Kennedy MJ, Smith D, McCaffrey J, Kelly CM, Egan K, Kerr J, Given M, Sheehy N, O'Donovan P, Hernando A, Teiserskiene A, Parker I, Kay E, McDermott R, Keane MM, O'Reilly S, Grogan L, Breathnach O, Morris PG, Toomey S, Hennessy BT. Abstract P5-16-08: Phase Ib/II trial evaluating safety and efficacy of copanlisib (PI3K inhibitor) and trastuzumab in pre-treated advanced HER2-positive breast cancer: Results from the PantHER study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-16-08] [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
Background: De novo and acquired resistance to HER2 directed therapy is frequently encountered. Upregulation of the phosphatidylinositol-3-kinase (PI3K) pathway is an important mediator of treatment resistance. This can occur through an activating mutation of the PIK3CA gene or PTEN loss. PIK3CA mutations are present in approximately 20% of HER2 positive breast cancers and as such, the PI3K pathway has emerged as an attractive target for restoring sensitivity to HER2 directed therapy. Methods: We performed a single arm, multicentre, open label Phase Ib/II trial. Patients (pts) with advanced HER2-positive breast cancer whose disease had progressed on at least 1 line of Trastuzumab/T-DM1 based treatment in the metastatic setting were eligible if they met following criteria: ECOG PS ≤ 2 and adequate organ function. Pts with treated, controlled brain metastases were permitted to enrol. Exclusion criteria included uncontrolled hypertension or diabetes mellitus. Pts on Phase IB were treated according to a 6+6 study design with a dose escalation schedule of Copanlisib IV (level 1 = 45mg, level 2 = 60mg) on Day 1, 8 and 15 of a 28-day cycle along with a fixed dose of Trastuzumab 2mg/kg weekly. Phase II treatment was the MTD (maximum tolerated dose) of Copanlisib in combination with Trastuzumab. Archival tumour tissue, voluntary biopsies and serial plasma samples were collected for genomic sequencing. Primary endpoints were MTD (Phase I) and clinical benefit rate (CBR) which was defined as complete response (CR) or partial response (PR) at any time point; or stable disease (SD) lasting at least 24 weeks (Phase II). Secondary endpoints included safety and tolerability, tumor response rate, duration of response, time to treatment failure (TTF) and progression free (PFS) and overall survival (OS). Results: Twelve pts were enrolled in Phase IB. No dose limiting toxicity was observed. The MTD was established as Copanlisib 60mg and Trastuzumab 2mg/kg. Fourteen pts were enrolled in Phase II (6 pts treated at the MTD in Phase IB were included in the final Phase II analysis resulting in a total of 20 pts). The median number of lines of prior treatment in the metastatic setting was 3 (1-8). The most common grade 3-4 toxicities encountered in the Phase Ib/II cohorts included hypertension (n=7, 27%), hyperglycaemia (n=2, 8%) and vomiting (n=2, 8%). Three pts discontinued treatment due to toxicity. The median follow-up for the Phase II cohort was 7.5 months (95% CI 6.0-14.5). PR was observed in 4 pts (20%) and SD (at any time point) was seen in 8 pts (40%). The CBR was 30% (n=6). The duration of response was 15.0 weeks (95% CI 4.9 - 16.1). The median TTF was 11.9 weeks (95% CI 7.5 - 21.1). The median PFS was 3.0 mo (95% CI 0.2 - 5.8) and OS was 14.0 mo (95% CI 5.2-22.8). At the time of analysis, 9 of 20 patients were alive. PIK3CA mutations were detectable in the archival tissue of 11 of 26 pts (42%). PIK3CA hotspot mutations (H1047R, E542K and E545K) were detectable in the plasma of all 26 pts at various points throughout treatment. Pre and post treatment biopsies of 2 pts in the Phase IB trial revealed somatic mutations in DNAH3 and TRRAP, the latter of which encodes a PI3K-like protein kinase. Targeted next generation sequencing was performed on the circulating tumour DNA of 20 pts in the Phase II cohort taken before, during and after treatment to further validate these findings and to assess for other mechanisms of response or resistance. The final translational results will be presented at the meeting. Conclusions: The combination of Copanlisib and Trastuzumab is a safe and tolerable regimen and is associated with clinical efficacy in a heavily pre-treated metastatic HER2-positive breast cancer population. Translational studies may have identified novel resistance biomarkers in this pt cohort.
Citation Format: Lisa Prior, Niamh M Keegan, Simon J Furney, Janice M Walshe, Giuseppe Gullo, John Crown, M John Kennedy, Diarmuid Smith, John McCaffrey, Catherine M Kelly, Keith Egan, Jennifer Kerr, Mark Given, Niall Sheehy, Peter O'Donovan, Andres Hernando, Ausra Teiserskiene, Imelda Parker, Elaine Kay, Ray McDermott, Maccon M Keane, Seamus O'Reilly, Liam Grogan, Oscar Breathnach, Patrick G Morris, Sinead Toomey, Bryan T Hennessy. Phase Ib/II trial evaluating safety and efficacy of copanlisib (PI3K inhibitor) and trastuzumab in pre-treated advanced HER2-positive breast cancer: Results from the PantHER study [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 P5-16-08.
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Affiliation(s)
- Lisa Prior
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh M Keegan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St James's Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Keith Egan
- Cancer Clinical Trials & Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Niall Sheehy
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Peter O'Donovan
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Elaine Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | | | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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22
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Pfeiffer S, Tomašcová A, Mamrak U, Haunsberger SJ, Connolly NMC, Resler A, Düssmann H, Weisová P, Jirström E, D'Orsi B, Chen G, Cremona M, Hennessy BT, Plesnila N, Prehn JHM. AMPK-regulated miRNA-210-3p is activated during ischaemic neuronal injury and modulates PI3K-p70S6K signalling. J Neurochem 2021; 159:710-728. [PMID: 33694332 DOI: 10.1111/jnc.15347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
Progressive neuronal injury following ischaemic stroke is associated with glutamate-induced depolarization, energetic stress and activation of AMP-activated protein kinase (AMPK). We here identify a molecular signature associated with neuronal AMPK activation, as a critical regulator of cellular response to energetic stress following ischaemia. We report a robust induction of microRNA miR-210-3p both in vitro in primary cortical neurons in response to acute AMPK activation and following ischaemic stroke in vivo. Bioinformatics and reverse phase protein array analysis of neuronal protein expression changes in vivo following administration of a miR-210-3p mimic revealed altered expression of phosphatase and tensin homolog (PTEN), 3-phosphoinositide-dependent protein kinase 1 (PDK1), ribosomal protein S6 kinase (p70S6K) and ribosomal protein S6 (RPS6) signalling in response to increasing miR-210-3p. In vivo, we observed a corresponding reduction in p70S6K activity following ischaemic stroke. Utilizing models of glutamate receptor over-activation in primary neurons, we demonstrated that induction of miR-210-3p was accompanied by sustained suppression of p70S6K activity and that this effect was reversed by miR-210-3p inhibition. Collectively, these results provide new molecular insight into the regulation of cell signalling during ischaemic injury, and suggest a novel mechanism whereby AMPK regulates miR-210-3p to control p70S6K activity in ischaemic stroke and excitotoxic injury.
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Affiliation(s)
- Shona Pfeiffer
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anna Tomašcová
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Biomedical Centre Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Uta Mamrak
- Institute for Stroke and Dementia Research (ISD), Munich, Germany
| | - Stefan J Haunsberger
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh M C Connolly
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alexa Resler
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Heiko Düssmann
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Petronela Weisová
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elisabeth Jirström
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Center, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Beatrice D'Orsi
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Institute of Neuroscience, Italian National Research Council (CNR), Pisa, Italy
| | - Gang Chen
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mattia Cremona
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Dept of Molecular Medicine (Medical Oncology group), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bryan T Hennessy
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Dept of Molecular Medicine (Medical Oncology group), Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD), Munich, Germany
- Munich Cluster of Systems Neurology (Synergy), Munich, Germany
| | - Jochen H M Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Center, Royal College of Surgeons Ireland, Dublin, Ireland
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23
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Linehan A, Fitzpatrick O, Cowzer D, Hennessy MA, Coyne ZL, Nolan A, Clarke M, Dhonaill RN, Hennessy BT, Morris PG, Grogan L, Breathnach O. COVID-19-related mortality in cancer patients in an Irish setting. Ir J Med Sci 2021; 191:2013-2018. [PMID: 34697787 PMCID: PMC8545357 DOI: 10.1007/s11845-021-02815-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Background The COVID-19 pandemic has impacted significantly on healthcare across the globe. It has been reported to have higher incidence and be associated with worse outcomes in patients with cancer. Aim To examine the characteristics of patients with cancer who were diagnosed with COVID-19 and to identify factors which may predict a poorer outcome. Methods Patients attending oncology services in Beaumont Hospital who were diagnosed with COVID-19 between March and May 2020 were included. Demographics and outcomes were determined by chart review. Results Twenty-seven patients were included in the study. The median age was 62; 59% were male. Ten patients (37%) died all of whom had metastatic or incurable locally advanced disease. Patients with lung cancer had a higher rate of COVID-19 and poorer outcomes. Those with a performance status (PS) ≥ 3 were more likely to die than those with PS ≤ 2. Compared to those who recovered, patients who died had a higher number of organs affected by cancer and a higher mean Palliative Prognostic Score. Conclusion Patients attending oncology services during the initial phase of the COVID-19 pandemic had an increased rate of SARS-CoV-2 infection and a higher mortality rate than the general population. Those who died had more advanced cancer as demonstrated by poorer performance status, a greater burden of metastatic disease and a higher Palliative Prognostic Score.
