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Spicer J, Basu B, Montes A, Banerji U, Kristeleit R, Miller R, Veal GJ, Corrigan CJ, Till SJ, Figini M, Canevari S, Barton C, Jones P, Mellor S, Carroll S, Selkirk C, Nintos G, Kwatra V, Funingana IG, Doherty G, Gould HJ, Pellizzari G, Nakamura M, Ilieva KM, Khiabany A, Stavraka C, Chauhan J, Gillett C, Pinder S, Bax HJ, Josephs DH, Karagiannis SN. Safety and anti-tumour activity of the IgE antibody MOv18 in patients with advanced solid tumours expressing folate receptor-alpha: a phase I trial. Nat Commun 2023; 14:4180. [PMID: 37491373 PMCID: PMC10368744 DOI: 10.1038/s41467-023-39679-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
All antibodies approved for cancer therapy are monoclonal IgGs but the biology of IgE, supported by comparative preclinical data, offers the potential for enhanced effector cell potency. Here we report a Phase I dose escalation trial (NCT02546921) with the primary objective of exploring the safety and tolerability of MOv18 IgE, a chimeric first-in-class IgE antibody, in patients with tumours expressing the relevant antigen, folate receptor-alpha. The trial incorporated skin prick and basophil activation tests (BAT) to select patients at lowest risk of allergic toxicity. Secondary objectives were exploration of anti-tumour activity, recommended Phase II dose, and pharmacokinetics. Dose escalation ranged from 70 μg-12 mg. The most common toxicity of MOv18 IgE is transient urticaria. A single patient experienced anaphylaxis, likely explained by detection of circulating basophils at baseline that could be activated by MOv18 IgE. The BAT assay was used to avoid enrolling further patients with reactive basophils. The safety profile is tolerable and maximum tolerated dose has not been reached, with evidence of anti-tumour activity observed in a patient with ovarian cancer. These results demonstrate the potential of IgE therapy for cancer.
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Affiliation(s)
- James Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Bristi Basu
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Ana Montes
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Udai Banerji
- Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | | | | | - Gareth J Veal
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Christopher J Corrigan
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stephen J Till
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Mariangela Figini
- ANP2, Department of Advanced Diagnostics, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Claire Barton
- Centre for Drug Development, Cancer Research UK, London, UK
- Barton Oncology Ltd, Hertfordshire, UK
| | - Paul Jones
- Centre for Drug Development, Cancer Research UK, London, UK
- UCB Pharma Ltd., Slough, UK
| | - Sarah Mellor
- Centre for Drug Development, Cancer Research UK, London, UK
| | - Simon Carroll
- Centre for Drug Development, Cancer Research UK, London, UK
| | - Chris Selkirk
- Centre for Drug Development, Cancer Research UK, London, UK
| | - George Nintos
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vineet Kwatra
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ionut-Gabriel Funingana
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Gary Doherty
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Hannah J Gould
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Giulia Pellizzari
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Kristina M Ilieva
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Atousa Khiabany
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Chara Stavraka
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Cheryl Gillett
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Health Partners Cancer Biobank, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Health Partners Cancer Biobank, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather J Bax
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Debra H Josephs
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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2
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Chauhan J, Grandits M, Palhares LCGF, Mele S, Nakamura M, López-Abente J, Crescioli S, Laddach R, Romero-Clavijo P, Cheung A, Stavraka C, Chenoweth AM, Sow HS, Chiaruttini G, Gilbert AE, Dodev T, Koers A, Pellizzari G, Ilieva KM, Man F, Ali N, Hobbs C, Lombardi S, Lionarons DA, Gould HJ, Beavil AJ, Geh JLC, MacKenzie Ross AD, Healy C, Calonje E, Downward J, Nestle FO, Tsoka S, Josephs DH, Blower PJ, Karagiannis P, Lacy KE, Spicer J, Karagiannis SN, Bax HJ. Anti-cancer pro-inflammatory effects of an IgE antibody targeting the melanoma-associated antigen chondroitin sulfate proteoglycan 4. Nat Commun 2023; 14:2192. [PMID: 37185332 PMCID: PMC10130092 DOI: 10.1038/s41467-023-37811-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/03/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Outcomes for half of patients with melanoma remain poor despite standard-of-care checkpoint inhibitor therapies. The prevalence of the melanoma-associated antigen chondroitin sulfate proteoglycan 4 (CSPG4) expression is ~70%, therefore effective immunotherapies directed at CSPG4 could benefit many patients. Since IgE exerts potent immune-activating functions in tissues, we engineer a monoclonal IgE antibody with human constant domains recognizing CSPG4 to target melanoma. CSPG4 IgE binds to human melanomas including metastases, mediates tumoricidal antibody-dependent cellular cytotoxicity and stimulates human IgE Fc-receptor-expressing monocytes towards pro-inflammatory phenotypes. IgE demonstrates anti-tumor activity in human melanoma xenograft models engrafted with human effector cells and is associated with enhanced macrophage infiltration, enriched monocyte and macrophage gene signatures and pro-inflammatory signaling pathways in the tumor microenvironment. IgE prolongs the survival of patient-derived xenograft-bearing mice reconstituted with autologous immune cells. No ex vivo activation of basophils in patient blood is measured in the presence of CSPG4 IgE. Our findings support a promising IgE-based immunotherapy for melanoma.
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Affiliation(s)
- Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Melanie Grandits
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Lais C G F Palhares
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Silvia Mele
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Jacobo López-Abente
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Silvia Crescioli
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Roman Laddach
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Department of Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, Bush House, London, WC2B 4BG, UK
| | - Pablo Romero-Clavijo
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Oncogene Biology Laboratory, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Anthony Cheung
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Chara Stavraka
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
- Cancer Centre at Guy's, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Alicia M Chenoweth
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Heng Sheng Sow
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Giulia Chiaruttini
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Amy E Gilbert
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Tihomir Dodev
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King's College London, London, SE1 9RT, UK
- Asthma UK Centre, Allergic Mechanisms in Asthma, King's College London, London, SE1 9RT, UK
| | - Alexander Koers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Giulia Pellizzari
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Kristina M Ilieva
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Francis Man
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 9NH, UK
| | - Niwa Ali
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
- Centre for Gene Therapy and Regenerative Medicine, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Carl Hobbs
- Wolfson Centre for Age-Related Diseases, King's College London, London, SE1 1UL, UK
| | - Sara Lombardi
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Guy's and St. Thomas' Oncology & Haematology Clinical Trials (OHCT), Cancer Centre at Guy's, London, SE1 9RT, UK
| | - Daniël A Lionarons
- Oncogene Biology Laboratory, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Hannah J Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King's College London, London, SE1 9RT, UK
- Asthma UK Centre, Allergic Mechanisms in Asthma, King's College London, London, SE1 9RT, UK
| | - Andrew J Beavil
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King's College London, London, SE1 9RT, UK
- Asthma UK Centre, Allergic Mechanisms in Asthma, King's College London, London, SE1 9RT, UK
| | - Jenny L C Geh
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH, UK
- Skin Tumour Unit, St. John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | | | - Ciaran Healy
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Eduardo Calonje
- Dermatopathology Department, St. John's Institute of Dermatology, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Julian Downward
- Oncogene Biology Laboratory, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Frank O Nestle
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Sanofi US, Cambridge, Massachusetts, USA
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, Bush House, London, WC2B 4BG, UK
| | - Debra H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
- Cancer Centre at Guy's, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Philip J Blower
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Panagiotis Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
- Department of Oncology, Haematology and Bone Marrow Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
- Cancer Centre at Guy's, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK.
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK.
| | - Heather J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK.
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK.
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3
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van de Haar J, Ma X, Ooft SN, van der Helm PW, Hoes LR, Mainardi S, Pinato DJ, Sun K, Salvatore L, Tortora G, Zurlo IV, Leo S, Giampieri R, Berardi R, Gelsomino F, Merz V, Mazzuca F, Antonuzzo L, Rosati G, Stavraka C, Ross P, Rodriquenz MG, Pavarana M, Messina C, Iveson T, Zoratto F, Thomas A, Fenocchio E, Ratti M, Depetris I, Cergnul M, Morelli C, Libertini M, Parisi A, De Tursi M, Zanaletti N, Garrone O, Graham J, Longarini R, Gobba SM, Petrillo A, Tamburini E, La Verde N, Petrelli F, Ricci V, Wessels LFA, Ghidini M, Cortellini A, Voest EE, Valeri N. Codon-specific KRAS mutations predict survival benefit of trifluridine/tipiracil in metastatic colorectal cancer. Nat Med 2023; 29:605-614. [PMID: 36864254 PMCID: PMC10033412 DOI: 10.1038/s41591-023-02240-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2023] [Indexed: 03/04/2023]
Abstract
Genomics has greatly improved how patients with cancer are being treated; however, clinical-grade genomic biomarkers for chemotherapies are currently lacking. Using whole-genome analysis of 37 patients with metastatic colorectal cancer (mCRC) treated with the chemotherapy trifluridine/tipiracil (FTD/TPI), we identified KRAS codon G12 (KRASG12) mutations as a potential biomarker of resistance. Next, we collected real-world data of 960 patients with mCRC receiving FTD/TPI and validated that KRASG12 mutations were significantly associated with poor survival, also in analyses restricted to the RAS/RAF mutant subgroup. We next analyzed the data of the global, double-blind, placebo-controlled, phase 3 RECOURSE trial (n = 800 patients) and found that KRASG12 mutations (n = 279) were predictive biomarkers for reduced overall survival (OS) benefit of FTD/TPI versus placebo (unadjusted interaction P = 0.0031, adjusted interaction P = 0.015). For patients with KRASG12 mutations in the RECOURSE trial, OS was not prolonged with FTD/TPI versus placebo (n = 279; hazard ratio (HR) = 0.97; 95% confidence interval (CI) = 0.73-1.20; P = 0.85). In contrast, patients with KRASG13 mutant tumors showed significantly improved OS with FTD/TPI versus placebo (n = 60; HR = 0.29; 95% CI = 0.15-0.55; P < 0.001). In isogenic cell lines and patient-derived organoids, KRASG12 mutations were associated with increased resistance to FTD-based genotoxicity. In conclusion, these data show that KRASG12 mutations are biomarkers for reduced OS benefit of FTD/TPI treatment, with potential implications for approximately 28% of patients with mCRC under consideration for treatment with FTD/TPI. Furthermore, our data suggest that genomics-based precision medicine may be possible for a subset of chemotherapies.
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Affiliation(s)
- Joris van de Haar
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Xuhui Ma
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Salo N Ooft
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Pim W van der Helm
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Louisa R Hoes
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sara Mainardi
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Imperial College Healthcare NHS Trust, London, UK
| | - Kristi Sun
- Imperial College Healthcare NHS Trust, London, UK
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Silvana Leo
- Medical Oncology, 'Vito Fazzi' Hospital, Lecce, Italy
| | - Riccardo Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | | | - Valeria Merz
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Federica Mazzuca
- Department of Clinical and Molecular Medicine, Sapienza University, Oncology Unit, Azienda Ospedialiera Universitaria Sant'Andrea, Rome, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Chara Stavraka
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Grazia Rodriquenz
- Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Pavarana
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carlo Messina
- Oncology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | | | - Federica Zoratto
- Unità Operativa Complessa Oncologia, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Anne Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Elisabetta Fenocchio
- Candiolo Cancer Institute FPO Istituto di Ricovero e Cura a Carattere Scientifico Candiolo, Candiolo, Italy
| | | | - Ilaria Depetris
- Division of Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Italy
| | - Massimiliano Cergnul
- Unità Operativa Oncologia Medica, Ospedale Civile di Legnano, Azienda Socio-Sanitaria Territoriale Ovest Milanese, Legnano, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | | | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Dipartimento di Tecnologie Innovative in Medicina & Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Nicoletta Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Ornella Garrone
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Stefania Maria Gobba
- Division of Clinical Oncology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi Varese, Varese, Italy
| | | | | | - Nicla La Verde
- Luigi Sacco Hospital-Polo Universitario, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
| | - Fausto Petrelli
- Oncology Unit, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Vincenzo Ricci
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale 'San Pio', Benevento, Italy
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Michele Ghidini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Emile E Voest
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Nicola Valeri
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
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Bax HJ, Chauhan J, Stavraka C, Santaolalla A, Osborn G, Khiabany A, Grandits M, López-Abente J, Palhares LCGF, Chan Wah Hak C, Robinson A, Pope A, Woodman N, Naceur-Lombardelli C, Malas S, Coumbe JEM, Nakamura M, Laddach R, Mele S, Crescioli S, Black AM, Lombardi S, Canevari S, Figini M, Sayasneh A, Tsoka S, FitzGerald K, Gillett C, Pinder S, Van Hemelrijck M, Kristeleit R, Ghosh S, Montes A, Spicer J, Karagiannis SN, Josephs DH. Folate receptor alpha in ovarian cancer tissue and patient serum is associated with disease burden and treatment outcomes. Br J Cancer 2023; 128:342-353. [PMID: 36402875 PMCID: PMC9902484 DOI: 10.1038/s41416-022-02031-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Survival rates for ovarian cancer remain poor, and monitoring and prediction of therapeutic response may benefit from additional markers. Ovarian cancers frequently overexpress Folate Receptor alpha (FRα) and the soluble receptor (sFRα) is measurable in blood. Here we investigated sFRα as a potential biomarker. METHODS We evaluated sFRα longitudinally, before and during neo-adjuvant, adjuvant and palliative therapies, and tumour FRα expression status by immunohistrochemistry. The impact of free FRα on the efficacy of anti-FRα treatments was evaluated by an antibody-dependent cellular cytotoxicity assay. RESULTS Membrane and/or cytoplasmic FRα staining were observed in 52.7% tumours from 316 ovarian cancer patients with diverse histotypes. Circulating sFRα levels were significantly higher in patients, compared to healthy volunteers, specifically in patients sampled prior to neoadjuvant and palliative treatments. sFRα was associated with FRα cell membrane expression in the tumour. sFRα levels decreased alongside concurrent tumour burden in patients receiving standard therapies. High concentrations of sFRα partly reduced anti-FRα antibody tumour cell killing, an effect overcome by increased antibody doses. CONCLUSIONS sFRα may present a non-invasive marker for tumour FRα expression, with the potential for monitoring patient response to treatment. Larger, prospective studies should evaluate FRα for assessing disease burden and response to systemic treatments.
