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Korte B, Mathios D. Innovation in Non-Invasive Diagnosis and Disease Monitoring for Meningiomas. Int J Mol Sci 2024; 25:4195. [PMID: 38673779 PMCID: PMC11050588 DOI: 10.3390/ijms25084195] [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: 02/19/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Meningiomas are tumors of the central nervous system that vary in their presentation, ranging from benign and slow-growing to highly aggressive. The standard method for diagnosing and classifying meningiomas involves invasive surgery and can fail to provide accurate prognostic information. Liquid biopsy methods, which exploit circulating tumor biomarkers such as DNA, extracellular vesicles, micro-RNA, proteins, and more, offer a non-invasive and dynamic approach for tumor classification, prognostication, and evaluating treatment response. Currently, a clinically approved liquid biopsy test for meningiomas does not exist. This review provides a discussion of current research and the challenges of implementing liquid biopsy techniques for advancing meningioma patient care.
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Affiliation(s)
- Brianna Korte
- Department of Neurosurgery, Washington University Medical Campus, St. Louis, MO 63110, USA
| | - Dimitrios Mathios
- Department of Neurosurgery, Washington University Medical Campus, St. Louis, MO 63110, USA
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Annapragada AV, Niknafs N, White JR, Bruhm DC, Cherry C, Medina JE, Adleff V, Hruban C, Mathios D, Foda ZH, Phallen J, Scharpf RB, Velculescu VE. Genome-wide repeat landscapes in cancer and cell-free DNA. Sci Transl Med 2024; 16:eadj9283. [PMID: 38478628 DOI: 10.1126/scitranslmed.adj9283] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
Genetic changes in repetitive sequences are a hallmark of cancer and other diseases, but characterizing these has been challenging using standard sequencing approaches. We developed a de novo kmer finding approach, called ARTEMIS (Analysis of RepeaT EleMents in dISease), to identify repeat elements from whole-genome sequencing. Using this method, we analyzed 1.2 billion kmers in 2837 tissue and plasma samples from 1975 patients, including those with lung, breast, colorectal, ovarian, liver, gastric, head and neck, bladder, cervical, thyroid, or prostate cancer. We identified tumor-specific changes in these patients in 1280 repeat element types from the LINE, SINE, LTR, transposable element, and human satellite families. These included changes to known repeats and 820 elements that were not previously known to be altered in human cancer. Repeat elements were enriched in regions of driver genes, and their representation was altered by structural changes and epigenetic states. Machine learning analyses of genome-wide repeat landscapes and fragmentation profiles in cfDNA detected patients with early-stage lung or liver cancer in cross-validated and externally validated cohorts. In addition, these repeat landscapes could be used to noninvasively identify the tissue of origin of tumors. These analyses reveal widespread changes in repeat landscapes of human cancers and provide an approach for their detection and characterization that could benefit early detection and disease monitoring of patients with cancer.
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Affiliation(s)
- Akshaya V Annapragada
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Noushin Niknafs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - James R White
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Daniel C Bruhm
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Christopher Cherry
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jamie E Medina
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Vilmos Adleff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Carolyn Hruban
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Dimitrios Mathios
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Zachariah H Foda
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jillian Phallen
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Robert B Scharpf
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Victor E Velculescu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Mathios D, Bobeff EJ, Longo D, Nilchian P, Estin J, Schwartz AC, Austria Q, Anand VK, Godfrey KJ, Schwartz TH. The lateral transorbital approach to the medial sphenoid wing, anterior clinoid, middle fossa, cavernous sinus, and Meckel's cave: target-based classification, approach-related complications, and intermediate-term ocular outcomes. J Neurosurg 2024; 140:677-687. [PMID: 37657097 DOI: 10.3171/2023.6.jns23678] [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: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The lateral transorbital approach (LTOA) is a relatively new minimal access skull base approach suited for addressing paramedian pathology of the anterior and middle fossa. The authors define target zones for this approach and describe a series of cases with detailed measurements of visual outcomes, including those obtained with exophthalmometry. METHODS The authors performed a retrospective analysis of a consecutive series of LTOA patients. Seven target zones were identified: 1) the orbit, 2) the lesser sphenoid wing and anterior clinoid, 3) the middle fossa, 4) the lateral wall of the cavernous sinus and Meckel's cave, 5) the infratemporal fossa, 6) the petrous apex, and 7) the anterior fossa. The authors used volumetric analyses of preoperative and postoperative MR and CT imaging data to calculate the volume of bone and tumor removed and to provide detailed ophthalmological, neurological, and cosmetic outcomes. RESULTS Of the 20 patients in this cohort, pathology was in zone 2 (n = 10), zone 4 (n = 6), zone 3 (n = 2), zone 1 (n = 1), and zone 5 (n = 1). Pathology was meningioma (n = 10), schwannoma (n = 2), metastasis (n = 2), epidermoid (n = 1), dermoid (n = 1), encephalocele (n = 1), adenoma (n = 1), glioblastoma (n = 1), and inflammatory lesion (n = 1). The goal was gross-total resection (GTR) in 9 patients, all of whom achieved GTR. Subtotal resection (STR) was the goal in 8 patients (5 spheno-orbital meningiomas, 1 giant cavernous sinus/Meckel's cave schwannoma, 1 cavernous sinus prolactinoma, and 1 cavernous sinus dermoid), 7 of whom achieved STR and 1 of whom achieved GTR. The goal was biopsy in 2 patient and repair of encephalocele in 1. Visual acuity was stable or improved in 18 patients and worse in 2. Transient early postoperative diplopia, ptosis, eyelid swelling, and peri-orbital numbness were common. All 9 patients with preoperative diplopia improved at their last follow-up. Seven of 8 patients with preoperative exophthalmos improved after surgery (average correction of 64%). There were no cases of clinically significant (> 2 mm) postoperative enophthalmos. The most frequent postoperative complaint was peri-orbital numbness (40%). There was 1 CSF leak. Most patients were satisfied with their ocular (84%-100% of patients provided positive satisfaction-related responses) and cosmetic (75%-100%) outcomes. CONCLUSIONS The LTOA is a safe minimal access approach to a variety of paramedian anterior skull base pathologies in several locations. Early follow-up revealed excellent resolution of exophthalmos with little risk of clinically significant enophthalmos. Transient diplopia, ptosis, and peri-orbital numbness were common but improved. Careful case selection is critical to ensure good outcome.
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Affiliation(s)
| | - Ernest J Bobeff
- Departments of1Neurological Surgery
- 4Department of Neurosurgery, Barlicki University Hospital, Łódź, Poland; and
- 5Department of Sleep Medicine and Metabolic Disorders, Medical University of Łódź, Poland
| | | | | | | | | | - Quillan Austria
- 3Ophthalmology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | | | - Kyle J Godfrey
- Departments of1Neurological Surgery
- 3Ophthalmology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Bobeff EJ, Mathios D, Mistry AA, Dobri GA, Souweidane MM, Anand VK, Tabaee A, Kacker A, Greenfield JP, Schwartz TH. Predictors of extent of resection and recurrence following endoscopic endonasal resection of craniopharyngioma. J Neurosurg 2023; 139:1235-1246. [PMID: 37119110 DOI: 10.3171/2023.3.jns222607] [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: 11/19/2022] [Accepted: 03/16/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Craniopharyngioma is a benign but surgically challenging brain tumor. Controversies exist regarding its ideal treatment strategy, goals of surgery, efficacy of radiation, and the long-term outcomes of these decisions. The authors of this study performed a detailed analysis of factors predictive of the extent of resection and recurrence in large series of craniopharyngiomas removed via an endoscopic endonasal approach (EEA) with long-term follow-up. METHODS From a prospective database of all EEAs done at Weill Cornell Medical College by the senior author from 2004 to 2022, a consecutive series of histologically proven craniopharyngiomas were identified. Gross-total resection (GTR) was generally the goal of surgery. Radiation was often given if GTR had not been achieved. The stalk was preserved if not infiltrated with tumor but was sacrificed to achieve GTR. Intentional subtotal resection (STR) was performed in select cases to avoid hypothalamic injury. RESULTS Among the 111 identified cases were 88 adults and 23 children. Newly diagnosed cases comprised 58.6% of the series. GTR was attempted in 77.5% of the patients and among those cases was achieved in 89.5% of treatment-naive tumors and 72.4% of recurrent tumors. An inability to achieve GTR was predicted by prior surgical treatment (OR 0.13, 95% CI 0.03-0.6, p = 0.009), tumor diameter ≥ 3.5 cm (OR 0.11, 95% CI 0.02-0.53, p = 0.006), and encasement of the optic nerve or a major artery (OR 0.11, 95% CI 0.01-0.8, p = 0.03). GTR with stalk preservation maintained some anterior pituitary function in 64.5% of cases and prevented diabetes insipidus in 25.8%. After a median follow-up of 51 months (IQR 17-80 months), the recurrence rate after GTR was 12.5% compared with 38.5% after non-GTR. The median recurrence-free survival was 5.5 years after STR, 8.3 years after near-total resection (≥ 98%), and not reached after GTR (p = 0.004, log-rank test). GTR was the strongest predictor of recurrence-free survival (OR 0.09, 95% CI 0.02-0.42, p = 0.002), whereas radiation did not show a statistically significant impact (OR 1.17, 95% CI 0.45-3.08). In GTR cases, the recurrence rate was higher if the stalk had been preserved (22.6%) as opposed to a sacrificed stalk (4.9%; OR 5.69, 95% CI 1.09-29.67). CONCLUSIONS The study data show that GTR should be the goal of surgery in craniopharyngiomas if it can be achieved safely. Although stalk preservation can maintain some endocrine function, the risk of recurrence is higher in such cases. Radiation may not be as effective as previously reported.
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Affiliation(s)
- Ernest J Bobeff
- Departments of1Neurological Surgery
- 5Department of Neurosurgery, Barlicki University Hospital, Lodz, Poland; and
- 6Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | | | | | | | | | | | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery
- 4Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Leal AIC, Mathios D, Jakubowski D, Johansen JS, Lau A, Wu T, Cristiano S, Medina JE, Phallen J, Bruhm DC, Carey J, Dracopoli NC, Bojesen SE, Scharpf RB, Velculescu VE, Vachani A, Bach PB. Cell-Free DNA Fragmentomes in the Diagnostic Evaluation of Patients With Symptoms Suggestive of Lung Cancer. Chest 2023; 164:1019-1027. [PMID: 37116747 DOI: 10.1016/j.chest.2023.04.033] [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: 10/31/2022] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The diagnostic workup of individuals suspected of having lung cancer can be complex and protracted because conventional symptoms of lung cancer have low specificity and sensitivity. RESEARCH QUESTION Among individuals with symptoms of lung cancer, can a blood-based approach to analyze cell-free DNA (cfDNA) fragmentation (the DNA evaluation of fragments for early interception [DELFI] score) enhance evaluation for the possible presence of lung cancer? STUDY DESIGN AND METHODS Adults were referred to Bispebjerg Hospital (Copenhagen, Denmark) for diagnostic evaluation of initial imaging anomalies and symptoms consistent with lung cancer. Numbers and types of symptoms were extracted from medical records. cfDNA from plasma samples obtained at the prediagnostic visit was isolated, sequenced, and analyzed for genome-wide cfDNA fragmentation patterns. The relationships among clinical presentation, cancer status, and DELFI score were examined. RESULTS A total of 296 individuals were analyzed. Median DELFI scores were higher for those with lung cancer (n = 98) than those without cancer (n = 198; 0.94 vs 0.19; P < .001). In a multivariate model adjusted for age, smoking history, and presenting symptoms, the addition of the DELFI score improved the prediction of lung cancer for those who demonstrated symptoms (area under the receiver operating characteristic curve, 0.74-0.94). INTERPRETATION The DELFI score distinguishes individuals with lung cancer from those without cancer better than suspicious symptoms do. These results represent proof-of-concept support that fragmentation-based biomarker approaches may facilitate diagnostic resolution for patients with concerning symptoms of lung cancer.