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Affiliation(s)
- Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Orla Fitzpatrick
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Maeve A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Zac L Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Amy Nolan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Maeve Clarke
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Roisin Ni Dhonaill
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
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24
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Johnstone KLF, Toomey S, Madden S, O'Neill BDP, Hennessy BT. Fusobacterium nucleatum: caution with interpreting historical patient sample cohort. J Pathol Transl Med 2021; 55:415-418. [PMID: 34555886 PMCID: PMC8601950 DOI: 10.4132/jptm.2021.08.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kate L F Johnstone
- Medical Oncology Laboratory, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Laboratory, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Bryan T Hennessy
- Medical Oncology Laboratory, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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25
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Smyth RJ, Thomas V, Fay J, Ryan R, Nicholson S, Morgan RK, Grogan L, Breathnach O, Morris PG, Toomey S, Hennessy BT, Furney SJ. Tumour Genome Characterization of a Rare Case of Pulmonary Enteric Adenocarcinoma and Prior Colon Adenocarcinoma. J Pers Med 2021; 11:jpm11080768. [PMID: 34442412 PMCID: PMC8398793 DOI: 10.3390/jpm11080768] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022] Open
Abstract
Pulmonary enteric adenocarcinoma (PEAC) is a rare variant of lung adenocarcinoma first described in the early 1990s in a lung tumour with overlapping lung and small intestine features. It is a rare tumour with fewer than 300 cases described in the published literature and was only formally classified in 2011. Given these characteristics the diagnosis is challenging, but even more so in a patient with prior gastrointestinal malignancy. A 68-year-old Caucasian female presented with a cough and was found to have a right upper lobe mass. Her history was significant for a pT3N1 colon adenocarcinoma. The resected lung tumour showed invasive lung adenocarcinoma but also features of colorectal origin. Immuno-stains were strongly and diffusely positive for lung and enteric markers. Multi-region, whole-exome sequencing of the mass and archival tissue from the prior colorectal cancer showed distinct genomic signatures with higher mutational burden in the PEAC and very minimal overlap in mutations between the two tumours. This case highlights the challenge of diagnosing rare lung tumours, but more specifically PEAC in a patient with prior gastro-intestinal cancer. Our use of multi-region, next-generation sequencing revealed distinct genomic signatures between the two tumours further supporting our diagnosis, and evidence of PEAC intra-tumour heterogeneity.
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Affiliation(s)
- Robert J. Smyth
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Valentina Thomas
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland;
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Joanna Fay
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
| | - Ronan Ryan
- Department of Histopathology, St James’s Hospital, D08 NHY1 Dublin, Ireland; (R.R.); (S.N.)
| | - Siobhan Nicholson
- Department of Histopathology, St James’s Hospital, D08 NHY1 Dublin, Ireland; (R.R.); (S.N.)
| | - Ross K. Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin and Royal College of Surgeons of Ireland, D02 YN77 Dublin, Ireland;
| | - Liam Grogan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Oscar Breathnach
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Patrick G. Morris
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
| | - Bryan T. Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
- Correspondence: (B.T.H.); (S.J.F.)
| | - Simon J. Furney
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland;
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
- Correspondence: (B.T.H.); (S.J.F.)
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26
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Prior L, O'Dwyer R, Farooq AR, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Othman EC, Watson G, Kelly D, Gleeson J, Kiely L, Hassan A, Walsh EM, O'Reilly D, Jones A, Featherstone H, Lim M, Murray H, Hennessy BT, Smyth LM, Leonard G, Grogan L, Breathnach O, Calvert P, Horgan AM, Coate L, Jordan EJ, O'Mahony D, Gupta R, Keane MM, Westrup J, Duffy K, O'Connor M, Morris PG, Kennedy MJ, O'Reilly S, McCaffrey J, Kelly CM, Carney D, Gullo G, Crown J, Higgins MJ, Walsh PM, Walshe JM. Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study. Breast Cancer Res Treat 2021; 189:269-283. [PMID: 34125341 DOI: 10.1007/s10549-021-06263-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes. METHODS This was a national, multi-site, retrospective observational study, including PABC patients treated in 12 oncology institutions from August 2001 to January 2020. Data extracted included information on patient demographics, tumour biology, staging, treatments, and maternal/foetal outcomes. Survival data for an age-matched breast cancer population over a similar time period was obtained from the National Cancer Registry of Ireland (NCRI). Standard biostatistical methods were used for analyses. RESULTS We identified 155 patients-71 (46%) were gp-PABC and 84 (54%) were pp-PABC. The median age was 36 years. Forty-four patients (28%) presented with Stage III disease and 25 (16%) had metastatic disease at diagnosis. High rates of triple-negative (25%) and HER2+ (30%) breast cancer were observed. We observed an inferior 5-year overall survival (OS) rate in our PABC cohort compared to an age-matched breast cancer population in both Stage I-III (77.6% vs 90.9%) and Stage IV disease (18% vs 38.3%). There was a low rate (3%) of foetal complications. CONCLUSION PABC patients may have poorer survival outcomes. Further prospective data are needed to optimise management of these patients.
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Affiliation(s)
- Lisa Prior
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland.
| | - Richard O'Dwyer
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | - Megan Greally
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cian Ward
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Connor O'Leary
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Razia Aslam
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Nada Ahmed
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Elly Che Othman
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Geoffrey Watson
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Deirdre Kelly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Jack Gleeson
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lisa Kiely
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Anees Hassan
- Department of Medical Oncology, Tallaght University Hospital, Dublin, Ireland
| | - Elaine M Walsh
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alfred Jones
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hannah Featherstone
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marvin Lim
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Hazel Murray
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lillian M Smyth
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory Leonard
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Paula Calvert
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Linda Coate
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Emmet J Jordan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Deirdre O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Rajnish Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Jennifer Westrup
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Karen Duffy
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Miriam O'Connor
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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27
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Eustace AJ, Madden SF, Fay J, Collins DM, Kay EW, Sheehan KM, Furney S, Moran B, Fagan A, Morris PG, Teiserskiene A, Hill AD, Grogan L, Walshe JM, Breathnach O, Power C, Duke D, Egan K, Gallagher WM, O'Donovan N, Crown J, Toomey S, Hennessy BT. The role of infiltrating lymphocytes in the neo-adjuvant treatment of women with HER2-positive breast cancer. Breast Cancer Res Treat 2021; 187:635-645. [PMID: 33983492 PMCID: PMC8197702 DOI: 10.1007/s10549-021-06244-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Pre-treatment tumour-associated lymphocytes (TILs) and stromal lymphocytes (SLs) are independent predictive markers of future pathological complete response (pCR) in HER2-positive breast cancer. Whilst studies have correlated baseline lymphocyte levels with subsequent pCR, few have studied the impact of neoadjuvant therapy on the immune environment. Methods We performed TIL analysis and T-cell analysis by IHC on the pretreatment and ‘On-treatment’ samples from patients recruited on the Phase-II TCHL (NCT01485926) clinical trial. Data were analysed using the Wilcoxon signed-rank test and the Spearman rank correlation. Results In our sample cohort (n = 66), patients who achieved a pCR at surgery, post-chemotherapy, had significantly higher counts of TILs (p = 0.05) but not SLs (p = 0.08) in their pre-treatment tumour samples. Patients who achieved a subsequent pCR after completing neo-adjuvant chemotherapy had significantly higher SLs (p = 9.09 × 10–3) but not TILs (p = 0.1) in their ‘On-treatment’ tumour biopsies. In a small cohort of samples (n = 16), infiltrating lymphocyte counts increased after 1 cycle of neo-adjuvant chemotherapy only in those tumours of patients who did not achieve a subsequent pCR. Finally, reduced CD3 + (p = 0.04, rho = 0.60) and CD4 + (p = 0.01, rho = 0.72) T-cell counts in 'On-treatment' biopsies were associated with decreased residual tumour content post-1 cycle of treatment; the latter being significantly associated with increased likelihood of subsequent pCR (p < 0.01). Conclusions The immune system may be ‘primed’ prior to neoadjuvant treatment in those patients who subsequently achieve a pCR. In those patients who achieve a pCR, their immune response may return to baseline after only 1 cycle of treatment. However, in those who did not achieve a pCR, neo-adjuvant treatment may stimulate lymphocyte influx into the tumour. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06244-1.
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Affiliation(s)
- A J Eustace
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
| | - S F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - E W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S Furney
- Department of Physiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - A Fagan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - A D Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - J M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - O Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - C Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Duke
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - W M Gallagher
- Conway Institute, University College Dublin, Dublin, Ireland
| | - N O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - J Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Cancer Trials Ireland, Dublin, Ireland
| | - S Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B T Hennessy
- Cancer Trials Ireland, Dublin, Ireland.,Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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28
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Keogh RJ, Milewski M, Browne K, Egan K, Hennessy MA, Coyne Z, Cowzer D, Linehan A, Hennessy BT, Grogan L, Morris PG, Breathnach OS. An exploration of the impact of ethanol diluent on breath alcohol concentration in patients receiving paclitaxel chemotherapy. Cancer Chemother Pharmacol 2021; 88:307-312. [PMID: 33944970 DOI: 10.1007/s00280-021-04279-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to provide a better understanding of the impact of paclitaxel chemotherapy on breath alcohol in an Irish population. METHODS Patients attending the Oncology Day Unit at Beaumont Hospital were invited to participate on the day of their treatment. The brand of paclitaxel used was Actavis Pharma Inc and contained 6 mg/mL paclitaxel in 50% Ethanol/ 50% Cremophor EL. Breath alcohol concentration was measured using the AlcoSense ™ Breathalyser on three separate visits. The primary end-point was the number of patients who were above the legal threshold for drink driving in Ireland. RESULTS In total, 50 patients were recruited. 36 (68%) were female. The most common diagnosis was breast cancer (56%). Ten (20%) patients had metastatic disease and 4 (8%) had liver metastases. The mean paclitaxel dose administered was 118 mg. The mean amount of ethanol infused was 7.7 g. 27 patients had a detectable breath alcohol level on at least one visit. The mean breath alcohol concentration was 2 mcg/100 mL or 0.02 mg/L of breath. The maximum concentration of ethanol in exhaled breath was 11 mcg/100 mL or 0.11 mg/L which is 50% of the statutory limit for drink driving in Ireland. A weak correlation was observed between ethanol concentration in exhaled breath and the total amount of ethanol administered. Although no patient exceeded the general limit for drink driving in Ireland, three (6%) participants had a breath alcohol concentration above the threshold for professional, learner or novice drivers. CONCLUSION Although definitive conclusions are limited by relatively small numbers, it seems unlikely that weekly paclitaxel infusions pose any significant risk to patients driving.
