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Mills M, Kotecha R, Herrera R, Kutuk T, Fahey M, Wuthrick E, Grass GD, Hoffe S, Frakes J, Chuong MD, Rosenberg SA. Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases. Clin Transl Radiat Oncol 2024; 45:100719. [PMID: 38292332 PMCID: PMC10824679 DOI: 10.1016/j.ctro.2023.100719] [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: 08/02/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose While dose escalation is associated with improved local control (LC) for adrenal gland metastases (AGMs), the proximity of gastrointestinal (GI) organs-at-risk (OARs) limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The advantages of magnetic resonance-guided SBRT (MRgSBRT), including tumor tracking and online plan adaptation, facilitate safe dose escalation. Methods This is a multi-institutional review of 57 consecutive patients who received MRgSBRT on a 0.35-T MR linac to 61 AGMs from 2019 to 2021. The Kaplan-Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and LC, and the Cox proportional hazards model was utilized for univariate analysis (UVA). Results Median follow up from MRgSBRT was 16.4 months (range [R]: 1.1-39 months). Median age was 67 years (R: 28-84 years). Primary histologies included non-small cell lung cancer (N = 38), renal cell carcinoma (N = 6), and melanoma (N = 5), amongst others. The median maximum diameter was 2.7 cm (R: 0.6-7.6 cm), and most AGMs were left-sided (N = 32). The median dose was 50 Gy (R: 30-60 Gy) in 5-10 fractions with a median BED10 of 100 Gy (R: 48-132 Gy). 45 cases (74 %) required adaptation for at least 1 fraction (median: 4 fractions, R: 0-10). Left-sided AGMs required adaptation in at least 1 fraction more frequently than right-sided AGMs (88 % vs 59 %, p = 0.018). There were 3 cases of reirradiation, including 60 Gy in 10 fractions (N = 1) and 40 Gy in 5 fractions (N = 2). One-year LC, PFS, and OS were 92 %, 52 %, and 78 %, respectively. On UVA, melanoma histology predicted for inferior 1-year LC (80 % vs 93 %, p = 0.012). There were no instances of grade 3+ toxicity. Conclusions We demonstrate that MRgSBRT achieves favorable early LC and no grade 3 + toxicity despite prescribing a median BED10 of 100 Gy to targets near GI OARs.
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Affiliation(s)
- Matthew Mills
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Roberto Herrera
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Matthew Fahey
- University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Evan Wuthrick
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - G. Daniel Grass
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Jessica Frakes
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
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Huelster HL, Gould B, Schiftan EA, Camperlengo L, Davaro F, Rose KM, Soupir AC, Jia S, Zheng T, Sexton WJ, Pow-Sang J, Spiess PE, Daniel Grass G, Wang L, Wang X, Vosoughi A, Necchi A, Meeks JJ, Faltas BM, Du P, Li R. Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non-organ-confined Upper Tract Urothelial Carcinoma. Eur Urol 2024; 85:283-292. [PMID: 37802683 DOI: 10.1016/j.eururo.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Optimal patient selection for neoadjuvant chemotherapy prior to surgical extirpation is limited by the inaccuracy of contemporary clinical staging methods in high-risk upper tract urothelial carcinoma (UTUC). OBJECTIVE To investigate whether the detection of plasma circulating tumor DNA (ctDNA) can predict muscle-invasive (MI) and non-organ-confined (NOC) UTUC. DESIGN, SETTING, AND PARTICIPANTS Plasma cell-free DNA was prospectively collected from chemotherapy-naïve, high-risk UTUC patients undergoing surgical extirpation and sequenced using a 152-gene panel and low-pass whole-genome sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To test for concordance, whole-exome sequencing was performed on matching tumor samples. The performance of ctDNA for predicting MI/NOC UTUC was summarized using the area under a receiver-operating curve, and a variant count threshold for predicting MI/NOC disease was determined by maximizing Youden's J statistic. Kaplan-Meier methods estimated survival, and Mantel-Cox log-rank testing assessed the association between preoperative ctDNA positivity and clinical outcomes. RESULTS AND LIMITATIONS Of 30 patients enrolled prospectively, 14 were found to have MI/NOC UTUC. At least one ctDNA variant was detected from 21/30 (70%) patients, with 52% concordance with matching tumor samples. Detection of at least two panel-based molecular alterations yielded 71% sensitivity at 94% specificity to predict MI/NOC UTUC. Imposing this threshold in combination with a plasma copy number burden score of >6.5 increased sensitivity to 79% at 94% specificity. Furthermore, the presence of ctDNA was strongly prognostic for progression-free survival (PFS; 1-yr PFS 69% vs 100%, p < 0.001) and cancer-specific survival (CSS; 1-yr CSS 56% vs 100%, p = 0.016). CONCLUSIONS The detection of plasma ctDNA prior to extirpative surgery was highly predictive of MI/NOC UTUC and strongly prognostic of PFS and CSS. Preoperative ctDNA demonstrates promise as a biomarker for selecting patients to undergo neoadjuvant chemotherapy prior to nephroureterectomy. PATIENT SUMMARY Here, we show that DNA from upper tract urothelial tumors can be detected in the blood prior to surgical removal of the kidney or ureter. This circulating tumor DNA can be used to predict that upper tract urothelial carcinoma is invasive into the muscular lining of the urinary tract and may help identify those patients who could benefit from chemotherapy prior to surgery.
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Affiliation(s)
- Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Elizabeth A Schiftan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lucia Camperlengo
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Facundo Davaro
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kyle M Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alex C Soupir
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Liang Wang
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Department of GU Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Joshua J Meeks
- Departments of Urology and Biochemistry, Northwestern University, Chicago, IL, USA
| | - Bishoy M Faltas
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pan Du
- Predicine Inc., Hayward, CA, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Ionescu F, Nguyen J, Segura CM, Paravathaneni M, Grass GD, Johnstone P, Zacharias NM, Pettaway CA, Lu X, Kim Y, Whiting J, Dhillon J, Eschrich SA, Chadha J, Gullapalli K, Roman Souza G, Miyagi H, Manley BJ, Spiess PE, Chahoud J. Multiplex Immunofluorescence Captures Progressive Immune Exhaustion with Advancing Penile Squamous Cell Cancer Stage. Cancers (Basel) 2024; 16:303. [PMID: 38275860 PMCID: PMC10814242 DOI: 10.3390/cancers16020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/25/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Penile squamous cell carcinoma (PSCC) is a rare and deadly malignancy. Therapeutic advances have been stifled by a poor understanding of disease biology. Specifically, the immune microenvironment is an underexplored component in PSCC and the activity of immune checkpoint inhibitors observed in a subset of patients suggests immune escape may play an important role in tumorigenesis. Herein, we explored for the first time the immune microenvironment of 57 men with PSCC and how it varies with the presence of human papillomavirus (HPV) infection and across tumor stages using multiplex immunofluorescence of key immune cell markers. We observed an increase in the density of immune effector cells in node-negative tumors and a progressive rise in inhibitory immune players such as type 2 macrophages and upregulation of the PD-L1 checkpoint in men with N1 and N2-3 disease. There were no differences in immune cell densities with HPV status.
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Affiliation(s)
- Filip Ionescu
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Jonathan Nguyen
- Pathology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Mahati Paravathaneni
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - G. Daniel Grass
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Peter Johnstone
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Niki M. Zacharias
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Curtis A. Pettaway
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Lu
- Department of Biological Sciences, University of Notre Dame, Norte Dame, IN 46556, USA;
| | - Youngchul Kim
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Junmin Whiting
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jasreman Dhillon
- Pathology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Steven A. Eschrich
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Juskaran Chadha
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Keerthi Gullapalli
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Gabriel Roman Souza
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Hiroko Miyagi
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Brandon J. Manley
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Philippe E. Spiess
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Jad Chahoud
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
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4
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Li R, Nocera L, Rose KM, Raggi D, Naidu S, Mercinelli C, Cigliola A, Tateo V, Patanè D, Grass GD, Gilbert SM, Sexton WJ, Bandini M, Moschini M, Briganti A, Montorsi F, Spiess PE, Necchi A. Comparative Effectiveness of Neoadjuvant Pembrolizumab Versus Cisplatin-based Chemotherapy or Upfront Radical Cystectomy in Patients with Muscle-invasive Urothelial Bladder Cancer. Eur Urol Oncol 2024:S2588-9311(23)00296-1. [PMID: 38184473 DOI: 10.1016/j.euo.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/21/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Recent progresses in the use of immune checkpoint inhibitor (ICI) have challenged the therapeutic standards in patients with muscle-invasive urothelial bladder carcinoma (MIBC). OBJECTIVE To compare neoadjuvant pembrolizumab followed by radical cystectomy (RC) versus neoadjuvant chemotherapy (NAC) and RC or upfront RC, according to cisplatin eligibility. DESIGN, SETTING, AND PARTICIPANTS We conducted two separate analyses for cisplatin-eligible and cisplatin-ineligible cT2-4N0M0 MIBC patients. We used a propensity score adjustment that relied on inverse probability of treatment-weighting (IPTW). INTERVENTION Pembrolizumab within the PURE-01 trial, and NAC and RC or upfront RC from a high-volume tertiary care referral center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint in both analyses was event-free survival (EFS), defined as freedom from recurrence, and/or death from any cause indexed from the date of treatment initiation or RC. The secondary endpoints included EFS in propensity score-matched patients, pathologic response rate, and recurrence-free survival (RFS) after RC. RESULTS AND LIMITATIONS A total of 458 patients who underwent RC, with or without NAC, at Moffitt Cancer Center between October 2005 and October 2020, and 146 patients enrolled in PURE-01 were analyzed. In cisplatin-ineligible patients, EFS was superior in those receiving pembrolizumab (p < 0.001). The estimated 3-yr EFS was 77.8% (95% confidence interval [CI]: 63.5-95.2) for pembrolizumab and RC, and 36.1% (95% CI: 28.6-45.5) for upfront RC. EFS remained superior in those receiving neoadjuvant ICI (NICI) following IPTW (p < 0.001). In cisplatin-eligible patients, EFS was superior in those receiving pembrolizumab and RC (p < 0.001). The estimated 3-yr EFS was 86.9% (95% CI: 80.9-93.3) for pembrolizumab and 63.5% (95% CI: 56.5-71.4) for NAC. EFS remained superior in those receiving NICI following IPTW (p < 0.001). Pathologic responses and RFS in pembrolizumab-treated patients were also superior to those in NAC-treated patients. Results are limited by the retrospective nature of the study. CONCLUSIONS In the first ever reported comprehensive comparison of outcomes between neoadjuvant ICI and NAC, followed by RC, or upfront RC, we report increased responses and improved oncologic outcomes with neoadjuvant ICI in patients with MIBC. PATIENT SUMMARY We compared the results obtained from the use of pembrolizumab and radical cystectomy with standard-of-care treatments in patients with bladder carcinoma infiltrating the muscle layer. We reported increased response and survival rates possibilities with the use of immunotherapy, anticipating the possibility to set new therapeutic standards in these patients, pending the results of ongoing randomized studies.