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Affiliation(s)
- Heather J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Chara Stavraka
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aida Santaolalla
- Translational Oncology & Urology Research (TOUR), School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Gabriel Osborn
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Atousa Khiabany
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Melanie Grandits
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Jacobo López-Abente
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Lais C G F Palhares
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Charleen Chan Wah Hak
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Robinson
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Amy Pope
- King's Health Partners Cancer Biobank, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Natalie Woodman
- King's Health Partners Cancer Biobank, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Cristina Naceur-Lombardelli
- King's Health Partners Cancer Biobank, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Sadek Malas
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Jack E M Coumbe
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Roman Laddach
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
- Department of Informatics, Faculty of Natural, Mathematical & Engineering Sciences, King's College London, Bush House, London, UK
| | - Silvia Mele
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Silvia Crescioli
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK
| | - Anna M Black
- Guy's and St Thomas' Oncology & Haematology Clinical Trials (OHCT), Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sara Lombardi
- Guy's and St Thomas' Oncology & Haematology Clinical Trials (OHCT), Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Silvana Canevari
- Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
| | - Mariangela Figini
- Biomarker Unit, Dipartimento di Ricerca Applicata e Sviluppo Tecnologico (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ahmad Sayasneh
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural, Mathematical & Engineering Sciences, King's College London, Bush House, London, UK
| | - Kevin FitzGerald
- Epsilogen Ltd., Waterfront, ARC West London, Manbre Road, Hammersmith, London, UK
| | - Cheryl Gillett
- King's Health Partners Cancer Biobank, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Sarah Pinder
- King's Health Partners Cancer Biobank, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Rebecca Kristeleit
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sharmistha Ghosh
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Montes
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK.
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, UK.
| | - Debra H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London, UK.
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK.
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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5
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Hughes DJ, Kapiris M, Podvez Nevajda A, McGrath H, Stavraka C, Ahmad S, Taylor B, Cook GJR, Ghosh S, Josephs D, Pintus E, Gennatas S, Bille A, Ryanna K, Santis G, Montes A, Van Hemelrijck M, Karapanagiotou E, Smith D, Spicer J, Georgiou A. Non-Small Cell Lung Cancer (NSCLC) in Young Adults, Age < 50, Is Associated with Late Stage at Presentation and a Very Poor Prognosis in Patients That Do Not Have a Targeted Therapy Option: A Real-World Study. Cancers (Basel) 2022; 14:6056. [PMID: 36551542 PMCID: PMC9776398 DOI: 10.3390/cancers14246056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon. Real-world evidence on the outcomes of these patients is limited. (2) Methods: We conducted a retrospective cohort study of young NSCLC patients, age < 50 years at diagnosis, who were treated between 2011−2020 in South-East-London cancer centres. Clinicopathological characteristics, treatment and outcomes were analysed. (3) Results: Of 248 NSCLC patients, median age was 46 years, 50% (n = 125) female, 58% (n = 145) white, 18% (n = 45) black and 4% (n = 10) Asian ethnicity. Amongst patients with a documented smoking history, 30% (n = 64) were never-smokers. Most patients had adenocarcinoma (77%, n = 191) and presented with metastatic disease (67%, n = 166). Only 31% (n = 76) had treatment with curative intent. In patients who presented or developed metastatic non-squamous NSCLC (n = 179), EGFR mutation status was known in 88% (n = 157) and mutation present in 19% (n = 34), ALK was known in 66% (n = 118) with a translocation in 10% (n = 18), ROS1 status was known in 57% (n = 102) with a translocation in 4% (n = 8), and KRAS status was known in 66% (n = 119) with a mutation in 12% (n = 22). Overall, 76% (n = 152) patients with metastatic NSCLC received first-line systemic anti-cancer therapy. Median overall survival in metastatic NSCLC was 9.0 months (95% CI 6.5−11.6 months), with superior median overall survival in those with a targeted therapy option (28.7 months) compared to those without (6.6 months; p < 0.001). (4) Conclusion: Young patients contribute a significant proportion of those presenting with lung cancer. They present with advanced stage at diagnosis and have a poor prognosis. Identification of a targeted therapy option is associated with improved survival. However, most patients do not have a known genomic driver, which is in part due to limited testing, particularly in the early years of this study period. These findings highlight the particular importance of rapid-turnaround comprehensive genomic profiling in this age group and the need to identify strategies to facilitate earlier diagnosis in young NSCLC patients.
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Affiliation(s)
- Daniel Johnathan Hughes
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Matthaios Kapiris
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Andreja Podvez Nevajda
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Harriet McGrath
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Chara Stavraka
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Shahreen Ahmad
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Benjamin Taylor
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Gary J. R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Sharmistha Ghosh
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Debra Josephs
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Elias Pintus
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - Spyridon Gennatas
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - Andrea Bille
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Kimuli Ryanna
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - George Santis
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Ana Montes
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Eleni Karapanagiotou
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Daniel Smith
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - James Spicer
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Alexandros Georgiou
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
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6
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Morton C, Ruta D, Stavraka C, Anam K, Spicer JF, Regan A, Sengul S, Cernile G, Borecki Y, Schwering T, Rai H, Brierley P, Duroe O, Quarterman A, Sarker D. Evaluation of an automated artificial intelligence (AI)/ natural language processing (NLP) engine to match patients (pts) with advanced solid cancers to biomarker-driven early phase (EP) clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13513] [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
e13513 Background: The increasing complexity of precision medicine in oncology creates significant challenges in identification of pts for biomarker-driven clinical trials. Worldwide expansion of genomic testing will identify more pts with potentially actionable alterations, but the manual task of matching pts to clinical trials requires laborious interpretation of fragmented medical information and knowledge of suitable trial eligibility criteria. Inspirata’s Trial Navigator (TN) solution uses AI and NLP to automatically extract relevant information from both patient medical records and trial protocols to identify appropriate trials. We conducted a retrospective study to evaluate the ability of TN to match pts referred to the Guy’s Hospital EP trials unit. Methods: Anonymised referral letters and genomic reports for pts referred from Jan 2019 to Dec 2020 were used. A subset was used to train TN to extract relevant variables for matching against eligibility criteria for all UK Experimental Cancer Medicine Centre (ECMC) Network trials open within 160 km of Guy’s Hospital at the time of referral, favouring biomarker-matched studies. Finally, TN was tasked with finding 5 ECMC trial matches for 40 referred pts. Matches were scored for eligibility and tumour and/ or biomarker suitability using a quality index (QI): 0, ineligible; 1, generic match; 2, tumour match; 3, biomarker match; 4, tumour and biomarker match. Results: Of 40 pts, most common tumour groups included gastrointestinal (55%), HNSCC (20%) and gynae (10%). TN was able to correctly identify at least 1 suitable trial (median = 4) for 39/40 pts (97%). Selection biomarkers were available for 27 pts, of whom 21 (78%) were matched to at least one appropriate biomarker-directed trial, 5 (12%) were matched to biomarker-agnostic trials and one was not correctly matched due to exclusion for progressive CNS metastases. Of 13 pts without biomarker information, 11 (84%) were matched to at least 1 tumour-appropriate trial and 2 to tumour-agnostic trials. Of all 200 trial matches, 134 (67%) were appropriately matched, of which 80 (59%) were external to Guy’s Cancer centre. Conclusions: TN successfully matched 90% of these preselected cancer pts to an appropriate biomarker- or tumour-directed trial, indicating potential to improve access and recruitment to early phase cancer trials, including those external to the primary treating site with which referrers may not be familiar. A prospective multicentre evaluation of TN is warranted to further define improvements in trial recruitment and efficiency.[Table: see text]
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Affiliation(s)
- Cienne Morton
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Daniel Ruta
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chara Stavraka
- Guy's and St. Thomas' NHS foundation Trust, London, United Kingdom
| | - Kaiser Anam
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Debashis Sarker
- King's College Hospital, Institute of Liver Studies, London, United Kingdom
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7
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Manickavasagar T, Stavraka C, Anam K, Coma S, Chowdhury S, Pachter JA, Parker T, Parmar M, Finneran L, Hall E, Spicer J, Minchom A, Banerji U. Abstract P036: Trial in progress: Combination of the dual RAF/MEK inhibitor VS-6766 with the mTOR inhibitor everolimus with expansion in patients with KRAS mutant NSCLC. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p036] [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
The RAS/RAF/MEK/ERK (MAPK) pathway is a frequently deregulated oncogenic pathway in cancer driven by RAS and RAF mutations as well as being a key signaling pathway downstream of deregulated receptor tyrosine kinases. Although RAF and MEK have been validated as anticancer targets and several BRAF and MEK inhibitors are FDA approved, acquired resistance develops in most patients. Preclinically, inhibition of RAF or MEK has been found to activate AKT/mTOR signaling as a potential resistance mechanism, and combination of MEK inhibition with an inhibitor of the AKT/mTOR pathway yields improved anti-tumor activity. However, combined inhibition of MEK with an AKT or mTOR inhibitor has typically shown poor clinical tolerability. VS-6766 is a unique dual RAF/MEK inhibitor which blocks MEK activity without the compensatory MEK activation that limits the efficacy of other MEK inhibitors. VS-6766 has shown clinical responses as a single agent in gynecological cancers and KRAS mutant non-small cell lung cancer (NSCLC) (Guo Lancet Oncology 2020), and has shown clinical responses in combination with the focal adhesion kinase (FAK) inhibitor defactinib in patients with low-grade serous ovarian cancer and KRAS mutated NSCLC. To explore the combination of VS-6766 with blockade of the AKT/mTOR pathway, we tested the combination of VS-6766 with the mTOR inhibitor everolimus for potential synergy across a variety of RAS pathway mutations and tumor types in preclinical experiments. In 3D proliferation assays in vitro, VS-6766 was synergistic with everolimus in reducing viability of cell lines representing multiple MAPK pathway alterations, including KRAS (G12C, G12D, G12V and G13D), BRAF V600E, NRAS and NF1 mutations. Synergy of VS-6766 with everolimus was observed in 8/9 NSCLC, 16/20 colorectal cancer, 7/10 melanoma and 5/7 pancreatic cancer cell lines tested. These preclinical data support testing the combination of VS-6766 with everolimus in patients with KRAS mutant NSCLC as well as in numerous other cancer indications with various MAPK pathway alterations. A phase I study is ongoing to assess the combination of VS-6766 with everolimus with an intermittent dosing schedule. The clinical trial uses a rule-based design of 3+3 dose escalation cohorts, initially with once weekly dosing of VS-6766 in combination with everolimus. If this was found to be tolerable, the combination of twice weekly dosing of both compounds was to be explored. Following establishment of the recommended phase 2 dose (RP2D) for the combination, an expansion cohort (n = 10) in patients with KRAS mutant NSCLC was planned. The trial is currently recruiting into an expansion cohort of patients with KRAS mutated NSCLC ;NCT02407509, (Trial in Progress).
Citation Format: Thubeena Manickavasagar, Chara Stavraka, Kaiser Anam, Silvia Coma, Sanjib Chowdhury, Jonathan A. Pachter, Tom Parker, Mona Parmar, Laura Finneran, Emma Hall, James Spicer, Anna Minchom, Udai Banerji. Trial in progress: Combination of the dual RAF/MEK inhibitor VS-6766 with the mTOR inhibitor everolimus with expansion in patients with KRAS mutant NSCLC [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P036.
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Affiliation(s)
- Thubeena Manickavasagar
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Chara Stavraka
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | - Kaiser Anam
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | | | | | | | - Tom Parker
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Mona Parmar
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Laura Finneran
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Emma Hall
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - James Spicer
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | - Anna Minchom
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Udai Banerji
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
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8
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Osborn G, Stavraka C, Adams R, Sayasneh A, Ghosh S, Montes A, Lacy KE, Kristeleit R, Spicer J, Josephs DH, Arnold JN, Karagiannis SN. Macrophages in ovarian cancer and their interactions with monoclonal antibody therapies. Clin Exp Immunol 2021; 209:4-21. [PMID: 35020853 PMCID: PMC9307234 DOI: 10.1093/cei/uxab020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/19/2021] [Indexed: 12/31/2022] Open
Abstract
Abstract
The unmet clinical need for effective treatments in ovarian cancer has yet to be addressed using monoclonal antibodies (mAbs), which have largely failed to overcome tumour-associated immunosuppression, restrict cancer growth, and significantly improve survival. In recent years, experimental mAb design has moved away from solely targeting ovarian tumours and instead sought to modulate the wider tumour microenvironment (TME). Tumour-associated macrophages (TAMs) may represent an attractive therapeutic target for mAbs in ovarian cancer due to their high abundance and close proximity to tumour cells and their active involvement in facilitating several pro-tumoural processes. Moreover, the expression of several antibody crystallisable fragment (Fc) receptors and broad phenotypic plasticity of TAMs provide opportunities to modulate TAM polarisation using mAbs to promote anti-tumoural phenotypes. In this review, we discuss the role of TAMs in ovarian cancer TME and the emerging strategies to target the contributions of these cells in tumour progression through the rationale design of mAbs.