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Affiliation(s)
- R J Keogh
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.
| | - M Milewski
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - K Browne
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - M A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Z Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - D Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | | | - B T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - O S Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
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Mezynski MJ, Farrelly AM, Cremona M, Carr A, Morgan C, Workman J, Armstrong P, McAuley J, Madden S, Fay J, Sheehan KM, Kay EW, Holohan C, Elamin Y, Rafee S, Morris PG, Breathnach O, Grogan L, Hennessy BT, Toomey S. Targeting the PI3K and MAPK pathways to improve response to HER2-targeted therapies in HER2-positive gastric cancer. J Transl Med 2021; 19:184. [PMID: 33933113 PMCID: PMC8088633 DOI: 10.1186/s12967-021-02842-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/10/2021] [Accepted: 04/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Aberrant PI3K signalling is implicated in trastuzumab resistance in HER2-positive gastric cancer (GC). The role of PI3K or MEK inhibitors in sensitising HER2-positive GCs to trastuzumab or in overcoming trastuzumab resistance is unclear. Methods Using mass spectrometry-based genotyping we analysed 105 hotspot, non-synonymous somatic mutations in PIK3CA and ERBB-family (EGFR, ERBB2, ERBB3 and ERBB4) genes in gastric tumour samples from 69 patients. A panel of gastric cell lines (N87, OE19, ESO26, SNU16, KATOIII) were profiled for anti-proliferative response to the PI3K inhibitor copanlisib and the MEK1/2 inhibitor refametinib alone and in combination with anti-HER2 therapies. Results Patients with HER2-positive GC had significantly poorer overall survival compared to HER2-negative patients (15.9 months vs. 35.7 months). Mutations in PIK3CA were only identified in HER2-negative tumours, while ERBB-family mutations were identified in HER2-positive and HER2-negative tumours. Copanlisib had anti-proliferative effects in 4/5 cell lines, with IC50s ranging from 23.4 (N87) to 93.8 nM (SNU16). All HER2-positive cell lines except SNU16 were sensitive to lapatinib (IC50s 0.04 µM–1.5 µM). OE19 cells were resistant to trastuzumab. The combination of lapatinib and copanlisib was synergistic in ESO-26 and OE-19 cells (ED50: 0.83 ± 0.19 and 0.88 ± 0.13, respectively) and additive in NCI-N87 cells (ED50:1.01 ± 0.55). The combination of copanlisib and trastuzumab significantly improved growth inhibition compared to either therapy alone in NCI-N87, ESO26 and OE19 cells (p < 0.05). Conclusions PI3K or MEK inhibition alone or in combination with anti-HER2 therapy may represent an improved treatment strategy for some patients with HER2-positive GC, and warrants further investigation in a clinical trial setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02842-1.
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Affiliation(s)
- M Janusz Mezynski
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Angela M Farrelly
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Clare Morgan
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Julie Workman
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Paul Armstrong
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Jennifer McAuley
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joanna Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Katherine M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ciara Holohan
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Yasir Elamin
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Shereen Rafee
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland.
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Kalachand RD, Stordal B, Madden S, Chandler B, Cunningham J, Goode EL, Ruscito I, Braicu EI, Sehouli J, Ignatov A, Yu H, Katsaros D, Mills GB, Lu KH, Carey MS, Timms KM, Kupryjanczyk J, Rzepecka IK, Podgorska A, McAlpine JN, Swisher EM, Bernards SS, O'Riain C, O'Toole S, O'Leary JJ, Bowtell DD, Thomas DM, Prieske K, Joosse SA, Woelber L, Chaudhry P, Häfner N, Runnebaum IB, Hennessy BT. BRCA1 Promoter Methylation and Clinical Outcomes in Ovarian Cancer: An Individual Patient Data Meta-Analysis. J Natl Cancer Inst 2021; 112:1190-1203. [PMID: 32413141 DOI: 10.1093/jnci/djaa070] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND BRCA1 methylation has been associated with homologous recombination deficiency, a biomarker of platinum sensitivity. Studies evaluating BRCA1-methylated tubal and ovarian cancer (OC) do not consistently support improved survival following platinum chemotherapy. We examine the characteristics of BRCA1-methylated OC in a meta-analysis of individual participant data. METHODS Data of 2636 participants across 15 studies were analyzed. BRCA1-methylated tumors were defined according to their original study. Associations between BRCA1 methylation and clinicopathological characteristics were evaluated. The effects of methylation on overall survival (OS) and progression-free survival (PFS) were examined using mixed-effects models. All statistical tests were 2-sided. RESULTS 430 (16.3%) tumors were BRCA1-methylated. BRCA1 methylation was associated with younger age and advanced-stage, high-grade serous OC. There were no survival differences between BRCA1-methylated and non-BRCA1-methylated OC (median PFS = 20.0 vs 18.5 months, hazard ratio [HR] = 1.01, 95% CI = 0.87 to 1.16; P = .98; median OS = 46.6 vs 48.0 months, HR = 1.02, 95% CI = 0.87 to 1.18; P = .96). Where BRCA1/2 mutations were evaluated (n = 1248), BRCA1 methylation displayed no survival advantage over BRCA1/2-intact (BRCA1/2 wild-type non-BRCA1-methylated) OC. Studies used different methods to define BRCA1 methylation. Where BRCA1 methylation was determined using methylation-specific polymerase chain reaction and gel electrophoresis (n = 834), it was associated with improved survival (PFS: HR = 0.80, 95% CI = 0.66 to 0.97; P = .02; OS: HR = 0.80, 95% CI = 0.63 to 1.00; P = .05) on mixed-effects modeling. CONCLUSION BRCA1-methylated OC displays similar clinicopathological features to BRCA1-mutated OC but is not associated with survival. Heterogeneity within BRCA1 methylation assays influences associations. Refining these assays may better identify cases with silenced BRCA1 function and improved patient outcomes.
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Affiliation(s)
- Roshni D Kalachand
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Britta Stordal
- Department of Natural Sciences, Middlesex University, Hendon, London NW4 4BT, UK
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin, Ireland
| | - Benjamin Chandler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Julie Cunningham
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen L Goode
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ilary Ruscito
- Department of Gynecology, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Cell Therapy Unit and Laboratory of Tumor Immunology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena I Braicu
- Department of Gynecology, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany
| | - Herbert Yu
- University of Hawaii Cancer Centre, Honolulu, HI, USA
| | - Dionyssios Katsaros
- AOU Citta della Salute and Department of Surgical Sciences, Gynecologic Oncology, University of Torino, Italy
| | - Gordon B Mills
- Department of Cell, Development and Cancer Biology Knight Cancer Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Karen H Lu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark S Carey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jolanta Kupryjanczyk
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Iwona K Rzepecka
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Agnieszka Podgorska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Jessica N McAlpine
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Ciaran O'Riain
- Department of Histopathology, Trinity College Dublin, Central Pathology Laboratory, St. James's Hospital, Dublin, Ireland
| | - Sharon O'Toole
- Department of Obstetrics and Gynaecology/Histopathology, Trinity College Dublin, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland.,Emer Casey Research Laboratory, Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin, Central Pathology Laboratory, St. James's Hospital, Dublin, Ireland.,Emer Casey Research Laboratory, Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - David M Thomas
- Genomic Cancer Medicine, Cancer Division, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, Australia
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Parvesh Chaudhry
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Norman Häfner
- Department for Gynaecology and Reproductive Medicine, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Ingo B Runnebaum
- Department for Gynaecology and Reproductive Medicine, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.,Our Lady of Lourdes Hospital, Drogheda, Ireland
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Abstract
Vitamin D is a potent steroid hormone that induces widespread changes in gene expression and controls key biological pathways. Here we review pathophysiology of vitamin D with particular reference to COVID-19 and pancreatic cancer. Utility as a therapeutic agent is limited by hypercalcemic effects and attempts to circumvent this problem have used vitamin D superagonists, with increased efficacy and reduced calcemic effect. A further caveat is that vitamin D mediates multiple diverse effects. Some of these (anti-fibrosis) are likely beneficial in patients with COVID-19 and pancreatic cancer, whereas others (reduced immunity), may be beneficial through attenuation of the cytokine storm in patients with advanced COVID-19, but detrimental in pancreatic cancer. Vitamin D superagonists represent an untapped resource for development of effective therapeutic agents. However, to be successful this approach will require agonists with high cell-tissue specificity.
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Affiliation(s)
- David J. Easty
- Department of Medical Oncology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Christine J. Farr
- Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Bryan T. Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Oncology, Our Lady of Lourdes Hospital, Drogheda, Ireland
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32
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Keogh RJ, Aslam R, Hennessy MA, Coyne Z, Hennessy BT, Breathnach OS, Grogan L, Morris PG. One year of procarbazine lomustine and vincristine is poorly tolerated in low grade glioma: a real world experience in a national neuro-oncology centre. BMC Cancer 2021; 21:140. [PMID: 33557783 PMCID: PMC7869199 DOI: 10.1186/s12885-021-07809-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/24/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Following optimal local therapy, adjuvant Procarbazine, Lomustine and Vincristine (PCV) improves overall survival (OS) in low-grade glioma (LGG). However, 1 year of PCV is associated with significant toxicities. In the pivotal RTOG 9802 randomised control trial, approximately half of the patients discontinued treatment after 6 months. As patients on clinical trials may be fitter, we aimed to further explore the tolerability of PCV chemotherapy in routine clinical practice. Methods We conducted a retrospective study between 2014 and 2018 at a National Neuro-Oncology centre. Patients who had received PCV during this time period were included. The primary objective was to assess tolerability of treatment. Secondary objectives included evaluation of treatment delays, dose modifications and toxicities. Results Overall, 41 patients were included, 24 (58%) were male and 21 (51%) aged ≥40 years. 38 (93%) underwent surgical resection and all patients received adjuvant radiotherapy prior to chemotherapy. The median number of cycles completed was 3,2,4 for procarbazine, lomustine and vincristine respectively. Only 4 (10%) completed all 6 cycles of PCV without dose modifications. There was a universal decline in dose intensity as cycles of chemotherapy progressed. Dose intensity for cycle 1 versus cycle 6 respectively: procarbazine (98% versus 46%), lomustine (94% versus 48%) and vincristine (93% versus 50%). Haematological toxicities were common. Six (14%) patients experienced Grade III-IV thrombocytopaenia and 13 (31%) experienced Grade III-IV neutropaenia. Conclusion Toxicities are frequently observed with the PCV regimen in clinical practice. It might be preferable to adjust doses from the start of chemotherapy to improve tolerability or consider alternative chemotherapy, particularly in older patients with LGG.