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Affiliation(s)
| | - Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jakob S Johansen
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anna Lau
- Delfi Diagnostics, Inc., Baltimore, MD
| | - Tony Wu
- Delfi Diagnostics, Inc., Baltimore, MD
| | - Stephen Cristiano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jamie E Medina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jillian Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Bruhm
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Stig E Bojesen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Robert B Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anil Vachani
- University of Pennsylvania School of Medicine, Philadelphia, PA
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Tosi U, Giantini-Larsen A, Mathios D, Kacker A, Anand VK, Ferdowssian K, Baaj A, Härtl R, Rapoport BI, Greenfield JP, Schwartz TH. Endoscopic odontoidectomy for brainstem compression in association with posterior fossa decompression and occipitocervical fusion. J Neurosurg 2023; 139:1152-1159. [PMID: 36933256 DOI: 10.3171/2023.1.jns222404] [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: 11/25/2022] [Accepted: 01/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Endonasal endoscopic odontoidectomy (EEO) is an alternative to transoral surgery for symptomatic ventral compression of the anterior cervicomedullary junction (CMJ), allowing for earlier extubation and feeding. Because the procedure destabilizes the C1-2 ligamentous complex, posterior cervical fusion is often performed concomitantly. The authors' institutional experience was reviewed to describe the indications, outcomes, and complications in a large series of EEO surgical procedures in which EEO was combined with posterior decompression and fusion. METHODS A consecutive, prospective series of patients who underwent EEO between 2011 and 2021 was studied. Demographic and outcome metrics, radiographic parameters, extent of ventral compression, extent of dens removal, and increase in CSF space ventral to the brainstem were measured on the preoperative and postoperative scans (first and most recent scans). RESULTS Forty-two patients (26.2% pediatric) underwent EEO: 78.6% had basilar invagination, and 76.2% had Chiari type I malformation. The mean ± SD age was 33.6 ± 3.0 years, with a mean follow-up of 32.3 ± 4.0 months. The majority of patients (95.2%) underwent posterior decompression and fusion immediately before EEO. Two patients underwent prior fusion. There were 7 intraoperative CSF leaks but no postoperative CSF leaks. The inferior limit of decompression fell between the nasoaxial and rhinopalatine lines. The mean ± SD vertical height of dens resection was 11.98 ± 0.45 mm, equivalent to a mean ± SD resection of 74.18% ± 2.56%. The mean increase in ventral CSF space immediately postoperatively was 1.68 ± 0.17 mm (p < 0.0001), which increased to 2.75 ± 0.23 mm (p < 0.0001) at the most recent follow-up (p < 0.0001). The median (range) length of stay was 5 (2-33) days. The median time to extubation was 0 (0-3) days. The median time to oral feeding (defined as, at minimum, toleration of a clear liquid diet) was 1 (0-3) day. Symptoms improved in 97.6% of patients. Complications were rare and mostly associated with the cervical fusion portion of the combined surgical procedures. CONCLUSIONS EEO is safe and effective for achieving anterior CMJ decompression and is often accompanied by posterior cervical stabilization. Ventral decompression improves over time. EEO should be considered for patients with appropriate indications.
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Affiliation(s)
| | | | | | - Ashutosh Kacker
- 2Otorhinolaryngology, Weill Cornell Medicine, New York, New York
| | - Vijay K Anand
- 2Otorhinolaryngology, Weill Cornell Medicine, New York, New York
| | | | - Ali Baaj
- Departments of1Neurological Surgery and
| | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery and
- 2Otorhinolaryngology, Weill Cornell Medicine, New York, New York
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Bruhm DC, Mathios D, Foda ZH, Annapragada AV, Medina JE, Adleff V, Chiao EJ, Ferreira L, Cristiano S, White JR, Mazzilli SA, Billatos E, Spira A, Zaidi AH, Mueller J, Kim AK, Anagnostou V, Phallen J, Scharpf RB, Velculescu VE. Single-molecule genome-wide mutation profiles of cell-free DNA for non-invasive detection of cancer. Nat Genet 2023; 55:1301-1310. [PMID: 37500728 PMCID: PMC10412448 DOI: 10.1038/s41588-023-01446-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Somatic mutations are a hallmark of tumorigenesis and may be useful for non-invasive diagnosis of cancer. We analyzed whole-genome sequencing data from 2,511 individuals in the Pan-Cancer Analysis of Whole Genomes (PCAWG) study as well as 489 individuals from four prospective cohorts and found distinct regional mutation type-specific frequencies in tissue and cell-free DNA from patients with cancer that were associated with replication timing and other chromatin features. A machine-learning model using genome-wide mutational profiles combined with other features and followed by CT imaging detected >90% of patients with lung cancer, including those with stage I and II disease. The fixed model was validated in an independent cohort, detected patients with cancer earlier than standard approaches and could be used to monitor response to therapy. This approach lays the groundwork for non-invasive cancer detection using genome-wide mutation features that may facilitate cancer screening and monitoring.
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Grants
- T32 GM136577 NIGMS NIH HHS
- R01 CA121113 NCI NIH HHS
- UG1 CA233259 NCI NIH HHS
- P50 CA062924 NCI NIH HHS
- P30 CA006973 NCI NIH HHS
- EIF | Stand Up To Cancer (SU2C)
- U.S. Department of Health & Human Services | National Institutes of Health (NIH)
- This work was supported in part by the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, SU2C in-Time Lung Cancer Interception Dream Team Grant, Stand Up to Cancer-Dutch Cancer Society International Translational Cancer Research Dream Team Grant (SU2C-AACR-DT1415), the Gray Foundation, the Commonwealth Foundation, the Mark Foundation for Cancer Research, the Cole Foundation, a research grant from Delfi Diagnostics, and US National Institutes of Health grants CA121113, CA006973, CA233259, CA062924, and 1T32GM136577.
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Affiliation(s)
- Daniel C Bruhm
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachariah H Foda
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshaya V Annapragada
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamie E Medina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vilmos Adleff
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elaine Jiayuee Chiao
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leonardo Ferreira
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen Cristiano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R White
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah A Mazzilli
- Division of Computational Biomedicine, Department of Medicine, Boston University, Boston, MA, USA
| | - Ehab Billatos
- Division of Computational Biomedicine, Department of Medicine, Boston University, Boston, MA, USA
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University, Boston, MA, USA
| | - Avrum Spira
- Division of Computational Biomedicine, Department of Medicine, Boston University, Boston, MA, USA
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University, Boston, MA, USA
| | - Ali H Zaidi
- Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jeffrey Mueller
- Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Amy K Kim
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valsamo Anagnostou
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jillian Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert B Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Victor E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mathios D, Bobeff EJ, Longo D, Tabaee A, Anand VK, Godfrey KJ, Schwartz TH. Lateral Transorbital Approach for Repair of Lateral Sphenoid Sinus Meningoencephaloceles in Proximity to Foramen Rotundum: Cadaveric Study and Case Report. Oper Neurosurg (Hagerstown) 2023; 25:168-175. [PMID: 37163719 DOI: 10.1227/ons.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The repair of lateral sphenoid sinus cerebrospinal fluid leaks is routinely accomplished through the use of the endonasal endoscopic approach (EEA) with a transpterygoidal extension. This approach can incur sinus morbidity, damage to the vidian, palatine and trigeminal nerves, and the contents of the pterygopalatine fossa, particularly if the encephalocele is lateral to the foramen rotundum (FR) and V2. OBJECTIVE To investigate the use of the lateral transorbital approach (LTOA) as an alternative approach for repair of lateral sphenoid sinus encephaloceles that avoids the potential morbidity of EEA. METHODS We performed cadaveric dissections of 2 specimens (4 sides) and present one of the first cases of a lateral sphenoid sinus encephalocele repair lateral to the FR in a patient through an ipsilateral LTOA. RESULTS We find that the LTOA provides a shorter distance to target compared with the EEA (56 vs 89.5 mm, P = .002). The LTOA field of view also affords excellent visualization of both the medial and lateral aspects of V2, whereas the EEA is less effective at exposing lateral to V2, even after sacrifice of the vidian nerve and maximal pterygopalatine fossa content retraction. We report a case of LTOA to repair a meningoencephalocele lateral to V2 in the sphenoid sinus. CONCLUSION The LTOA to the foramen rotundum is a more direct approach that minimizes the morbidity associated with EEA to repair meningoencephaloceles both medial and lateral to foramen rotundum.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Ernest J Bobeff
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
- Department of Neurosurgery, Barlicki University Hospital, Lodz, Poland
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Davide Longo
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Kyle J Godfrey
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
- Department of Ophthalmology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
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Mathios D, Joshua S, Bobeff EJ, Mistry AA, Schwartz AC, Dobri GA, Tabaee A, Kacker A, Anand VK, Schwartz TH. Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients. Acta Neurochir (Wien) 2023; 165:2277-2282. [PMID: 37046123 DOI: 10.1007/s00701-023-05575-w] [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: 03/05/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The most common presenting symptom in patients with both small and large Rathke cleft cysts (RCC) is headache (H/A). It is well established that patients with large RCC can have significant symptomatic improvement after cyst drainage. However, patients with small RCC (≤ 1 cm) are rarely operated on, even if they present with debilitating H/A. It is not well understood whether resection of these smaller RCCs can lead to durable H/A resolution. METHODS A retrospective search of our institutional database for sub-centimeter RCCs presenting with intractable H/A and treated with an endoscopic endonasal approach was carried out. A detailed H/A questionnaire as well as patient chart review was conducted to assess the long-term outcome of these patients after surgical intervention. RESULTS Ten consecutive patients with 11 endonasal surgeries met inclusion criteria. Eight responded to the questionnaire. The median cyst diameter was 6 mm (IQR 3-9). Median preoperative H/A duration was 12 months (range 2 months-15 years). H/As occurred on average for 20 days per month and all required analgesics for symptomatic control for more than 15 of these 20 days. Half of the patients also had to miss work because of H/A. Average preoperative H/A intensity was 8.7 (scale 0-10) compared with postoperative scores of 2.9 at one month, 1.6 at 3 months, and 0.9 at 1 year. There were no permanent endocrinological or other surgical complications. After a median follow-up of 2 years, one patient had radiographic and symptomatic recurrence which resolved after re-operation. CONCLUSIONS Endoscopic fenestration of sub-centimeter RCCs provides a safe and durable treatment for patients with intractable H/A.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Shejoy Joshua
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Aster Medcity, Kochi, Kerala, India
| | - Ernest J Bobeff
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Adina A Mistry
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra C Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Endocrinology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.
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Annapragada AV, Medina JE, Lof P, Mathios D, Foda ZH, Noë M, Short S, Bartolomucci A, Bruhm DC, Jung E, Canzoniero J, Niknafs N, Cristiano S, Adleff V, Symecko H, van de Broek D, Baylin SB, Press MF, Slamon D, Konecny G, Domchek S, Drapkin R, Phallen J, Scharpf RB, Lok C, Velculescu VE. Abstract 773: Early detection of ovarian cancer using cell-free DNA fragmentomes. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-773] [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: 04/07/2023]
Abstract
Abstract
Introduction: Ovarian cancer is the leading cause of death from gynecological related cancers worldwide. Most patients are diagnosed at late stages due to asymptomatic disease and lack of effective screening modalities. Additionally, in women with an ovarian mass the diagnosis of ovarian cancer can be challenging with many women having surgery only to discover a benign pathology. Liquid biopsies, including analyses of cell-free DNA (cfDNA) fragmentomes in the circulation, have shown promise for the early detection of cancer and may provide a useful avenue for detection of ovarian cancer.