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Affiliation(s)
- Gabriel Osborn
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Chara Stavraka
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom.,Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Rebecca Adams
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Ahmad Sayasneh
- Department of Gynecological Oncology, Surgical Oncology Directorate, Guy's and St Thomas' NHS Foundation Trust, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Sharmistha Ghosh
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ana Montes
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Rebecca Kristeleit
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Debra H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom.,Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - James N Arnold
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom.,Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London, United Kingdom
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9
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Stavraka C, Pouptsis A, Synowiec A, Angelis V, Satterthwaite L, Khan S, Chauhan M, Holden C, Young S, Karampera C, Martinou M, Mills-Baldock T, Baxter M, Barry A, Eccles B, Iveson T, Shiu KK, Hill M, Abdel-Raouf S, Graham JS, Thomas A, Ross PJ. Trifluridine/Tipiracil in Metastatic Colorectal Cancer: A UK Multicenter Real-world Analysis on Efficacy, Safety, Predictive and Prognostic Factors. Clin Colorectal Cancer 2021; 20:342-349. [PMID: 34696965 DOI: 10.1016/j.clcc.2021.09.009] [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: 04/20/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The orally administered combination trifluridine/tipiracil has been approved as third line treatment in mCRC, demonstrating survival benefit and acceptable toxicity profile in the phase III RECOURSE study. PATIENT AND METHODS We performed a multicenter retrospective real-world analysis of patients with mCRC receiving trifluridine/tipiracil between 2016 and 2019 in eight cancer centers across the United Kingdom. RESULTS A total of 236 patients were included with median age of 69 years. All patients had received at least 2 lines of fluoropyrimidine-based chemotherapy doublet with oxaliplatin or irinotecan. About 10% of patients had ECOG ≥ 2. Median duration of trifluridine/tipiracil treatment was 3 months with an ORR of 2.1% and disease control rate of 21.6%. Median OS was 7.6 and median PFS 3.3 months. A dose reduction was required in 27% of patients, while 7.6% discontinued treatment due to toxicity. The most common grade 3 toxicities were neutropenia (34%), fatigue (10%), anemia (9%) and febrile neutropenia (5%). Baseline NLR <5 and CEA <200 had favorable prognostic (HR: 0.52 and 0.39, P≤ .001) and predictive value (OR: 4.1 and 6.7, P< .05). Development of grade 3 neutropenia predicted treatment response (OR: 0.32, P< .001). Following treatment with trifluridine/tipiracil 41% were referred for phase I trial or rechallenged with chemotherapy. CONCLUSION Trifluridine/tipiracil is well tolerated in refractory mCRC patients with comparable efficacy and toxicity profile to that of the phase III RECOURSE. Pretreatment NLR and CEA could serve as potential markers for patient selection, while treatment-induced grade 3 neutropenia predicted response. Prospective validation is needed.
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Affiliation(s)
- Chara Stavraka
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, United Kingdom.
| | - Athanasios Pouptsis
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Liyana Satterthwaite
- Department of Medical Oncology, Southampton University Hospitals NHS Trust, Southampton, United Kingdom
| | - Sam Khan
- Department of Medical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Meera Chauhan
- Department of Medical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Chloe Holden
- Department of Medical Oncology, Poole hospital NHS Foundation Trust, Poole, United Kingdom
| | - Sally Young
- Department of Medical Oncology, Poole hospital NHS Foundation Trust, Poole, United Kingdom
| | - Christina Karampera
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria Martinou
- Department of Medical Oncology, Queen's Hospital, Essex, United Kingdom
| | | | - Mark Baxter
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Ainsley Barry
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Bryony Eccles
- Department of Medical Oncology, Poole hospital NHS Foundation Trust, Poole, United Kingdom
| | | | - Kai-Keen Shiu
- Department of Medical Oncology, University College London Hospital, London, United Kingdom
| | - Mark Hill
- Kent Oncology Centre, Maidstone, United Kingdom
| | | | - Janet Shirley Graham
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Anne Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Paul J Ross
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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10
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Naqash AR, Kihn-Alarcón AJ, Stavraka C, Kerrigan K, Maleki Vareki S, Pinato DJ, Puri S. The role of gut microbiome in modulating response to immune checkpoint inhibitor therapy in cancer. Ann Transl Med 2021; 9:1034. [PMID: 34277834 PMCID: PMC8267312 DOI: 10.21037/atm-20-6427] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
Immunotherapy has led to a paradigm shift in the treatment of several cancers. There have been significant efforts to identify biomarkers that can predict response and toxicities related to immune checkpoint inhibitor (ICPI) therapy. Despite these advances, it has been challenging to tease out why a subset of patients benefit more than others or why certain patients experience immune-related adverse events (irAEs). Although the immune-modulating properties of the human gut bacterial ecosystem are yet to be fully elucidated, there has been growing interest in evaluating the role of the gut microbiome in shaping the therapeutic response to cancer immunotherapy. Considerable research efforts are currently directed to utilizing metagenomic and metabolic profiling of stool microbiota in patients on ICPI-based therapies. Dysbiosis or loss of microbial diversity has been associated with a poor treatment response to ICPIs and worse survival outcomes in cancer patients. Emerging data have shown that certain bacterial strains, such as Faecalibacterium that confer sensitivity to ICPI, also have a higher propensity to increase the risk of irAEs. Additionally, the microbiome can modulate the local immune response at the intestinal interface and influence the trafficking of bacterial peptide primed T-cells distally, influencing the toxicity patterns to ICPI. Antibiotic or diet induced alterations in composition of the microbiome can also indirectly alter the production of certain bacterial metabolites such as deoxycholate and short chain fatty acids that can influence the anti-tumor tolerogenesis. Gaining sufficient understanding of the exact mechanisms underpinning the interplay between ICPI induced anti-tumor immunity and the immune modulatory role gut microbiome can be vital in identifying potential avenues of improving outcomes to cancer immunotherapy. In the current review, we have summarized and highlighted the key emerging data supporting the role of gut microbiome in regulating response to ICPIs in cancer.
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Affiliation(s)
- Abdul Rafeh Naqash
- Department of Investigational Cancer Therapeutics, National Cancer Institute, Bethesda, MD, USA
| | - Alba J Kihn-Alarcón
- Department of Research, Liga Nacional Contra el Cáncer & Instituto de Cancerología, Guatemala City, Guatemala
| | - Chara Stavraka
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Kathleen Kerrigan
- Division of Medical Oncology Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Saman Maleki Vareki
- Division of Experimental Oncology, Department of Oncology, University of Western Ontario, London, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Western Ontario, London, ON, Canada.,Cancer Research Laboratory Program, Lawson Health Research Institute, London, ON, Canada
| | | | - Sonam Puri
- Division of Medical Oncology Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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11
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Chrysovergis A, Papanikolaou V, Mastronikolis N, Spyropoulou D, Adamopoulou M, Tsiambas E, Ragos V, Peschos D, Roukas D, Stavraka C, Niotis A, Kyrodimos E. C-Fos Digital Expression Analysis in Human PapillomavirusRelated Oral Squamous Cell Carcinoma. Asian Pac J Cancer Biol 2021. [DOI: 10.31557/apjcb.2021.6.2.117-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Fos Proto-Oncogene (c-Fos) represents a well analyzed gene involved in solid malignancies’ development and progression. The corresponding protein forms heterodimer with c-jun, a strong transcription factor. C-Fos/c-Jun complex influences critically the intracellular signal transduction to the nucleus. Our aim was to detect and evaluate c-Fos protein expression patterns in oral squamous cell carcinomas (OSCC) tissues. Materials and Methods: Fifty (n=50) formalin-fixed, paraffin-embedded primary OSCCs tissue sections were used. Immunohistochemistry and digital image analysis were implemented for identifying and evaluating c-Fos protein expression levels, respectively. Results: C-Fos protein over expression (moderate to high imunostaining intensity values) was observed in 28/50 (56%) tissue cores, whereas low expression rates were detected in the rest of the examined cases (22/50- 44%). C-Fos overall expression was strongly associated with the stage and grade of the examined tumors (p=0.014, p=0.003, respectively) and also with Human papillomavirus (HPV) persistent infection (p=0.004). c-Fos up regulation is frequently observed in OSCCs. Conclusion: C-Fos high expression levels are correlated with an aggressive phenotype (advanced stage/lymph node metastasis) in patients with OSCC, especially in HPV positive cases, especially High Risk subtypes. Due to its elevated oncogenic activity, c-Fos should be a target for novel therapeutic strategies in OSCC combined or not with other oncogenes involving in signaling transduction pathways.
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12
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Nakamura M, Souri EA, Osborn G, Laddach R, Chauhan J, Stavraka C, Lombardi S, Black A, Khiabany A, Khair DO, Figini M, Winship A, Ghosh S, Montes A, Spicer JF, Bax HJ, Josephs DH, Lacy KE, Tsoka S, Karagiannis SN. IgE Activates Monocytes from Cancer Patients to Acquire a Pro-Inflammatory Phenotype. Cancers (Basel) 2020; 12:E3376. [PMID: 33203088 PMCID: PMC7698027 DOI: 10.3390/cancers12113376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/11/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
IgE contributes to host-protective functions in parasitic and bacterial infections, often by monocyte and macrophage recruitment. We previously reported that monocytes contribute to tumour antigen-specific IgE-mediated tumour growth restriction in rodent models. Here, we investigate the impact of IgE stimulation on monocyte response, cellular signalling, secretory and tumour killing functions. IgE cross-linking on human monocytes with polyclonal antibodies to mimic formation of immune complexes induced upregulation of co-stimulatory (CD40, CD80, CD86), and reduced expression of regulatory (CD163, CD206, MerTK) monocyte markers. Cross-linking and tumour antigen-specific IgE antibody-dependent cellular cytotoxicity (ADCC) of cancer cells by cancer patient-derived monocytes triggered release of pro-inflammatory mediators (TNFα, MCP-1, IL-10, CXCL-10, IL-1β, IL-6, IL-23). High intratumoural gene expression of these mediators was associated with favourable five-year overall survival in ovarian cancer. IgE cross-linking of trimeric FcεRI on monocytes stimulated the phosphorylation of intracellular protein kinases widely reported to be downstream of mast cell and basophil tetrameric FcεRI signalling. These included recently-identified FcεRI pathway kinases Fgr, STAT5, Yes and Lck, which we now associate with monocytes. Overall, anti-tumour IgE can potentiate pro-inflammatory signals, and prime tumour cell killing by human monocytes. These findings will inform the development of IgE monoclonal antibody therapies for cancer.
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Affiliation(s)
- Mano Nakamura
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
| | - Elmira Amiri Souri
- Department of Informatics, Faculty of Natural & Mathematical Sciences, King’s College London, London WC2B 4BG, UK; (E.A.S.); (S.T.)
| | - Gabriel Osborn
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
| | - Roman Laddach
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- Department of Informatics, Faculty of Natural & Mathematical Sciences, King’s College London, London WC2B 4BG, UK; (E.A.S.); (S.T.)
| | - Jitesh Chauhan
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Chara Stavraka
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Sara Lombardi
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Anna Black
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Atousa Khiabany
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Duaa O. Khair
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
| | - Mariangela Figini
- Biomarker Unit, Department of Applied Research and Technology Development, Fondazione, IRCCS Istituto Nazionale dei Tumouri Milano, 20133 Milan, Italy;
| | - Anna Winship
- Department of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Sharmistha Ghosh
- Department of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Ana Montes
- Department of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - James F. Spicer
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Heather J. Bax
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Debra H. Josephs
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Katie E. Lacy
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural & Mathematical Sciences, King’s College London, London WC2B 4BG, UK; (E.A.S.); (S.T.)
| | - Sophia N. Karagiannis
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Tower Wing, 9th Floor, Guy’s Hospital, London SE1 9RT, UK; (M.N.); (G.O.); (R.L.); (J.C.); (C.S.); (S.L.); (A.B.); (A.K.); (D.O.K.); (H.J.B.); (D.H.J.); (K.E.L.)
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
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Personeni N, Lleo A, Pressiani T, Colapietro F, Openshaw MR, Stavraka C, Pouptsis A, Pinato DJ, Rimassa L. Biliary Tract Cancers: Molecular Heterogeneity and New Treatment Options. Cancers (Basel) 2020; 12:E3370. [PMID: 33202975 PMCID: PMC7696875 DOI: 10.3390/cancers12113370] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 10/15/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Most patients with biliary tract cancer (BTC) are diagnosed with advanced disease, relapse rates are high in those undergoing surgery and prognosis remains poor, while the incidence is increasing. Treatment options are limited, and chemotherapy is still the standard of care in both adjuvant and advanced disease setting. In recent years, different subtypes of BTC have been defined depending on the anatomical location and genetic and/or epigenetic aberrations. Especially for intrahepatic cholangiocarcinoma (iCCA) novel therapeutic targets have been identified, including fibroblast growth factor receptor 2 gene fusions and isocitrate dehydrogenase 1 and 2 mutations, with molecularly targeted agents having shown evidence of activity in this subgroup of patients. Additionally, other pathways are being evaluated in both iCCA and other subtypes of BTC, alongside targeting of the immune microenvironment. The growing knowledge of BTC biology and molecular heterogeneity has paved the way for the development of new therapeutic approaches that will completely change the treatment paradigm for this disease in the near future. This review provides an overview of the molecular heterogeneity of BTC and summarizes new targets and emerging therapies in development. We also discuss resistance mechanisms, open issues, and future perspectives in the management of BTC.
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Affiliation(s)
- Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy; (N.P.); (T.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (A.L.); (F.C.)
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (A.L.); (F.C.)
- Internal Medicine Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy; (N.P.); (T.P.)
| | - Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (A.L.); (F.C.)