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Affiliation(s)
- Rachel J Keogh
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Razia Aslam
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Maeve A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Zac Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Oscar S Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland. .,Royal College of Surgeons Ireland, Dublin, Ireland.
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Hennessy MA, Linehan A, Cowzer D, Coyne ZL, Fitzpatrick O, Barrett F, Ni Dhonaill R, Hennessy BT, Grogan L, Morris PG, Breathnach OS. Chemotherapy in the Covid-19 era: the patient's perception. Ir J Med Sci 2021; 190:1303-1308. [PMID: 33449325 PMCID: PMC7809239 DOI: 10.1007/s11845-020-02457-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/11/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Background The Covid-19 pandemic poses significant challenges for the management of patients with cancer. In our institution, we adapted our delivery of outpatient systemic anti-cancer therapy (SACT) by introducing a number of ‘risk-reducing’ measures including pre-assessment screening. Aims We sought to evaluate the experience and perceptions of patients with cancer undergoing SACT during the Covid-19 pandemic. Methods Patients on SACT during the Covid-19 pandemic were eligible for participation. Data were collected by anonymous survey over a 1 week period during the most intensive phase of government restrictions. Patients were asked questions under three headings: perceived risk of infection exposure, changes to treatment plan and psychological impact of Covid-19. Results One hundred patients were assessed, 60% were male, 41% were > 65 years of age and 67% had advanced cancer. Eleven percent of patients were living alone. Fifty-seven percent reported feeling at increased risk in general of contracting Covid-19. Sixty-eight percent of patients did not feel worried about contracting Covid-19 in the hospital. Ninety-two percent of patients reported wanting to continue on SACT as originally planned. Fifty-eighty percent felt isolated and 40% reported increased anxiety. Conclusion Though patients on active treatment for cancer during the Covid-19 pandemic reported increased anxiety and feelings of isolation due to Covid-19, the majority of patients wanted to continue SACT as originally planned. Patients would benefit from enhanced psycho-oncological supports in the event of a prolonged Covid-19 pandemic.
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Affiliation(s)
- Maeve A Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Zachary L Coyne
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | | | - Fiona Barrett
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | | | - Bryan T Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.
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Ryan DJ, Toomey S, Madden SF, Casey M, Breathnach OS, Morris PG, Grogan L, Branagan P, Costello RW, De Barra E, Hurley K, Gunaratnam C, McElvaney NG, OBrien ME, Sulaiman I, Morgan RK, Hennessy BT. Use of exhaled breath condensate (EBC) in the diagnosis of SARS-COV-2 (COVID-19). Thorax 2021; 76:86-88. [PMID: 33097604 PMCID: PMC7590263 DOI: 10.1136/thoraxjnl-2020-215705] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
False negatives from nasopharyngeal swabs (NPS) using reverse transcriptase PCR (RT-PCR) in SARS-CoV-2 are high. Exhaled breath condensate (EBC) contains lower respiratory droplets that may improve detection. We performed EBC RT-PCR for SARS-CoV-2 genes (E, S, N, ORF1ab) on NPS-positive (n=16) and NPS-negative/clinically positive COVID-19 patients (n=15) using two commercial assays. EBC detected SARS-CoV-2 in 93.5% (29/31) using the four genes. Pre-SARS-CoV-2 era controls (n=14) were negative. EBC was positive in NPS negative/clinically positive patients in 66.6% (10/15) using the identical E and S (E/S) gene assay used for NPS, 73.3% (11/15) using the N/ORF1ab assay and 14/15 (93.3%) combined.
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Affiliation(s)
- Daniel J Ryan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michelle Casey
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | | | - Liam Grogan
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Peter Branagan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Eoghan De Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Killian Hurley
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Imran Sulaiman
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Ross K Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
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Collins DM, Madden SF, Gaynor N, AlSultan D, Le Gal M, Eustace AJ, Gately KA, Hughes C, Davies AM, Mahgoub T, Ballot J, Toomey S, O'Connor DP, Gallagher WM, Holmes FA, Espina V, Liotta L, Hennessy BT, O'Byrne KJ, Hasmann M, Bossenmaier B, O'Donovan N, Crown J. Effects of HER Family-targeting Tyrosine Kinase Inhibitors on Antibody-dependent Cell-mediated Cytotoxicity in HER2-expressing Breast Cancer. Clin Cancer Res 2020; 27:807-818. [PMID: 33122343 DOI: 10.1158/1078-0432.ccr-20-2007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Antibody-dependent cell-mediated cytotoxicity (ADCC) is one mechanism of action of the monoclonal antibody (mAb) therapies trastuzumab and pertuzumab. Tyrosine kinase inhibitors (TKIs), like lapatinib, may have added therapeutic value in combination with mAbs through enhanced ADCC activity. Using clinical data, we examined the impact of lapatinib on HER2/EGFR expression levels and natural killer (NK) cell gene signatures. We investigated the ability of three TKIs (lapatinib, afatinib, and neratinib) to alter HER2/immune-related protein levels in preclinical models of HER2-positive (HER2+) and HER2-low breast cancer, and the subsequent effects on trastuzumab/pertuzumab-mediated ADCC. EXPERIMENTAL DESIGN Preclinical studies (proliferation assays, Western blotting, high content analysis, and flow cytometry) employed HER2+ (SKBR3 and HCC1954) and HER2-low (MCF-7, T47D, CAMA-1, and CAL-51) breast cancer cell lines. NCT00524303 provided reverse phase protein array-determined protein levels of HER2/pHER2/EGFR/pEGFR. RNA-based NK cell gene signatures (CIBERSORT/MCP-counter) post-neoadjuvant anti-HER2 therapy were assessed (NCT00769470/NCT01485926). ADCC assays utilized flow cytometry-based protocols. RESULTS Lapatinib significantly increased membrane HER2 levels, while afatinib and neratinib significantly decreased levels in all preclinical models. Single-agent lapatinib increased HER2 or EGFR levels in 10 of 11 (91%) tumor samples. NK cell signatures increased posttherapy (P = 0.03) and associated with trastuzumab response (P = 0.01). TKI treatment altered mAb-induced NK cell-mediated ADCC in vitro, but it did not consistently correlate with HER2 expression in HER2+ or HER2-low models. The ADCC response to trastuzumab and pertuzumab combined did not exceed either mAb alone. CONCLUSIONS TKIs differentially alter tumor cell phenotype which can impact NK cell-mediated response to coadministered antibody therapies. mAb-induced ADCC response is relevant when rationalizing combinations for clinical investigation.
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Affiliation(s)
- Denis M Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland.
| | - Stephen F Madden
- RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin, Ireland
| | - Nicola Gaynor
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland
| | - Dalal AlSultan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland.,RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin, Ireland
| | - Marion Le Gal
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland
| | - Alex J Eustace
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland
| | - Kathy A Gately
- Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - Clare Hughes
- Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - Anthony M Davies
- Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - Thamir Mahgoub
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland
| | - Jo Ballot
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Sinead Toomey
- RCSI Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Education & Research Centre, Beaumont Hospital, Beaumont, Dublin, Ireland
| | - Darran P O'Connor
- Royal College of Surgeons in Ireland, School of Pharmacy & Biomolecular Science, Dublin, Ireland
| | - William M Gallagher
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Frankie A Holmes
- Texas Oncology-Memorial Hermann Memorial City, US Oncology Research, Houston, -Texas
| | - Virginia Espina
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Lance Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Bryan T Hennessy
- RCSI Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Education & Research Centre, Beaumont Hospital, Beaumont, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Kenneth J O'Byrne
- Princess Alexandra Hospital, Translational Research Institute and Queensland University of Technology, Brisbane, Queensland, Australia
| | - Max Hasmann
- Roche Innovation Center Penzberg, Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Norma O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland
| | - John Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland.,Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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Mullally WJ, Keane F, Nolan A, Grogan L, Breathnach OS, Hennessy BT, Collins DC, Morris PG. Lack of familiarity with genetic testing among patients in Ireland with Cancer. Ir J Med Sci 2020; 190:547-553. [PMID: 32813148 DOI: 10.1007/s11845-020-02333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer gene panel testing is available in Ireland. The need for a clear strategy to deal with patient information generated from tumour genomic testing is recognised as a challenge in the National Cancer Strategy. However, the public's attitude and opinions regarding these results is not known in Ireland. AIMS This prospective questionnaire study assessed the knowledge and opinions of patients in a national oncology centre, surrounding cancer gene panel testing. METHODS An anonymised modified validated questionnaire was completed by volunteering patients in the medical oncology department. It comprised 14 questions which assessed patient's familiarity, intention, benefits and concerns associated with tumour genetic testing using a four-point Likert scale. Patients recorded their primary cancer diagnosis and family cancer history. RESULTS Eighty-four patients completed the questionnaire with 77 (92%) patients declaring their primary cancer diagnosis. The median age was 56 (range 26 to 83) years. Overall, 42% (n = 35) of oncology patients were familiar/somewhat familiar with testing and 90% (n = 76) stated they would avail of genetic testing if available. Patients with breast cancer were no more likely to avail of genetic testing when compared with the non-breast cancer cohort (n = 21 vs. 56, p = 0.58) though they identified concerns with potential discrimination. CONCLUSION This is the first prospective Irish study to assess opinions surrounding cancer gene results. Addressing patient's lack of information as regards genetic testing is the first step in establishing a national cancer genetics testing programme in Ireland.