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Affiliation(s)
- Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - Luigi Nocera
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kyle M Rose
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Shreyas Naidu
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Damiano Patanè
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - G Daniel Grass
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Marco Bandini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Andrea Necchi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Vita-Salute San Raffaele University, Milan, Italy
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Liveringhouse C, Netzley A, Bryant JM, Linkowski LC, Weygand J, Sandoval ML, Dohm A, Dookhoo M, Kelley S, Rosenberg SA, Latifi K, Torres-Roca JF, Johnstone PA, Yamoah K, Grass GD. Trimodal Therapy Using an MR-guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer. Adv Radiat Oncol 2023; 8:101268. [PMID: 38047218 PMCID: PMC10692296 DOI: 10.1016/j.adro.2023.101268] [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] [Received: 12/06/2022] [Accepted: 05/03/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging-guided radiation therapy (MRgRT) for partial bladder boost (PBB). Methods and Materials A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography-based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Results Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n = 16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Conclusions Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques.
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Affiliation(s)
- Casey Liveringhouse
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Alexander Netzley
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - John M. Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Joseph Weygand
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Maria L. Sandoval
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ammoren Dohm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marsha Dookhoo
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Stacey Kelley
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Javier F. Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A.S. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G. Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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6
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Parza K, Mustasam A, Ionescu F, Paravathaneni M, Sandstrom R, Safa H, Grass GD, Johnstone PA, Eschrich SA, Chadha J, Zacharias N, Pettaway CA, Spiess PE, Chahoud J. The Prognostic Role of Human Papillomavirus and p16 Status in Penile Squamous Cell Carcinoma-A Systematic Review. Cancers (Basel) 2023; 15:3713. [PMID: 37509374 PMCID: PMC10378259 DOI: 10.3390/cancers15143713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
PSCC is a rare cancer, with approximately half of all cases related to HPV. While HPV and p16 IHC testing have proven their prognostic value for oropharyngeal cancer, this is not yet established for PSCC. The current level of evidence exploring the relation between PSCC and HPV is moderate, so we conducted a systematic review following PRISMA guidelines to evaluate the prognostic role of HPV and p16 IHC in PSCC clinical outcomes. We searched the PubMed, Embase, and Cochrane databases and identified 34 relevant studies that met our inclusion criteria. Of these, 33 were retrospective cohort studies, and one was a cross-sectional study. Nine studies reported that HPV-positive and p16-positive PSCC had better overall survival (OS) and disease-free survival (DFS). This study highlights the need for a meta-analysis to determine the role of routine HPV status or p16 staining testing as part of the initial diagnosis and staging of PSCC patients worldwide.
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Affiliation(s)
- Kevin Parza
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
| | - Arfa Mustasam
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Filip Ionescu
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Mahati Paravathaneni
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Reagan Sandstrom
- Graduate Medication Education, USF Health Morsani College of Medicine, Tampa, FL 33602, USA
| | - Houssein Safa
- Hematology Oncology Department, Baylor College of Medicine, Houston, TX 77001, USA
| | - G Daniel Grass
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Peter A Johnstone
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Steven A Eschrich
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Juskaran Chadha
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Niki Zacharias
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Curtis A Pettaway
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Philippe E Spiess
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Jad Chahoud
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
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Oliver DE, Laborde JM, Singh DP, Milano MT, Videtic GM, Williams GR, LaRiviere MJ, Chan JW, Peters GW, Decker RH, Samson P, Robinson CG, Breen WG, Owen D, Tian S, Higgins KA, Almeldin D, Jabbour SK, Wang F, Grass GD, Perez BA, Dilling TJ, Strosberg J, Rosenberg SA. Early-Stage Primary Lung Neuroendocrine Tumors Treated With Stereotactic Body Radiation Therapy: A Multi-Institution Experience. Int J Radiat Oncol Biol Phys 2023; 116:849-857. [PMID: 36708788 PMCID: PMC10845843 DOI: 10.1016/j.ijrobp.2023.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Current guidelines recommend surgery as standard of care for primary lung neuroendocrine tumor (LNET). Given that LNET is a rare clinical entity, there is a lack of literature regarding treatment of LNET with stereotactic body radiation therapy (SBRT). We hypothesized that SBRT could lead to effective locoregional tumor control and long-term outcomes. METHODS AND MATERIALS We retrospectively reviewed 48 tumors in 46 patients from 11 institutions with a histologically confirmed diagnosis of LNET, treated with primary radiation therapy. Data were collected for patients treated nonoperatively with primary radiation therapy between 2006 and 2020. Patient records were reviewed for lesion characteristics and clinical risk factors. Kaplan-Meier analysis, log-rank tests, and Cox multivariate models were used to compare outcomes. RESULTS Median age at treatment was 71 years and mean tumor size was 2 cm. Thirty-two lesions were typical carcinoid histology, 7 were atypical, and 9 were indeterminate. The most common SBRT fractionation schedule was 50 to 60 Gy in 5 daily fractions. Overall survival at 3, 6, and 9 years was 64%, 43%, and 26%, respectively. Progression-free survival at 3, 6, and 9 years was 88%, 78%, and 78%, respectively. Local control at 3, 6, and 9 years was 97%, 91%, and 91%, respectively. There was 1 regional recurrence in a paraesophageal lymph node. No grade 3 or higher toxicity was identified. CONCLUSIONS This is the largest series evaluating outcomes in patients with LNET treated with SBRT. This treatment is well tolerated, provides excellent locoregional control, and should be offered as an alternative to surgical resection for patients with early-stage LNET, particularly those who may not be ideal surgical candidates.
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Affiliation(s)
| | - Jose M Laborde
- Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Deepinder P Singh
- Department of Radiation Oncology, Wilmot Cancer Center, Rochester, New York
| | - Michael T Milano
- Department of Radiation Oncology, Wilmot Cancer Center, Rochester, New York
| | - Gregory M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Graeme R Williams
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason W Chan
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Pamela Samson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Doaa Almeldin
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Fen Wang
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | | | | | | | - Jonathan Strosberg
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
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8
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Torres-Roca JF, Grass GD, Scott JG, Eschrich SA. Towards Data Driven RT Prescription: Integrating Genomics into RT Clinical Practice. Semin Radiat Oncol 2023; 33:221-231. [PMID: 37331777 DOI: 10.1016/j.semradonc.2023.03.007] [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: 06/20/2023]
Abstract
The genomic era has significantly changed the practice of clinical oncology. The use of genomic-based molecular diagnostics including prognostic genomic signatures and new-generation sequencing has become routine for clinical decisions regarding cytotoxic chemotherapy, targeted agents and immunotherapy. In contrast, clinical decisions regarding radiation therapy (RT) remain uninformed about the genomic heterogeneity of tumors. In this review, we discuss the clinical opportunity to utilize genomics to optimize RT dose. Although from the technical perspective, RT has been moving towards a data-driven approach, RT prescription dose is still based on a one-size-fits all approach, with most RT dose based on cancer diagnosis and stage. This approach is in direct conflict with the realization that tumors are biologically heterogeneous, and that cancer is not a single disease. Here, we discuss how genomics can be integrated into RT prescription dose, the clinical potential for this approach and how genomic-optimization of RT dose could lead to new understanding of the clinical benefit of RT.
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Affiliation(s)
- Javier F Torres-Roca
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL; Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL.
| | - G Daniel Grass
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
| | - Jacob G Scott
- Translational Hematology and Oncology Research, Radiation Oncology Department, Cleveland Clinic, Cleveland, OH
| | - Steven A Eschrich
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, Tampa, FL
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9
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Rose KM, Huelster HL, Meeks JJ, Faltas BM, Sonpavde GP, Lerner SP, Ross JS, Spiess PE, Grass GD, Jain RK, Kamat AM, Vosoughi A, Wang L, Wang X, Li R. Circulating and urinary tumour DNA in urothelial carcinoma - upper tract, lower tract and metastatic disease. Nat Rev Urol 2023; 20:406-419. [PMID: 36977797 DOI: 10.1038/s41585-023-00725-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 03/30/2023]
Abstract
Precision medicine has transformed the way urothelial carcinoma is managed. However, current practices are limited by the availability of tissue samples for genomic profiling and the spatial and temporal molecular heterogeneity observed in many studies. Among rapidly advancing genomic sequencing technologies, non-invasive liquid biopsy has emerged as a promising diagnostic tool to reproduce tumour genomics, and has shown potential to be integrated in several aspects of clinical care. In urothelial carcinoma, liquid biopsies such as plasma circulating tumour DNA (ctDNA) and urinary tumour DNA (utDNA) have been investigated as a surrogates for tumour biopsies and might bridge many shortfalls currently faced by clinicians. Both ctDNA and utDNA seem really promising in urothelial carcinoma diagnosis, staging and prognosis, response to therapy monitoring, detection of minimal residual disease and surveillance. The use of liquid biopsies in patients with urothelial carcinoma could further advance precision medicine in this population, facilitating personalized patient monitoring through non-invasive assays.