- Internal Medicine Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
| | - Mark Robert Openshaw
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W120HS, UK; (M.R.O.); (D.J.P.)
| | - Chara Stavraka
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK;
| | - Athanasios Pouptsis
- Department of Medical Oncology, “Euromedica” General Clinic, 54645 Thessaloniki, Greece;
| | - David James Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W120HS, UK; (M.R.O.); (D.J.P.)
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy; (N.P.); (T.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (A.L.); (F.C.)
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14
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Pouptsis A, Swafe L, Patwardhan M, Stavraka C. Surgical and Systemic Treatment of Hereditary Breast Cancer: A Mini-Review With a Focus on BRCA1 and BRCA2 Mutations. Front Oncol 2020; 10:553080. [PMID: 33194613 PMCID: PMC7607003 DOI: 10.3389/fonc.2020.553080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
Hereditary breast cancer accounts for 5%-10% of breast cancer cases. The majority of familial cases have been linked to germline mutations in BRCA1 and BRCA2 genes, though other high penetrance susceptibility genes have also been identified through genomic testing advances. Optimal surgical treatment for these patients, who are of a younger age, has several challenges as it usually involves aggressive therapeutic and risk reducing interventions. At the same time, the therapeutic armamentarium for BRCA1/2 mutation carriers apart from platinum salts, has been enriched with the addition of poly-ADP ribose polymerase (PARP) inhibitors with promising outcomes. In this review we provide a succinct and comprehensive overview of the surgical and systemic treatment options for patients with BRCA1/2 mutation related breast cancer and an update on the most recent systemic treatment advances.
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Affiliation(s)
- Athanasios Pouptsis
- Department of Medical Oncology, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
| | - Leyla Swafe
- Department of Surgery, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Maneesha Patwardhan
- Department of Surgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Chara Stavraka
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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15
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Spicer J, Basu B, Montes A, Banerji U, Kristeleit R, Veal GJ, Corrigan C, Till S, Nintos G, Brier T, Funingana IG, Ang JE, Zaki K, Griffin A, Barton C, Jones P, Mellor S, Brook S, Stoddart K, Selkirk C, Carroll S, Lentfer H, Woodman N, Pope A, Pellizzari G, Nakamura M, Ilieva KM, Khiabany A, Stavraka C, Gould H, Chauhan J, Bax H, Pinder S, Josephs D, Karagiannis S. Abstract CT141: Phase 1 trial of MOv18, a first-in-class IgE antibody therapy for cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: All antibodies approved for the treatment of cancer are monoclonal IgGs, and no IgE therapy has yet been tested in humans. The biology of IgE, compared with IgG, offers potential for enhanced immune surveillance and superior effector cell potency against tumor cells. IgE antibodies in preclinical cancer models are not associated with allergic toxicity even in immunocompetent animals, and in vivo efficacy compares favorably with equivalent IgGs.
Methods: We conducted a first-in-human first-in-class trial of MOv18, a chimeric monoclonal IgE, in patients with solid tumors expressing folate receptor-alpha, the antigen recognized by this antibody. Antigen expression was deemed positive in the presence of >5% membrane staining of any intensity using the mouse clone BN3.2. Intravenous treatment was administered weekly for 6 weeks, then two-weekly. The trial incorporated pre-treatment skin prick testing with MOv18 IgE, and an ex vivo basophil activation test (BAT) using patient whole blood, with the aim of predicting systemic allergic toxicity and excluding patients at potential risk. Safety, efficacy, markers of immune response, and pharmacokinetics have been evaluated in 24 patients to date, at total doses ranging from 0.07 to 3.0mg.
Results: Treatment was well tolerated in almost all patients. The most common toxicity was readily manageable urticaria, without systemic symptoms, signs or tryptase elevation. One patient treated at the 0.5mg dose experienced anaphylaxis, with tryptase elevation, despite a negative pre-dose skin prick test. This was the only patient in the trial with baseline circulating basophils that could be activated by ex vivo exposure to MOv18 IgE. This BAT assay was subsequently used to ensure no further patient with reactive basophils was exposed. Maximum tolerated dose has not yet been reached. Dose-dependent increases in Cmax were observed, and plasma concentrations of 70-100ng/mL achieved at the 1.5mg dose are comparable to typical levels of endogenous IgE. No consistent anti-drug antibody response has been detected. Preliminary evidence of anti-tumor activity was seen in a patient with ovarian cancer at a total MOv18 IgE dose of 0.7mg. Shrinkage of peritoneal metastases was accompanied by a tumor marker reduction meeting Gynecologic Cancer InterGroup criteria for response.
Conclusions: These results support for the first time the safety of IgE as a treatment for cancer, and provide preliminary evidence for anti-tumor efficacy of this new therapeutic class. The mechanism of cutaneous toxicity is being investigated. Clinical testing of class-switched IgE versions of approved IgG-based therapeutic antibodies is warranted.
Citation Format: James Spicer, Bristi Basu, Ana Montes, Udai Banerji, Rebecca Kristeleit, Gareth J. Veal, Christopher Corrigan, Stephen Till, George Nintos, Timothy Brier, Ionut G. Funingana, Joo Ern Ang, Kam Zaki, Annie Griffin, Claire Barton, Paul Jones, Sarah Mellor, Susan Brook, Katie Stoddart, Christopher Selkirk, Simon Carroll, Heike Lentfer, Natalie Woodman, Amy Pope, Giulia Pellizzari, Mano Nakamura, Kristina M. Ilieva, Atousa Khiabany, Chara Stavraka, Hannah Gould, Jitesh Chauhan, Heather Bax, Sarah Pinder, Debra Josephs, Sophia Karagiannis. Phase 1 trial of MOv18, a first-in-class IgE antibody therapy for cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT141.
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Affiliation(s)
| | - Bristi Basu
- 2University of Cambridge, Cambridge, United Kingdom
| | - Ana Montes
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- 4The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | | | - Gareth J. Veal
- 6Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - George Nintos
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Timothy Brier
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ionut G. Funingana
- 7Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joo Ern Ang
- 4The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Kam Zaki
- 8University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Annie Griffin
- 9University of Southampton, Southampton, United Kingdom
| | | | - Paul Jones
- 11Cancer Research UK, London, United Kingdom
| | | | - Susan Brook
- 11Cancer Research UK, London, United Kingdom
| | | | | | | | | | | | - Amy Pope
- 1King's College London, London, United Kingdom
| | | | | | | | | | | | | | | | - Heather Bax
- 1King's College London, London, United Kingdom
| | - Sarah Pinder
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Debra Josephs
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Stavraka C, Gousis C, Kapiris M, Tsotra E, Clark J, Ravindra S, Sandri I, Swampillai A. Clinicopathological Features and Survival Outcomes of Breast Cancer Patients with Brain Metastases: a Single Centre Experience. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bax HJ, Khiabany A, Stavraka C, Pellizzari G, Chan Wah Hak C, Robinson A, Ilieva KM, Woodman N, Naceur‐Lombardelli C, Gillett C, Pinder S, Gould HJ, Corrigan CJ, Till SJ, Katugampola S, Barton C, Winship A, Ghosh S, Montes A, Josephs DH, Spicer JF, Karagiannis SN. Basophil activation test in cancer patient blood evaluating potential hypersensitivity to an anti-tumor IgE therapeutic candidate. Allergy 2020; 75:2069-2073. [PMID: 32086828 PMCID: PMC7581190 DOI: 10.1111/all.14245] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Heather J. Bax
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesKing’s College LondonGuy’s HospitalLondonUK
| | - Atousa Khiabany
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesKing’s College LondonGuy’s HospitalLondonUK
| | - Chara Stavraka
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesKing’s College LondonGuy’s HospitalLondonUK
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Giulia Pellizzari
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
| | - Charleen Chan Wah Hak
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Alexandra Robinson
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
| | - Kristina M. Ilieva
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy’s Cancer CentreKing’s College LondonLondonUK
| | - Natalie Woodman
- King’s Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Cristina Naceur‐Lombardelli
- King’s Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Cheryl Gillett
- King’s Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Sarah Pinder
- King’s Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Hannah J. Gould
- Randall Centre for Cell and Molecular BiophysicsSchool of Basic and Medical BiosciencesKing's College LondonLondonUK
- Asthma UK CentreAllergic Mechanisms in AsthmaKing's College LondonLondonUK
| | - Christopher J. Corrigan
- Asthma UK CentreAllergic Mechanisms in AsthmaKing's College LondonLondonUK
- Department of Respiratory Medicine and Allergy and School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Stephen J. Till
- Asthma UK CentreAllergic Mechanisms in AsthmaKing's College LondonLondonUK
- Department of Respiratory Medicine and Allergy and School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | | | - Claire Barton
- Centre for Drug DevelopmentCancer Research UKLondonUK
- Barton Oncology LtdEastcoteUK
| | - Anna Winship
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Sharmistha Ghosh
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Ana Montes
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Debra H. Josephs
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesKing’s College LondonGuy’s HospitalLondonUK
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - James F. Spicer
- School of Cancer & Pharmaceutical SciencesKing’s College LondonGuy’s HospitalLondonUK
- Departments of Medical Oncology and Clinical OncologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Sophia N. Karagiannis
- St. John’s Institute of DermatologySchool of Basic & Medical BiosciencesKing’s College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy’s Cancer CentreKing’s College LondonLondonUK
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Bax HJ, Chauhan J, Stavraka C, Khiabany A, Nakamura M, Pellizzari G, Ilieva KM, Lombardi S, Gould HJ, Corrigan CJ, Till SJ, Katugampola S, Jones PS, Barton C, Winship A, Ghosh S, Montes A, Josephs DH, Spicer JF, Karagiannis SN. Basophils from Cancer Patients Respond to Immune Stimuli and Predict Clinical Outcome. Cells 2020; 9:cells9071631. [PMID: 32645919 PMCID: PMC7408103 DOI: 10.3390/cells9071631] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Basophils are involved in manifestations of hypersensitivity, however, the current understanding of their propensity for activation and their prognostic value in cancer patients remains unclear. As in healthy and atopic individuals, basophil populations were identified in blood from ovarian cancer patients (n = 53) with diverse tumor histologies and treatment histories. Ex vivo basophil activation was measured by CD63 expression using the basophil activation test (BAT). Irrespective of prior treatment, basophils could be activated by stimulation with IgE- (anti-FcεRI and anti-IgE) and non-IgE (fMLP) mediated triggers. Basophil activation was detected by ex vivo exposure to paclitaxel, but not to other anti-cancer therapies, in agreement with a clinical history of systemic hypersensitivity reactions to paclitaxel. Protein and gene expression analyses support the presence of basophils (CCR3, CD123, FcεRI) and activated basophils (CD63, CD203c, tryptase) in ovarian tumors. Greater numbers of circulating basophils, cells with greater capacity for ex vivo stimulation (n = 35), and gene signatures indicating the presence of activated basophils in tumors (n = 439) were each associated with improved survival in ovarian cancer. Circulating basophils in cancer patients respond to IgE- and non-IgE-mediated signals and could help identify hypersensitivity to therapeutic agents. Activated circulating and tumor-infiltrating basophils may be potential biomarkers in oncology.
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Affiliation(s)
- Heather J. Bax
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Jitesh Chauhan
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Chara Stavraka
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Atousa Khiabany
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Mano Nakamura
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
| | - Giulia Pellizzari
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
| | - Kristina M. Ilieva
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
| | - Sara Lombardi
- Guy’s and St Thomas’ Oncology & Haematology Clinical Trials (OHCT), Guy’s Cancer Centre, London SE1 9RT, UK;
| | - Hannah J. Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King’s College London, London SE1 9RT, UK;
- Asthma UK Centre, Allergic Mechanisms in Asthma, King’s College London, London SE1 9RT, UK; (C.J.C.); (S.J.T.)
| | - Christopher J. Corrigan
- Asthma UK Centre, Allergic Mechanisms in Asthma, King’s College London, London SE1 9RT, UK; (C.J.C.); (S.J.T.)
- Department of Respiratory Medicine and Allergy and School of Immunology and Microbial Sciences, King’s College London, London SE1 9RT, UK
| | - Stephen J. Till
- Asthma UK Centre, Allergic Mechanisms in Asthma, King’s College London, London SE1 9RT, UK; (C.J.C.); (S.J.T.)
- Department of Respiratory Medicine and Allergy and School of Immunology and Microbial Sciences, King’s College London, London SE1 9RT, UK
| | - Sidath Katugampola
- Centre for Drug Development, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK; (S.K.); (P.S.J.); (C.B.)
| | - Paul S. Jones
- Centre for Drug Development, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK; (S.K.); (P.S.J.); (C.B.)
| | - Claire Barton
- Centre for Drug Development, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK; (S.K.); (P.S.J.); (C.B.)
- Barton Oncology Ltd., 8 Elm Avenue, Eastcote, Middlesex HA4 8PD, UK
| | - Anna Winship
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Sharmistha Ghosh
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Ana Montes
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Debra H. Josephs
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - James F. Spicer
- School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
- Departments of Medical Oncology and Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.W.); (S.G.); (A.M.)
| | - Sophia N. Karagiannis
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London SE1 9RT, UK; (H.J.B.); (J.C.); (C.S.); (A.K.); (M.N.); (G.P.); (K.M.I.); (D.H.J.)