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Affiliation(s)
| | - Fergus Keane
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Amy Nolan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Liam Grogan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
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Lindner AU, Carberry S, Monsefi N, Barat A, Salvucci M, O'Byrne R, Zanella ER, Cremona M, Hennessy BT, Bertotti A, Trusolino L, Prehn JHM. Systems analysis of protein signatures predicting cetuximab responses in
KRAS
,
NRAS
,
BRAF
and
PIK3CA
wild‐type patient‐derived xenograft models of metastatic colorectal cancer. Int J Cancer 2020; 147:2891-2901. [DOI: 10.1002/ijc.33226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/22/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Andreas U. Lindner
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Steven Carberry
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Naser Monsefi
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Ana Barat
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Manuela Salvucci
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Robert O'Byrne
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
| | - Eugenia R. Zanella
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination Candiolo Cancer Institute Fondazione del Piemonte per l'Oncologia IRCCS Turin Italy
| | - Mattia Cremona
- Department of Medical Oncology Beaumont Hospital, Royal College of Surgeons in Ireland Dublin Ireland
| | - Bryan T. Hennessy
- Department of Medical Oncology Beaumont Hospital, Royal College of Surgeons in Ireland Dublin Ireland
| | - Andrea Bertotti
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination Candiolo Cancer Institute Fondazione del Piemonte per l'Oncologia IRCCS Turin Italy
- Department of Oncology University of Turin Medical School Turin Italy
| | - Livio Trusolino
- Translational Cancer Medicine, Surgical Oncology, and Clinical Trials Coordination Candiolo Cancer Institute Fondazione del Piemonte per l'Oncologia IRCCS Turin Italy
- Department of Oncology University of Turin Medical School Turin Italy
| | - Jochen H. M. Prehn
- Department of Physiology and Medical Physics and Centre Systems Medicine Royal College of Surgeons in Ireland Dublin Ireland
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Kaukonen D, Kaukonen R, Polit L, Hennessy BT, Lund R, Madden SF. Analysis of H3K4me3 and H3K27me3 bivalent promotors in HER2+ breast cancer cell lines reveals variations depending on estrogen receptor status and significantly correlates with gene expression. BMC Med Genomics 2020; 13:92. [PMID: 32620123 PMCID: PMC7333309 DOI: 10.1186/s12920-020-00749-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role of histone modifications is poorly characterized in breast cancer, especially within the major subtypes. While epigenetic modifications may enhance the adaptability of a cell to both therapy and the surrounding environment, the mechanisms by which this is accomplished remains unclear. In this study we focus on the HER2 subtype and investigate two histone trimethylations that occur on the histone 3; the trimethylation located at lysine 4 (H3K4me3) found in active promoters and the trimethylation located at lysine 27 (H3K27me3) that correlates with gene repression. A bivalency state is the result of the co-presence of these two marks at the same promoter. METHODS In this study we investigated the relationship between these histone modifications in promoter regions and their proximal gene expression in HER2+ breast cancer cell lines. In addition, we assessed these patterns with respect to the presence or absence of the estrogen receptor (ER). To do this, we utilized ChIP-seq and matching RNA-seq from publicly available data for the AU565, SKBR3, MB361 and UACC812 cell lines. In order to visualize these relationships, we used KEGG pathway enrichment analysis, and Kaplan-Meyer plots. RESULTS We found that the correlation between the three types of promoter trimethylation statuses (H3K4me3, H3K27me3 or both) and the expression of the proximal genes was highly significant overall, while roughly a third of all genes are regulated by this phenomenon. We also show that there are several pathways related to cancer progression and invasion that are associated with the bivalent status of the gene promoters, and that there are specific differences between ER+ and ER- HER2+ breast cancer cell lines. These specific differences that are differentially trimethylated are also shown to be differentially expressed in patient samples. One of these genes, HIF1AN, significantly correlates with patient outcome. CONCLUSIONS This study highlights the importance of looking at epigenetic markings at a subtype specific level by characterizing the relationship between the bivalent promoters and gene expression. This provides a deeper insight into a mechanism that could lead to future targets for treatment and prognosis, along with oncogenesis and response to therapy of HER2+ breast cancer patients.
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Affiliation(s)
- Damien Kaukonen
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Riina Kaukonen
- Turku Bioscience, University of Turku and Åbo Akademi University, Turku, Finland
| | - Lélia Polit
- Institute Cochin, University Paris Descartes, Paris, France
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Riikka Lund
- Turku Bioscience, University of Turku and Åbo Akademi University, Turku, Finland
| | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Barat A, Smeets D, Moran B, Zhang W, Cao S, Das S, Klinger R, Betge J, Murphy V, Bacon O, Kay EW, Van Grieken NCT, Verheul HMW, Gaiser T, Schulte N, Ebert MP, Fender B, Hennessy BT, McNamara DA, O'Connor D, Gallagher WM, Cremolini C, Loupakis F, Parikh A, Mancao C, Ylstra B, Lambrechts D, Lenz HJ, Byrne AT, Prehn JHM. Combination of variations in inflammation- and endoplasmic reticulum-associated genes as putative biomarker for bevacizumab response in KRAS wild-type colorectal cancer. Sci Rep 2020; 10:9778. [PMID: 32555399 PMCID: PMC7299973 DOI: 10.1038/s41598-020-65869-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/05/2020] [Indexed: 12/30/2022] Open
Abstract
Chemotherapy combined with the angiogenesis inhibitor bevacizumab (BVZ) is approved as a first-line treatment in metastatic colorectal cancer (mCRC). Limited clinical benefit underpins the need for improved understanding of resistance mechanisms and the elucidation of novel predictive biomarkers. We assessed germline single-nucleotide polymorphisms (SNPs) in 180 mCRC patients (Angiopredict [APD] cohort) treated with combined BVZ + chemotherapy and investigated previously reported predictive SNPs. We further employed a machine learning approach to identify novel associations. In the APD cohort IL8 rs4073 any A carriers, compared to TT carriers, were associated with worse progression-free survival (PFS) (HR = 1.51, 95% CI:1.03-2.22, p-value = 0.037) and TBK1 rs7486100 TT carriers, compared to any A carriers, were associated with worse PFS in KRAS wild-type (wt) patients (HR = 1.94, 95% CI:1.04-3.61, p-value = 0.037), replicating previous findings. Machine learning identified novel associations in genes encoding the inflammasome protein NLRP1 and the ER protein Sarcalumenin (SRL). A negative association between PFS and carriers of any A at NLRP1 rs12150220 and AA for SRL rs13334970 in APD KRAS wild-type patients (HR = 4.44, 95% CI:1.23-16.13, p-value = 0.005), which validated in two independent clinical cohorts involving BVZ, MAVERICC and TRIBE. Our findings highlight a key role for inflammation and ER signalling underpinning BVZ + chemotherapy responsiveness.
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Affiliation(s)
- Ana Barat
- Centre for Systems Medicine and Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Bruce Moran
- UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Wu Zhang
- USC Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Shu Cao
- USC Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Sudipto Das
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rut Klinger
- UCD, School of Biomolecular and Biomedical Science, Dublin, Ireland
| | - Johannes Betge
- Department of Medicine II, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Cancer Research Center (DKFZ), Division Signaling and Functional Genomics, Heidelberg, Germany
| | | | - Orna Bacon
- Centre for Systems Medicine and Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | | | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Timo Gaiser
- Institute of Pathology, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadine Schulte
- Department of Medicine II, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bozena Fender
- OncoMark Ltd., NovaUCD, Belfield Innovation Park, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Darran O'Connor
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Chiara Cremolini
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Fotios Loupakis
- Oncology Unit, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy
| | - Aparna Parikh
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, USA
| | - Christoph Mancao
- Oncology Biomarker Development, Genentech Inc., San Francisco, USA
| | - Bauke Ylstra
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Annette T Byrne
- Centre for Systems Medicine and Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jochen H M Prehn
- Centre for Systems Medicine and Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.
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coyne Z, Cowzer D, Hennessy M, Linehan A, Hennessy BT, Grogan W, Breathnach OS, Morris PG. Cannabis and cancer: Examining the use and perceived benefits in an Irish cancer cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24178 Background: Medicinal cannabis is currently approved for symptom control in cancer patients. There is limited evidence to suggest cannabis is efficacious in the treatment of cancer. In this study we aim to characterise the extent of cannabis use in patients receiving anti-cancer therapies and what impact they think cannabis use has on their cancer. Methods: An anonymous survey was distributed to patients with cancer attending the Beaumont Hospital Oncology Day Unit for anti-cancer therapy over a period of 4 weeks. Results: 175 patients completed the survey. 166 (95%) of patients said they would be comfortable talking to their oncologist about cannabis use. 161 (92%) felt their oncologist should prescribe cannabis as part of their cancer treatment. 17% thought cannabis would cure their cancer. 38% thought cannabis would slow the growth of their cancer and 33% thought cannabis would treat cancer related symptoms. 42 (24%) of all patients had tried some form of cannabis at least once in their life. 26 (15%) were actively taking CBD (Cannabidiol) oil as part of their treatment independently of any healthcare professional guidance. More females (15) were taking CBD compared to males (11). A higher proportion of patients < 50 years (14) were taking CBD during their treatment. 30% of patients using CBD had breast cancer and 23% had a primary CNS malignancy. Of the patients taking CBD, 20 (77%) patients felt it would cure or slow cancer growth and 10 (38%) patients believed it would help with cancer related symptoms. Conclusions: Patients with cancer appear to have a positive attitude towards cannabis as part of their treatment despite limited evidence to support this. With the increasing availability of cannabis-based products globally, medical oncologists must now take into consideration patient’s attitude towards cannabis while treating their cancer. [Table: see text]
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Affiliation(s)
- zac coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Cowzer D, Hennessy M, Linehan A, coyne Z, Creegan D, Glynn E, Hennessy BT, Morris PG, Grogan W, Breathnach OS. Patient knowledge and expectations of anti-cancer treatments in the advanced disease setting. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24187 Background: Systemic treatments can improve symptom burden and prolong life in patients with advanced cancer. However, these therapies come with associated toxicities and in some cases can result in reduced quality of life for patients with no possibility of cure. International data has suggested that this cohort of patients have a poor understanding surrounding the goals of treatment in the advanced disease setting. We aimed to evaluate the expectations for cure and palliation from systemic therapies among patients with advanced, incurable cancer in our institution. Methods: Patients on active treatment attending the Oncology Day Ward completed anonymous questionnaires over a four week period. Personal demographics, decision making for treatment and expectation of benefit and toxicity was assessed. Analysis was carried out on patients assessed to have advanced metastatic disease. Results: 254 patients completed the questionnaire. 217 patients were assessed to have metastatic/incurable disease based on responses. 57% were male, 56% were age 30-64 and 35% had completed university level education. 42% of patients stated that treatment was very likely or somewhat likely to cure their cancer. Among patients who reported that a cure was very likely, there were more men (62%) compared to women (38%), more patients were aged less than 65 (62%) compared to over 65 (38%) and more patients had only completed elementary school level education (71%) compared to university level education (29%). Most patients (84%) felt treatment was either very likely or somewhat likely to help them live longer. 68% of patients felt treatment would help them with problems related to their cancer and 33% of patients felt that treatment was very likely to have side effects or complications. 22% of patients stated that doctors made decisions without their input. Conclusions: Many patients receiving treatment for incurable cancers do not understand that it is unlikely to be curative. Male gender, younger age and a lower level of education appears to be associated with unrealistic expectations. This could compromise their ability to make informed treatment decisions. More effective communication around goals of treatment and end of life care may help to improve patients understanding and expectations around the outcomes of chemotherapy.