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Affiliation(s)
- Kyle M Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Joshua J Meeks
- Department of Urology, Northwestern University, Chicago, IL, USA
| | - Bishoy M Faltas
- Department of Hematology/Oncology, Weill-Cornell Medicine, New York, NY, USA
| | - Guru P Sonpavde
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Seth P Lerner
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Ross
- Foundation Medicine, Inc, Cambridge, MA, USA
- Departments of Urology and Pathology, Upstate Medical University, Syracuse, NY, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Aram Vosoughi
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Liang Wang
- Department of Tumour Biology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics/Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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10
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Obermayer AN, Chang D, Nobles G, Teng M, Tan AC, Wang X, Chen YA, Eschrich S, Rodriguez PC, Grass GD, Meshinchi S, Tarhini A, Chen DT, Shaw TI. PATH-SURVEYOR: pathway level survival enquiry for immuno-oncology and drug repurposing. BMC Bioinformatics 2023; 24:266. [PMID: 37380943 DOI: 10.1186/s12859-023-05393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/19/2023] [Indexed: 06/30/2023] Open
Abstract
Pathway-level survival analysis offers the opportunity to examine molecular pathways and immune signatures that influence patient outcomes. However, available survival analysis algorithms are limited in pathway-level function and lack a streamlined analytical process. Here we present a comprehensive pathway-level survival analysis suite, PATH-SURVEYOR, which includes a Shiny user interface with extensive features for systematic exploration of pathways and covariates in a Cox proportional-hazard model. Moreover, our framework offers an integrative strategy for performing Hazard Ratio ranked Gene Set Enrichment Analysis and pathway clustering. As an example, we applied our tool in a combined cohort of melanoma patients treated with checkpoint inhibition (ICI) and identified several immune populations and biomarkers predictive of ICI efficacy. We also analyzed gene expression data of pediatric acute myeloid leukemia (AML) and performed an inverse association of drug targets with the patient's clinical endpoint. Our analysis derived several drug targets in high-risk KMT2A-fusion-positive patients, which were then validated in AML cell lines in the Genomics of Drug Sensitivity database. Altogether, the tool offers a comprehensive suite for pathway-level survival analysis and a user interface for exploring drug targets, molecular features, and immune populations at different resolutions.
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Affiliation(s)
- Alyssa N Obermayer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Darwin Chang
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Gabrielle Nobles
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Mingxiang Teng
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Aik-Choon Tan
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Y Ann Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Steven Eschrich
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Paulo C Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Children's Oncology Group, Monrovia, CA, USA
| | - Ahmad Tarhini
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Timothy I Shaw
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
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11
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Rose KM, Huelster HL, Meeks JJ, Faltas BM, Sonpavde GP, Lerner SP, Ross JS, Spiess PE, Grass GD, Jain RK, Kamat AM, Vosoughi A, Wang L, Wang X, Li R. Author Correction: Circulating and urinary tumour DNA in urothelial carcinoma - upper tract, lower tract and metastatic disease. Nat Rev Urol 2023:10.1038/s41585-023-00783-6. [PMID: 37217696 DOI: 10.1038/s41585-023-00783-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Kyle M Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Joshua J Meeks
- Department of Urology, Northwestern University, Chicago, IL, USA
| | - Bishoy M Faltas
- Department of Hematology/Oncology, Weill-Cornell Medicine, New York, NY, USA
| | - Guru P Sonpavde
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Seth P Lerner
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Ross
- Foundation Medicine, Inc, Cambridge, MA, USA
- Departments of Urology and Pathology, Upstate Medical University, Syracuse, NY, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Aram Vosoughi
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Liang Wang
- Department of Tumour Biology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics/Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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12
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Obermayer A, Chang D, Nobles G, Teng M, Tan AC, Wang X, Eschrich S, Rodriguez P, Grass GD, Meshinchi S, Tarhini A, Chen DT, Shaw T. DRPPM-PATH-SURVEIOR: Plug-and-Play Survival Analysis of Pathway-level Signatures and Immune Components. Res Sq 2023:rs.3.rs-2688545. [PMID: 36993526 PMCID: PMC10055629 DOI: 10.21203/rs.3.rs-2688545/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Pathway-level survival analysis offers the opportunity to examine molecular pathways and immune signatures that influence patient outcomes. However, available survival analysis algorithms are limited in pathway-level function and lack a streamlined analytical process. Here we present a comprehensive pathway-level survival analysis suite, DRPPM-PATH-SURVEIOR, which includes a Shiny user interface with extensive features for systematic exploration of pathways and covariates in a Cox proportional-hazard model. Moreover, our framework offers an integrative strategy for performing Hazard Ratio ranked Gene Set Enrichment Analysis (GSEA) and pathway clustering. As an example, we applied our tool in a combined cohort of melanoma patients treated with checkpoint inhibition (ICI) and identified several immune populations and biomarkers predictive of ICI efficacy. We also analyzed gene expression data of pediatric acute myeloid leukemia (AML) and performed an inverse association of drug targets with the patient's clinical endpoint. Our analysis derived several drug targets in high-risk KMT2A-fusion-positive patients, which were then validated in AML cell lines in the Genomics of Drug Sensitivity database. Altogether, the tool offers a comprehensive suite for pathway-level survival analysis and a user interface for exploring drug targets, molecular features, and immune populations at different resolutions.
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Affiliation(s)
| | - Darwin Chang
- H. Lee Moffitt Cancer Center and Research Institute
| | | | | | - Aik-Choon Tan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Xuefeng Wang
- H. Lee Moffitt Cancer Center and Research Institute
| | | | | | | | | | | | | | - Timothy Shaw
- H. Lee Moffitt Cancer Center and Research Institute
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13
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Awasthi S, Grass GD, Torres-Roca J, Johnstone PAS, Pow-Sang J, Dhillon J, Park J, Rounbehler RJ, Davicioni E, Hakansson A, Liu Y, Fink AK, DeRenzis A, Creed JH, Poch M, Li R, Manley B, Fernandez D, Naghavi A, Gage K, Lu-Yao G, Katsoulakis E, Burri RJ, Leone A, Ercole CE, Palmer JD, Vapiwala N, Deville C, Rebbeck TR, Dicker AP, Kelly W, Yamoah K. Genomic Testing in Localized Prostate Cancer Can Identify Subsets of African Americans With Aggressive Disease. J Natl Cancer Inst 2022; 114:1656-1664. [PMID: 36053178 PMCID: PMC9745424 DOI: 10.1093/jnci/djac162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Personalized genomic classifiers have transformed the management of prostate cancer (PCa) by identifying the most aggressive subsets of PCa. Nevertheless, the performance of genomic classifiers to risk classify African American men is thus far lacking in a prospective setting. METHODS This is a prospective study of the Decipher genomic classifier for National Comprehensive Cancer Network low- and intermediate-risk PCa. Study-eligible non-African American men were matched to African American men. Diagnostic biopsy specimens were processed to estimate Decipher scores. Samples accrued in NCT02723734, a prospective study, were interrogated to determine the genomic risk of reclassification (GrR) between conventional clinical risk classifiers and the Decipher score. RESULTS The final analysis included a clinically balanced cohort of 226 patients with complete genomic information (113 African American men and 113 non-African American men). A higher proportion of African American men with National Comprehensive Cancer Network-classified low-risk (18.2%) and favorable intermediate-risk (37.8%) PCa had a higher Decipher score than non-African American men. Self-identified African American men were twice more likely than non-African American men to experience GrR (relative risk [RR] = 2.23, 95% confidence interval [CI] = 1.02 to 4.90; P = .04). In an ancestry-determined race model, we consistently validated a higher risk of reclassification in African American men (RR = 5.26, 95% CI = 1.66 to 16.63; P = .004). Race-stratified analysis of GrR vs non-GrR tumors also revealed molecular differences in these tumor subtypes. CONCLUSIONS Integration of genomic classifiers with clinically based risk classification can help identify the subset of African American men with localized PCa who harbor high genomic risk of early metastatic disease. It is vital to identify and appropriately risk stratify the subset of African American men with aggressive disease who may benefit from more targeted interventions.
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Affiliation(s)
| | - G Daniel Grass
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jasreman Dhillon
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jong Park
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | | | - Yang Liu
- Veracyte Inc, South San Francisco, CA, USA
| | - Angelina K Fink
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Amanda DeRenzis
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jordan H Creed
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael Poch
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Roger Li
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Brandon Manley
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel Fernandez
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Arash Naghavi
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kenneth Gage
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Grace Lu-Yao
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | - Joshua D Palmer
- The James Cancer Hospital at Ohio State University, Columbus, OH, USA
| | - Neha Vapiwala
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Adam P Dicker
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - William Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kosj Yamoah
- Correspondence: Kosj Yamoah, MD, PhD, Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr, Tampa, FL 33612, USA (e-mail: )
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14
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Patel A, Naghavi AO, Johnstone PA, Spiess PE, Grass GD. Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer. Asian J Urol 2022; 9:389-406. [PMID: 36381600 PMCID: PMC9643293 DOI: 10.1016/j.ajur.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Penile cancer is a rare malignancy in most developed countries, but may represent a significant oncologic challenge in certain African, Asian, and South American regions. Various treatment approaches have been described in penile cancer, including radiotherapy. This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities. In addition, we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making. Methods Peer-reviewed manuscripts related to the treatment of penile cancer with radiotherapy were evaluated by a PubMed search (1960–2021) in order to assess its role in the definitive and adjuvant settings. Selected manuscripts were also evaluated for descriptions of radiation-related toxicity. Results Though surgical resection of the primary is an excellent option for tumor control, select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy. Data from randomized controlled trials comparing radiotherapy and surgery are lacking, and thus management is frequently determined by institutional practice patterns and available expertise. Similarly, this lack of clinical trial data leads to divergence in opinion regarding lymph node management. This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques. Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy. Intrinsic differences in tumor biology, based on human papillomavirus infection, may help aid future prognostic and predictive models in patient risk stratification or treatment approach. Conclusion Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions. As a result, the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions. More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.
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15
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Daniel Grass G, Alfonso JCL, Welsh E, Ahmed KA, Teer JK, Pilon-Thomas S, Harrison LB, Cleveland JL, Mulé JJ, Eschrich SA, Enderling H, Torres-Roca JF. The Radiosensitivity Index (RSI) Gene Signature Identifies Distinct Tumor Immune Microenvironment Characteristics Associated with Susceptibility to Radiotherapy. Int J Radiat Oncol Biol Phys 2022; 113:635-647. [PMID: 35289298 DOI: 10.1016/j.ijrobp.2022.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/09/2022]
Abstract
PURPOSE Radiotherapy (RT) is a mainstay of cancer care and accumulating evidence suggests the potential for synergism with components of the immune response. However, little data describes the tumor immune contexture in relation to RT-sensitivity. To address this challenge, we employed the radiation sensitivity index (RSI) gene signature to estimate the RT-sensitivity of >10,000 primary tumors and characterized their immune microenvironments in relation to the RSI. MATERIAL AND METHODS We analyzed gene expression profiles of 10,469 primary tumors (31 types) within a prospective tissue collection protocol. The RT-sensitivity of each tumor was estimated by the RSI and respective distributions were characterized. The tumor biology measured by the RSI was evaluated by differentially expressed genes (DEGs) combined with single sample gene set enrichment analysis (ssGSEA). Differences in the expression of immune regulatory molecules were assessed and deconvolution algorithms were used to estimate immune cell infiltrates in relation to the RSI. A subset (n=2,368) of tumors underwent DNA sequencing for mutational frequency characterization. RESULTS We identified a wide range of RSI values within and across various tumor types, with several demonstrating non-unimodal distributions (e.g. colon, renal, lung, prostate, esophagus, pancreas and PAM50 breast subtypes; p <0.05). Across all tumors types, stratifying RSI at a tumor type-specific median, identified 7,148 DEGs, of which 146 were coordinate in direction. Network topology analysis demonstrates RSI measures a coordinated STAT1, IRF1, and CCL4/MIP-1β transcriptional network. Tumors with an estimated high sensitivity to RT demonstrated distinct enrichment of interferon-associated signaling pathways and immune cell infiltrates (e.g. CD8+ T cells, activated natural killer cells, M1-macrophages; q < 0.05), which was in the context of diverse expression patterns of various immunoregulatory molecules. CONCLUSION This analysis describes the immune microenvironments of patient tumors in relation to the RSI gene expression signature.