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
- Correspondence: ; Tel.: +44(0)20-7188-6355; Fax: +44(0)20-7188-8050
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Chrysovergis A, Papanikolaou V, Mastronikolis N, Tsiambas E, Ragos V, Peschos D, Riziotis C, Stavraka C, Roukas D, Kyrodimos E. Chromosome 17 In Situ Hybridization Grid-based Analysis in Oral Squamous Cell Carcinoma. Anticancer Res 2020; 40:3759-3764. [PMID: 32620615 DOI: 10.21873/anticanres.14365] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Oral squamous cell carcinoma (OSCC) is an aggressive malignancy due to its increased ability for local metastases and distant lymph node metastases. Extensive cytogenetic analyses have detected chromosome instability (CI) patterns in OSCC including gross chromosome numerical alterations, such as polysomy and sporadically monosomy that negatively affect the biological behaviour of the malignancy. Our aim was to investigate the frequency and impact of chromosome 17 (Chr 17) numerical imbalances in OSCC. MATERIALS AND METHODS Fifty (n=50) formalin-fixed, paraffin-embedded primary OSCCs tissue sections were used. Chromogenic in situ hybridization (CISH) was implemented for detecting Chr 17 centromeric numerical imbalances. Concerning the screening process in CISH slides, a novel real-time reference and calibration grid platform was implemented. RESULTS Chr 17 multiple copies were observed in 12/50 (24%) of the examined cases. Polysomy was observed in 10/50 (20%) tissue sections, monosomy in 2/50 (4%), whereas the rest of them demonstrated a normal, diploid pattern (38/50-76%). Chr 17 numerical differences were associated with the grade of differentiation of the examined tumors (p=0.001). CONCLUSION Chr 17 numerical imbalances (polysomy predominantly and monosomy) are observed in sub-groups of OSCCs correlating with a progressive dedifferentiation of malignant tissues. The proposed grid-based platform on CISH slides provides a novel, fast and accurate screening-mapping mechanism for detecting chromosome numerical aberrations.
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Affiliation(s)
| | | | | | | | - Vasileios Ragos
- Department of Maxillofacial-Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Peschos
- Department of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Christos Riziotis
- Theoretical and Physical Chemistry Institute, Photonics for Nanoapplications Laboratory, National Hellenic Research Foundation, Athens, Greece.,Defence and Security Research Institute, University of Nicosia, Nicosia, Cyprus
| | - Chara Stavraka
- Department of Medical Oncology, Guy's and St Thomas, NHS Foundation Trust, London, U.K
| | - Dimitrios Roukas
- Department of Psychiatry, 417 VA (NIMTS) Hospital, Athens, Greece
| | - Efthymios Kyrodimos
- 1 ENT Department, Hippocration Hospital, University of Athens, Athens, Greece
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Galanis N, Stavraka C, Agathangelidis F, Petsatodis E, Giankoulof C, Givissis P. Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia. J Surg Case Rep 2020; 2020:rjaa204. [PMID: 32661487 PMCID: PMC7332286 DOI: 10.1093/jscr/rjaa204] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 12/25/2022] Open
Abstract
Coagulation abnormalities and thrombosis have been recently identified as sequelae of severe infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report a case of severe coagulopathy manifesting with right upper limb arterial and deep vein thrombosis in an 80-year-old male patient with severe COVID-19 associated pneumonia. He clinically deteriorated and received care in the intensive care unit where he was intubated. At that point, his coagulation laboratory tests were deranged, and he eventually developed dry gangrene in his right thumb and index finger, as well as a deep venous thromboembolism in his right axillary vein. Despite receiving treatment dose anticoagulation and undergoing arterial embolectomy, revascularization was unsuccessful. Amputation of the right arm at the level of the elbow was considered, but the patient died from respiratory failure.
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Affiliation(s)
- Nikiforos Galanis
- First Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, George Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Chara Stavraka
- School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Filon Agathangelidis
- First Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, George Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Evangelos Petsatodis
- Radiology Department, George Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Christos Giankoulof
- Radiology Department, George Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Panagiotis Givissis
- First Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, George Papanikolaou General Hospital, Thessaloniki 57010, Greece
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Papanikolaou V, Chrysovergis A, Mastronikolis N, Tsiambas E, Ragos V, Peschos D, Stavraka C, Roukas D, Kyrodimos E. Topoisomerase IIa Protein Expression Patterns in Laryngeal Squamous Cell Carcinoma. Anticancer Res 2020; 40:807-811. [PMID: 32014923 DOI: 10.21873/anticanres.14012] [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: 12/02/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Topoisomerase II alpha (TopoIIa) is a critical gene associated with response to chemo-therapeutic agents, such as anthracyclines, especially in breast adenocarcinoma. The aim of this study was to investigate the role of aberrant TopoIIa protein expression in laryngeal squamous cell carcinoma (LSCC). MATERIALS AND METHODS Fifty (n=50) LSCC cases were enrolled in the study. Immunohistochemistry and a digital image analysis assay were implemented. RESULTS TopoIIa protein overexpression was observed in 32/50 (64%) cases, whereas low expression rates were detected in 18/50 (36%). TopoIIa overall expression presented strong association with the grade of the examined malignant tissues and borderline association with stage. TopoIIa overexpression correlated also with Human papillomavirus (HPV) positivity. CONCLUSION TopoIIa overexpression was observed in significant subsets of LSCCs, and correlated predominantly with the grade of differentiation. HPV persistent infection seems to be associated with increased TopoIIa protein expression. TopoIIa expression analysis appears to be critical in identifying sub-groups of patients eligible for specific chemotherapy.
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Affiliation(s)
- Vasileios Papanikolaou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, Greece
| | - Aristeidis Chrysovergis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, Greece
| | | | - Evangelos Tsiambas
- Department of Immunohistochemistry & Molecular Biology, 401 General Army Hospital, Athens, Greece
| | - Vasileios Ragos
- Department of Maxillofacial, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Peschos
- Department of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Chara Stavraka
- Department of Medical Oncology, Guy's and St Thomas NHS Foundation Trust, London, U.K
| | - Dimitrios Roukas
- Department of Psychiatry, 417 VA (NIMTS) Hospital, Athens, Greece
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, Greece
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Metaxas G, Tsiambas E, Kavantzas N, Stavraka C, C Lazaris EPA, E Thomopoulou G. Impact of Cyclin D1 deregulation in HPV-mediated squamous intraepithelial lesions based on cell spots analysis. J BUON 2020; 25:792-796. [PMID: 32521869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Human papillomavirus (HPV) involvement in cervical carcinogenesis represents a classical template of analyzing viral-mediated carcinogenesis. Our purpose was to investigate the role of abnormal cyclin D1 protein expression in HPV-mediated squamous intraepithelial lesions (SILs). METHODS Eighty cases characterized as squamous intraepithelial lesions (SILs) and also borderline cases with molecularly proven HPV infection were examined. Using liquid-based cytology, we constructed 10 slides, each containing 8 cell spots. Immunocytochemistry (ICC) was performed using an anti-Cyclin D1 antibody. Digital image analysis was also implemented for evaluating objectively the protein expression levels on the corresponding stained slides. RESULTS Cyclin D1 protein overexpression (moderate to high staining intensity values) was observed in 8/80 (10%) cell spots, whereas low expression rates were detected in 72/80 (90%) cases. Cyclin D1 overall expression was strongly associated with the HPV type group (HR-HPV) of the examined cases (p=0.001) and borderline with the cervical intraepithelial neoplasia (CIN) categorization (p=0.06). Concerning the influence of marker's protein expression in SIL cytological categorization, no statistical significance was identified (p=0.10). CONCLUSIONS Cyclin D1 overexpression is observed in a subset of SILs developed by HR-HPV persistent infection in cervical epithelial host cells. Although SIL and CIN categorization seem to be not influenced by cyclin D1 expression levels, mechanisms of gene's deregulation should be a promising molecular target for discriminating specific genetic signatures in the corresponding initial cervical neoplastic lesions.
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Affiliation(s)
- George Metaxas
- Department of Obstetrics and Gynaecology, Alexandra University Hospital, Athens, Greece
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Stavraka C, Evans TRJ, Dunlop J, Earl H, Cameron DA, Coleman RE, Perren T, Leonard RCF, Mansi JL. Abstract P2-16-15: 10-year outcome for women randomized in a phase III trial comparing doxorubicin and cyclophosphamide with doxorubicin and docetaxel as primary medical therapy in early breast cancer: An anglo-celtic cooperative oncology group study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-16-15] [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
Aim: The aim of this study was to compare the long-term outcome of women with primary or locally advanced breast cancer randomised to receive either doxorubicin and cyclophosphamide (AC) or doxorubicin and docetaxel (AD) as primary chemotherapy.
Patients and methods: Eligible patients with histology-proven breast cancer with primary tumours ≥ 3 cm, inflammatory or locally advanced disease, and no evidence of distant metastases, were randomised to receive a maximum of 6 cycles of either doxorubicin (60 mg/m(2)) plus cyclophosphamide (600 mg/m(2)) i/v or doxorubicin (50 mg/m(2)) plus docetaxel (75 mg/m(2)) i/v every 3 weeks, followed by surgery on completion of chemotherapy.
Results: Clinical and pathologic responses have previously been reported 1. Time to relapse, site of relapse, and all-cause mortality were recorded. This updated analysis compares long-term disease-free (DFS) and overall survival (OS) using stratified log rank methods. A total of 363 patients were randomised to AC (n = 181) or AD (n = 182). At a median follow-up of 119 months, there is no significant difference between the two groups for DFS (P = 0.274) and OS (P = 0.327). The 10-year DFS for AC is 54% (95% CI 47-62%) and for AD 60% (95% CI 52-67). The 10-year OS is 49% (95% CI 42-57%) for AC and 51% (95% CI 43-58%) for AD. Metastatic breast cancer accounted for 89% of deaths in those treated with AC and 86% in those treated with AD. Estrogen receptor (ER) and nodal status were independent prognostic factors for DFS and OS (p<0.0005), but not the chemotherapy regimen (p=0.282 for DFS, p=0.426 for OS).
Conclusions: This was one of the first studies to evaluate taxanes versus anthracyclines in the neoadjuvant setting. Our mature data do not support an added clinical benefit for the simultaneous administration of AD compared to AC. This supports current practice with respect to sequential treatment with taxanes followed by anthracyclines leading to an increase in pathological complete response rate and better survival outcomes.
1. Evans TR, Yellowlees A, Foster E et al. Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an Anglo-Celtic cooperative Oncology group study. J Clin Oncol 2005, 23: 2988–2995.
Citation Format: Chara Stavraka, T. R. Jeffry Evans, Joanna Dunlop, Helena Earl, David A. Cameron, Robert E Coleman, Timothy Perren, Robert CF Leonard, Janine L Mansi. 10-year outcome for women randomized in a phase III trial comparing doxorubicin and cyclophosphamide with doxorubicin and docetaxel as primary medical therapy in early breast cancer: An anglo-celtic cooperative oncology group 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 P2-16-15.
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Affiliation(s)
| | - T. R. Jeffry Evans
- 2Institute of Cancer Sciences, CR-UK Beatson Institute, Glasqow, United Kingdom
| | - Joanna Dunlop
- 3Scottish Clinical Trials Research Unit (SCTRU), NHS National Services Scotland, Edinburgh, UK., Edinburgh, United Kingdom
| | - Helena Earl
- 4University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - David A. Cameron
- 5Cancer Edinburgh Research Centre, The Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital,, Edinburgh, United Kingdom
| | - Robert E Coleman
- 6Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield S10 2TN, UK., Sheffield, United Kingdom
| | - Timothy Perren
- 7St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Robert CF Leonard
- 8Department of Surgery and Cancer, Hammersmith Campus, Imperial College, London, United Kingdom
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Ilieva KM, Fazekas‐Singer J, Bax HJ, Crescioli S, Montero‐Morales L, Mele S, Sow HS, Stavraka C, Josephs DH, Spicer JF, Steinkellner H, Jensen‐Jarolim E, Tutt ANJ, Karagiannis SN. AllergoOncology: Expression platform development and functional profiling of an anti-HER2 IgE antibody. Allergy 2019; 74:1985-1989. [PMID: 30964550 PMCID: PMC6817356 DOI: 10.1111/all.13818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Kristina M. Ilieva
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical SciencesKing's College London, Guy's Cancer CentreLondonUK
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Judit Fazekas‐Singer
- Institute of Pathophysiology and Allergy ResearchMedical University of ViennaViennaAustria
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine ViennaMedical University Vienna and University ViennaViennaAustria
| | - Heather J. Bax
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Silvia Crescioli
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Laura Montero‐Morales
- Department of Applied Genetics and Cell BiologyUniversity of Natural Resources and Life SciencesViennaAustria
| | - Silvia Mele
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Heng Sheng Sow
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Chara Stavraka
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
| | - Debra H. Josephs
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
- School of Cancer & Pharmaceutical SciencesKing's College London, Guy's HopsitalLondonUK
| | - James F. Spicer
- School of Cancer & Pharmaceutical SciencesKing's College London, Guy's HopsitalLondonUK
| | - Herta Steinkellner
- Department of Applied Genetics and Cell BiologyUniversity of Natural Resources and Life SciencesViennaAustria
| | - Erika Jensen‐Jarolim
- Institute of Pathophysiology and Allergy ResearchMedical University of ViennaViennaAustria
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine ViennaMedical University Vienna and University ViennaViennaAustria
| | - Andrew N. J. Tutt
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical SciencesKing's College London, Guy's Cancer CentreLondonUK
- Breast Cancer Now Toby Robins Research CentreInstitute of Cancer ResearchLondonUK
| | - Sophia N. Karagiannis
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical SciencesKing's College London, Guy's Cancer CentreLondonUK
- St. John's Institute of Dermatology, School of Basic & Medical BiosciencesKing's College London, Guy's HospitalLondonUK
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Stavraka C, Pouptsis A, Synowiec A, Aggelis V, Satterthwaite L, Khan S, Chauhan M, Holden C, Young S, Karampera C, Martinou M, Mills-Baldock T, Baxter M, Eccles B, Iveson T, Shiu KK, Hill M, Abdel-Raouf S, Thomas A, Ross P. Trifluridine/tipiracil in metastatic colorectal cancer: An updated multicentre real-world analysis on efficacy, safety and predictive factors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stavraka C, Pouptsis A, Okonta L, De Souza K, Marinaki A, Karapanagiotou E, Papadatos-Pastos D, Mansi J. Pretreatment DPYD Genotyping Reduces the Risk of Capecitabine-associated Severe Toxicities: a Prospective Validation Study. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stavraka C, Pouptsis A, Okonta L, DeSouza K, Charlton P, Kapiris M, Marinaki A, Karapanagiotou E, Papadatos-Pastos D, Mansi J. Clinical implementation of pre-treatment DPYD genotyping in capecitabine-treated metastatic breast cancer patients. Breast Cancer Res Treat 2019; 175:511-517. [PMID: 30746637 PMCID: PMC6533219 DOI: 10.1007/s10549-019-05144-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 12/26/2022]
Abstract
Purpose Metastatic breast cancer (mBC) patients with DPYD genetic variants linked to loss of dihydropyrimidine dehydrogenase (DPD) activity are at risk of severe capecitabine-associated toxicities. However, prospective DPYD genotyping has not yet been implemented in routine clinical practice. Following a previous internal review in which two patients underwent lengthy hospitalisations whilst receiving capecitabine, and were subsequently found to be DPD deficient, we initiated routine DPYD genotyping prior to starting capecitabine. This study evaluates the clinical application of routine DPYD screening at a large cancer centre in London. Methods We reviewed medical records for consecutive patients with mBC who underwent DPYD genotyping before commencing capecitabine between December 2014 and December 2017. Patients were tested for four DPYD variants associated with reduced DPD activity. Results Sixty-six patients underwent DPYD testing. Five (8.4%) patients were found to carry DPYD genetic polymorphisms associated with reduced DPD activity; of these, two received dose-reduced capecitabine. Of the 61 patients with DPYD wild-type, 14 (23%) experienced grade 3 toxicities which involved palmar–plantar erythrodysesthesia (65%), and gastrointestinal toxicities (35%); no patient was hospitalised due to toxicity. Conclusions Prospective DPYD genotyping can be successfully implemented in routine clinical practice and can reduce the risk of severe fluoropyrimidine toxicities.