Methods: To evaluate cfDNA fragmentomes for detecting ovarian cancer, we assessed plasma from 507 women, including 128 with ovarian cancers comprising high grade serous, endometrioid, mucinous and clear cell subtypes, 48 with benign masses, and 223 without cancer, as well as a validation cohort of 108 women with (n=14) and without (n=94) ovarian cancers from a separate institution. We obtained cfDNA from each individual and performed low-coverage (1-2x) whole genome sequencing. The cfDNA fragmentome data were analyzed with our DELFI (DNA evaluation of fragments for early interception) approach optimized for high specificity. We used a cross-validated machine learning model, and the fixed DELFI model was evaluated in the external validation cohort.
Results: Individuals with ovarian cancer had significantly higher DELFI scores than those without cancer (mean 0.59 vs 0.18, respectively, p < 0.0001) resulting in an AUC of 0.85 (95% CI = 0.80-0.90). DELFI was successful in identifying high-grade serous ovarian cancer across all stages, with sensitivities of 56%, 60%, 58% and 100% for stages I - IV, respectively, at 99% specificity. We further applied DELFI to evaluate women with ovarian masses in a prospective observational cohort (NL58253.031.16). Women with benign masses had DELFI scores lower than those with ovarian cancer (mean 0.23 vs 0.59, p< .0001) and were distinguished with an overall AUC of 0.80 (95% CI = 0.73-0.86). In the external validation cohort, women with cancer were distinguished from women without cancer with an AUC of 0.88 (95% CI = 0.72 - 1.0). At the DELFI score threshold with 99% specificity in the cross-validated cohort, the external validation cohort had specificity of 97% with an overall sensitivity of 79%. The cfDNA fragmentome profiles reflected chromosomal, chromatin, transcription factor binding site, and disease-specific pathway changes known to be altered in ovarian cancer. We are extending these efforts to over 1000 individuals with and without ovarian cancer and the integrated results will be presented.
Conclusion: Overall, we demonstrate the utility of cfDNA fragmentomes for noninvasive detection of ovarian cancer. These results may provide a feasible approach for ovarian cancer screening and management of patients with ovarian masses.
Citation Format: Akshaya V. Annapragada, Jamie E. Medina, Pien Lof, Dimitrios Mathios, Zachariah H. Foda, Michaël Noë, Sarah Short, Adrianna Bartolomucci, Daniel C. Bruhm, Euihye Jung, Jenna Canzoniero, Noushin Niknafs, Stephen Cristiano, Vilmos Adleff, Heather Symecko, Daan van de Broek, Stephen B. Baylin, Michael F. Press, Dennis Slamon, Gottfried Konecny, Susan Domchek, Ronny Drapkin, Jillian Phallen, Robert B. Scharpf, Christianne Lok, Victor E. Velculescu. Early detection of ovarian cancer using cell-free DNA fragmentomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 773.
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Affiliation(s)
| | | | - Pien Lof
- 2, Antoni van Leeuwenhoek Hospital – The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Michaël Noë
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah Short
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Euihye Jung
- 3University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | | | | | - Vilmos Adleff
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Heather Symecko
- 4Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daan van de Broek
- 2, Antoni van Leeuwenhoek Hospital – The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Michael F. Press
- 5Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dennis Slamon
- 6University of California Los Angeles, Los Angeles, CA
| | | | - Susan Domchek
- 4Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Ronny Drapkin
- 3University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | | | - Christianne Lok
- 2, Antoni van Leeuwenhoek Hospital – The Netherlands Cancer Institute, Amsterdam, Netherlands
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Foda ZH, Annapragada AV, Boyapati K, Bruhm DC, Vulpescu NA, Medina JE, Mathios D, Cristiano S, Niknafs N, Luu HT, Goggins MG, Anders RA, Sun J, Meta SH, Thomas DL, Kirk GD, Adleff V, Phallen J, Scharpf RB, Kim AK, Velculescu VE. Detecting Liver Cancer Using Cell-Free DNA Fragmentomes. Cancer Discov 2023; 13:616-631. [PMID: 36399356 PMCID: PMC9975663 DOI: 10.1158/2159-8290.cd-22-0659] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
Liver cancer is a major cause of cancer mortality worldwide. Screening individuals at high risk, including those with cirrhosis and viral hepatitis, provides an avenue for improved survival, but current screening methods are inadequate. In this study, we used whole-genome cell-free DNA (cfDNA) fragmentome analyses to evaluate 724 individuals from the United States, the European Union, or Hong Kong with hepatocellular carcinoma (HCC) or who were at average or high-risk for HCC. Using a machine learning model that incorporated multifeature fragmentome data, the sensitivity for detecting cancer was 88% in an average-risk population at 98% specificity and 85% among high-risk individuals at 80% specificity. We validated these results in an independent population. cfDNA fragmentation changes reflected genomic and chromatin changes in liver cancer, including from transcription factor binding sites. These findings provide a biological basis for changes in cfDNA fragmentation in patients with liver cancer and provide an accessible approach for noninvasive cancer detection. SIGNIFICANCE There is a great need for accessible and sensitive screening approaches for HCC worldwide. We have developed an approach for examining genome-wide cfDNA fragmentation features to provide a high-performing and cost-effective approach for liver cancer detection. See related commentary Rolfo and Russo, p. 532. This article is highlighted in the In This Issue feature, p. 517.
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Affiliation(s)
- Zachariah H. Foda
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akshaya V. Annapragada
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kavya Boyapati
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel C. Bruhm
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas A. Vulpescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie E. Medina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Cristiano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Noushin Niknafs
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harry T. Luu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael G. Goggins
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A. Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shruti H. Meta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David L. Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vilmos Adleff
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jillian Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert B. Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy K. Kim
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Victor E. Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Azad TD, Materi J, Hwang BY, Mathios D, Lehner KR, Hansen L, Bernhardt LJ, Xia Y, Shah PP, Kannapadi NV, Theodore N. Spinal cord untethering and midline myelotomy for delayed, symptomatic post-traumatic syringomyelia due to retained ballistic fragments: case report. Spinal Cord Ser Cases 2022; 8:66. [DOI: 10.1038/s41394-022-00533-7] [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] [Received: 01/24/2022] [Revised: 06/05/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022] Open
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Mathios D, Phallen J. Advances in molecular biomarkers and liquid biopsy in gliomas. Neurooncol Adv 2022; 4:ii15-ii21. [PMID: 36380861 PMCID: PMC9650470 DOI: 10.1093/noajnl/vdac151] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There have been significant strides toward understanding the molecular landscape of brain cancer. These advances have been focused on analyses of the tumor microenvironment and have recently expanded to include liquid biopsies to identify molecular biomarkers noninvasively. Moving from tissue to liquid-based analyses of molecular biomarkers has been challenging and currently, there are no approved noninvasive tests that are clinically useful. However, the emerging field of molecular liquid biopsy assay development in the neuro-oncology space has great potential to revolutionize the detection and monitoring of patients with brain cancer.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA
| | - Jillian Phallen
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA
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14
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Mathios D, Bach PB, Phallen JA, Scharpf RB, Velculescu VE. Reply to: Limitations of molecular testing in combination with computerized tomographic for lung cancer screening. Nat Commun 2022; 13:3892. [PMID: 35803904 PMCID: PMC9270318 DOI: 10.1038/s41467-022-31420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jillian A Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert B Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Victor E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kannapadi NV, Shah PP, Mathios D, Jackson CM. Synthesizing Molecular and Immune Characteristics to Move Beyond WHO Grade in Meningiomas: A Focused Review. Front Oncol 2022; 12:892004. [PMID: 35712492 PMCID: PMC9194503 DOI: 10.3389/fonc.2022.892004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
No portion of this manuscript has previously been presented. Meningiomas, the most common primary intracranial tumors, are histologically categorized by the World Health Organization (WHO) grading system. While higher WHO grade is generally associated with poor clinical outcomes, a significant subset of grade I tumors recur or progress, indicating a need for more reliable models of meningioma behavior. Several groups have developed risk scores based on molecular or immunologic characteristics. These classification schemes show promise, with several models preliminarily demonstrating similar or superior accuracy to WHO grading. Improved understanding of immune system recognition and targeting of meningioma subtypes is necessary to advance the predictive power, as well as develop new therapies. Here, we characterize meningioma molecular drivers, predictive of recurrence and progression, and describe specific aspects of the immune response to meningiomas while highlighting critical questions and ongoing research. Relevant manuscripts of interest were identified using a systematic approach and synthesized into this focused review. Finally, we summarize the ongoing and completed clinical trials for immunotherapy in meningiomas and offer perspective on future directions.
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Affiliation(s)
- Nivedha V Kannapadi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pavan P Shah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Annapragada AV, Mathios D, Cristiano S, Medina JE, Adleff V, Niknafs N, Carey J, Dracopoli N, Bach P, Phallen J, Velculescu VE, Scharpf RB. Abstract 5159: Towards population-scale screening of human cancer using genome-wide fragmentation profiles of cell-free DNA. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5159] [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
Introduction: Earlier detection is a critical clinical intervention to reduce cancer-related mortality. The DELFI liquid biopsy approach (DNA evaluation of fragments for early interception) utilizing low coverage (1-2x) whole genome sequencing (WGS) to analyze cell-free DNA (cfDNA) fragmentation provides a promising avenue for cancer detection. As sequencing costs remain a barrier to adoption of liquid biopsy approaches for early detection, we evaluated WGS for DELFI using 2-channel Illumina NovaSeq sequencing as a more affordable (~7-fold cost savings) alternative to 4-channel HiSeq instruments.
Methods: We performed WGS on the prospectively collected LUCAS cohort of 365 individuals at risk for lung cancer using both HiSeq and NovaSeq platforms (Mathios et. al., Nature Communications 2021). Genome-wide fragmentation was summarized in non-overlapping 5 Mb bins by ratio of short (100-150 bp) to long (151-220 bp) fragments.To measure within-sequencer repeatability, we compared fragmentation profiles of non-cancer individuals to the median non-cancer fragmentation profile by Spearman correlation. Principal component analyses were performed to assess the extent to which the sequencer explains variation of fragmentation profiles across samples.For cancer prediction, we used a penalized logistic regression model with fragmentation profiles and other genome-wide characteristics as features. Machine learning performance was assessed by cross-validation and area under the receiver operator characteristic curve (AUC). To evaluate whether we could have developed the classifier from a combination of NovaSeq with HiSeq sequenced samples, we evaluated performance trained on 90:10%, 75:25%, 50:50%, 25:75%, and 10:90% HiSeq:NovaSeq mixtures, respectively.
Results: cfDNA fragmentation profiles were highly concordant among non-cancer individuals for both platforms with median correlations of 0.96 (IQR: 0.95 - 0.97) and 0.95 (IQR: 0.94 - 0.96). Visualization of fragmentation principal components did not reveal separation by sequencing platform. The DELFI approach applied to samples sequenced by NovaSeq recapitulated previously published performance measures based on HiSeq (AUC 0.90, 95% CI 0.86 - 0.94). In simulations of mixed-platform datasets, we found the same qualitative performance (AUC range: 0.893-0.902).
Conclusions: cfDNA fragmentation profiles were similar between HiSeq and NovaSeq platforms, and classification accuracies from machine learning models trained on these platforms were equivalent. Our results indicate HiSeq and NovaSeq sequenced samples can be combined in models with no discernible loss in classification accuracy provided a balance of non-cancers and cancers are sequenced on both platforms. The lower cost of NovaSeq sequencing may enable wider adoption of genome-wide fragmentation-based approaches for cancer detection.