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Affiliation(s)
- G Daniel Grass
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Juan C L Alfonso
- Departments of Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research
| | - Eric Welsh
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Kamran A Ahmed
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Jamie K Teer
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Shari Pilon-Thomas
- Departments of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Louis B Harrison
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - John L Cleveland
- Departments of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - James J Mulé
- Departments of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Steven A Eschrich
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Heiko Enderling
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA; Departments of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA.
| | - Javier F Torres-Roca
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA.
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16
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Kutuk T, Grass GD, Oliver D, Mokhtari S, Sahebjam S, Kim S, Penagaricano J, Yu HHM, Tran N, Etame A, Peterson JL, Forsyth P, Robinson T. Revisiting the concept of recurrence of primary CNS lymphomas after complete response to methotrexate-based therapy: Periventricular reseeding as the predominant mechanism of recurrence. Adv Radiat Oncol 2022; 7:100940. [PMID: 35814853 PMCID: PMC9260129 DOI: 10.1016/j.adro.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/28/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Understanding patterns of relapse for primary central nervous system lymphoma (PCNSL) may inform mechanisms of recurrence and optimal consolidation strategies. In this study, we report patterns of relapse among patients with PCNSL who achieved a complete response to high-dose methotrexate (HD-MTX)-based chemotherapy with or without consolidation radiation therapy (RT). Methods and Materials We conducted an institutional retrospective analysis of patients with PCNSL who received HD-MTX-based chemotherapy between November 2001 and May 2019. Relapses were characterized as in-field (within original T1 contrasted lesion), marginal (within T2 fluid-attenuated inversion recovery but not T1), local (in-field or marginal), distant brain (no overlap), or distant (distant brain, cerebrospinal fluid, vitreous or extra-axial) and further characterized with respect to periventricular location (≤10 mm of ventricles). Results Seventy-eight patients with PCNSL met inclusion criteria, of whom 29 (37%) underwent consolidation RT. Median progression-free survival and overall survival were 57.0 and 66.7 months, respectively. After a median follow-up of 38.9 months, a total of 32 patients (41%) experienced recurrence. Most patients (21 [65.6%]) had a periventricular failure. Surprisingly, local recurrences (n = 11) were exclusively observed within periventricular lesions, whereas distant recurrences (n = 21) were seen in both periventricular and nonperiventricular locations (P = .009). The median time to progression was shorter for locally recurrent lesions compared with distant recurrences (13.8 vs 26.1 months; P = .03). Conclusions After complete response to HD-MTX, few failures occurred within initial T1 contrast-enhancing lesions and many of these may have been alternatively classified as periventricular failures. These observations argue against the use of purely focal RT consolidation for patients who achieve a complete response after HD-MTX-based chemotherapy and suggest that periventricular reseeding may have a central role in PCNSL recurrence.
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Gupta S, Grass GD, Maughan BL, Jain RK, Dechet CB, Sanchez A, O Neil B, Poch MA, Li R, Lloyd S, Tward JD, Phunrab TK, Hawks J, Swami U, Boucher KM, Agarwal N. NEXT: A single-arm, phase 2, open-label study of adjuvant nivolumab after completion of chemo-radiation therapy in patients with localized muscle-invasive bladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
506 Background: Nivolumab has known efficacy as adjuvant therapy after radical cystectomy in localized muscle invasive bladder cancer (MIBC). We are evaluating the efficacy of nivolumab adjuvant to definitive chemo-radiation therapy (CRT) in MIBC. Methods: In the NEXT study, we are currently enrolling patients with localized MIBC undergoing standard CRT. Participants are started on nivolumab 480 mg IV every 4 weeks (up to 12 doses) within 90 days of completion of CRT. Cystoscopic and scan-based assessments are done every 3 months for the first two years (yrs). The primary endpoint is failure-free survival (FFS) at 2 yrs from the start of CRT, with failure defined as local or systemic disease recurrence. Secondary endpoints include toxicity and quality of life (QOL) assessments. We have planned correlative studies on peripheral blood and tumor tissue. We performed a protocol-defined interim safety and efficacy analysis to assess the 6-month FFS rate with CRT and adjuvant nivolumab. Results: From 8/03/2017 to 9/28/2021, 20 patients were enrolled at two centers; median age is 76 yrs, clinical stage range is T2-T4b, N0-N+, M0; the median number of nivolumab cycles is 6.5, and the median follow-up is 8.9 months. The estimated 6-month FFS rate is 88.2% (95% CI 74.2% - 100%). Disease has progressed in 9 patients, of which 4 have local bladder recurrence (T1 in 3/4) and 5 have distant metastases. The estimated median FFS is 17.1 months (95% CI 8.71 months - infinity). Grade ≥3 treatment-related adverse events (AEs) are noted in 3/20 patients (15%): elevated transaminases, diarrhea, and polymyalgia rheumatica. Grade 3 radiation therapy oncology group (RTOG) AEs occurred in 2 patients. QOL measures are serially evaluable in 13 patients for the first 3 months of adjuvant nivolumab, and are stable in the domains of disease-related physical symptoms, treatment side effects, and function/well-being, while are significantly improved (p=0.023) in the domain of disease-related emotional symptoms. Conclusions: In this first report of the role of immunotherapy adjuvant to CRT for localized bladder cancer, adjuvant nivolumab is well tolerated and has promising efficacy. Clinical trial information: NCT03171025.
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Affiliation(s)
- Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | | | | | - Brock O Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Roger Li
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - Shane Lloyd
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Josiah Hawks
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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18
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Johnstone PAS, Spiess PE, Sedor G, Grass GD, Yamoah K, Scott JG, Torres-Roca JF. Changing Radiotherapy Paradigms in Penile Cancer. EUR UROL SUPPL 2022; 36:47-48. [PMID: 35028598 PMCID: PMC8739469 DOI: 10.1016/j.euros.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/15/2022] Open
Abstract
Radiation therapy (RT) has not been prominent in the treatment of penile cancer because of poorly reproducible results when used in the adjuvant setting. A genomic signature has recently been described that assays radiosensitivity of tumors and informs radiotherapy doses in these cases. Clinical validation in more than 1600 patients demonstrated associations with both overall survival and time to first recurrence. In addition, the signature predicted and quantified the therapeutic benefit of RT for each individual patient. Since penile cancer patients were not part of this analysis, we applied the model to patients with primary and nodal penile cancer tissue and clinical outcomes. Patient summary: Radiotherapy has not been widely used for treatment of penile cancer. New genetic data suggest that radiation doses commonly used to treat penile cancer are too low. This would explain prior poor results using radiation in this disease.
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Affiliation(s)
| | | | | | - G Daniel Grass
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kosj Yamoah
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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19
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Alfonso JCL, Grass GD, Welsh E, Ahmed KA, Teer JK, Pilon-Thomas S, Harrison LB, Cleveland JL, Mulé JJ, Eschrich SA, Torres-Roca JF, Enderling H. Tumor-immune ecosystem dynamics define an individual Radiation Immune Score to predict pan-cancer radiocurability. Neoplasia 2021; 23:1110-1122. [PMID: 34619428 PMCID: PMC8502777 DOI: 10.1016/j.neo.2021.09.003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023] Open
Abstract
Radiotherapy efficacy is the result of radiation-mediated cytotoxicity coupled with stimulation of antitumor immune responses. We develop an in silico 3-dimensional agent-based model of diverse tumor-immune ecosystems (TIES) represented as anti- or pro-tumor immune phenotypes. We validate the model in 10,469 patients across 31 tumor types by demonstrating that clinically detected tumors have pro-tumor TIES. We then quantify the likelihood radiation induces antitumor TIES shifts toward immune-mediated tumor elimination by developing the individual Radiation Immune Score (iRIS). We show iRIS distribution across 31 tumor types is consistent with the clinical effectiveness of radiotherapy, and in combination with a molecular radiosensitivity index (RSI) combines to predict pan-cancer radiocurability. We show that iRIS correlates with local control and survival in a separate cohort of 59 lung cancer patients treated with radiation. In combination, iRIS and RSI predict radiation-induced TIES shifts in individual patients and identify candidates for radiation de-escalation and treatment escalation. This is the first clinically and biologically validated computational model to simulate and predict pan-cancer response and outcomes via the perturbation of the TIES by radiotherapy.
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Affiliation(s)
- Juan C L Alfonso
- Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eric Welsh
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jamie K Teer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shari Pilon-Thomas
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John L Cleveland
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - James J Mulé
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Steven A Eschrich
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Javier F Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Heiko Enderling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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20
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A. S. Johnstone P, de Vries HM, Chipollini J, Daniel Grass G, Boyd F, Korkes F, Albersen M, Roussel E, Zhu Y, Ye DW, Master V, Le TL, Muneer A, Brouwer OR, Spiess PE. Impact of radiation therapy on perineal urethrostomy for penile cancer. Clin Transl Radiat Oncol 2021; 30:84-87. [PMID: 34430718 PMCID: PMC8367760 DOI: 10.1016/j.ctro.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE A lack of demonstrated clinical benefit precludes radiotherapy (RT) from being recommended for pN1/pN2 penile cancer (PeCa) lesions; but it may be recommended in case of extranodal (pN3) disease or for positive resection margins. Perineal urethrostomy (PU) is a technique of urinary diversion in patients with PeCa requiring total or subtotal penectomy as primary therapy. Prior studies suggest PU failure rates of up to 30%, without specific mention of the potential role of RT. When RT is delivered for PeCa it is usually to the pre-pubic fat, groin and lateral pelvis, and not to the region of the PU. Here we describe the role of perioperative RT in a large, multi-institutional registry of PU for PeCa. METHODS In our cohort, 299 patients from seven international, high-volume centers in Belgium, Brazil, China, Netherlands, United Kingdom and the United States underwent PU as urinary diversion for PeCa between 2000 and 2020. Demographic and clinicopathologic characteristics were reviewed. RESULTS Median patient age was 67 years and median follow-up was 19 months. Seven patients (2.3%) received pre-operative RT; six of them with chemotherapy. 37 received RT post-operatively, 21 (57%) with chemotherapy. Stenosis of the PU occurred in 35 (12%) of the total population. The majority of these patients (74%) required surgical revision at a median of 6.1 months post-operatively. RT delivery was neither significantly related to PU stenosis (p = 0.16) or to subsequent revision (p = 0.75). CONCLUSION Receipt of RT was not significantly associated with increased stenosis risk in PeCa patients who underwent PU.