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Affiliation(s)
- Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - zac coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Daniel Creegan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Emily Glynn
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Breen L, Gaule PB, Canonici A, Walsh N, Collins DM, Cremona M, Hennessy BT, Duffy MJ, Crown J, Donovan NO, Eustace AJ. Targeting c-Met in triple negative breast cancer: preclinical studies using the c-Met inhibitor, Cpd A. Invest New Drugs 2020; 38:1365-1372. [PMID: 32318883 DOI: 10.1007/s10637-020-00937-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
Introduction Triple negative breast cancer (TNBC) represents a heterogeneous subtype of breast cancer that carries a poorer prognosis. There remains a need to identify novel drivers of TNBC, which may represent targets to treat the disease. c-Met overexpression is linked with decreased survival and is associated with the basal subtype of breast cancer. Cpd A, a kinase inhibitor selective/specific for Met kinase has demonstrated preclinical anti-cancer efficacy in TNBC. We aimed to assess the anti-cancer efficacy of Cpd A when combined with Src kinase, ErbB-family or hepatocyte growth factor (HGF) inhibitors in TNBC cell lines. Methods We determined the anti-proliferative effects of Cpd A, rilotumumab, neratinib and saracatinib tested alone and in combination in a panel of TNBC cells by acid phosphatase assays. We performed reverse phase protein array analysis of c-Met and IGF1Rβ expression and phosphorylation of c-Met (Y1234/1235) in TNBC cells and correlated their expression/phosphorylation with Cpd A sensitivity. We examined the impact of Cpd A, neratinib and saracatinib tested alone and in combination on invasive potential and colony formation.Results TNBC cells are not inherently sensitive to Cpd A, and neither c-Met expression nor phosphorylation are biomarkers of sensitivity to Cpd A. Cpd A enhanced the anti-proliferative effects of neratinib in vitro; however, this effect was limited to cell lines with innate sensitivity to Cpd A. Cpd A had limited anti-invasive effects but it reduced colony formation in the TNBC cell line panel.Conclusions Despite Cpd A having a potential role in reducing cancer cell metastasis, identification of strong predictive biomarkers of c-Met sensitivity would be essential to the development of a c-Met targeted treatment for an appropriately selected cohort of TNBC patients.
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Affiliation(s)
- Laura Breen
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Patricia B Gaule
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Alexandra Canonici
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Naomi Walsh
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Denis M Collins
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael J Duffy
- UCD Clinical Research Centre, St. Vincent's University Hospital, Dublin, Ireland
- UCD School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - John Crown
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Norma O' Donovan
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Alex J Eustace
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
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Toomey S, Carr A, Mezynski MJ, Elamin Y, Rafee S, Cremona M, Morgan C, Madden S, Abdul-Jalil KI, Gately K, Farrelly A, Kay EW, Kennedy S, O'Byrne K, Grogan L, Breathnach O, Morris PG, Eustace AJ, Fay J, Cummins R, O'Grady A, Kalachand R, O'Donovan N, Kelleher F, O'Reilly A, Doherty M, Crown J, Hennessy BT. Identification and clinical impact of potentially actionable somatic oncogenic mutations in solid tumor samples. J Transl Med 2020; 18:99. [PMID: 32087721 PMCID: PMC7036178 DOI: 10.1186/s12967-020-02273-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background An increasing number of anti-cancer therapeutic agents target specific mutant proteins that are expressed by many different tumor types. Successful use of these therapies is dependent on the presence or absence of somatic mutations within the patient’s tumor that can confer clinical efficacy or drug resistance. Methods The aim of our study was to determine the type, frequency, overlap and functional proteomic effects of potentially targetable recurrent somatic hotspot mutations in 47 cancer-related genes in multiple disease sites that could be potential therapeutic targets using currently available agents or agents in clinical development. Results Using MassArray technology, of the 1300 patient tumors analysed 571 (43.9%) had at least one somatic mutation. Mutations were identified in 30 different genes. KRAS (16.5%), PIK3CA (13.6%) and BRAF (3.8%) were the most frequently mutated genes. Prostate (10.8%) had the lowest number of somatic mutations identified, while no mutations were identified in sarcoma. Ocular melanoma (90.6%), endometrial (72.4%) and colorectal (66.4%) tumors had the highest number of mutations. We noted high concordance between mutations in different parts of the tumor (94%) and matched primary and metastatic samples (90%). KRAS and BRAF mutations were mutually exclusive. Mutation co-occurrence involved mainly PIK3CA and PTPN11, and PTPN11 and APC. Reverse Phase Protein Array (RPPA) analysis demonstrated that PI3K and MAPK signalling pathways were more altered in tumors with mutations compared to wild type tumors. Conclusions Hotspot mutational profiling is a sensitive, high-throughput approach for identifying mutations of clinical relevance to molecular based therapeutics for treatment of cancer, and could potentially be of use in identifying novel opportunities for genotype-driven clinical trials.
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Affiliation(s)
- Sinead Toomey
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland.
| | - Aoife Carr
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Mateusz Janusz Mezynski
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Yasir Elamin
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Shereen Rafee
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Clare Morgan
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Khairun I Abdul-Jalil
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Kathy Gately
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland
| | - Angela Farrelly
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland.,Department of Pathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Kenneth O'Byrne
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland.,Princess Alexandra Hospital, Brisbane, Australia
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Alexander J Eustace
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Joanna Fay
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert Cummins
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony O'Grady
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roshni Kalachand
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Norma O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Fergal Kelleher
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aine O'Reilly
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Mark Doherty
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - John Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Mullally WJ, Bracken-Clarke D, Padmore A, O'Reilly S, O’Mahony D, Walshe J, Kennedy J, Gupta R, Kelly C, O'Connor M, Duffy K, Keane M, Hennessy BT, Morris PG. Abstract P3-08-56: The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-56] [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
Background: The 21 gene recurrence score (OncotypeDx ®) is reimbursed in Ireland to guide adjuvant treatment decisions for ER+, LN-negative, human epidermal growth factor receptor 2 (HER2)-negative BC. There is emerging evidence supporting the clinical utility of this test in patients with LN+ disease. Although the exact cut-off for chemotherapy has not been defined in this population, SEER data support the omission of chemotherapy for patients with RS <18 and the WSG Plan B randomised prospective study suggested excellent 5- year outcomes in patients with RS ≤11 treated with hormone therapy alone. However, the RS has not yet been reimbursed for patients with LN+ disease in Ireland. Methods: The Oncotype DX Breast Recurrence Score test N+ Access Programme (PONDx) aimed to collect real-life data on the use of the 21 gene RS in patients with LN+ ER+, HER2- early stage breast cancer. The PONDx study was conducted between March 2018 and May 2019 across the national oncology centres to determine the extent to which use of the RS could alter chemotherapy recommendations. Eligible patients had 1-3 LN+, HR+ and HER2- BC and were deemed possible candidates for chemotherapy. Anonymous questionnaires were completed by a Consultant Oncologist after the RS test was available. Data on patient demographics, tumour characteristics and treatment recommendations were collected.
Results: In total, 294 patients were enrolled across the - nine centres. Complete data is available on 123 patients (range 38 to 75, median 54 years), which included two male patients. Of the remaining 121 (98%) patients, 49 (40%) were premenopausal, 26 (21%) perimenopausal and 46 (37%) postmenopausal. The median tumour size was 38 mm (Range 7 to 58 mm). There were 101 (82%) patients with invasive ductal carcinoma, 17 (14%) with lobular carcinoma and 5 (4%) classified as other breast histology. Seventeen patients (14%) had grade 1, 74 (60%) grade 2 and 32 (26%) grade 3 disease. There were 79 (64%) patients with 1 LN+, 35 (29%) with 2 LN+ and 9 (7%) with 3 LN+ status. Overall access to the 21 gene RS test led to a 32% reduction in chemotherapy, 112 (91%) to 72 (59%) patients. This was most notable in patients with ductal histology (91 vs 61) and grade 2 breast cancer (66 vs 41) representing a 24.4% and 20.3% reduction, respectively. Similarly patients with 1 LN+ (71 vs 46) and 2 LN+ (34 vs 21) represented a 20.3% and 9.7% reduction, respectively. This study also identified four patients aged less than 40, for whom chemotherapy was not recommended. The biggest reduction in chemotherapy occurred in women aged over 50 (62 vs 36) at 21.1%. Overall, in 65% of cases, medical oncologists deemed the RS test result significantly changed treatment recommendations. Conclusion: These findings are consistent with results from similar studies in other countries. Broader access to the 21-gene RS could result in a reduction in the use of chemotherapy in Ireland.