Citation Format: Akshaya V. Annapragada, Dimitrios Mathios, Stephen Cristiano, Jamie E. Medina, Vilmos Adleff, Noushin Niknafs, Jacob Carey, Nic Dracopoli, Peter Bach, Jillian Phallen, Victor E. Velculescu, Robert B. Scharpf. Towards population-scale screening of human cancer using genome-wide fragmentation profiles of cell-free DNA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5159.
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Medikonda R, Choi J, Pant A, Saleh L, Routkevitch D, Tong L, Belcaid Z, Kim YH, Jackson CM, Jackson C, Mathios D, Xia Y, Shah PP, Patel K, Kim T, Srivastava S, Huq S, Ehresman J, Pennington Z, Tyler B, Brem H, Lim M. Synergy between glutamate modulation and anti-programmed cell death protein 1 immunotherapy for glioblastoma. J Neurosurg 2022; 136:379-388. [PMID: 34388730 DOI: 10.3171/2021.1.jns202482] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/25/2020] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Immune checkpoint inhibitors such as anti-programmed cell death protein 1 (anti-PD-1) have shown promise for the treatment of cancers such as melanoma, but results for glioblastoma (GBM) have been disappointing thus far. It has been suggested that GBM has multiple mechanisms of immunosuppression, indicating a need for combinatorial treatment strategies. It is well understood that GBM increases glutamate in the tumor microenvironment (TME); however, the significance of this is not well understood. The authors posit that glutamate upregulation in the GBM TME is immunosuppressive. The authors utilized a novel glutamate modulator, BHV-4157, to determine synergy between glutamate modulation and the well-established anti-PD-1 immunotherapy for GBM. METHODS C57BL/6J mice were intracranially implanted with luciferase-tagged GL261 glioma cells. Mice were randomly assigned to the control, anti-PD-1, BHV-4157, or combination anti-PD-1 plus BHV-4157 treatment arms, and median overall survival was assessed. In vivo microdialysis was performed at the tumor site with administration of BHV-4157. Intratumoral immune cell populations were characterized with immunofluorescence and flow cytometry. RESULTS The BHV-4157 treatment arm demonstrated improved survival compared with the control arm (p < 0.0001). Microdialysis demonstrated that glutamate concentration in TME significantly decreased after BHV-4157 administration. Immunofluorescence and flow cytometry demonstrated increased CD4+ T cells and decreased Foxp3+ T cells in mice that received BHV-4157 treatment. No survival benefit was observed when CD4+ or CD8+ T cells were depleted in mice prior to BHV-4157 administration (p < 0.05). CONCLUSIONS In this study, the authors showed synergy between anti-PD-1 immunotherapy and glutamate modulation. The authors provide a possible mechanism for this synergistic benefit by showing that BHV-4157 relies on CD4+ and CD8+ T cells. This study sheds light on the role of excess glutamate in GBM and provides a basis for further exploring combinatorial approaches for the treatment of this disease.
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Affiliation(s)
- Ravi Medikonda
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - John Choi
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ayush Pant
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Laura Saleh
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Denis Routkevitch
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Luqing Tong
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Zineb Belcaid
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Young Hoon Kim
- 2Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Christopher M Jackson
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Christina Jackson
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Dimitrios Mathios
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Yuanxuan Xia
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Pavan P Shah
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Kisha Patel
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Timothy Kim
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Siddhartha Srivastava
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Sakibul Huq
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Jeff Ehresman
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Zach Pennington
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Betty Tyler
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Henry Brem
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael Lim
- 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Choi J, Medikonda R, Saleh L, Kim T, Pant A, Srivastava S, Kim YH, Jackson C, Tong L, Routkevitch D, Jackson C, Mathios D, Zhao T, Cho H, Brem H, Lim M. Combination checkpoint therapy with anti-PD-1 and anti-BTLA results in a synergistic therapeutic effect against murine glioblastoma. Oncoimmunology 2021; 10:1956142. [PMID: 34484870 PMCID: PMC8409779 DOI: 10.1080/2162402x.2021.1956142] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Clinical trials involving anti-programmed cell death protein-1 (anti-PD-1) failed to demonstrate improved overall survival in glioblastoma (GBM) patients. This may be due to the expression of alternative checkpoints such as B- and T- lymphocyte attenuator (BTLA) on several immune cell types including regulatory T cells. Murine GBM models indicate that there is significant upregulation of BTLA in the tumor microenvironment (TME) with associated T cell exhaustion. We investigate the use of antibodies against BTLA and PD-1 on reversing immunosuppression and increasing long-term survival in a murine GBM model. C57BL/6 J mice were implanted with the murine glioma cell line GL261 and randomized into 4 arms: (i) control, (ii) anti-PD-1, (iii) anti-BTLA, and (iv) anti-PD-1 + anti-BTLA. Kaplan–Meier curves were generated for all arms. Flow cytometric analysis of blood and brains were done on days 11 and 16 post-tumor implantation. Tumor-bearing mice treated with a combination of anti-PD-1 and anti-BTLA therapy experienced improved overall long-term survival (60%) compared to anti-PD-1 (20%) or anti-BTLA (0%) alone (P = .003). Compared to monotherapy with anti-PD-1, mice treated with combination therapy also demonstrated increased expression of CD4+ IFN-γ (P < .0001) and CD8+ IFN-γ (P = .0365), as well as decreased levels of CD4+ FoxP3+ regulatory T cells on day 16 in the brain (P = .0136). This is the first preclinical investigation into the effects of combination checkpoint blockade with anti-PD-1 and anti-BTLA treatment in GBM. We also show a direct effect on activated immune cell populations such as CD4+ and CD8 + T cells and immunosuppressive regulatory T cells through this combination therapy.
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Affiliation(s)
- John Choi
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ravi Medikonda
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Laura Saleh
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Timothy Kim
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ayush Pant
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Siddhartha Srivastava
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Young-Hoon Kim
- Department of Neurosurgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Christina Jackson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Luqing Tong
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Denis Routkevitch
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Tianna Zhao
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Hyerim Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, USA
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19
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Mathios D, Johansen JS, Cristiano S, Medina JE, Phallen J, Larsen KR, Bruhm DC, Niknafs N, Ferreira L, Adleff V, Chiao JY, Leal A, Noe M, White JR, Arun AS, Hruban C, Annapragada AV, Jensen SØ, Ørntoft MBW, Madsen AH, Carvalho B, de Wit M, Carey J, Dracopoli NC, Maddala T, Fang KC, Hartman AR, Forde PM, Anagnostou V, Brahmer JR, Fijneman RJA, Nielsen HJ, Meijer GA, Andersen CL, Mellemgaard A, Bojesen SE, Scharpf RB, Velculescu VE. Detection and characterization of lung cancer using cell-free DNA fragmentomes. Nat Commun 2021; 12:5060. [PMID: 34417454 PMCID: PMC8379179 DOI: 10.1038/s41467-021-24994-w] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
Non-invasive approaches for cell-free DNA (cfDNA) assessment provide an opportunity for cancer detection and intervention. Here, we use a machine learning model for detecting tumor-derived cfDNA through genome-wide analyses of cfDNA fragmentation in a prospective study of 365 individuals at risk for lung cancer. We validate the cancer detection model using an independent cohort of 385 non-cancer individuals and 46 lung cancer patients. Combining fragmentation features, clinical risk factors, and CEA levels, followed by CT imaging, detected 94% of patients with cancer across stages and subtypes, including 91% of stage I/II and 96% of stage III/IV, at 80% specificity. Genome-wide fragmentation profiles across ~13,000 ASCL1 transcription factor binding sites distinguished individuals with small cell lung cancer from those with non-small cell lung cancer with high accuracy (AUC = 0.98). A higher fragmentation score represented an independent prognostic indicator of survival. This approach provides a facile avenue for non-invasive detection of lung cancer. DNA from tumour cells can be detected in the blood of cancer patients. Here, the authors show that cell free DNA fragmentation patterns can identify lung cancer patients and when this information is further interrogated it can be used to predict lung cancer histological subtype.
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Affiliation(s)
- Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Stephen Cristiano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie E Medina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jillian Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Klaus R Larsen
- Department of Respiratory Medicine, Infiltrate Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Daniel C Bruhm
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noushin Niknafs
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leonardo Ferreira
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vilmos Adleff
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jia Yuee Chiao
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alessandro Leal
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Noe
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R White
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adith S Arun
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Hruban
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshaya V Annapragada
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Østrup Jensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Beatriz Carvalho
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Meike de Wit
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | - Patrick M Forde
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valsamo Anagnostou
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie R Brahmer
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Remond J A Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology 360, Hvidovre Hospital, Hvidovre, Denmark
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Anders Mellemgaard
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Stig E Bojesen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Robert B Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Victor E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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20
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Mathios D, Srivastava S, Kim T, Bettegowda C, Lim M. Emerging Technologies for Non-invasive Monitoring of Treatment Response to Immunotherapy for Brain Tumors. Neuromolecular Med 2021; 24:74-87. [PMID: 34297308 DOI: 10.1007/s12017-021-08677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022]
Abstract
Glioblastoma is the most common primary malignant brain tumor and one of the most aggressive tumors across all cancer types with remarkable resistance to any treatment. While immunotherapy has shown a robust clinical benefit in systemic cancers, its benefit is still under investigation in brain cancers. The broader use of immunotherapy in clinical trials for glioblastoma has highlighted the challenges of traditional methods of monitoring progression via imaging. Development of new guidelines, advanced imaging techniques, and immune profiling have emerged to counter premature diagnoses of progressive disease. However, these approaches do not provide a timely diagnosis and are costly and time consuming. Surgery is currently the standard of care for diagnosis of pseudoprogression in cases where MRI is equivocal. However, it is invasive, risky, and disruptive to patient's lives and their oncological treatment. With its increased vascularity, glioblastoma is continually shedding tumor components into the vasculature including tumor cells, genetic material, and extracellular vesicles. These elements can be isolated from routine blood draws and provide a real-time non-invasive indicator of tumor progression. Liquid biopsy therefore presents as an attractive alternative to current methods to guide treatment. While the initial evaluation of liquid biopsy for brain tumors via identification of mutations in the plasma was disappointing, novel technologies and use of alternatives to plasma cell-free DNA analytes provide promise for an effective liquid biopsy approach in brain tumors. This review aims to summarize developments in the use of liquid biopsy to monitor glioblastoma, especially in the context of immunotherapy.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Siddhartha Srivastava
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA.
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21
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Bettegowda C, Upadhayaya M, Evans DG, Kim A, Mathios D, Hanemann CO. Genotype-Phenotype Correlations in Neurofibromatosis and Their Potential Clinical Use. Neurology 2021; 97:S91-S98. [PMID: 34230207 DOI: 10.1212/wnl.0000000000012436] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Because clinically validated biomarkers for neurofibromatosis 1 (NF1) and neurofibromatosis 2 (NF2) have not been identified, we aimed to determine whether genotype-phenotype correlations are useful in clinical trials in NF1 and NF2. METHODS The Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) Biomarker Group first performed a systematic literature search and reviewed existing data on genetic biomarkers in NF1 and NF2 and in in malignant peripheral nerve sheath tumors. The group then met during a series of consensus meetings to develop a joint report. RESULTS We found that in NF2, the genetic severity score is clearly of potential clinical use. In NF1, despite over 3,000 constitutional variants having been described in the NF1 gene, only 4 actionable genotype-phenotype correlations exist. The diagnosis and treatment decision of these tumors should ideally include histopathology and compilation of some of the genetic markers. CONCLUSION We summarized emerging clinical use of genotype-phenotype correlations in neurofibromatosis.
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Affiliation(s)
- Chetan Bettegowda
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Meena Upadhayaya
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - D Gareth Evans
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - AeRang Kim
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Dimitrios Mathios
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Clemens O Hanemann
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK.