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Affiliation(s)
| | - Hielke M. de Vries
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Juan Chipollini
- Department of Urology, University of Arizona, Tucson, AZ, United Kingdom
| | - G. Daniel Grass
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United Kingdom
| | - Franklin Boyd
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United Kingdom
| | - Fernando Korkes
- Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Viraj Master
- Department of Urology, Emory University, Atlanta, GA, United Kingdom
| | - Thien-Linh Le
- Department of Urology, Emory University, Atlanta, GA, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Oscar R. Brouwer
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United Kingdom
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21
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Sandoval ML, Youssef I, Latifi K, Grass GD, Torres-Roca J, Rosenberg S, Yamoah K, Johnstone PA. Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results. J Clin Med 2021; 10:3396. [PMID: 34362179 PMCID: PMC8347281 DOI: 10.3390/jcm10153396] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for smaller margins and adaptive daily planning. Currently, the only publications of MRgRT for prostate SBRT describe European clinical experiences which utilized adaptive planning. However, adaptive planning adds significantly to the time required for daily treatment. OBJECTIVES Since prostate SBRT has demonstrated acceptable toxicity for several years, we did not consider daily adaptation critical to the process of prostate SBRT. After Institutional Review Board approval, we analyzed and now report our experience using MRgRT without adaptation. METHODS Between 25 September 2019 and 21 December 2020, 35 consecutive patients were treated with MRgRT prostate SBRT at our center. Patients treated with MRgRT included favorable intermediate risk (43%) and unfavorable intermediate risk (54%), and only one patient had low-risk prostate cancer. Nine patients (25%) received adjuvant leuprolide for a median of 4.5 months (range 4-6 m). Our clinical pathway allows for a maximum prostate gland volume of 60 cc; median prostate volume of this cohort was 35.0 cc (range 17-58.4 cc). Median pre-treatment PSA was 6.30 (range 2.55-16.77). Each patient was treated with 36.25 Gy delivered in five fractions over 2 weeks with urethral sparing to a maximal dose of 35 Gy. Target volumes included the prostate gland and proximal seminal vesicles with a 3 mm margin. RESULTS Median follow-up as of 26 May 2021 was 11.97 months (range 4.37-19.80). First follow-up data are available for all patients, with a median of 1.10 month from completion of treatment (0.63-3.40). The median PSA at first visit was 2.75 (range 0.02-9.00) with a median AUA symptom score of 9 (range 1-24). Second follow-up data are available for 34 patients at a median of 4.45 months (range 2.57-8.90). At second follow-up, the median PSA was 1.60 (range 0.02-5.40) with a median AUA symptom score of 6 (range 1-33). Seventeen patients had third follow-up data with a median of 9.77 months (range 4.70-12.33) after SBRT. The median PSA was 1.13 (range 0.02-4.73) with an AUA score of 9 (2-22) at the third follow-up. We observed a statistically significant decrease in PSA between pre-treatment and at first follow-up (p < 0.005). The most common toxicity was grade 2 urethritis, managed in all cases by tamsulosin. One patient developed grade 2 tenesmus relieved by topical steroids. No cases of grade ≥ 3 toxicity were seen in our patient population. CONCLUSIONS By avoiding the extra time required for plan adaptation, MRgRT without daily adaptation allows for successful prostate SBRT with manageable toxicity. We continue to reserve our limited adaptive treatment slots for preoperative pancreatic and ultra-central lung SBRT patients, which require time-intensive respiratory gating and adaptive planning.
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Affiliation(s)
- Maria L. Sandoval
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - Irini Youssef
- Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - G. Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - Javier Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - Stephen Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
| | - Peter A. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.L.S.); (K.L.); (G.D.G.); (J.T.-R.); (S.R.); (K.Y.)
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22
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Grass GD, Scott JG, Sedor G, Kattan MW, Torres-Roca JF. Response to: Noncancer Cells in Tumor Samples May Bias the Predictive Genomically Adjusted Radiation Dose. J Thorac Oncol 2021; 16:e48-e49. [PMID: 34034894 DOI: 10.1016/j.jtho.2021.03.020] [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] [Received: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- G Daniel Grass
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jacob G Scott
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Geoffrey Sedor
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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23
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Li R, Berglund A, Zemp L, Dhillon J, Putney R, Kim Y, Jain RK, Grass GD, Conejo-Garcia J, Mulé JJ. The 12-CK Score: Global Measurement of Tertiary Lymphoid Structures. Front Immunol 2021; 12:694079. [PMID: 34267760 PMCID: PMC8276102 DOI: 10.3389/fimmu.2021.694079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
There is emerging evidence that the adaptive anti-tumor activity may be orchestrated by secondary lymphoid organ-like aggregates residing in the tumor microenvironment. Known as tertiary lymphoid structures, these lymphoid aggregates serve as key outposts for lymphocyte recruitment, priming and activation. They have been linked to favorable outcomes in many tumor types, and more recently, have been shown to be effective predictors of response to immune checkpoint blockade. We have previously described a 12-chemokine (12-CK) transcriptional score which recapitulates an overwhelming enrichment for immune-related and inflammation-related genes in colorectal carcinoma. Subsequently, the 12-CK score was found to prognosticate favorable survival in multiple tumors types including melanoma, breast cancer, and bladder cancer. In the current study, we summarize the discovery and validation of the 12-CK score in various tumor types, its relationship to TLSs found within the tumor microenvironment, and explore its potential role as both a prognostic and predictive marker in the treatment of various cancers.
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Affiliation(s)
- Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States.,Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Ryan Putney
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - José Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - James J Mulé
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
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24
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Yamoah K, Dhillon J, Johnstone PA, Pow-Sang JM, Davicioni E, Fink A, DeRenzis AC, Grass GD, Li R, Manley BJ, Gage KL, Katsoulakis E, Burri RJ, Leone A, Ercole CE, Palmer JD, Vapiwala N, Deville C, Rebbeck T, Dicker AP. A prospective validation of the genomic classifier to define high-metastasis risk in a subset of African American men with early localized prostate cancer: VanDAAM study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5005 Background: Risk stratification of prostate cancer (PC) using routine clinical variables remains suboptimal as they do not account for underlying tumor biology. The genomic classifier provides information on underlying biology and independently predicts an individual patient’s risk of metastasis. Although the performance of the genomic classifier has been tested across different cohorts primarily comprised of White men, its validation as an optimal genomic risk classifier for African American men (AAM) is thus far lacking in a prospective trial. We report the initial results on the prospective validation of the genomic classifier in a matched cohort of AAM and non-AAM (NAAM). Methods: This was a multisite, prospective validation trial of the genomic classifier i.e. Decipher score in AAM. Participants were recruited on a 1:1 enrollment ratio of AAM to NAAM diagnosed with low-intermediate risk PC. Patient on active surveillance were ineligible. NAAM were matched to AAM on PSA, age, biopsy Gleason score, clinical stage, and percent positive biopsy cores. Diagnostic biopsy specimens were processed at a CLIA certified laboratory and Decipher score was assessed using whole transcriptome profiling platform. Total target accrual was 250 men treated for low-intermediate PC over three years. Statistical analyses include categorical comparison of race dependent risk group migration between NCCN risk group and genomic classifier. Relative risk of metastasis was estimated using negative binomial model. Results: Final analytical cohort included 207 evaluable cases (AAM = 102 and NAAM = 107) with comprehensive genomic information. Risk of metastasis was determined based on pretreatment biopsy Decipher score, and patients were classified as low, favorable-, and unfavorable intermediate risk. Despite achieving a robustly matched clinical cohort, we observed significant genomic heterogeneity between AAM and NAAM across NCCN risk groups. In a comparative analysis, 49% of low-favorable intermediate risk AAM harbored high genomic risk tumors as compared to only 10% NAAM, p = 0.02. Similarly, using the modified clinico-genomic risk classifier (cGC), comprised of both Decipher score and clinical variables, AAM experienced an extreme deviation of risk status (difference [δ] between cGC and NCCN ≥ 2) as compared to NAAM (26.8% vs 8.1%, p = 0.03). In a binomial model, low-favorable NCCN risk AAM were 3.9 times more likely to be reclassified as high genomic risk for distant metastasis compared to NAAM (RR = 3.99, 95% CI, 1.15 – 13.86, p = 0.02). Conclusions: Clinical NCCN risk classification is an inadequate surrogate of tumor biology and offers suboptimal risk stratification for AAM with PC. Integration of patient specific genomic classifier into standard of care will improve accuracy in disease risk classification and treatment recommendations for AAM. Clinical trial information: NCT02723734.