Citation Format: William J Mullally, Dara Bracken-Clarke, Andrew Padmore, Seamus O'Reilly, Deirdre O’Mahony, Janice Walshe, John Kennedy, Rajnish Gupta, Cathy Kelly, Miriam O'Connor, Karen Duffy, Maccon Keane, Bryan T Hennessy, Patrick G Morris. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-56.
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Affiliation(s)
| | | | - Andrew Padmore
- 3Genomic Health Inc, 301 Penobscot Drive, Redwood City, CA
| | | | | | - Janice Walshe
- 4St. Vincent's University Hospital, Dublin 4, Ireland
| | | | | | - Cathy Kelly
- 7Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | - Karen Duffy
- 9Letterkenny University Hospital, Letterkenny, Ireland
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Keegan NM, Furney S, Walshe J, Gullo G, Kennedy J, Bulger K, McCaffrey J, Kelly CM, Egan K, O'Donovan P, Hernando A, Teiserskiene A, Parker I, Farrelly AM, Carr A, Calzaferri G, McDermott R, Keane MM, Grogan L, Breathnach OS, Morris PG, Toomey S, Hennessy BT. Abstract P1-19-24: A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER”. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-24] [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
Background Activation of the phosphoinositide -3 kinase (PI3K) pathway is a resistance mechanism to anti-HER2 targeted therapy. This trial was conducted to determine the maximum tolerated dose (MTD) of copanlisib, an oral pan-class I PI3K inhibitor, combined with trastuzumab for patients with advanced HER2 positive breast cancer resistant to anti-HER2 therapy. Patients and Methods In this phase Ib open label dose escalation study, using a 6 + 6 design, patients with advanced HER2-positive breast cancer who had disease progression following at least one prior line of HER2 therapy in the metastatic setting were treated with a dose escalation schedule of copanlisib (dose level 1 =45mg or dose level 2 = 60mg) IV on days 1, 8 and 15 of a 28 day cycle along with a fixed dose of trastuzumab 2mg/kg weekly after a loading dose of 4mg/kg in cycle 1. Archival tumour tissue, voluntary serial tumour biopsies and serial plasma samples were collected for genomic sequencing. Results Twelve patients were enrolled. MTD was determined as copanlisib 60mg plus trastuzumab 2mg/kg weekly. There was no dose limiting toxicity. The most common treatment-related adverse events (AE) of any grade experienced in more than 2 patients were hyperglycemia (58%), fatigue (58%), nausea (58%) and hypertension (50%). Confirmed stable disease at 16 weeks was observed in 6 (50%) participants. PIK3CA mutations were detected in archival tumour tissue of 6 (50%) patients and did not appear to influence likelihood of clinical benefit. PIK3CA mutations were detected in serial plasma ctDNA of all 12 patients and fluctuated over the course of treatment. Next-Generation Sequencing (NGS) analysis identified novel somatic mutations in the TTRAP gene, which encodes a PI3K-like protein kinase, detected only in tumour samples obtained at metastatic time points. Additionally, NGS analysis demonstrated clear temporal genomic heterogeneity with decreasing PIK3CA mutation variant allele frequency (VAF) post therapy Conclusions The combination of copanlisib and trastuzumab was safely administered with good overall tolerability in this trial. Preliminary anti-tumour stability was observed in patients with heavily pre-treated metastatic HER2 positive breast cancer. Translational studies identified a number of potential biomarkers for further study in the now initiated phase 2 clinical trial.
Citation Format: Niamh M Keegan, Simon Furney, Janice Walshe, Giuseppe Gullo, John Kennedy, Kyran Bulger, John McCaffrey, Catherine M Kelly, Keith Egan, P O'Donovan, Andres Hernando, Ausra Teiserskiene, Imelda Parker, Angela M Farrelly, Aoife Carr, Giulio Calzaferri, Ray McDermott, Maccon M Keane, Liam Grogan, Oscar S Breathnach, Patrick G Morris, Sinead Toomey, Bryan T Hennessy. A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER” [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-24.
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Affiliation(s)
| | - Simon Furney
- 2Genomic Oncology Research Group, Department of Physiology & Medical Physics, Center for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janice Walshe
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Giuseppe Gullo
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - John Kennedy
- 4Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - Kyran Bulger
- 5Department of Medical Oncology, Midland Regional Hospital, Tullamore, Ireland
| | - John McCaffrey
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Catherine M Kelly
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Keith Egan
- 7Cancer Clinical Trials & Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - P O'Donovan
- 8Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Andres Hernando
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | | | - Imelda Parker
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Angela M Farrelly
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Aoife Carr
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Giulio Calzaferri
- 11Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland, Dublin 4, Ireland
| | - Ray McDermott
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Maccon M Keane
- 12Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | | | | | - Sinead Toomey
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
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Collins DM, Browne A, Madden SF, Gaynor N, Kay EW, Fay J, Sheehan K, Toomey S, Eustace AJ, Gallagher WM, Hennessy BT, Crown J. Abstract P1-10-13: Examination of CCL26, CCL17 and CCL19 chemokines as biomarkers in HER2+ breast cancer (BC) in the neo-adjuvant setting. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-10-13] [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
Background: Increased tumour infiltrating lymphocytes (TILs) are associated with a better prognosis in HER2+ BC patients treated with neo-adjuvant chemotherapy. The signalling mechanisms associated with increased TIL levels are not fully understood. Chemotactic cytokines (chemokines) and their respective receptors have a major role to play in tumour immune cell infiltrate. Analysis of plasma chemokine levels and TIL levels in HER2+ BC patients treated in the neo-adjuvant setting has identified three chemokines of interest - CCL26, CCL17 and CCL19. Examination of tumor mRNA expression levels of their corresponding receptors CCR3, CCR4, and CCR7 in publicly available datasets reveals a significant association with overall survival in PAM50-defined HER2-enriched BC patients.
Methods: Pre-treatment (n=43) and post-treatment (n=29) (2 weeks pre-surgery) blood samples were collected from patients enrolled in ICORG 10-05 (neo-adjuvant chemotherapy (docetaxel/carboplatin) +/- trastuzumab, lapatinib or trastuzumab/lapatinib). Patients were classified as having a pathological complete response (CR) or a non-CR (nCR). Plasma chemokine levels were determined by Luminex xMAP assay and validated by ELISA. TIL levels were determined from H and E-, AE1/AE3- and CD45- stained FFPE tissue. Chemokine receptor mRNA expression was interrogated in publicly available datasets using BreastMark (http://glados.ucd.ie/BreastMark/index.html). The PAM50 HER2-enriched molecular signature and a median cut-off was used for all analyses.
Results: Circulating CCL17 levels were significantly lower in patients achieving CR, pre- (p=0.015) and post-treatment (p=0.012). Baseline CCL17 levels correlated with baseline TIL count (r=0.582, p=0.011) for CR but not nCR. There was no association between pre- or post-treatment CCL19 and CCL26 plasma levels and treatment response. However, baseline CCL26 levels were inversely correlated with baseline TILs for patients achieving CR (r= -0.49, p=0.028) but not nCR. Baseline CCL19 displayed a similar trend that did not reach significance (r=0.414, p=0.077). Analysis of publicly available datasets reveals tumor mRNA expression of CCR3 (Hazard ratio (HR)=1.9, p=0.001) and CCR7 (HR=0.53, p=0.002) are associated with overall survival in patients with a HER2-enriched molecular signature.
Conclusions: Our results suggest circulating chemokine levels may have value as biomarkers of response and TIL status in HER2+ BC. The strong correlation of chemokine receptors with overall survival in tumors with a HER2-enriched molecular signature suggests further examination of chemokine/chemokine receptor axes is warranted in a larger cohort of HER2+ BC patients.
Citation Format: Denis Martin Collins, Alacoque Browne, Stephen F Madden, Nicola Gaynor, Elaine W Kay, Joanna Fay, Katherine Sheehan, Sinead Toomey, Alex J Eustace, William M Gallagher, Bryan T Hennessy, John Crown. Examination of CCL26, CCL17 and CCL19 chemokines as biomarkers in HER2+ breast cancer (BC) in the neo-adjuvant setting [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-10-13.
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Affiliation(s)
- Denis Martin Collins
- 1National Institute for Cellular Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Alacoque Browne
- 1National Institute for Cellular Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Stephen F Madden
- 2RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nicola Gaynor
- 1National Institute for Cellular Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Elaine W Kay
- 3Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joanna Fay
- 4Department of Pathology, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Katherine Sheehan
- 3Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Toomey
- 5Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alex J Eustace
- 1National Institute for Cellular Biotechnology, Dublin City University, Dublin 9, Ireland
| | | | | | - John Crown
- 8Department of Medical Oncology, Saint Vincent's University Hospital, Dublin 4, Ireland
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Kennedy SP, O'Neill M, Cunningham D, Morris PG, Toomey S, Blanco-Aparicio C, Martinez S, Pastor J, Eustace AJ, Hennessy BT. Preclinical evaluation of a novel triple-acting PIM/PI3K/mTOR inhibitor, IBL-302, in breast cancer. Oncogene 2020; 39:3028-3040. [PMID: 32042115 PMCID: PMC7118022 DOI: 10.1038/s41388-020-1202-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 11/09/2022]
Abstract
The proviral integration of Moloney virus (PIM) family of protein kinases are overexpressed in many haematological and solid tumours. PIM kinase expression is elevated in PI3K inhibitor-treated breast cancer samples, suggesting a major resistance pathway for PI3K inhibitors in breast cancer, potentially limiting their clinical utility. IBL-302 is a novel molecule that inhibits both PIM and PI3K/AKT/mTOR signalling. We thus evaluated the preclinical activity of IBL-302, in a range of breast cancer models. Our results demonstrate in vitro efficacy of IBL-302 in a range of breast cancer cell lines, including lines with acquired resistance to trastuzumab and lapatinib. IBL-302 demonstrated single-agent, anti-tumour efficacy in suppression of pAKT, pmTOR and pBAD in the SKBR-3, BT-474 and HCC-1954 HER2+/PIK3CA-mutated cell lines. We have also shown the in vivo single-agent efficacy of IBL-302 in the subcutaneous BT-474 and HCC-1954 xenograft model in BALB/c nude mice. The combination of trastuzumab and IBL-302 significantly increased the anti-proliferative effect in HER2+ breast cancer cell line, and matched trastuzumab-resistant line, relative to testing either drug alone. We thus believe that the novel PIM and PI3K/mTOR inhibitor, IBL-302, represents an exciting new potential treatment option for breast cancer, and that it should be considered for clinical investigation.