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22
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Mathios D, Johansen JS, Cristiano S, Medina J, Phallen J, Richter Larsen K, Bruhm D, Niknafs N, Nielsen HJ, Meijer GA, Andersen CL, Bojesen SE, Scharpf R, Velculescu VE. Early detection of lung cancer using cfDNA fragmentation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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
8519 Background: Lung cancer incidence and mortality are increasing worldwide despite more effective treatments. This is primarily due to the late stage of diagnosis when treatments are less effective. Although large randomized trials have demonstrated a significant decrease in lung cancer mortality through screening of high-risk individuals with chest low dose computed tomography (LDCT), LDCT has made little impact in the community, mainly due to lack of accessibility. There is therefore an unmet clinical need for development of cost-effective and easily implemented tests for early lung cancer detection. Methods: We have previously shown that altered genome-wide fragmentation of cell free DNA (cfDNA) is a common characteristic of many cancers. In this study, we leverage this knowledge to increase the sensitivity of lung cancer detection by interrogating characteristics of the size distribution of cfDNA fragments across the genome using machine learning methods. The approach we present, called DELFI (DNA evaluation of fragments for early interception) generates a score that reflects the presence of tumor-derived DNA in plasma based on a multi-feature genomic analysis that assesses millions of cfDNA fragments for tumor-derived genomic and epigenomic changes in a small amount of blood (2-4 mls) via inexpensive low coverage (1-2x) whole genome sequencing. We applied this methodology in a prospectively collected cohort of 365 individuals under investigation for lung cancer and we prospectively validated it in a separate case-control cohort of patients with newly diagnosed early stage lung cancer as well as individuals without cancer (n=427). Results: These analyses revealed high performance for detection of early and late stage disease (Table). When DELFI was used as a prescreen for LDCT it increased specificity from 58% with CT imaging alone to 80% using the combined approach. The DELFI score was significantly associated with T and N stage in lung cancer cases (p<0.0001) as well as with overall survival (p=0.003). In a multivariable analysis including age, histology and stage, DELFI score was an independent prognostic factor of overall survival (HR=2.53; p=0.0003). Finally, we determined that genome-wide fragmentation profiles can be used to distinguish small cell lung cancer from non-small cell lung cancer with high accuracy (AUC 0.98). Conclusions: These findings provide key insights into cfDNA fragmentation in patients with cancer and a new and easily accessible avenue for non-invasive diagnosis and molecular profiling of lung cancer.[Table: see text]
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Affiliation(s)
- Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Jamie Medina
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Daniel Bruhm
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Gerrit A. Meijer
- Netherlands Cancer Institute, Department of Pathology, Amsterdam, Netherlands
| | | | - Stig Egil Bojesen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Robert Scharpf
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor E. Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Medikonda R, Choi J, Pant A, Saleh L, Routkevitch D, Tong L, Belcaid Z, Kim YH, Jackson CM, Mathios D, Shah PP, Lim M. Glutamate Modulation Synergizes With Anti-PD-1 Immunotherapy in Glioblastoma. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_845] [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: 11/13/2022] Open
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24
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Belcaid Z, Berrevoets C, Choi J, van Beelen E, Stavrakaki E, Pierson T, Kloezeman J, Routkevitch D, van der Kaaij M, van der Ploeg A, Mathios D, Sleijfer S, Dirven C, Lim M, Debets R, Lamfers MLM. Low-dose oncolytic adenovirus therapy overcomes tumor-induced immune suppression and sensitizes intracranial gliomas to anti-PD-1 therapy. Neurooncol Adv 2020; 2:vdaa011. [PMID: 32642679 PMCID: PMC7212906 DOI: 10.1093/noajnl/vdaa011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/28/2022] Open
Abstract
Background The tumor-selective human adenovirus Delta24-RGD is currently under investigation in phase II clinical trials for patients with recurrent glioblastoma (GBM). To improve treatments for patients with GBM, we explored the potential of combining Delta24-RGD with antibodies targeting immune checkpoints. Methods C57BL/6 mice were intracranially injected with GL261 cells and treated with a low dose of Delta24-RGD virus. The expression dynamics of 10 co-signaling molecules known to affect immune activity was assessed in tumor-infiltrating immune cells by flow cytometry after viral injection. The antitumor activity was measured by tumor cell killing and IFNγ production in co-cultures. Efficacy of the combination viro-immunotherapy was tested in vitro and in the GL261 and CT2A orthotopic mouse GBM models. Patient-derived GBM cell cultures were treated with Delta24-RGD to assess changes in PD-L1 expression induced by virus infection. Results Delta24-RGD therapy increased intratumoral CD8+ T cells expressing Inducible T-cell co-stimulator (ICOS) and PD-1. Functionality assays confirmed a significant positive correlation between tumor cell lysis and IFNγ production in ex vivo cultures (Spearman r = 0.9524; P < .01). Co-cultures significantly increased IFNγ production upon treatment with PD-1 blocking antibodies. In vivo, combination therapy with low-dose Delta24-RGD and anti-PD-1 antibodies significantly improved outcome compared to single-agent therapy in both syngeneic mouse glioma models and increased PD-1+ tumor-infiltrating CD8+ T cells. Delta24-RGD infection induced tumor-specific changes in PD-L1 expression in primary GBM cell cultures. Conclusions This study demonstrates the potential of using low-dose Delta24-RGD therapy to sensitize glioma for combination with anti-PD-1 antibody therapy.
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Affiliation(s)
- Zineb Belcaid
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands.,Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cor Berrevoets
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - John Choi
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward van Beelen
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eftychia Stavrakaki
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tessa Pierson
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jenneke Kloezeman
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Denis Routkevitch
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mariëlle van der Kaaij
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alicia van der Ploeg
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stefan Sleijfer
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Clemens Dirven
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reno Debets
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martine L M Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, The Netherlands
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25
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Abstract
Chordomas are malignant, highly recurrent tumors of the midline skeleton that arise from the remnants of the notochord. The development of systemic therapy is critically important to ultimately managing this tumor. Several ongoing trials are attempting to use molecular targeted therapies for mutated pathways in recurrent and advanced chordomas and have shown promise. In addition, immunotherapies, including brachyury-directed vaccination and checkpoint inhibition, have also been attempted with encouraging results. This article discusses the major pathways that have been implicated in the pathogenesis of chordoma with an emphasis on molecular vulnerabilities that future therapies are attempting to exploit.
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Affiliation(s)
- Mohammad Zeeshan Ozair
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Pavan Pinkesh Shah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21287, USA
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21287, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21287, USA
| | - Nelson S Moss
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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26
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Mathios D, Hwang T, Xia Y, Phallen J, Rui Y, See AP, Maxwell R, Belcaid Z, Casaos J, Burger PC, McDonald KL, Gallia GL, Cope L, Kai M, Brem H, Pardoll DM, Ha P, Green JJ, Velculescu VE, Bettegowda C, Park C, Lim M. Genome‐wide investigation of intragenic DNA methylation identifies
ZMIZ1
gene as a prognostic marker in glioblastoma and multiple cancer types. Int J Cancer 2019; 145:3425-3435. [DOI: 10.1002/ijc.32587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Dimitrios Mathios
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Taeyoung Hwang
- Department of Biomedical EngineeringJohns Hopkins University School of Medicine Baltimore MD
- Lieber Institute for Brain Development Baltimore MD
| | - Yuanxuan Xia
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Jillian Phallen
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
| | - Yuan Rui
- Department of Biomedical EngineeringJohns Hopkins University School of Medicine Baltimore MD
- Lieber Institute for Brain Development Baltimore MD
| | - Alfred P. See
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard School of Medicine Boston MA
| | - Russell Maxwell
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Zineb Belcaid
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Joshua Casaos
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Peter C. Burger
- Department of NeuropathologyJohns Hopkins University School of Medicine Baltimore MD
| | - Kerrie L. McDonald
- Cure for Life Neuro‐Oncology Group, Lowy Cancer Research CentrePrince of Wales Clinical School, University of New South Wales Sydney NSW Australia
| | - Gary L. Gallia
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Leslie Cope
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
| | - Mihoko Kai
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Henry Brem
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Drew M. Pardoll
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
- Department of MedicineJohns Hopkins University School of Medicine Baltimore MD
- Department of PathologyJohns Hopkins University School of Medicine Baltimore MD
| | - Patrick Ha
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Jordan J. Green
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
- Department of Biomedical EngineeringJohns Hopkins University School of Medicine Baltimore MD
- Lieber Institute for Brain Development Baltimore MD
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
| | - Victor E. Velculescu
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
- Department of PathologyJohns Hopkins University School of Medicine Baltimore MD
| | - Chetan Bettegowda
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
- Department of Oncology and Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of Medicine Baltimore MD
| | - Chul‐Kee Park
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
- Department of NeurosurgerySeoul National University College of Medicine Seoul Republic of Korea
| | - Michael Lim
- Department of NeurosurgeryJohns Hopkins University School of Medicine Baltimore MD
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27
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Hwang T, Mathios D, McDonald KL, Daris I, Park SH, Burger PC, Kim S, Dho YS, Carolyn H, Bettegowda C, Shin JH, Lim M, Park CK. Integrative analysis of DNA methylation suggests down-regulation of oncogenic pathways and reduced somatic mutation rates in survival outliers of glioblastoma. Acta Neuropathol Commun 2019; 7:88. [PMID: 31159876 PMCID: PMC6545689 DOI: 10.1186/s40478-019-0744-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
The study of survival outliers of glioblastoma can provide important clues on gliomagenesis as well as on the ways to alter clinical course of this almost uniformly lethal cancer type. However, there has been little consensus on genetic and epigenetic signatures of the long-term survival outliers of glioblastoma. Although the two classical molecular markers of glioblastoma including isocitrate dehydrogenase 1 or 2 (IDH1/2) mutation and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation are associated with overall survival rate of glioblastoma patients, they are not specific to the survival outliers. In this study, we compared the two groups of survival outliers of glioblastoma with IDH wild-type, consisting of the glioblastoma patients who lived longer than 3 years (n = 17) and the patients who lived less than 1 year (n = 12) in terms of genome-wide DNA methylation profile. Statistical analyses were performed to identify differentially methylated sites between the two groups. Functional implication of DNA methylation patterns specific to long-term survivors of glioblastoma were investigated by comprehensive enrichment analyses with genomic and epigenomic features. We found that the genome of long-term survivors of glioblastoma is differentially methylated relative to short-term survivor patients depending on CpG density: hypermethylation near CpG islands (CGIs) and hypomethylation far from CGIs. Interestingly, these two patterns are associated with distinct oncogenic aspects in gliomagenesis. In the long-term survival glioblastoma-specific sites distant from CGI, somatic mutations of glioblastoma are enriched with higher DNA methylation, suggesting that the hypomethylation in long-term survival glioblastoma can contribute to reduce the rate of somatic mutation. On the other hand, the hypermethylation near CGIs associates with transcriptional downregulation of genes involved in cancer progression pathways. Using independent cohorts of IDH1/2- wild type glioblastoma, we also showed that these two patterns of DNA methylation can be used as molecular markers of long-term survival glioblastoma. Our results provide extended understanding of DNA methylation, especially of DNA hypomethylation, in cancer genome and reveal clinical importance of DNA methylation pattern as prognostic markers of glioblastoma.