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Affiliation(s)
- Chara Stavraka
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Athanasios Pouptsis
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Leroy Okonta
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Karen DeSouza
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Philip Charlton
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Matthaios Kapiris
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Anthony Marinaki
- Purine Research Laboratory, Viapath, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Eleni Karapanagiotou
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Dionysis Papadatos-Pastos
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
| | - Janine Mansi
- Breast Unit, Guy’s and St Thomas’ NHS Foundation Trust and King’s Biomedical Centre, 4th Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
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Stavraka C, Pouptsis A, Kabuubi P, Angelis V, Synowiec A, Baxter M, Barrie A, Andres Costa A, Nizam A, De Naurois J, Mikropoulos C, Hill M, Graham JS, Harris V, Bridgewater JA, Ross PJ. Real-world experience of trifluridine/tipiracil in patients with metastatic colorectal cancer: A multicenter United Kingdom study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.668] [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
668 Background: TAS-102 is an orally administered combination of the thymidine-based nucleic acid analogue, trifluridine and the thymidine phosphorylase inhibitor, tipiracil hydrochloride. Following the phase III RECOURSE study, it received approval as third line treatment for metastatic colorectal cancer showing significant improvement in overall and progression free survival and an acceptable toxicity profile. Methods: We performed a multicenter retrospective observational study of patients with metastatic colorectal cancer receiving TAS-102 as third line treatment between 2016 and 2018 in Cancer centers across the UK. Results: A total of 143 patients were included (94 men, 49 women). Median age was 68 years (35-82). All patients had received at least 2 lines of fluoropyrimidine-based chemotherapy doublet with oxaliplatin or irinotecan. About 90% of patients had ECOG ≥ 1. Median duration of treatment was 2.9 months (0.5-22.9), with a response rate of 1.6% and stable disease achieved in 24%. Median OS was 7 months (95% CI 5.84-8.15) and median PFS 2.6 months (95% CI 2.2-3.36). A dose reduction was required in 28% of patients, while 8% discontinued treatment due to toxicity. AEs reported included fatigue 81.3% (G3 16.8%), nausea 34.5% (G3 4.5%) and diarrhoea 25.5% (G3 1.8%). Neutropenia was common 50.4%, (≥ G3: 25.4%) with 4.2% cases of neutropenic fever while thrombocytopenia was less frequent 8.7% (≥ G3 1.8%). Conclusions: The OS, PFS and ORR observed in our real-world experience were consistent with the RECOURSE trial, though we noted a lower disease control rate. Overall, TAS-102 was well tolerated and the most prevalent adverse events seen in our patients were in keeping with those reported in the trial. Although severe toxicities were less frequent than the trial, we experienced higher rates of toxicity induced dose reductions and treatment cessations, which could reflect the differences between trial and real world populations. Further validation is warranted.
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Affiliation(s)
- Chara Stavraka
- Guy's and St Thomas' NHS foundation Trust, London, United Kingdom
| | | | - Paul Kabuubi
- Guy's and St Thomas' NHS foundation Trust, London, United Kingdom
| | | | - Alicja Synowiec
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Mark Baxter
- NHS Greater Glasqow and Clyde, Glasgow, United Kingdom
| | | | | | - Alia Nizam
- University College Hospital NHS Trust, London, United Kingdom
| | | | | | - Mark Hill
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom
| | | | - Victoria Harris
- Guy's and St Thomas' NHS foundation Trust, London, United Kingdom
| | | | - Paul J. Ross
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Stavraka C, Rush H, Ross P. Combined hepatocellular cholangiocarcinoma (cHCC-CC): an update of genetics, molecular biology, and therapeutic interventions. J Hepatocell Carcinoma 2018; 6:11-21. [PMID: 30643759 PMCID: PMC6312394 DOI: 10.2147/jhc.s159805] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Combined hepatocellular cholangiocarcinoma (CC) is a rare and aggressive primary hepatic malignancy with significant histological and biological heterogeneity. It presents with more aggressive behavior and worse survival outcomes than either hepatocellular carcinoma or CC and remains a diagnostic challenge. An accurate diagnosis is crucial for its optimal management. Major hepatectomy with hilar node resection remains the mainstay of treatment in operable cases. Advances in the genetic and molecular characterization of this tumor will contribute to the better understanding of its pathogenesis and shape its future management.
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Affiliation(s)
- Chara Stavraka
- Department of Medical Oncology, Guy's Cancer, Guy's & St Thomas' NHS Foundation Trust, London, UK,
| | - Hannah Rush
- Department of Medical Oncology, Guy's Cancer, Guy's & St Thomas' NHS Foundation Trust, London, UK,
| | - Paul Ross
- Department of Medical Oncology, Guy's Cancer, Guy's & St Thomas' NHS Foundation Trust, London, UK, .,Department of Oncology, King's College Hospital NHS Foundation Trust, London, UK,
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Galanis N, Stavraka C, Valavani E, Kirkos J. Unsupervised Exercise-Induced Myositis Ossificans in the Brachialis Muscle of a Young Healthy Male: A Case Report. Orthop J Sports Med 2017; 5:2325967117718780. [PMID: 28795074 PMCID: PMC5524241 DOI: 10.1177/2325967117718780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Chara Stavraka
- Department of Cancer and Surgery, Imperial College London, Hammersmith Hospital, London, UK
| | - Evdoxia Valavani
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
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Stavraka C, Mura M, Fischer R, Thezenas ML, Maghami SG, Chettle J, Buluwela L, Kessler B, Blagden SP. Abstract B44: Protein interactions involving LARP1 in chemotherapy resistant ovarian cancer cells. Cancer Res 2017. [DOI: 10.1158/1538-7445.transcontrol16-b44] [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
Ovarian cancer (OC) is the most lethal gynecological malignancy accounting for 152,000 deaths annually worldwide. Due to the lack of a validated diagnostic tool, patients usually present with disseminated disease and the majority will develop resistance to platinum chemotherapy. Resensitizing OC to cisplatin-based chemotherapy is an unmet clinical need. The RNA-binding protein LARP1 is highly expressed in OC and is a post-transcriptional regulator of cell survival and tumorigenesis. LARP1 depletion using RNA interference (RNAi) restores platinum sensitivity in cisplatin-resistant OC cell lines and shows a synergistic anti-tumour effect with cisplatin. We explored the effect of this resensitization on the efficiency of protein translation using the Surface Sensing of Translation (SUnSET) method. Whilst cisplatin-induced genotoxic stress attenuated de novo protein synthesis in platinum sensitive OVCAR3 cells, this was not observed in platinum-resistant OVCAR8 cells where residual protein synthesis was maintained. However this residual translation was completely abolished after RNAi to LARP1 suggesting that, in the OVCAR8 cells, LARP1 maintains protein synthesis during genotoxic stress. Although LARP1 is known to bind Poly A binding protein (PABP) we questioned whether other interacting partners might also regulate this response. Using immunoprecipitation followed by ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) in OVCAR3 and OVCAR8 cells before and after cisplatin treatment, we identified PABPC1, PABPC4 and YB-1 as strong interactors with LARP1. By western blotting, Duolink Proximity Ligation Assay and Immunofluorescence we then confirmed these candidates as being complexed with LARP1. We are currently elucidating the functional role of these interactions on the LARP1-mediated genotoxic stress response with the overall aim of identifying therapeutic strategies to overcome platinum-resistance in ovarian cancer.
Citation Format: Chara Stavraka, Manuela Mura, Roman Fischer, Marie-Laetitia Thezenas, Sadaf Ghaem Maghami, James Chettle, Laki Buluwela, Benedikt Kessler, Sarah P. Blagden. Protein interactions involving LARP1 in chemotherapy resistant ovarian cancer cells. [abstract]. In: Proceedings of the AACR Special Conference on Translational Control of Cancer: A New Frontier in Cancer Biology and Therapy; 2016 Oct 27-30; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2017;77(6 Suppl):Abstract nr B44.
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Ghazaly EA, Quesne JL, Jiang D, Mangala SL, Chettle J, Rodriguez-Aguayo C, Lopez-Berestein G, Gnanaranjan C, Mura M, Stavraka C, Sood AK, Blagden SP. Abstract B30: The RNA-binding protein LARP1 is a cancer therapeutic target. Cancer Res 2017. [DOI: 10.1158/1538-7445.transcontrol16-b30] [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
Ovarian cancer is the most lethal of gynecological cancers killing 60% of women diagnosed with the disease within 5 years. The major contributor to this high mortality is the emergence of chemotherapy resistance; the tumor is initially sensitive to chemotherapy (especially cisplatin, the mainstay of treatment) but recurs with increasingly resistant disease. Effective methods of overcoming treatment resistance are a major unmet medical need and would prolong survival and improve quality of life for women with this disease. We have shown previously that the RNA binding protein La-related protein 1 (LARP1) binds and post-transcriptionally regulates the stability of mRNAs encoding cell survival and stress response proteins including mTOR, BCL2 and BIK. In ovarian cancer tissue, elevated levels of LARP1 protein correlate with adverse survival outcome and chemotherapy resistance. In vivo inhibition of LARP1 using therapeutic RNA interference (packaged in DOPC nanoliposomes) restores cisplatin sensitivity in resistant ovarian cancer xenograft models. In concurrent studies, using a novel ultra-high performance liquid chromatography tandem mass spectrometry method, we have quantified LARP1 in the circulation of ovarian cancer patients and found that high levels correspond with poor prognosis. Circulating LARP1 has prognostic significance and may act as a companion biomarker to a LARP1 inhibitor. We conclude that LARP1, through its regulation of multiple mRNAs within critical pathophysiological pathways, is an important cancer therapeutic target and that RNA-based drugs designed to target LARP1 restore chemotherapy sensitivity in xenograft models.
Citation Format: Essam A. Ghazaly, John Le Quesne, Dahai Jiang, Selanere L. Mangala, James Chettle, Cristian Rodriguez-Aguayo, Gabriel Lopez-Berestein, Chathunissa Gnanaranjan, Manuela Mura, Chara Stavraka, Anil K. Sood, Sarah P. Blagden. The RNA-binding protein LARP1 is a cancer therapeutic target. [abstract]. In: Proceedings of the AACR Special Conference on Translational Control of Cancer: A New Frontier in Cancer Biology and Therapy; 2016 Oct 27-30; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2017;77(6 Suppl):Abstract nr B30.
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Affiliation(s)
- Essam A. Ghazaly
- 1Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,
| | - John Le Quesne
- 2MRC Toxicology Unit, Leicester, Leicestershire, United Kingdom,
| | - Dahai Jiang
- 3The University of Texas MD Anderson Cancer Center, Houston, TX,
| | | | - James Chettle
- 4Department of Oncology, University of Oxford, Oxford, Oxfordshire, United Kingdom,
| | | | | | | | - Manuela Mura
- 5Ovarian Cancer Action Research Centre, Imperial College London, London, United Kingdom
| | - Chara Stavraka
- 5Ovarian Cancer Action Research Centre, Imperial College London, London, United Kingdom
| | - Anil K. Sood
- 3The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - Sarah P. Blagden
- 4Department of Oncology, University of Oxford, Oxford, Oxfordshire, United Kingdom,
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Abstract
The evolutionarily-conserved La-related protein (LARP) family currently comprises Genuine La, LARP1, LARP1b, LARP4, LARP4b, LARP6 and LARP7. Emerging evidence suggests each LARP has a distinct role in transcription and/or mRNA translation that is attributable to subtle sequence variations within their La modules and specific C-terminal domains. As emerging research uncovers the function of each LARP, it is evident that La, LARP1, LARP6, LARP7 and possibly LARP4a and 4b are dysregulated in cancer. Of these, LARP1 is the first to be demonstrated to drive oncogenesis. Here, we review the role of each LARP and the evidence linking it to malignancy. We discuss a future strategy of targeting members of this protein family as cancer therapy.