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Affiliation(s)
- Sean P Kennedy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.
| | - Michael O'Neill
- Inflection Biosciences, Anglesea House, Blackrock, Dublin, Ireland
| | | | - Patrick G Morris
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland
| | - Carmen Blanco-Aparicio
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Sonia Martinez
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Joaquin Pastor
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Alex J Eustace
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.,Cancer Trials Ireland, Innovation House, Old Finglas Road, Botanic, Dublin, Ireland
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Canonici A, Browne AL, Ibrahim MFK, Fanning KP, Roche S, Conlon NT, O’Neill F, Meiller J, Cremona M, Morgan C, Hennessy BT, Eustace AJ, Solca F, O’Donovan N, Crown J. Combined targeting EGFR and SRC as a potential novel therapeutic approach for the treatment of triple negative breast cancer. Ther Adv Med Oncol 2020; 12:1758835919897546. [PMID: 32064003 PMCID: PMC6987485 DOI: 10.1177/1758835919897546] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Triple negative breast cancer (TNBC) is an aggressive subtype of breast
cancer with limited therapeutic options. Epidermal growth factor receptor
(EGFR) has been shown to be over-expressed in TNBC and represents a rational
treatment target. Methods: We examined single agent and combination effects for afatinib and dasatinib
in TNBC. We then determined IC50 and combination index values
using Calcusyn. Functional analysis of single and combination treatments was
performed using reverse phase protein array and cell cycle analysis.
Finally, we determined the anticancer effects of the combination in
vivo. Results: A total of 14 TNBC cell lines responded to afatinib with IC50
values ranging from 0.008 to 5.0 µM. Three cell lines, belonging to the
basal-like subtype of TNBC, were sensitive to afatinib. The addition of
afatinib enhanced response to the five other targeted therapies in HCC1937
and HDQP1 cells. The combination of afatinib with dasatinib caused the
greatest growth inhibition in both cell lines. The afatinib/dasatinib
combination was synergistic and/or additive in 13/14 TNBC cell lines.
Combined afatinib/dasatinib treatment induced G1 cell cycle arrest. Reverse
phase protein array results showed the afatinib/dasatinib combination
resulted in efficient inhibition of both pERK(T202/T204) and pAkt(S473)
signalling in BT20 cells, which was associated with the greatest
antiproliferative effects. High baseline levels of pSrc(Y416) and pMAPK(p38)
correlated with sensitivity to afatinib, whereas low levels of B-cell
lymphoma 2 (Bcl2) and mammalian target of rapamycin (mTOR) correlated with
synergistic growth inhibition by combined afatinib and dasatinib treatment.
In vivo, the combination treatment inhibited tumour
growth in a HCC1806 xenograft model. Conclusions: We demonstrate that afatinib combined with dasatinib has potential clinical
activity in TNBC but warrants further preclinical investigation.
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Affiliation(s)
- Alexandra Canonici
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Alacoque L. Browne
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Mohamed F. K. Ibrahim
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Kevin P. Fanning
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Sandra Roche
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Neil T. Conlon
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Fiona O’Neill
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Justine Meiller
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular
Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin,
Ireland
| | - Clare Morgan
- Medical Oncology Group, Department of Molecular
Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin,
Ireland
| | - Bryan T. Hennessy
- Medical Oncology Group, Department of Molecular
Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin,
Ireland
| | | | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co KG,
Vienna, Austria
| | - Norma O’Donovan
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
| | - John Crown
- National Institute for Cellular Biotechnology,
Dublin City University, Dublin, Ireland
- Department of Medical Oncology, St Vincent’s
University Hospital, Dublin, Ireland
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Gleeson JP, Keane F, Keegan NM, Mammadov E, Harrold E, Alhusaini A, Harte J, Eakin-Love A, O'Halloran PJ, MacNally S, Hennessy BT, Breathnach OS, Grogan L, Morris PG. Similar overall survival with reduced vs. standard dose bevacizumab monotherapy in progressive glioblastoma. Cancer Med 2019; 9:469-475. [PMID: 31756059 PMCID: PMC6970030 DOI: 10.1002/cam4.2616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bevacizumab has demonstrated activity in glioblastoma (GBM), but the true benefits and optimal dose-schedule are debated. A lower dose-schedule than standard-dose bevacizumab (10 mg/kg 2-weekly) might offer similar benefits with lower costs. At our Institution, patients are randomly assigned at time of primary diagnosis to Neuro-Oncologists, who have varying practices in terms of bevacizumab dose-schedule upon progression. METHODS In a retrospective analysis we examined overall survival (OS), measured from first administered bevacizumab dose until death, according to dose-schedule. Patients with de novo WHO Grade IV GBM who received standard- or reduced-dose (5 mg/kg 2-weekly) bevacizumab were included. MGMT methylation status and time from diagnosis to bevacizumab start were examined as prognostic variables. Clinical benefit and a comparative cost analysis were assessed. RESULTS In total, 1127 bevacizumab doses were administered to 118 patients [Median: 7, Range: 1-44]. Median OS (mOS) was 5.8 months. 69 (59%) patients received standard-dose bevacizumab (mOS: 5.97 months) and 49 patients received reduced-dose (mOS: 5.7 months). No statistically significant difference in OS between dosing schedule was seen (HR: 1.11, P-value: .584). Patients with MGMT methylated tumors (43%) had improved OS compared to those with unmethylated tumors; 7.03 vs 4.97 months (HR: 0.61, P-value: .027). If all patients were treated with reduced-dose bevacizumab, an estimated €2.4M cost reduction would be observed. CONCLUSIONS In this retrospective study, reduced-dose bevacizumab schedule resulted in similar OS to standard-dose bevacizumab monotherapy with substantial cost savings. MGMT methylation appears to convey a survival benefit in the setting of bevacizumab treatment for progressive GBM.
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Affiliation(s)
- Jack Patrick Gleeson
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fergus Keane
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Niamh M Keegan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emin Mammadov
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Emily Harrold
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Abdullah Alhusaini
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | - Jeffrey Harte
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | | | | | | | - Bryan T Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
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Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Abstract OT3-06-01: Phase Ib clinical trial of co PANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive bre Ast cancer (BC) “PANTHERA”-CTRIAL-IE 17-13. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-06-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background:The phosphoinositide 3 kinase (PI3K) pathway is important in the oncogenic function of HER2. Aberrant activation of PI3K is implicated in resistance to trastuzumab and other HER2-targeted therapies and is frequent, with up to 22% of HER2 positive breast cancer having a PIK3CA mutation. Copanlisib is a pan-class 1 PI3K inhibitor administered i.v. with low nanomolar activity against both PI3Kα and PI3Kβ. Copanlisib has been shown to re-sensitise trastuzumab resistant cell lines to trastuzumab with synergism seen in some cell lines between copanlisib and HER2 targeted therapy.
Trial design: This is a phase Ib open label, single arm adaptive, multi-centre trial of copanlisib in combination with T-DM1. Eligible patients will receive T-DM1 at 3.6mg/kg i.v. on day 1 of a 21-day cycle plus copanlisib. Copanlisib will be administered i.v. according to the dose escalation scheme (dose level 1 is 45mg on days 1 and 8, dose level 2 is 60mg on days 1 and 8, dose level 3 is 60mg on days 1, 8, and 15). Dose level -1 will be 45 mg on day 1 in case dose de-escalation is needed. We will enrol 3 to 6 patients per dose level. All patients in each level must have completed at least the first cycle of therapy before enrolment in the next dose level. Patients not completing the first cycle for a reason other than toxicity will be replaced. Dose escalation and determination of the Maximum Tolerated Dose (MTD) will be based on the occurrence of Dose Limiting Toxicities (DLT).
Eligibility criteria:Eligible patients are those with unresectable locally advanced or metastatic HER2-positive BC who previously received trastuzumab and a taxane, separately or in combination. Participants must have adequate organ function and ECOG PS ≤ 2
Objectives:The primary objective is to determine the MTD for copanlisib in combination with T-DM1 in patients with pre-treated unresectable locally advanced or metastatic HER2-positive BC. Secondary objectives include evaluating the safety, efficacy and cardiotoxicity in patients treated with this regimen. Exploratory objectives include examining for predictive biomarkers in tumour tissue and blood or plasma and to examine molecular tumour adaptation to clinical trial therapy.
Statistical methods: Patients will be accrued in cohorts of 3 patients according to a standard 3+3 algorithm, with dose escalation and determination of MTD based on the occurrence of DLT, using the usual threshold probability of 33%. The final dose level will be expanded to include a total of 6 additional patients (expansion cohort).
Present accrual and target accrual:The trial will start accrual in October 2018. Maximum of 24 patients will be enrolled.
Citation Format: Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Phase Ib clinical trial of coPANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive breAst cancer (BC) “PANTHERA”-CTRIAL-IE 17-13 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-06-01.
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Affiliation(s)
- A Hassan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - G Gullo
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S O'Reilly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Ruiz-Borrego
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Toomey
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Grogan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - O Breathnach
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - PG Morris
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - JM Walshe
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Crown
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - D O'Mahony
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Falcon
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Egan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Hernando
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Teiserskiene
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - CM Kelly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Coate
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - BT Hennessy
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
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