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28
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Chen JA, Mathios D, Hidalgo J, Cohen AR. Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant. Childs Nerv Syst 2019; 35:719-723. [PMID: 30446813 DOI: 10.1007/s00381-018-4003-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma. CASE REPORT We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage. CONCLUSION We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Dimitrios Mathios
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joaquin Hidalgo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan R Cohen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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29
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Oncology and Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Oncology and Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
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30
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Harris-Bookman S, Mathios D, Martin AM, Xia Y, Kim E, Xu H, Belcaid Z, Polanczyk M, Barberi T, Theodros D, Kim J, Taube JM, Burger PC, Selby M, Taitt C, Korman A, Ye X, Drake CG, Brem H, Pardoll DM, Lim M. Expression of LAG-3 and efficacy of combination treatment with anti-LAG-3 and anti-PD-1 monoclonal antibodies in glioblastoma. Int J Cancer 2018; 143:3201-3208. [PMID: 30248181 DOI: 10.1002/ijc.31661] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [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: 02/08/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 02/03/2023]
Abstract
Like in many tumor types, immunotherapy is currently under investigation to assess its potential efficacy in glioblastoma patients. Trials are under way to assess the efficacy of new immune checkpoint inhibitors including anti-PD-1 or CTLA4. We here investigate the expression and efficacy of a novel immune-checkpoint inhibitor, called LAG-3. We show that LAG-3 is expressed in human glioblastoma samples and in a mouse glioblastoma model we show that knock out or LAG-3 inhibition with a blocking antibody is efficacious against glioblastoma and can be used in combination with other immune checkpoint inhibitors toward complete eradication of the model glioblastoma tumors. From a mechanistic standpoint we show that LAG-3 expression is an early marker of T cell exhaustion and therefore early treatment with LAG-3 blocking antibody is more efficacious than later treatment. These data provide insight and support the design of trials that incorporate LAG-3 in the treatment of glioblastoma.
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MESH Headings
- Aged
- Animals
- Antibodies, Blocking/immunology
- Antibodies, Blocking/therapeutic use
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antineoplastic Agents, Immunological/therapeutic use
- Brain Neoplasms/immunology
- Brain Neoplasms/therapy
- Cell Line, Tumor
- Female
- Flow Cytometry
- Glioblastoma/immunology
- Glioblastoma/therapy
- Humans
- Immunohistochemistry
- Immunologic Memory
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Middle Aged
- Programmed Cell Death 1 Receptor/immunology
- Survival Analysis
- Xenograft Model Antitumor Assays
- Lymphocyte Activation Gene 3 Protein
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Affiliation(s)
- Sarah Harris-Bookman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison M Martin
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eileen Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haiying Xu
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zineb Belcaid
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Magdalena Polanczyk
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Theresa Barberi
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Debebe Theodros
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Janis M Taube
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter C Burger
- Department of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Selby
- Bristol-Myers Squibb Company, New York, NY
| | | | | | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles G Drake
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Drew M Pardoll
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- Division Pediatric Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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31
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Hwang T, Mathios D, McDonald K, Daris I, Park S, Burger P, Kim S, Dho Y, Hruban C, Bettegowda C, Shin J, Lim M, Park C. P04.32 Integrative analysis of DNA methylation suggests down-regulation of oncogenic pathways and reduced de-novo mutation in survival outliers of glioblastoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Hwang
- Lieber Institute for Brain Development, Baltimore, MD, United States
| | - D Mathios
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - K McDonald
- University of New South Wales, Sydney, Australia
| | - I Daris
- University of New South Wales, Sydney, Australia
| | - S Park
- Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - P Burger
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - S Kim
- Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Y Dho
- Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - C Hruban
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - C Bettegowda
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J Shin
- Lieber Institute for Brain Development, Baltimore, MD, United States
| | - M Lim
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - C Park
- Seoul National University College of Medicine, Seoul, Korea, Republic of
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32
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Maxwell R, Luksik AS, Garzon-Muvdi T, Hung AL, Kim ES, Wu A, Xia Y, Belcaid Z, Gorelick N, Choi J, Theodros D, Jackson CM, Mathios D, Ye X, Tran PT, Redmond KJ, Brem H, Pardoll DM, Kleinberg LR, Lim M. Contrasting impact of corticosteroids on anti-PD-1 immunotherapy efficacy for tumor histologies located within or outside the central nervous system. Oncoimmunology 2018; 7:e1500108. [PMID: 30524891 PMCID: PMC6279341 DOI: 10.1080/2162402x.2018.1500108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022] Open
Abstract
Immune checkpoint blockade targeting programmed cell death protein 1 (PD-1) is emerging as an important treatment strategy in a growing list of cancers, yet its clinical benefits are limited to a subset of patients. Further investigation of tumor-intrinsic predictors of response and how extrinsic factors, such as iatrogenic immunosuppression caused by conventional therapies, impact the efficacy of anti-PD-1 therapy are paramount. Given the widespread use of corticosteroids in cancer management and their immunosuppressive nature, this study sought to determine how corticosteroids influence anti-PD-1 responses and whether their effects were dependent on tumor location within the periphery versus central nervous system (CNS), which may have a more limiting immune environment. In well-established anti-PD-1-responsive murine tumor models, corticosteroid therapy resulted in systemic immune effects, including severe and persistent reductions in peripheral CD4+ and CD8 + T cells. Corticosteroid treatment was found to diminish the efficacy of anti-PD-1 therapy in mice bearing peripheral tumors with responses correlating with peripheral CD8/Treg ratio changes. In contrast, in mice bearing intracranial tumors, corticosteroids did not abrogate the benefits conferred by anti-PD-1 therapy. Despite systemic immune changes, anti-PD-1-mediated antitumor immune responses remained intact during corticosteroid treatment in mice bearing intracranial tumors. These findings suggest that anti-PD-1 responses may be differentially impacted by concomitant corticosteroid use depending on tumor location within or outside the CNS. As an immune-specialized site, the CNS may potentially play a protective role against the immunosuppressive effects of corticosteroids, thus sustaining antitumor immune responses mediated by PD-1 blockade.
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Affiliation(s)
- Russell Maxwell
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, USA
| | - Andrew S Luksik
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | | | - Alice L Hung
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Eileen S Kim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Adela Wu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Zineb Belcaid
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Noah Gorelick
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - John Choi
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Debebe Theodros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | | | | | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Phuoc T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
| | - Drew M Pardoll
- Department of Oncology, Johns Hopkins Hospital, Baltimore, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, USA
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33
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Hung AL, Maxwell R, Theodros D, Belcaid Z, Mathios D, Luksik AS, Kim E, Wu A, Xia Y, Garzon-Muvdi T, Jackson C, Ye X, Tyler B, Selby M, Korman A, Barnhart B, Park SM, Youn JI, Chowdhury T, Park CK, Brem H, Pardoll DM, Lim M. TIGIT and PD-1 dual checkpoint blockade enhances antitumor immunity and survival in GBM. Oncoimmunology 2018; 7:e1466769. [PMID: 30221069 PMCID: PMC6136875 DOI: 10.1080/2162402x.2018.1466769] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022] Open
Abstract
The use of inhibitory checkpoint blockade in the management of glioblastoma has been studied in both preclinical and clinical settings. TIGIT is a novel checkpoint inhibitor recently discovered to play a role in cancer immunity. In this study, we sought to determine the effect of anti-PD-1 and anti-TIGIT combination therapy on survival in a murine glioblastoma (GBM) model, and to elucidate the underlying immune mechanisms. Using mice with intracranial GL261-luc+ tumors, we found that TIGIT expression was upregulated on CD8+ and regulatory T cells (Tregs) in the brain compared to draining cervical lymph nodes (CLN) and spleen. We then demonstrated that treatment using anti-PD-1 and anti-TIGIT dual therapy significantly improved survival compared to control and monotherapy groups. The therapeutic effect was correlated with both increased effector T cell function and downregulation of suppressive Tregs and tumor-infiltrating dendritic cells (TIDCs). Clinically, TIGIT expression on tumor-infiltrating lymphocytes was shown to be elevated in patient GBM samples, suggesting that the TIGIT pathway may be a valuable therapeutic target. Expression of the TIGIT ligand, PVR, further portended a poor survival outcome in patients with low-grade glioma. We conclude that anti-TIGIT is an effective treatment strategy against murine GBM when used in combination with anti-PD-1, improving overall survival via modifications of both the T cell and myeloid compartments. Given evidence of PVR expression on human GBM cells, TIGIT presents as a promising immune therapeutic target in the management of these patients.
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Affiliation(s)
- Alice L Hung
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Russell Maxwell
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Debebe Theodros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zineb Belcaid
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew S Luksik
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eileen Kim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adela Wu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | - Su-Myeong Park
- Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Korea
| | - Je-In Youn
- Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Tamrin Chowdhury
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Drew M Pardoll
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
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34
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Mathios D, Kim JE, Mangraviti A, Phallen J, Park CK, Jackson CM, Garzon-Muvdi T, Kim E, Theodros D, Polanczyk M, Martin AM, Suk I, Ye X, Tyler B, Bettegowda C, Brem H, Pardoll DM, Lim M. Anti-PD-1 antitumor immunity is enhanced by local and abrogated by systemic chemotherapy in GBM. Sci Transl Med 2017; 8:370ra180. [PMID: 28003545 DOI: 10.1126/scitranslmed.aag2942] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/06/2016] [Accepted: 09/27/2016] [Indexed: 12/15/2022]
Abstract
The immunosuppressive effects of chemotherapy present a challenge for designing effective cancer immunotherapy strategies. We hypothesized that although systemic chemotherapy (SC) exhibits negative immunologic effects, local chemotherapy (LC) can potentiate an antitumor immune response. We show that LC combined with anti-programmed cell death protein 1 (PD-1) facilitates an antitumor immune response and improves survival (P < 0.001) in glioblastoma. LC-treated mice had increased infiltration of tumor-associated dendritic cells and clonal expansion of antigen-specific T effector cells. In comparison, SC resulted in systemic and intratumoral lymphodepletion, with decreased immune memory in long-term survivors. Furthermore, adoptive transfer of CD8+ cells from LC-treated mice partially rescued SC-treated mice after tumor rechallenge. Last, the timing of chemo- and immunotherapy had differential effects on anti-PD-1 efficacy. This study suggests that both mode of delivery and timing have distinct effects on the efficacy of anti-PD-1. The results of this work could help guide the selection and scheduling of combination treatment for patients with glioblastoma and other tumor types.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jennifer E Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Antonella Mangraviti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jillian Phallen
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Chul-Kee Park
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Eileen Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Debebe Theodros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Magdalena Polanczyk
- Department of Cancer Immunology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Allison M Martin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Drew M Pardoll
- Department of Cancer Immunology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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35
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Patel MA, Kim JE, Theodros D, Tam A, Velarde E, Kochel CM, Francica B, Nirschl TR, Ghasemzadeh A, Mathios D, Harris-Bookman S, Jackson CC, Jackson C, Ye X, Tran PT, Tyler B, Coric V, Selby M, Brem H, Drake CG, Pardoll DM, Lim M. Erratum to: Agonist anti-GITR monoclonal antibody and stereotactic radiation induce immune-mediated survival advantage in murine intracranial glioma. J Immunother Cancer 2016; 4:74. [PMID: 27822377 PMCID: PMC5096004 DOI: 10.1186/s40425-016-0181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mira A Patel
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer E Kim
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Debebe Theodros
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ada Tam
- Department of Oncology, Baltimore, USA
| | | | | | | | | | | | - Dimitrios Mathios
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Sarah Harris-Bookman
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Christopher C Jackson
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Christina Jackson
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Xiaobu Ye
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Phuoc T Tran
- Department of Oncology, Baltimore, USA.,Department Radiation Oncology, Baltimore, USA.,The Brady Urological Institute, Baltimore, USA
| | - Betty Tyler
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | | | - Mark Selby
- Bristol-Myers Squibb Company, San Francisco, CA USA
| | - Henry Brem
- The Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | | | | | - Michael Lim
- The Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
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36
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Goodwin CR, Theodros D, Abu-Bonsrah NA, Bender M, Zhou X, De la Garza-Ramos R, Mathios D, Garzon-Muvdi T, Blitz AM, Olivi A, Carson BS, Bettegowda C. 194 Efficacy of Primary Microvascular Decompression vs Salvage Microvascular Decompression for Trigeminal Neuralgia. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489764.44018.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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37
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Theodros D, Rory Goodwin C, Bender MT, Zhou X, Garzon-Muvdi T, De la Garza-Ramos R, Abu-Bonsrah N, Mathios D, Blitz AM, Olivi A, Carson B, Bettegowda C, Lim M. Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia. J Neurosurg 2016; 126:1691-1697. [PMID: 27419826 DOI: 10.3171/2016.5.jns151692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/06/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD. METHODS A retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis. RESULTS In patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041). Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572). CONCLUSIONS The results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ari M Blitz
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
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Belcaid Z, Berrevoets C, Kloezeman J, van der Kaaij M, Mathios D, Lim M, Dirven C, Debets R, Lamfers M. Abstract 3221: Oncolytic virotherapy combined with T-cell co-signaling antibodies for intracranial gliomas. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3221] [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
Introduction: The tumor-selective human adenovirus Delta24-RGD (DNX-2401) is currently under investigation in phase II clinical trials for recurrent glioblastoma. In recent preclinical studies, our group demonstrated that the immune system, and CD8+ T cells in particular, plays an important role in the establishment of a protective anti-glioma immune memory (Kleijn, PLoS ONE, 2014). In order to improve anti-tumor efficacy of Delta24-RGD therapy with antibody immunotherapy, we are currently investigating the role of T cell co-signaling molecules in our model and their contribution toward an anti-glioma T cell response.