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Affiliation(s)
- Chara Stavraka
- Ovarian Cancer Research Centre, Institute for Reproductive and Developmental Biology, Imperial College, Du Cane Road, London W12 0HS, UK.
| | - Sarah Blagden
- Ovarian Cancer Research Centre, Institute for Reproductive and Developmental Biology, Imperial College, Du Cane Road, London W12 0HS, UK.
- Department of Oncology, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LE, UK.
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Blagden SP, Rizzuto I, Stavraka C, O'Shea D, Suppiah P, Patel M, Sukumaran A, Loyse N, Bharwani N, Rockall A, Gabra H, El-Bahrawy M, Wasan H, Leonard RCF, Habib NA, Gribben JG, Ghazaly EA, McGuigan C. Final results of ProGem1, the first in-human phase I/II study of NUC-1031 in patients with solid malignancies. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ivana Rizzuto
- NIHR/Wellcome Trust Imperial Clinical Research Facility, London, United Kingdom
| | - Chara Stavraka
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Daniel O'Shea
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Puvan Suppiah
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Markand Patel
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | | | - Naomi Loyse
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | | | | | - Hani Gabra
- Ovarian Cancer Action Research Centre, London, United Kingdom
| | | | - Harpreet Wasan
- Department of Oncology, Imperial College, London, United Kingdom
| | | | | | - John G. Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Essam Ahmed Ghazaly
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Blagden SP, Rizzuto I, Stavraka C, O'Shea D, Suppiah P, Patel M, Loyse N, Sukumaran A, Bharwani N, Rockall A, Gabra H, El-Bahrawy M, Wasan HS, Leonard RCF, Habib NA, McGuigan C, Gribben JG, Ghazaly EA. A first in human Phase I/II study of NUC-1031 in patients with advanced gynecological cancers. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ivana Rizzuto
- NIHR/Wellcome Trust Imperial Clinical Research Facility, London, United Kingdom
| | - Chara Stavraka
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Daniel O'Shea
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Puvan Suppiah
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Markand Patel
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | - Naomi Loyse
- NIHR/Wellcome Trust Imperial CRF, London, United Kingdom
| | | | | | | | - Hani Gabra
- Ovarian Cancer Action Research Centre, London, United Kingdom
| | | | | | | | | | | | - John G. Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Essam Ahmed Ghazaly
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Blagden S, Omlin A, Olmin A, Josephs D, Stavraka C, Zivi A, Pinato DJ, Anthoney A, Decordova S, Swales K, Riisnaes R, Pope L, Noguchi K, Shiokawa R, Inatani M, Prince J, Jones K, Twelves C, Spicer J, Banerji U. First-in-human study of CH5132799, an oral class I PI3K inhibitor, studying toxicity, pharmacokinetics, and pharmacodynamics, in patients with metastatic cancer. Clin Cancer Res 2014; 20:5908-17. [PMID: 25231405 DOI: 10.1158/1078-0432.ccr-14-1315] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE This phase I dose-escalation study investigated the maximum-tolerated dose (MTD), dose-limiting toxicities (DLT), safety, pharmacokinetics (PK), pharmacodynamics (PD), and preliminary clinical activity of CH5132799. EXPERIMENTAL DESIGN Patients with metastatic solid tumors were eligible for the study. CH5132799 was administered orally once daily or twice daily in 28-day cycles. RESULTS Thirty-eight patients with solid tumors received CH5132799 at 2 to 96 mg once daily or 48 to 72 mg twice daily. The MTD was 48 mg on the twice-daily schedule but was not reached on the once daily schedule. DLTs were grade 3 elevated liver function tests (LFT), grade 3 fatigue, grade 3 encephalopathy, grade 3 diarrhea, and grade 3 diarrhea with grade 3 stomatitis; all DLTs were reversible. Most drug-related adverse events were grade 1/2. Diarrhea (34%) and nausea (32%) were the most common events. Mean Cmax and AUC0-24 in steady state at MTD were 175 ng/mL and 1,550 ng·h/mL, respectively, consistent with efficacious exposure based on preclinical modeling. Reduction in SUVmax with [(18)F] fluorodeoxyglucose positron emission tomography (FDG-PET) was observed in 5 of 7 patients at MTD. A patient with PIK3CA-mutated clear cell carcinoma of the ovary achieved a partial response by GCIG CA125 criteria and further, a heavily pretreated patient with triple-negative breast cancer had marked improvement in her cutaneous skin lesions lasting six cycles. CONCLUSION CH5132799 is well tolerated at the MTD dose of 48 mg twice daily. At this dose, the drug had a favorable PK and PD profile and preliminary evidence of clinical activity.
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Affiliation(s)
- Sarah Blagden
- Imperial NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College and Hammersmith Hospital Healthcare NHS Trust, London, United Kingdom
| | | | - Aurelius Olmin
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Debra Josephs
- King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chara Stavraka
- Imperial NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College and Hammersmith Hospital Healthcare NHS Trust, London, United Kingdom
| | - Andrea Zivi
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Pinato
- Imperial NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College and Hammersmith Hospital Healthcare NHS Trust, London, United Kingdom
| | - Alan Anthoney
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | | | - Karen Swales
- The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | - Lorna Pope
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jenny Prince
- Chugai Pharma Europe Ltd., London, United Kingdom
| | - Keith Jones
- Chugai Pharma Europe Ltd., London, United Kingdom
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - James Spicer
- King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
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Hopkins TG, Stavraka C, Gabra H, Fallowfield L, Hood C, Blagden S. Sexual activity and functioning in ovarian cancer survivors: an internet-based evaluation. Climacteric 2014; 18:94-8. [PMID: 25029389 DOI: 10.3109/13697137.2014.929104] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Sexual dysfunction is a known complication of treatment for many cancers, but there have been relatively few studies investigating outcomes for ovarian cancer survivors. We have previously reported that women treated for ovarian cancer experience persistent psychological and physical problems. Sexual functioning was highlighted as a significant factor and we sought to investigate this further. METHODS Women were invited to complete a questionnaire using both paper and online response formats. A validated tool, the Sexual Activity Questionnaire, was used to obtain information from women following a diagnosis of ovarian cancer. RESULTS Across all responders (n = 102, mean age 51.3 years), 63% of women reported their ovarian cancer diagnosis had negatively changed their sex life. The most common reasons given for an absence of sexual activity were a lack of interest in sex, physical problems that prevented sex or no partner. Of the 46% of responders who stated they were sexually active, 77% reported pain or discomfort during intercourse and 87% described vaginal dryness. CONCLUSION For the majority of women, treatment for ovarian cancer negatively impacts on their sex lives. Many of the symptoms described by participants are potentially reversible and clinicians should be open to raising the issue of sexual functioning with their patients.
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Affiliation(s)
- T G Hopkins
- Department of Gynaecological Oncology, Imperial College, Hammersmith Hospital
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Affiliation(s)
- Vishal Narwani
- Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Leyla Swafe
- Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Chara Stavraka
- Department of Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Ketan Dhatariya
- Department of Medicine and Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Stavraka C, Pinato DJ, Turnbull SJ, Flynn MJ, Forster MD, O'Cathail SM, Babar S, Seckl MJ, Kristeleit RS, Blagden SP. Developing an objective marker to optimize patient selection and predict survival benefit in early-phase cancer trials. Cancer 2013; 120:262-70. [PMID: 24399418 DOI: 10.1002/cncr.28381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 05/24/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several prognostic indices have been devised to optimize patient selection for phase 1 oncology trials with no consensus as to the optimal score and none qualifying as a marker of treatment response. METHODS Multivariate predictors of overall survival (OS) were tested on 118 referred patients to develop the Hammersmith Score (HS). The score's ability to predict OS, progression-free survival (PFS), and 90-day mortality (90DM) was compared with other prognostic indices. Changes in HS were recalculated during treatment. RESULTS Albumin<35 g/L, lactate dehydrogenase>450 U/L, and sodium<135 mmol/L emerged as independent prognostic factors. These were used with equal weighting to devise the HS, a compound prognostic index ranging from 0 to 3. High (HS=2-3) score predicted worse OS (hazard ratio [HR]=6.5, P<.001), PFS (HR=2.8, P=.01), and 90DM (OR=9.0, P<.001). HS was a more accurate multivariate predictor of OS (HR=6.4, P<.001, C-index=0.72), PFS (HR=2.7, P=.03), and 90DM (area under the ROC curve 0.703) compared with other scores. Worsening of the HS during treatment predicted for shorter OS (P<.001). HS retained prognostic and predictive ability following external validation. CONCLUSIONS HS is a simple, validated index to optimize patient selection and predict survival benefit from phase 1 oncology treatments. Prospective validation is ongoing.
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Affiliation(s)
- Chara Stavraka
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Ghazaly EA, Joel S, Gribben JG, Mohammad T, Emiloju O, Stavraka C, Hopkins T, Gabra H, Wasan H, Habib NA, Leonard RCF, McGuigan C, Slusarczyk M, Blagden SP. ProGem1: Phase I first-in-human study of the novel nucleotide NUC-1031 in adult patients with advanced solid tumors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
2576 Background: NUC-1031 is a novel nucleotide (ProTide) that evades all three key cellular resistance mechanisms associated with gemcitabine (dFdC). NUC-1031 bypasses nucleoside transporters, is activated independent of deoxycytidine kinase and is resistant to cytidine deaminase-mediated degradation. NUC-1031 has demonstrated broad antiproliferative activity in vitro and in vivo. Methods: Patients with relapsed/refractory advanced solid tumors entered in sequential cohorts of up to 6 patients, with escalating doses of NUC-1031 administered as a 5-10 minute IV injection weekly or twice-weekly. Ongoing objectives are to determine recommended phase II dose, safety profile, pharmacokinetics (PK) and preliminary anti-tumor activity. Results: 8 patients (5 female, 3 male) with pancreatic (2), colorectal (2), breast (1), and ovarian (1) cancers; cholangiocarcinoma (1) and unknown primary (1) have been enrolled. Two dose levels - 500mg/m2 (4) and 1000mg/m2 (1) weekly and one dose level - 375 mg/m2(3) twice-weekly. No DLTs have been observed. Mean AUC (0 - 24 h) for NUC-1031 was 150.3 ± 84.8 µM/h (n=5). dFdC and dFdU were detected in plasma up to 24 h (range of 0 - 5.8 µM for dFdC and 0 - 14.9 µM for dFdU). NUC-1031 excreted in urine mainly as dFdU. The Table shows rapid elimination of NUC-1031 from plasma and high intracellular levels of the active gemcitabine triphosphate at 2 and 24 h. Stable disease achieved in 1 patient with rapidly progressing breast cancer. Two further patients had symptomatic relief and improved QOL, including a dramatic reduction in ascites and pain. Conclusions: PK data show NUC-1031 has ≥ 10x higher intracellular levels of the active compound, dFdCTP, and significantly lower plasma Cmax levels of the toxic metabolite, dFdU, compared to equivalent levels of gemcitabine. NUC-1031 has shown better intracellular delivery and toxicity profile than gemcitabine with some promising early indicators of clinical efficacy. Clinical trial information: NCT01621854. [Table: see text]
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Affiliation(s)
- Essam Ahmed Ghazaly
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Simon Joel
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - John G. Gribben
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Tariq Mohammad
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College, London, United Kingdom
| | - Oluwadunni Emiloju
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College, London, United Kingdom
| | - Chara Stavraka
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College, London, United Kingdom
| | - Tom Hopkins
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College, London, United Kingdom
| | - Hani Gabra
- Department of Oncology, Imperial College, London, United Kingdom
| | - Harpreet Wasan
- Department of Oncology, Imperial College, London, United Kingdom
| | - Nagy A Habib
- Department of Oncology, Imperial College, London, United Kingdom
| | | | - Christopher McGuigan
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Magdalena Slusarczyk
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Sarah Patricia Blagden
- NIHR/Wellcome Trust Imperial Clinical Research Facility and Department of Oncology, Imperial College, London, United Kingdom
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Stavraka C, Maclaran K, Gabra H, Agarwal R, Ghaem-Maghami S, Taylor A, Dhillo WS, Panay N, Blagden SP. A study to evaluate the cause of bone demineralization in gynecological cancer survivors. Oncologist 2013; 18:423-9. [PMID: 23363808 PMCID: PMC3639529 DOI: 10.1634/theoncologist.2012-0416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 10/24/2012] [Accepted: 11/19/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND An association between treatment for gynecological cancers and risk of osteoporosis has never been formally evaluated. Women treated for these cancers are now living longer than ever before, and prevention of treatment-induced morbidities is important. We aimed to distinguish, in gynecological cancer survivors, whether cancer therapy has additional detrimental effects on bone health above those attributable to hormone withdrawal. METHODS We performed a retrospective cross-sectional analysis of dual energy x-ray absorptiometry (DEXA) scan results from 105 women; 64 had undergone bilateral salpingo-oophorectomy (BSO) followed by chemotherapy or radiotherapy for gynecological malignancies, and 41 age-matched women had undergone BSO for benign etiologies. All were premenopausal prior to surgery. RESULTS The median age at DEXA scan for the cancer group was 42 years, and 66% had received hormonal replacement therapy (HRT) following their cancer treatment. For the benign group, the median age was 40 years, and 87% had received HRT. Thirty-nine percent of cancer survivors had abnormal DEXA scan results compared to 15% of the control group, with the majority demonstrating osteopenia. The mean lumbar spine and femoral neck bone mineral densities (BMDs) were significantly lower in cancer patients. A history of gynecological cancer treatment was associated with significantly lower BMD in a multivariate logistic regression. CONCLUSIONS Women treated for gynecological malignancies with surgery and adjuvant chemotherapy have significantly lower BMDs than age-matched women who have undergone oophorectomy for noncancer indications. Prospective evaluation of BMD in gynecological cancer patients is recommended to facilitate interventions that will reduce the risk of subsequent fragility fractures.