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Affiliation(s)
- Kosj Yamoah
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | | | | | | | | | - Roger Li
- Moffitt Cancer Center, Tampa, FL
| | | | | | | | - Ryan J Burri
- Bay Pines Veterans Affairs Healthcare System, Bay Pines, FL
| | - Andrew Leone
- Bay Pines Veterans Affairs Healthcare System, Tampa, FL
| | | | - Joshua David Palmer
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Adam P. Dicker
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Parikh N, Keshishian E, Manley B, Grass GD, Torres-Roca J, Boulware D, Feuerlein S, Pow-Sang JM, Bagla S, Yamoah K, Bhatia S. Effectiveness and Safety of Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms from Benign Prostatic Hyperplasia in Men with Concurrent Localized Prostate Cancer. J Vasc Interv Radiol 2021; 32:1053-1061. [PMID: 33794373 DOI: 10.1016/j.jvir.2021.03.534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess the effectiveness and safety of prostatic artery embolization (PAE) on lower urinary tract symptoms (LUTS) in the setting of localized prostate cancer (PCa). MATERIALS AND METHODS This was a retrospective, single-center, institutional review board-approved study from December 2016 to June 2020 of 21 patients (median age, 72; range, 63-83 years) with moderate LUTS and localized PCa. Clinical effectiveness was evaluated at 6 and 12 weeks using International Prostate Symptom Score (IPSS) and quality of life (QoL) improvement. Seventeen patients were scheduled to receive definitive radiotherapy (RT) after PAE; 13 patients completed RT. Short-term imaging signs of oncologic progression were evaluated at 6 and 12 weeks defined by at least one of the following on magnetic resonance imaging: increased Prostate Imaging-Reporting and Data System score of index lesion(s) to at least 4, new extracapsular extension, seminal vesicle involvement, or pelvic lymphadenopathy. Nonparametric Wilcoxon signed-rank test was used for analysis. RESULTS IPSS improved by a median of 12 (n = 19, P < .0001) and 14 (n = 14, P < .0001) at 6 and 12 weeks, respectively. QoL improved by a median of 2 (n = 19, P < .0001) and 3 (n = 3, P < .0001) at 6 and 12 weeks. Prostate volume decreased by a median of 24% (n = 19, P < .0001) and 36% (n = 12, P = .015) at 6 and 12 weeks. No patients demonstrated disease progression at 6 (n = 16) or 12 (n = 8) weeks by imaging. No patients experienced increased prostate-specific antigen after RT, grade ≥3 adverse events, or greater genitourinary toxicity. CONCLUSIONS PAE is effective and safe for the treatment of men with LUTS from benign prostatic hyperplasia in the setting of concomitant, localized, non-obstructive PCa.
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Affiliation(s)
- Nainesh Parikh
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
| | - Edward Keshishian
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Brandon Manley
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Javier Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David Boulware
- Department of Biostatistics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sebastian Feuerlein
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, Florida
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Scott JG, Sedor G, Scarborough JA, Kattan MW, Peacock J, Grass GD, Mellon EA, Thapa R, Schell M, Waller A, Poppen S, Andl G, Teer J, Eschrich SA, Dilling TJ, Dalton WS, Harrison LB, Fox T, Torres-Roca JF. Personalizing Radiotherapy Prescription Dose Using Genomic Markers of Radiosensitivity and Normal Tissue Toxicity in NSCLC. J Thorac Oncol 2021; 16:428-438. [PMID: 33301984 PMCID: PMC8549863 DOI: 10.1016/j.jtho.2020.11.008] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cancer sequencing efforts have revealed that cancer is the most complex and heterogeneous disease that affects humans. However, radiation therapy (RT), one of the most common cancer treatments, is prescribed on the basis of an empirical one-size-fits-all approach. We propose that the field of radiation oncology is operating under an outdated null hypothesis: that all patients are biologically similar and should uniformly respond to the same dose of radiation. METHODS We have previously developed the genomic-adjusted radiation dose, a method that accounts for biological heterogeneity and can be used to predict optimal RT dose for an individual patient. In this article, we use genomic-adjusted radiation dose to characterize the biological imprecision of one-size-fits-all RT dosing schemes that result in both over- and under-dosing for most patients treated with RT. To elucidate this inefficiency, and therefore the opportunity for improvement using a personalized dosing scheme, we develop a patient-specific competing hazards style mathematical model combining the canonical equations for tumor control probability and normal tissue complication probability. This model simultaneously optimizes tumor control and toxicity by personalizing RT dose using patient-specific genomics. RESULTS Using data from two prospectively collected cohorts of patients with NSCLC, we validate the competing hazards model by revealing that it predicts the results of RTOG 0617. We report how the failure of RTOG 0617 can be explained by the biological imprecision of empirical uniform dose escalation which results in 80% of patients being overexposed to normal tissue toxicity without potential tumor control benefit. CONCLUSIONS Our data reveal a tapestry of radiosensitivity heterogeneity, provide a biological framework that explains the failure of empirical RT dose escalation, and quantify the opportunity to improve clinical outcomes in lung cancer by incorporating genomics into RT.
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Affiliation(s)
- Jacob G. Scott
- Departments of Translational Hematology and Oncology Research and Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University School Of Medicine, Cleveland, OH
| | - Geoff Sedor
- Case Western Reserve University School Of Medicine, Cleveland, OH
| | - Jessica A. Scarborough
- Departments of Translational Hematology and Oncology Research and Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University School Of Medicine, Cleveland, OH
| | - Michael W. Kattan
- Department of Quantiative Health Sciences, Lerner Research Institiute, Cleveland Clinic, Cleveland, OH
| | - Jeffrey Peacock
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - G. Daniel Grass
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Eric A. Mellon
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - Ram Thapa
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Michael Schell
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | | | | | | | - Jamie Teer
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | | | | | - William S. Dalton
- DeBartolo Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | | | - Tim Fox
- Varian Medical Systems, Palo Alto, CA
| | - Javier F. Torres-Roca
- Department of Quantiative Health Sciences, Lerner Research Institiute, Cleveland Clinic, Cleveland, OH
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Bandini M, Ross JS, Zhu Y, Ye DW, Ornellas AA, Watkin N, Ayres BA, Hakenberg OW, Heidenreich A, Salvioni R, Catanzaro M, Raggi D, Giannatempo P, Marandino L, Haidl F, Pederzoli F, Briganti A, Montorsi F, Chipollini J, Azizi M, De Meerleer G, Brouwer OR, Grass GD, Johnstone PA, Albersen M, Spiess PE, Necchi A. Association Between Human Papillomavirus Infection and Outcome of Perioperative Nodal Radiotherapy for Penile Carcinoma. Eur Urol Oncol 2020; 4:802-810. [PMID: 33199252 DOI: 10.1016/j.euo.2020.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Data on the impact of human papillomavirus (HPV) infection status and outcomes for perioperative treatments for patients with lymph node-involved penile squamous-cell carcinoma (PSCC) are lacking. OBJECTIVE To analyze the benefit from perioperative radiotherapy (RT) for PSCC according to HPV infection status. DESIGN, SETTING, AND PARTICIPANTS In an international multicenter database of 1254 patients with PSCC who received inguinal lymph node dissection (ILND), 507 had suitable clinical information. INTERVENTION ILND, with or without chemotherapy or RT for involved lymph nodes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier and restricted mean survival time (RMST) analyses for overall survival (OS) were performed for all patients and after propensity score-matching (PSM; n = 136), for which patient age, histology, type of penile surgical procedure, pathological tumor and nodal stage, ILND laterality, pelvic LND, and perioperative treatment were taken into account when assessing differences between HPV+ and HPV- patients. Finally, we looked at genomic alterations in PSCC using data from the Foundation Medicine database (n = 199) to characterize HPV+ PSCC. RESULTS AND LIMITATIONS Patients with HPV+ PSCC (n = 86; 17%) had lower clinical N stage (p < 0.001) and inguinal lymph node metastasis density (p < 0.001). Perioperative RT was delivered in 49 patients (9.7%), with the vast majority receiving adjuvant RT (n = 40). HPV+ patients had similar median OS (p = 0.1) but longer RMST than HPV- patients at different time points. Nevertheless, HPV+ patients treated with perioperative RT exhibited longer median OS (p = 0.015) and longer RMST compared to HPV- patients. In the PSM cohorts, HPV+ status remained significantly associated with longer OS after RT. The HPV- PSCC group had a higher frequency of TP53 mutations compared to HPV+ PSCC (75% vs 15%; p < 0.001). The results are limited by the retrospective nature of the data. CONCLUSIONS Perioperative RT was more effective in the HPV+ PSCC subgroup. Reasons for the enhanced radiosensitivity may be related to the lack of TP53 mutations. PATIENT SUMMARY We analyzed data from a large multicenter database for patients with penile cancer who had received inguinal lymph node dissection, with or without chemotherapy or radiotherapy. We found that for tumors positive for human papillomavirus (HPV), use of radiotherapy resulted in prolonged survival compared to HPV-negative tumors. On the basis of these results we are inspired to design studies on the use of radiotherapy in HPV-selected patients.
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Affiliation(s)
- Marco Bandini
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, USA; Upstate Medical University, Syracuse, NY, USA
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Nick Watkin
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Benjamin A Ayres
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Filippo Pederzoli
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Juan Chipollini
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mounsif Azizi
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Oscar R Brouwer
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - G Daniel Grass
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | - Andrea Necchi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Yuan Z, Fernandez D, Dhillon J, Abraham-Miranda J, Awasthi S, Kim Y, Zhang J, Jain R, Serna A, Pow-Sang JM, Poch M, Li R, Manley B, Fink A, Naghavi A, Torres-Roca JF, Grass GD, Kim S, Latifi K, Hunt D, Johnstone PAS, Yamoah K. Proof-of-principle Phase I results of combining nivolumab with brachytherapy and external beam radiation therapy for Grade Group 5 prostate cancer: safety, feasibility, and exploratory analysis. Prostate Cancer Prostatic Dis 2020; 24:140-149. [PMID: 32651467 DOI: 10.1038/s41391-020-0254-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND To determine whether combining brachytherapy with immunotherapy is safe in prostate cancer (PCa) and provides synergistic effects, we performed a Phase I/II trial on the feasibility, safety, and benefit of concurrent delivery of anti-PD-1 (nivolumab) with high-dose-rate (HDR) brachytherapy and androgen deprivation therapy (ADT) in patients with Grade Group 5 (GG5) PCa. METHODS Eligible patients were aged 18 years or older with diagnosis of GG5 PCa. Patients received ADT, nivolumab every two weeks for four cycles, with two cycles prior to first HDR, and two more cycles prior to second HDR, followed by external beam radiotherapy. The primary endpoint was to determine safety and feasibility. This Phase I/II trial is registered with ClinicalTrials.gov (NCT03543189). RESULTS Between September 2018 and June 2019, six patients were enrolled for the Phase I safety lead-in with a minimum observation period of 3 months after nivolumab administration. Overall, nivolumab was well tolerated in combination with ADT and HDR treatment. One patient experienced a grade 3 dose-limiting toxicity (elevated Alanine aminotransferase and Aspartate aminotransferase) after the second cycle of nivolumab. Three patients (50%) demonstrated early response with no residual tumor detected in ≥4 of 6 cores on biopsy post-nivolumab (4 cycles) and 1-month post-HDR. Increase in CD8+ and FOXP3+/CD4+ T cells in tissues, and CD4+ effector T cells in peripheral blood were observed in early responders. CONCLUSION Combination of nivolumab with ADT and HDR is well tolerated and associated with evidence of increased immune infiltration and antitumor activity.