Methods: Immune-competent C57bl/6 mice were intracranially injected with GL261 glioma tumor cells and treated on day 5 with an intra-tumoral injection of Delta24-RGD virus. Single cell suspensions of brain tumors and spleens were stained for flow cytometry with antibodies against CD3, CD4, CD8 as well as ten selected T cell co-signaling molecules: ICOS, 4-1BB, CD28, OX-40, CD40L, CTLA-4, PD-1, LAG-3, TIM-3, BTLA. Tumor cell lysis and IFNy production was assessed in ex vivo cultures of brain tumor cells and immune cells. In addition, IFNy production was assessed from co-cultures with splenocytes and GL261 glioma tumor cells treated with either a PD-1 blocking antibody or an agonist ICOS antibody.
Results: In brain tumors, we observed an increase in numbers of CD8+, but not CD4+ T cells, on day 9 and 14 after virus-treatment. Expression analysis of the co-signaling molecules in infiltrating brain T cells revealed higher expression levels of the co-signaling molecules ICOS, CD28 and PD-1. In the ex vivo tumor cell and immune cell cultures derived from Delta24-RGD treated mice, there is a significant positive correlation between the observed tumor cell lysis and IFNy production ex vivo (Spearman r = 0,9524; p < 0.01). Interestingly, the amount of tumor cell lysis inversely correlated with a low density of CD3+ PD-1+ T cells in vivo (Spearman r = -0,7619; p < 0.05). Co-cultures of splenocytes from virus-treated mice and GL261 glioma tumor cells showed a significant increase in IFNy production when treated with a PD-1 blocking antibody (p < 0.01), but not when treated with an ICOS agonistic antibody.
Conclusion: The inverse relationship between the presence of a low density of PD-1+ TILs in vivo and a higher T cell functionality ex vivo provides rationale for inhibiting the PD-1 receptor with antibody immunotherapy in combination with Delta24-RGD therapy in order to improve therapeutic efficacy. In vivo studies combining these therapies are underway.
Citation Format: Zineb Belcaid, Cor Berrevoets, Jenneke Kloezeman, Marielle van der Kaaij, Dimitrios Mathios, Michael Lim, Clemens Dirven, Reno Debets, Martine Lamfers. Oncolytic virotherapy combined with T-cell co-signaling antibodies for intracranial gliomas. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3221.
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Kim JE, Patel MA, Mangraviti A, Kim ES, Theodros D, Velarde E, Liu A, Sankey EW, Tam A, Xu H, Mathios D, Jackson CM, Harris-Bookman S, Garzon-Muvdi T, Sheu M, Martin AM, Tyler BM, Tran PT, Ye X, Olivi A, Taube JM, Burger PC, Drake CG, Brem H, Pardoll DM, Lim M. Combination Therapy with Anti-PD-1, Anti-TIM-3, and Focal Radiation Results in Regression of Murine Gliomas. Clin Cancer Res 2016; 23:124-136. [PMID: 27358487 DOI: 10.1158/1078-0432.ccr-15-1535] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 05/01/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Checkpoint molecules like programmed death-1 (PD-1) and T-cell immunoglobulin mucin-3 (TIM-3) are negative immune regulators that may be upregulated in the setting of glioblastoma multiforme. Combined PD-1 blockade and stereotactic radiosurgery (SRS) have been shown to improve antitumor immunity and produce long-term survivors in a murine glioma model. However, tumor-infiltrating lymphocytes (TIL) can express multiple checkpoints, and expression of ≥2 checkpoints corresponds to a more exhausted T-cell phenotype. We investigate TIM-3 expression in a glioma model and the antitumor efficacy of TIM-3 blockade alone and in combination with anti-PD-1 and SRS. EXPERIMENTAL DESIGN C57BL/6 mice were implanted with murine glioma cell line GL261-luc2 and randomized into 8 treatment arms: (i) control, (ii) SRS, (iii) anti-PD-1 antibody, (iv) anti-TIM-3 antibody, (v) anti-PD-1 + SRS, (vi) anti-TIM-3 + SRS, (vii) anti-PD-1 + anti-TIM-3, and (viii) anti-PD-1 + anti-TIM-3 + SRS. Survival and immune activation were assessed. RESULTS Dual therapy with anti-TIM-3 antibody + SRS or anti-TIM-3 + anti-PD-1 improved survival compared with anti-TIM-3 antibody alone. Triple therapy resulted in 100% overall survival (P < 0.05), a significant improvement compared with other arms. Long-term survivors demonstrated increased immune cell infiltration and activity and immune memory. Finally, positive staining for TIM-3 was detected in 7 of 8 human GBM samples. CONCLUSIONS This is the first preclinical investigation on the effects of dual PD-1 and TIM-3 blockade with radiation. We also demonstrate the presence of TIM-3 in human glioblastoma multiforme and provide preclinical evidence for a novel treatment combination that can potentially result in long-term glioma survival and constitutes a novel immunotherapeutic strategy for the treatment of glioblastoma multiforme. Clin Cancer Res; 23(1); 124-36. ©2016 AACR.
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Affiliation(s)
- Jennifer E Kim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Mira A Patel
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | | | - Eileen S Kim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Debebe Theodros
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Esteban Velarde
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Eric W Sankey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Ada Tam
- Flow Cytometry Core, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Haiying Xu
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Tomas Garzon-Muvdi
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Mary Sheu
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Allison M Martin
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Betty M Tyler
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Phuoc T Tran
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Alessandro Olivi
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Janis M Taube
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Peter C Burger
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Charles G Drake
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Drew M Pardoll
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
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Patel MA, Kim JE, Theodros D, Tam A, Velarde E, Kochel CM, Francica B, Nirschl TR, Ghasemzadeh A, Mathios D, Harris-Bookman S, Jackson CC, Jackson C, Ye X, Tran PT, Tyler B, Coric V, Selby M, Brem H, Drake CG, Pardoll DM, Lim M. Agonist anti-GITR monoclonal antibody and stereotactic radiation induce immune-mediated survival advantage in murine intracranial glioma. J Immunother Cancer 2016; 4:28. [PMID: 27190629 PMCID: PMC4869343 DOI: 10.1186/s40425-016-0132-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/26/2016] [Indexed: 12/29/2022] Open
Abstract
Background Glioblastoma (GBM) is a poorly immunogenic neoplasm treated with focused radiation. Immunotherapy has demonstrated synergistic survival effects with stereotactic radiosurgery (SRS) in murine GBM. GITR is a co-stimulatory molecule expressed constitutively on regulatory T-cells and by effector T-cells upon activation. We tested the hypothesis that anti-GITR monoclonal antibody (mAb) and SRS together would confer an immune-mediated survival benefit in glioma using the orthotopic GL261 glioma model. Methods Mice received SRS and anti-GITR 10 days after implantation. The anti-GITR mAbs tested were formatted as mouse IgG1 D265A (anti-GITR (1)) and IgG2a (anti-GITR (2a)) isotypes. Mice were randomized to four treatment groups: (1) control; (2) SRS; (3) anti-GITR; (4) anti-GITR/SRS. SRS was delivered to the tumor in one fraction, and mice were treated with mAb thrice. Mice were euthanized on day 21 to analyze the immunologic profile of tumor, spleen, and tumor draining lymph nodes. Results Anti-GITR (1)/SRS significantly improved survival over either treatment alone (p < .0001) with a cure rate of 24 % versus 0 % in a T-lymphocyte-dependent manner. There was elevated intratumoral CD4+ effector cell infiltration relative to Treg infiltration in mice treated with anti-GITR (1)/SRS, as well as significantly elevated IFNγ and IL-2 production by CD4+ T-cells and elevated IFNγ and TNFα production by CD8+ T-cells. There was increased mRNA expression of M1 markers and decreased expression of M2 markers in tumor infiltrating mononuclear cells. The anti-GITR (2a)/SRS combination did not improve survival, induce tumor regression, or result in Treg depletion. Conclusions These findings provide preclinical evidence for the use of anti-GITR (1) non-depleting antibodies in combination with SRS in GBM. Electronic supplementary material The online version of this article (doi:10.1186/s40425-016-0132-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mira A Patel
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer E Kim
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Debebe Theodros
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ada Tam
- Department of Oncology, Baltimore, USA
| | | | | | | | | | | | - Dimitrios Mathios
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Sarah Harris-Bookman
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Christopher C Jackson
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Christina Jackson
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Xiaobu Ye
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | - Phuoc T Tran
- Department of Oncology, Baltimore, USA.,Department Radiation Oncology, Baltimore, USA.,and the Brady Urological Institute, Baltimore, USA
| | - Betty Tyler
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | | | - Mark Selby
- Bristol-Myers Squibb Company, San Francisco, CA USA
| | - Henry Brem
- The Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
| | | | | | - Michael Lim
- The Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St. Phipps Building Rm 123, Baltimore, 21287 MD USA
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Mathios D, Ruzevick J, Jackson CM, Xu H, Shah SR, Taube JM, Burger PC, McCarthy EF, Quinones-Hinojosa A, Pardoll DM, Lim M. Erratum to: PD-1, PD-L1, PD-L2 expression in the chordoma microenvironment. J Neurooncol 2016; 128:183. [PMID: 27161248 DOI: 10.1007/s11060-016-2130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob Ruzevick
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haiying Xu
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sagar R Shah
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janis M Taube
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter C Burger
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward F McCarthy
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Drew M Pardoll
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Neurosurgery - Phipps 123, Baltimore, MD, 21287, USA.