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Affiliation(s)
| | | | - Hani Gabra
- Queen Charlotte's & Chelsea and Westminster Hospital, London, United Kingdom
| | | | | | | | - Waljit S. Dhillo
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Nick Panay
- Queen Charlotte's & Chelsea and Westminster Hospital, London, United Kingdom
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Pinato DJ, Stavraka C, Tanner M, Esson A, Jacobson EW, Wilkins MR, Libri V. Clinical, ethical and financial implications of incidental imaging findings: experience from a phase I trial in healthy elderly volunteers. PLoS One 2012; 7:e49814. [PMID: 23166776 PMCID: PMC3500322 DOI: 10.1371/journal.pone.0049814] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 10/17/2012] [Indexed: 12/05/2022] Open
Abstract
Background The detection of incidental findings (IF) in magnetic resonance imaging (MRI) studies is common and increases as a function of age. Responsible handling of IF is required, with implications for the conduct of research and the provision of good clinical care. Aim To investigate the prevalence and clinical significance of IF in a prospective cohort of healthy elderly volunteers who underwent MRI of the torso as a baseline investigation for a phase I trial. We assessed the follow-up pathway with consequent cost implications and impact on trial outcomes. Methods A total of 29 elderly healthy volunteers (mean age 67, range 61–77, 59% female) were eligible at screening and underwent MRI for assessment of visceral and subcutaneous fat. Results IF were detected in 19 subjects (66%). Suspected IF of high and low clinical significance were found in 14% and 52% of participants, respectively. Follow up of IF was conducted in 18 individuals, confirming abnormalities in 13 subjects, 3 of whom were recommended for deferred clinical re-evaluation. The remaining 5 subjects had false positive IF based on second line imaging tests. Costs of follow-up medical care were considerable. Conclusion MRI abnormalities are common in elderly individuals, as a result of age and non-diagnostic quality of research scans. In the presence of IF in the context of clinical trials, immediate referrals and follow up assessments may be required to rule out suspected pathology prior to exposing trial participants to investigational medicine products (IMP). Unanticipated costs, ethical implication and the possible impact of IF on trial outcomes need to be taken into account when designing and conducting trials with an IMP.
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Affiliation(s)
- David J. Pinato
- The National Institute for Health Research (NIHR)-Wellcome Trust Imperial College Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
| | - Chara Stavraka
- The National Institute for Health Research (NIHR)-Wellcome Trust Imperial College Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
| | - Mark Tanner
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Audrey Esson
- The National Institute for Health Research (NIHR)-Wellcome Trust Imperial College Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
| | - Eric W. Jacobson
- Sirtris Pharmaceuticals Inc., Cambridge, Massachusetts, United States of America
| | - Martin R. Wilkins
- The National Institute for Health Research (NIHR)-Wellcome Trust Imperial College Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
| | - Vincenzo Libri
- The National Institute for Health Research (NIHR)-Wellcome Trust Imperial College Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
- * E-mail:
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Omlin AG, Spicer JF, Sarker D, Pinato DJ, Agarwal R, Cassier PA, Stavraka C, Blanco M, Suder A, Allan S, Heaton S, Decordova S, Pope L, Prince J, Noguchi K, Jones K, Inatani M, Shiokawa R, Banerji U, Blagden SP. A pharmacokinetic (PK) pharmacodynamic (PD) driven first-in-human study of the oral class I PI3K inhibitor CH5132799, in patients with advanced solid tumors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3022] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
3022 Background: The phosphatidylinositol 3-kinase (PI3K) pathway is a promising target in cancer. CH5132799 is a novel PI3K inhibitor, selectively inhibiting class I PI3Ks (α, β, δ and γ) with no inhibition of class II and III or mTOR, and with potent antitumor activity in preclinical studies (Tanaka et al, Clin Cancer Res; 17; 3272-81, 2011). First-in-human study objectives were determination of maximum tolerated dose (MTD), safety/tolerability, PK/PD and clinical activity (RECIST). Methods: A 3+3 dose escalation design was used. The initial dosing schedule of CH5132799(schedule A) was once a day (QD). Due to a relatively short half-life, a twice a day (BID) schedule (schedule B) was introduced. PK profiles were studied over 72 hours. PD analyses included quantification of various phosphoproteins in platelet rich plasma (PRP). Tumor assessments were performed at baseline and cycle 3 day 1 (C3D1) and FDG-PET scans at baseline, C1D8 and C3D1. Results: 29 patients (pts) with a variety of solid tumors have been treated (A 23 pts, B 6 pts, the most common tumors were breast, oesophageal, colorectal and ovarian). The starting doses were 2 mg (A) and 48 mg (B). The current doses being explored are 96 mg (A) and 72 mg (B). The most frequently reported drug-related AEs were Grade 1/2 diarrhea, nausea, fatigue, anorexia and anemia. 1 DLT (Grade 3 elevated LFT) was observed in a hepatocellular carcinoma pt at 48 mg BID. MTD has not yet been determined. The preliminary mean ±SD Cmax and AUC at 96 mg QD were 202±129 ng/ml and 1407±935 ng·hr/ml respectively, which is consistent with an efficacious exposure based on preclinical models. Some patients achieved the expected exposure at over 32 mg. From single dose of 48mg there was a reduction of phosphorylation of AKT in PRP after treatment, consistent with pathway modulation. A patient with clear cell ovarian cancer and a PIK3CA mutation treated at 48 mg BID showed >50% decrease in SUV on a PET scan at C1D8 and a 75% decrease in CA-125 at C2D1. 5 pts exhibited SD (>8 weeks). Conclusions: CH5132799 is well tolerated either QD ≤96 mg or BID ≤48 mg. Dose-escalation continues and updated safety/efficacy/PK/PD data will be presented.
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Affiliation(s)
- Aurelius Gabriel Omlin
- Section of Medicine, The Institute of Cancer Research, Sutton, UK and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - James F. Spicer
- King's College London, Guy's Hospital Campus, London, United Kingdom
| | - Debashis Sarker
- King's College London, Guy's Hospital Campus, Sutton, United Kingdom
| | | | - Roshan Agarwal
- Ovarian Cancer Action Research Centre, Imperial College London, London, United Kingdom
| | - Philippe Alexandre Cassier
- Section of Medicine, The Institute of Cancer Research, Sutton, UK and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Monsterrat Blanco
- Section of Medicine, The Institute of Cancer Research, Sutton, UK and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aneta Suder
- King's College London, Guy's Hospital Campus, London, United Kingdom
| | - Suzanne Allan
- King's College London, Guy's Hospital Campus, London, United Kingdom
| | - Simon Heaton
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Lorna Pope
- The Institute of Cancer Research, Sutton, United Kingdom
| | - Jenny Prince
- Chugai Pharma Europe Ltd., London, United Kingdom
| | | | - Keith Jones
- CHUGAI Pharma Europe Ltd, London, United Kingdom
| | | | - Rie Shiokawa
- Chugai Pharmaceutical Ltd, Tokyo, Japan, Tokyo, Japan
| | - Udai Banerji
- Section of Medicine, The Institute of Cancer Research, Sutton, UK and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Pinato DJ, Stavraka C, O'Cathail SM, Seckl M, Blagden SP. Use of inflammation-based scores to optimize the selection of patients with advanced cancer considered for early-phase clinical trials. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13033] [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
e13033 Background: The presence of adequate organ function, favorable performance status (PS) and exhaustion of standard treatments are the main factors guiding accrual onto Phase I trials. As inflammation is inherent to the pathogenesis and prognosis of cancer we investigated the prognostic and predictive performance of inflammation based indices including the neutrophil (NLR) and platelet to lymphocyte ratio (PLR). Methods: Unselected referrals to the Phase I unit (2007-2011) were considered. Demographic, treatment, staging data and routine blood tests were collected. Patients were defined as high risk if NLR>5 or PLR>300 respectively. Changes in the NLR (ΔNLR) were recalculated at disease reassessment. Kaplan Meier and log rank test were used to assess Progression Free (PFS) and Overall Survival (OS) with each variable. Significant factors were further tested in a multivariate Cox model. C-index was used to calculate the discriminative ability of each score and ROC curves to predict 90 days survival (90DS). Results: We included 126 patients with median age 63 years (range: 22-80); median OS 4.4 months (0.2-39), 36% male; 92% with metastases, 23% PS>1. On univariate analysis LDH>450, PS, NLR≥5, hypoalbuminaemia, NLR normalization (ΔNLR) (p<0.001), >2 previous treatment lines (p=0.01) predicted for OS. After multivariate analysis low albumin, high LDH and ΔNLR remained independent predictors (p<0.05). Shorter PFS was predicted by elevated LDH and ΔNLR (p<0.05). PS and NLR ranked as most accurate predictors of both 90DS with area under the ROC curve values of 0.66 (0.55-0.77) and 0.64 (0.54-0.75) and OS with c-index scores of 0.69 (0.56-0.82) and 0.60 (0.50-0.70). When combined to PS, the NLR improved its accuracy to 0.72 (0.59-0.83). NLR≥5 at screening was associated with advanced PS, low albumin (p<0.002), LDH>450 and >2 metastatic sites (p<0.05). Conclusions: The NLR can improve the selection of patients considered for experimental therapies, with its normalization following treatment predicting for a survival benefit of 7 months in our series.
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Affiliation(s)
| | | | | | - Michael Seckl
- Charing Cross Hospital Trophoblastic Disease Centre, London, United Kingdom
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Stavraka C, Pinato DJ, O'Cathail SM, Williams FJ, Seckl M, Blagden SP. Multivariate screening of prognostic factors to identify a novel, simple, and objective marker to optimize patient selection and predict survival benefit in early-phase trials. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.2608] [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
2608 Background: Several prognostic indices have been devised to optimize patient selection for phase I trials. However, there is no consensus as to the optimal score and none qualifies as a marker of response. We developed a simple score through a multivariate screening of individual variables and compared its performance with existing prognostic scores including the Royal Marsden, Nijmegen and Prince Margaret Hospital scores. Methods: We retrospectively analyzed characteristics and outcomes of 120 referrals to our phase I center (2007 - 2011). Independent predictors for overall survival (OS) were identified from univariate (Kaplan Meier) and multivariate (Cox regression) analyses and used to create the Hammersmith Hospital score (HS). This was compared with the other indices for predicting progression free survival (PFS), OS and 90 day mortality (90 DM). Multivariate logistic regression and ROC curves were used to estimate 90 DM and c-index was used to estimate the prognostic ability of the different indices. Changes in HS following treatment (ΔHS) were calculated at 6 weeks RECIST in a subset of patients receiving targeted therapies (n= 50). Results: Median age was 62 years (range: 28 – 80); median OS 4.3 months (range: 0.2 – 39); 34% male; 25% PS>1. Multivariate screening identified albumin <35 g/L, lactate dehydrogenase (LDH) >450 U/L and sodium <135mmol/L as the strongest independent predictors of OS (p<0.05). These were entered into a 3-point score (HS) that classifies patients as being at high risk (score 2-3) vs. low risk (score 0-1) of worse OS (HR= 5.8, p<0.001), PFS (HR= 2.7, p= 0.04) and 90 DM (OR= 5.9, p= 0.001). All scores predicted for OS on univariate analysis (p<0.05). On multivariate analysis HS performed best to predict OS (HR= 3.9, p<0.001 C-index score= 0.71), PFS (HR= 2.6 p= 0.04) and 90 DM with area under the ROC curve 0.71. ΔHS independently predicted for OS (p<0.001), with worsening of the score reflecting poorer OS. Prospective validation is ongoing. Conclusions: HS is a simple score that outperforms other prognostic indices. This can be used to select individuals for future studies as well as an additional marker of response.
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Affiliation(s)
| | | | | | | | - Michael Seckl
- Charing Cross Hospital Trophoblastic Disease Centre, London, United Kingdom
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Stavraka C, Ford A, Ghaem-Maghami S, Crook T, Agarwal R, Gabra H, Blagden S. A study of symptoms described by ovarian cancer survivors. Gynecol Oncol 2012; 125:59-64. [DOI: 10.1016/j.ygyno.2011.12.421] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/23/2011] [Accepted: 12/01/2011] [Indexed: 12/21/2022]
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Galanis N, Stavraka C, Boutsiadou T, Kirkos JM, Kapetanos G. Postoperative pain management and acupuncture: a case report of meniscal cyst excision. Acupunct Med 2009; 27:79-80. [PMID: 19502467 DOI: 10.1136/aim.2008.000356] [Citation(s) in RCA: 3] [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: 11/04/2022]
Abstract
We report a case of pain management after a meniscal cyst excision, with the use of electroacupuncture (EA). There are a few reports which indicate that postoperative pain management is prerequisite for the patient's optimal recovery, but surveys in the UK and the USA have identified an unacceptable prevalence of poor pain control after surgery, which might increase the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In our case, the rehabilitation lasted for 6 months without significant benefit. After that period our patient was treated with EA. By the end of the first EA session the relief of pain was notable and after a course of 10 treatments the patient reported complete relief of the symptoms with no recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be useful for postoperative pain management.
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Affiliation(s)
- Nikiforos Galanis
- University Department of Orthopaedics, General Hospital Papageorgiou, Medical School, Aristotle University of Thessaloniki, Greece.
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