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Affiliation(s)
- Zhigang Yuan
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Daniel Fernandez
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Jasreman Dhillon
- Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Julieta Abraham-Miranda
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Shivanshu Awasthi
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Youngchul Kim
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Jingsong Zhang
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Rohit Jain
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Amparo Serna
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Julio M Pow-Sang
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Michael Poch
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Roger Li
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Brandon Manley
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Angelina Fink
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Arash Naghavi
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Javier F Torres-Roca
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - G Daniel Grass
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Sungjune Kim
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kujtim Latifi
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Dylan Hunt
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Peter A S Johnstone
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kosj Yamoah
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA. .,Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
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Glazar DJ, Grass GD, Arrington JA, Forsyth PA, Raghunand N, Yu HHM, Sahebjam S, Enderling H. Tumor Volume Dynamics as an Early Biomarker for Patient-Specific Evolution of Resistance and Progression in Recurrent High-Grade Glioma. J Clin Med 2020; 9:E2019. [PMID: 32605050 PMCID: PMC7409184 DOI: 10.3390/jcm9072019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022] Open
Abstract
Recurrent high-grade glioma (HGG) remains incurable with inevitable evolution of resistance and high inter-patient heterogeneity in time to progression (TTP). Here, we evaluate if early tumor volume response dynamics can calibrate a mathematical model to predict patient-specific resistance to develop opportunities for treatment adaptation for patients with a high risk of progression. A total of 95 T1-weighted contrast-enhanced (T1post) MRIs from 14 patients treated in a phase I clinical trial with hypo-fractionated stereotactic radiation (HFSRT; 6 Gy × 5) plus pembrolizumab (100 or 200 mg, every 3 weeks) and bevacizumab (10 mg/kg, every 2 weeks; NCT02313272) were delineated to derive longitudinal tumor volumes. We developed, calibrated, and validated a mathematical model that simulates and forecasts tumor volume dynamics with rate of resistance evolution as the single patient-specific parameter. Model prediction performance is evaluated based on how early progression is predicted and the number of false-negative predictions. The model with one patient-specific parameter describing the rate of evolution of resistance to therapy fits untrained data ( R 2 = 0.70 ). In a leave-one-out study, for the nine patients that had T1post tumor volumes ≥1 cm3, the model was able to predict progression on average two imaging cycles early, with a median of 9.3 (range: 3-39.3) weeks early (median progression-free survival was 27.4 weeks). Our results demonstrate that early tumor volume dynamics measured on T1post MRI has the potential to predict progression following the protocol therapy in select patients with recurrent HGG. Future work will include testing on an independent patient dataset and evaluation of the developed framework on T2/FLAIR-derived data.
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Affiliation(s)
- Daniel J. Glazar
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
| | - G. Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - John A. Arrington
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL 33612, USA
- Department of Radiology, University of South Florida, Tampa, FL 33612, USA
| | - Peter A. Forsyth
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Natarajan Raghunand
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - Solmaz Sahebjam
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
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Mohammadi H, Shiue K, Grass GD, Verma V, Engellandt K, Daubner D, Schackert G, Gondim MJ, Gondim D, Vortmeyer AO, Kamer AP, Jin W, Robinson TJ, Watson G, Yu HHM, Lautenschlaeger T. Isocitrate dehydrogenase 1 mutant glioblastomas demonstrate a decreased rate of pseudoprogression: a multi-institutional experience. Neurooncol Pract 2020; 7:185-195. [PMID: 32626587 PMCID: PMC7318854 DOI: 10.1093/nop/npz050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pseudoprogression (psPD) represents false radiologic evidence of tumor progression and is observed in some glioblastoma (GBM) patients after postoperative chemoradiation (CRT) with temozolomide (TMZ). The ambiguity of the psPD diagnosis confounds identification of true progression and may lead to unnecessary interventions. The association between psPD and isocitrate dehydrogenase 1 (IDH1) mutational (mut) status is understudied, and its incidence may alter clinical decision making. METHODS We retrospectively evaluated 120 patients with IDH1-mut (n = 60) and IDH1-wild-type (IDH-WT; [n = 60]) GBMs who received postoperative CRT with TMZ at 4 academic institutions. Response Assessment in Neuro-Oncology criteria were used to identify psPD rates in routine brain MRIs performed up to 90 days after CRT completion. RESULTS Within 90 days of completing CRT, 9 GBM patients (1 [1.7%] IDH1-mut and 8 [13.3%] IDH1-WTs) demonstrated true progression, whereas 17 patients (3 [5%] IDH1-muts and 14 [23.3%] IDH1-WTs) demonstrated psPD (P = .004). IDH1-mut GBMs had a lower probability of psPD (hazard ratio: 0.173, 95% CI, 0.047-0.638, P = .008). Among the patients with radiologic signs suggestive of progression (n = 26), psPD was found to be the cause in 3 of 4 (75.0%) of the IDH1-mut GBMs and 14 of 22 (63.6%) of the IDH1-WT GBMs (P = .496). Median overall survival for IDH1-mut and IDH1-WT GBM patients was 40.3 and 23.0 months, respectively (P < .001). CONCLUSIONS IDH1-mut GBM patients demonstrate lower absolute rates of psPD expression. Irrespective of GBM subtype, psPD expression was more likely than true progression within 90 days of completing CRT. Continuing adjuvant treatment for IDH1-mut GBMs is suggested if radiologic progression is suspected during this time interval.
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Affiliation(s)
- Homan Mohammadi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kevin Shiue
- Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kay Engellandt
- Department of Neurochirurgie and Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Dirk Daubner
- Department of Neurochirurgie and Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurochirurgie and Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Mercia J Gondim
- Department of Pathology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - Dibson Gondim
- Department of Pathology, Indiana University Simon Cancer Center, Indianapolis, USA
| | | | - Aaron P Kamer
- Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - William Jin
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Timothy J Robinson
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gordon Watson
- Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - Hsiang-Hsuan M Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
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31
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Yuan Z, Grass GD, Azizi M, Ahmed KA, Yoder GSJ, Welsh EA, Fulp WJ, Dhillon J, Torres-Roca JF, Giuliano AR, Spiess PE, Johnstone PA. Intrinsic radiosensitivity, genomic-based radiation dose and patterns of failure of penile cancer in response to adjuvant radiation therapy. Rep Pract Oncol Radiother 2019; 24:593-599. [PMID: 31719799 DOI: 10.1016/j.rpor.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/15/2019] [Accepted: 09/21/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Optimal postoperative radiation therapy (PORT) dose is unclear in penile squamous cell carcinoma (PeSCC). Herein, we characterized the radiosensitivity index (RSI) and genomic-adjusted radiation dose (GARD) profiles in a cohort of patients with PeSCC, and assessed the application of GARD to personalize PORT. Methods A total of 25 PeSCC samples were identified for transcriptomic profiling. The RSI score and GARD were derived for each sample. A cohort of 34 patients was reviewed for clinical correlation. Results The median RSI for PeSCC was 0.482 (range 0.215-0.682). The majority (n = 21; 84%) of cases were classified as radioresistant. PeSCC GARD ranged from 9.56 to 38.39 (median 18.25), suggesting variable therapeutic effects from PORT. We further determined the optimal GARD-based RT doses to improve locoregional control. We found that therapeutic benefit was only achieved in 52% of PeSCC lesions with PORT of 50 Gy, in contrast to 84% benefit from GARD-modeled PORT of 66 Gy. In the clinical cohort, the majority of patients presented with pathological N2 or N3 disease (n = 31; 91%) and was treated with adjuvant concurrent platinum-based chemoradiotherapy (CRT, n = 30; 88%). Fourteen of the 34 patients (41%) had locoregional recurrence (LRR), of which half had LRR within six months of completion of PORT. Conclusions The majority of PeSCC are intrinsically radioresistant with a low GARD-based therapeutic effect from PORT dose of 50 Gy, consistent with the observed high rate of LRR in the clinical cohort. A GARD-based strategy will allow personalizing PORT dose prescription to individual tumor biology and improve outcomes.
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Affiliation(s)
- Zhigang Yuan
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - G Sean J Yoder
- Moffitt Genomics core, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Eric A Welsh
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Jasreman Dhillon
- Department of Anatomic Pathology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Javier F Torres-Roca
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
| | - Peter A Johnstone
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL 33612, USA
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Liveringhouse CL, Grass GD, Figura NB, Mills MN, Purcell JD, Rosensweig SR, Blumencranz PW, Allen KG, Ahmed KA, Harrison LB, Torres-Roca JF, Robinson TJ, Diaz R. Abstract P4-08-15: Locoregional recurrence in invasive breast cancer and association with tumor infiltrating leukocyte (TIL) presence. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-08-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
The presence of TILs has been correlated with clinical outcomes and response to therapy in breast cancer. However, evaluation of TILs in breast cancer has largely been based on pathologic examination of tumor samples. Here, we report the relationship between invasive breast cancer locoregional recurrence (LRR) and the presence of TILs estimated by transcriptomic analysis with the deconvolution algorithm CIBERSORT.
Methods:
Patients were identified from an IRB-approved prospective tissue collection protocol at one academic institution and two community hospitals. 526 primary breast tumor samples were identified and gene expression profiling was assessed with high density Affymetrix microarray chips. Proportions of 22 different TIL types in samples were inferred based on the CIBERSORT algorithm, which uses gene expression data to estimate TIL presence. TIL presence was determined by dichotomization at the level of the first quartile among all samples (>Q1=TIL presence). Patient characteristics and clinical outcomes were obtained by chart review. Time to event analysis was performed using Kaplan Meier (KM) estimates and the log-rank test. Associations between patient factors, tumor factors, TIL presence, and LRR were explored with univariable (UVA) and multivariable (MVA) analyses. Factors significant on UVA (p<0.10) were included on MVA. P<0.05 was considered statistically significant on MVA.