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Mathios D, Kim J, Phallen J, Mangraviti A, Park CK, Theodros D, Jackson C, Garzon-Muvdi T, Kim E, Ye X, Tyler B, Brem H, Pardoll D, Lim M. Optimizing the delivery of chemotherapy in the setting of immunotherapy in a preclinical glioblastoma model. J Immunother Cancer 2015. [PMCID: PMC4649405 DOI: 10.1186/2051-1426-3-s2-p307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim JE, Patel MA, Mangraviti A, Polanczyk M, Kim ES, Theodros D, Velarde E, Liu A, Sankey E, Mathios D, Jackson CM, Olivi A, Tran P, Drake CG, Tyler B, Ye X, Brem H, Pardoll DM, Lim M. IMPS-20COMBINATION THERAPY WITH ANTI-PD-1, ANTI-TIM-3, AND FOCAL RADIATION RESULTS IN REGRESSION OF MURINE GLIOMAS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov217.20] [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: 11/13/2022] Open
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Eseonu CI, Goodwin CR, Zhou X, Theodros D, Bender MT, Mathios D, Bettegowda C, Lim M. Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement. J Neurosurg 2015; 123:1476-9. [PMID: 26230465 DOI: 10.3171/2015.1.jns142102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 11/06/2022]
Abstract
OBJECT Calcium phosphate cement provides a biomaterial that can be used for calvarial reconstruction in a retrosigmoid craniectomy for microvascular decompression (MVD). This study evaluates the outcomes of postoperative CSF leak and wound infection for patients undergoing a complete cranioplasty using calcium phosphate cement versus incomplete cranioplasty using polyethylene titanium mesh following a retrosigmoid craniectomy for MVD. METHODS The authors evaluated 211 cases involving patients who underwent first-time retrosigmoid craniectomies performed by a single attending surgeon fortrigeminal neuralgia from October 2008 to June 2014. From this patient population, 111 patients underwent calvarial reconstruction after retrosigmoid craniectomy using polyethylene titanium mesh, and 100 patients had reconstructions using calcium phosphate cement. A Pearson's chi-square test was used to compare postoperative complications of CSF leak and wound infection in these 2 types of cranioplasties. RESULTS The polyethylene titanium mesh group included 5 patients (4.5%) with postoperative CSF leak or pseudomeningocele and 3 patients (2.7%) with wound infections. In the calcium phosphate cement group, no patients had a CSF leak, and 2 patients (2%) had wound infections. This represented a statistically significant reduction of postoperative CSF leak in patients who underwent calcium phosphate reconstructions of their calvarial defect compared with those who underwent polyethylene titanium mesh reconstructions (p = 0.03). No significant difference was seen between the 2 groups in the number of patients with postoperative wound infections. CONCLUSIONS Calcium phosphate cement provides a viable alternative biomaterial for calvarial reconstruction of retrosigmoid craniectomy defects in patients who have an MVD. The application of this material provides a biocompatible barrier that reduces the incidence of postoperative CSF leaks.
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Affiliation(s)
- Chikezie I Eseonu
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xin Zhou
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debebe Theodros
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Bender
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dimitrios Mathios
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Lim
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mathios D, Park CK, Marcus WD, Alter S, Rhode PR, Jeng EK, Wong HC, Pardoll DM, Lim M. Therapeutic administration of IL-15 superagonist complex ALT-803 leads to long-term survival and durable antitumor immune response in a murine glioblastoma model. Int J Cancer 2015; 138:187-94. [PMID: 26174883 DOI: 10.1002/ijc.29686] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 01/24/2023]
Abstract
Glioblastoma is the most aggressive primary central nervous system malignancy with a poor prognosis in patients. Despite the need for better treatments against glioblastoma, very little progress has been made in discovering new therapies that exhibit superior survival benefit than the standard of care. Immunotherapy has been shown to be a promising treatment modality that could help improve clinical outcomes of glioblastoma patients by assisting the immune system to overcome the immunosuppressive tumor environment. Interleukin-15 (IL-15), a cytokine shown to activate several effector components of the immune system, may serve as an excellent immunotherapeutic candidate for the treatment of glioblastoma. Thus, we evaluated the efficacy of an IL-15 superagonist complex (IL-15N72D:IL-15RαSu-Fc; also known as ALT-803) in a murine GL261-luc glioblastoma model. We show that ALT-803, as a single treatment as well as in combination with anti-PD-1 antibody or stereotactic radiosurgery, exhibits a robust antitumor immune response resulting in a prolonged survival including complete remission in tumor bearing mice. In addition, ALT-803 treatment results in long-term immune memory against glioblastoma tumor rechallenge. Flow cytometric analysis of tumor infiltrating immune cells shows that ALT-803 leads to increased percentage of CD8+-cell infiltration, but not the NK cells, and IFN-γ production into the tumor microenvironment. Cell depletion studies, in accordance with the flow cytometric results, show that the ALT-803 therapeutic effect is dependent on CD4+ and CD8+ cells. These results provide a rationale for evaluating the therapeutic activity of ALT-803 against glioblastoma in the clinical setting.
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Affiliation(s)
- Dimitrios Mathios
- Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD
| | - Chul-Kee Park
- Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD.,Seoul National University College of Medicine, Department of Neurosurgery, Seoul, Republic of Korea
| | | | | | | | | | | | - Drew M Pardoll
- Johns Hopkins University School of Medicine, Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Michael Lim
- Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD
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Mathios D, Phallen J, Park CK, Jackson C, Nicholas S, Tyler B, Pardoll D, Brem H, Lim M. IT-21 * PD-1 BLOCKADE SHOWS SYNERGISTIC SURVIVAL, ANTI-TUMOR IMMUNE RESPONSE AND LONG-TERM MEMORY WITH INTERSTITIAL BUT NOT SYSTEMIC CHEMOTHERAPY: STUDY IN A MURINE GLIOBLASTOMA MODEL. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou258.19] [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: 11/14/2022] Open
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Bydon M, Mathios D, Macki M, de la Garza-Ramos R, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine 2014; 21:727-31. [PMID: 25127430 DOI: 10.3171/2014.7.spine131110] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors conducted a study to investigate the rate and timing of reoperation due to symptom recurrence after unilateral posterior cervical foraminotomy (PCF).
Methods
The authors retrospectively reviewed demographic, surgical, and clinical data from 151 patients who underwent unilateral PCF at their institution with an average follow-up of 4.15 years. The main outcome variables were reoperation rate, time to reoperation, and short- and long-term radiculopathy improvement rates. Kaplan-Meier analyses were conducted to assess risk of reoperation and recurrence of radiculopathy over time.
Results
After index PCF in 151 patients, the overall reoperation rate was 9.9% (15 patients). The average time until reoperation was 2.4 years, and the average last follow-up examination was 4.15 years after the first surgery. Patients who presented with preoperative neck pain in addition to radiculopathy had a higher risk for reoperation and a shorter time to reoperation. The majority of patients who underwent a reoperation had an anterior cervical discectomy and fusion (80%). A smaller number of patients had reoperation that included a repeat PCF (6.7%) or laminectomy with posterior cervical fusion (13.3%). The rate of same-level reoperation (6.6%, 10 patients) was significantly higher (p = 0.05) when compared with adjacent-segment (1.3%, 2 patients) or distant-segment (1.9%, 3 patients) reoperation. At last follow-up, the overall rate of improvement in radiculopathy was 85%, with the majority of patients (91.4%) experiencing resolution as early as 1 month after index surgery. Following the subgroup that experienced initial symptom improvement, 16.1% of these patients experienced radiculopathy recurrence an average of 7.3 years after the initial operation. While the reoperation rate for the overall cohort in this series was 9.9%, patients with follow-up periods longer than 2 years had a reoperation rate of 18.3%. Moreover, patients with more than 10 years of follow-up had a reoperation rate of 24.3%.
Conclusions
PCF is a procedure performed to address nerve root compression in the cervical spine. The authors evaluated 151 patients who underwent unilateral PCF and found a reoperation rate of 9.9% at an average of 2.4 years after the initial surgery (6.6% at same level, 3.3% elsewhere). The reoperation rates reached 18.3% and 24.3% in patients with follow-up periods longer than 2 and 10 years, respectively. The authors' analysis revealed that patients with no preoperative neck pain had the lowest rates of revision surgery after PCF.
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Affiliation(s)
- Mohamad Bydon
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dimitrios Mathios
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mohamed Macki
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Rafael de la Garza-Ramos
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M. Sciubba
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
| | - Timothy F. Witham
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
| | | | - Ziya L. Gokaslan
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
| | - Ali Bydon
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory, and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Bydon M, Mathios D, Macki M, De la Garza-Ramos R, Aygun N, Sciubba DM, Witham TF, Gokaslan ZL, Bydon A, Wolinksy JP. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Clin Neurol Neurosurg 2014; 125:24-7. [DOI: 10.1016/j.clineuro.2014.07.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 06/30/2014] [Accepted: 07/13/2014] [Indexed: 10/25/2022]
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Belcaid Z, Phallen J, Zeng J, See A, Mathios D, Gottschalk C, Nicholas S, Ruzevick J, Jackson C, Albesiano E, Durham N, Tyler B, Wong J, Brem H, Pardoll D, Drake C, Lim M. Stereotactic Radiation Combined with 41BB Activation and CTLA-4 Blockade Yields Long-Term Survival and a Protective Antigen-Specific Memory Response an a Murine Glioma Model. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.158] [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: 11/27/2022]
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Belcaid Z, Phallen JA, Zeng J, See AP, Mathios D, Gottschalk C, Nicholas S, Kellett M, Ruzevick J, Jackson C, Albesiano E, Durham NM, Ye X, Tran PT, Tyler B, Wong JW, Brem H, Pardoll DM, Drake CG, Lim M. Focal radiation therapy combined with 4-1BB activation and CTLA-4 blockade yields long-term survival and a protective antigen-specific memory response in a murine glioma model. PLoS One 2014; 9:e101764. [PMID: 25013914 PMCID: PMC4094423 DOI: 10.1371/journal.pone.0101764] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/11/2014] [Indexed: 01/19/2023] Open
Abstract
Background Glioblastoma (GBM) is the most common malignant brain tumor in adults and is associated with a poor prognosis. Cytotoxic T lymphocyte antigen -4 (CTLA-4) blocking antibodies have demonstrated an ability to generate robust antitumor immune responses against a variety of solid tumors. 4-1BB (CD137) is expressed by activated T lymphocytes and served as a co-stimulatory signal, which promotes cytotoxic function. Here, we evaluate a combination immunotherapy regimen involving 4-1BB activation, CTLA-4 blockade, and focal radiation therapy in an immune-competent intracranial GBM model. Methods GL261-luciferace cells were stereotactically implanted in the striatum of C57BL/6 mice. Mice were treated with a triple therapy regimen consisted of 4-1BB agonist antibodies, CTLA-4 blocking antibodies, and focal radiation therapy using a small animal radiation research platform and mice were followed for survival. Numbers of brain-infiltrating lymphocytes were analyzed by FACS analysis. CD4 or CD8 depleting antibodies were administered to determine the relative contribution of T helper and cytotoxic T cells in this regimen. To evaluate the ability of this immunotherapy to generate an antigen-specific memory response, long-term survivors were re-challenged with GL261 glioma en B16 melanoma flank tumors. Results Mice treated with triple therapy had increased survival compared to mice treated with focal radiation therapy and immunotherapy with 4-1BB activation and CTLA-4 blockade. Animals treated with triple therapy exhibited at least 50% long-term tumor free survival. Treatment with triple therapy resulted in a higher density of CD4+ and CD8+ tumor infiltrating lymphocytes. Mechanistically, depletion of CD4+ T cells abrogated the antitumor efficacy of triple therapy, while depletion of CD8+ T cells had no effect on the treatment response. Conclusion Combination therapy with 4-1BB activation and CTLA-4 blockade in the setting of focal radiation therapy improves survival in an orthotopic mouse model of glioma by a CD4+ T cell dependent mechanism and generates antigen-specific memory.
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Affiliation(s)
- Zineb Belcaid
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jillian A. Phallen
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jing Zeng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Alfred P. See
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Dimitrios Mathios
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Chelsea Gottschalk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sarah Nicholas
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Meghan Kellett
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jacob Ruzevick
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Emilia Albesiano
- Department of Oncology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nicholas M. Durham
- Department of Oncology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Phuoc T. Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - John W. Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Departments of Oncology, Ophthalmology, and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Drew M. Pardoll
- Department of Oncology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Charles G. Drake
- Department of Oncology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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