Results:
526 women with invasive breast cancer and available genomic profiling were retrospectively identified for analysis. Median age at diagnosis was 58 years. 70% of tumors were Stage I-II. 69% were luminal subtypes and 17% were triple negative. 37% received mastectomy, 25% received mastectomy + radiation, and 32% received breast conserving therapy. 64% received chemotherapy, and 62% received hormonal therapy. Median follow-up was 74.4 months. There were 61 LRRs. We found significant differences in time to LRR when comparing presence vs. no presence of resting memory CD4+ T-cells (RMCD4+) (p=0.01), activated natural killer cells (ANK) (p=0.003), and neutrophils (PMNs) (p=0.03). On UVA, factors associated with LRR were patient age at diagnosis (p=0.009), pathologic T stage (p=0.045), Estrogen receptor status (p=0.03), biologic subtype (p=0.01), lymphovascular invasion (LVI) (p=0.018), positive margins (p<0.0001), receipt of hormonal therapy (0.014), and presence of tumor infiltrating RMCD4+ (p=0.012), ANK (p=0.0004), and PMNs (p=0.033). On MVA, factors remaining significant were LVI (HR 2.16 CI 1.13-4.13, p=0.011), positive margins (HR 4.36 CI 1.57-12.11, p=0.018), receipt of hormonal therapy (HR 0.31 CI 0.12-0.77, p=0.042), and presence of RMCD4+ (HR 0.48 CI 0.26-0.88, p=0.017), ANK (HR 0.43 CI 0.23-0.83, p=0.012), and PMNs (HR 2.15 CI 1.02-4.53, p=0.043).
Conclusion:
In this study of 526 women with invasive breast cancer, we identified that enrichment of certain TILs is associated with LRR. These results suggest genomic-based assays of TIL presence may be useful to predict LRR in invasive breast cancer.
Citation Format: Liveringhouse CL, Grass GD, Figura NB, Mills MN, Purcell JD, Rosensweig SR, Blumencranz PW, Allen KG, Ahmed KA, Harrison LB, Torres-Roca JF, Robinson TJ, Diaz R. Locoregional recurrence in invasive breast cancer and association with tumor infiltrating leukocyte (TIL) presence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-15.
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Affiliation(s)
- CL Liveringhouse
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - GD Grass
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - NB Figura
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - MN Mills
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - JD Purcell
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - SR Rosensweig
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - PW Blumencranz
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - KG Allen
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - KA Ahmed
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - LB Harrison
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - JF Torres-Roca
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - TJ Robinson
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
| | - R Diaz
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Morton Plant Hospital, Clearwater, FL
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Sandoval ML, Yuan Z, Grass GD, Felder S, Sanchez J, Dessureault S, Imanirad I, Kim RD, Hoffe SE, Frakes J. Impact of sarcopenia on outcomes in patients with rectal carcinoma treated with trimodality therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
687 Background: Sarcopenia has been identified as a negative prognostic factor in several gastrointestinal malignancies. We sought to evaluate whether total psoas area (TPA) was predictive of grade ≥ 3 toxicity, recurrence and overall survival in patients with rectal carcinoma who received tri-modality therapy. Methods: After IRB approval, a retrospective analysis of 112 patients with biopsy-proven rectal cancer treated with neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy was performed. The L4 vertebra was identified on pre-treatment axial CT and the bilateral psoas muscles were manually contoured to determine the skeletal muscle index, which was normalized by height. Sarcopenia was defined as TPA less than the median of the cohort. (< 1463 mm3/m). Acute toxicity was defined as within 3 months of radiation based on Common Terminology Criteria for Adverse Events version 4. Chi-square was used to assess differences between groups. Time to event analysis was estimated by Kaplan-Meier methods followed by log rank comparison. Predictor variables for outcomes were assessed with Cox regression. Results: Median follow-up was 31 months. Female gender was strongly associated with being sarcopenic (P < 0.001) otherwise no other differences in clinical or treatment characteristics were found. 20 patients (17.8%) developed recurrence (95% distant). Patients with sarcopenia had a decreased risk of recurrence (P = 0.048) as well as a longer time to recurrence from radiation (50 vs. 21.4 months, P = 0.006) and surgery (47.2 vs. 17.9 months, P = 0.006). Gender was not associated with risk of recurrence (p = 0.131). On multivariable analysis, absence of sarcopenia was predictive of time to recurrence following radiation (HR 4.7, 95% CI: 1.2-18.8; P = 0.03). The presence of sarcopenia was not associated with overall survival (P = 0.12) or grade ≥ 3 acute toxicity (P = 0.242). Conclusions: In our cohort, patients with sarcopenia appear to have better tumor control when compared to patients without sarcopenia independent of gender, suggesting this may be a predictor of treatment response. However, sarcopenia was not associated with overall survival or probability of having grade ≥ 3 acute toxicity.
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Affiliation(s)
| | | | | | - Seth Felder
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Iman Imanirad
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard D. Kim
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Sarah E. Hoffe
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Grass GD, Naghavi AO, Abuodeh YA, Perez BA, Dilling TJ. Analysis of Relapse Events After Definitive Chemoradiotherapy in Locally Advanced Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2018; 20:e1-e7. [PMID: 30268836 DOI: 10.1016/j.cllc.2018.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/18/2018] [Revised: 07/24/2018] [Accepted: 08/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The appropriate follow-up frequency after definitive chemoradiotherapy (CRT) for locally advanced non-small-cell lung cancer patients is unknown. Although surveillance guidelines have been proposed, very few data support current recommendations. Here we analyze relapse events after CRT and investigate whether symptomatic relapses versus those detected by surveillance imaging influences outcomes. PATIENTS AND METHODS Stage III non-small-cell lung cancer patients treated with CRT at our institution between 2005 and 2014 were retrospectively analyzed. Relapse events were grouped into posttreatment intervals and analyzed with cumulative tables. Time to relapse and overall survival (OS) were compared between patients with relapse detection via symptomatic presentation versus surveillance imaging. RESULTS A total of 211 patients were identified for analysis. The median follow-up was 43 months for patients alive at the time of analysis. The median age was 63 years, and equal proportions had IIIA or IIIB disease. A total of 135 patients (64%) experienced disease relapse, and of these, 74% did so within 12 months. In those who did not experience relapse at ≤ 12 months, 16%, 6%, and < 5% experienced relapse during 12 to 24, 24 to 36, and > 36 months of follow-up, respectively. In patients with relapse, 56% presented symptomatically, which led to inferior median OS compared to those identified by surveillance imaging (23 vs. 36 months; P = .013). CONCLUSION This study identified that most relapses occur within 1 year of completing CRT, and approximately half of these occur within 6 months. A symptomatic relapse led to inferior OS. More aggressive surveillance imaging may therefore identify asymptomatic relapses that are amenable to earlier salvage therapy.
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Affiliation(s)
- G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Bradford A Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Oliver DE, Donnelly OG, Grass GD, Naghavi AO, Yang GQ, Dilling TJ, Perez BA. Extracranial metastatic burden in extensive-stage small cell lung cancer: implications for prophylactic cranial irradiation. J Thorac Dis 2018; 10:4321-4327. [PMID: 30174879 DOI: 10.21037/jtd.2018.06.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. Methods We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes. Results Median follow-up was 10.7 months (range, 3-58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% vs. 61.3%; P=0.020) and multivariable (MVA) analysis [hazard ratio (HR) 2.33, 95% CI: 1.08-5.01; P=0.03). Conclusions Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.
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Affiliation(s)
- Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Olivia G Donnelly
- Department of Medicine, Florida State University School of Medicine, Tallahassee, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - George Q Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bradford A Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Ahmed KA, Scott JG, Arrington JA, Naghavi AO, Grass GD, Perez BA, Caudell JJ, Berglund AE, Welsh EA, Eschrich SA, Dilling TJ, Torres-Roca JF. Radiosensitivity of Lung Metastases by Primary Histology and Implications for Stereotactic Body Radiation Therapy Using the Genomically Adjusted Radiation Dose. J Thorac Oncol 2018; 13:1121-1127. [PMID: 29733909 DOI: 10.1016/j.jtho.2018.04.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We assessed the radiosensitivity of lung metastases on the basis of primary histologic type by using a validated gene signature and model lung metastases for the gnomically adjusted radiation dose (GARD). METHODS Tissue samples were identified from our prospective observational protocol. The radiosensitivity index (RSI) 10-gene assay was run on samples and calculated alongside the GARD by using the previously published algorithms. A cohort of 105 patients with 137 lung metastases treated with stereotactic body radiation therapy (SBRT) at our institution was used for clinical correlation. RESULTS A total of 138 unique metastatic lung lesions from our institution's tissue biorepository were identified for inclusion. There were significant differences in the RSI of lung metastases on the basis of histology. In order of decreasing radioresistance, the median RSIs for the various histologic types of cancer were endometrial adenocarcinoma (0.49), soft-tissue sarcoma (0.47), melanoma (0.44), rectal adenocarcinoma (0.43), renal cell carcinoma (0.33), head and neck squamous cell cancer (0.33), colon adenocarcinoma (0.32), and breast adenocarcinoma (0.29) (p = 0.002). We modeled the GARD for these samples and identified the biologically effective dose necessary to optimize local control. The 12- and 24-month Kaplan-Meier rates of local control for radioresistant versus radiosensitive histologic types from our clinical correlation cohort after lung SBRT were 92%/87% and 100%, respectively (p = 0.02). CONCLUSIONS In this analysis, we have noted significant differences in radiosensitivity on the basis of primary histologic type of lung metastases and have modeled the biologically effective dose necessary to optimize local control. This study suggests that primary histologic type may be an additional factor to consider in selection of SBRT dose to the lung and that dose personalization may be feasible.
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Affiliation(s)
- Kamran A Ahmed
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jacob G Scott
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - John A Arrington
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Arash O Naghavi
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G Daniel Grass
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bradford A Perez
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Anders E Berglund
- Department of Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eric A Welsh
- Department of Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Steven A Eschrich
- Department of Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Thomas J Dilling
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Javier F Torres-Roca
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
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Berglund AE, Gerke T, Awasthi S, Grass GD, Park HY, Cleveland JL, Park JY, Yamoah K, Rounbehler RJ. Abstract 5716: Tristetraprolin is a prognostic biomarker for biochemical recurrence in low Gleason score patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5716] [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
PURPOSE: Most prostate cancer patients currently classified as having a low-risk of disease-specific death are overtreated in the United States, resulting in hundreds of thousands of men to have debilitating side effects from unnecessary treatment. However, ~30% of low-risk patients on active surveillance are later reclassified and require therapeutic intervention. Thus, there is a dire need for biomarkers that can discriminate which prostate tumors currently classified as low-risk will progress into aggressive disease.
EXPERIMENTAL DESIGN: Retrospective analyses of two independent prostate cancer expression datasets were performed to determine the relationship between the expression levels of the tumor suppressor Tristetraprolin (TTP, ZFP36) and biochemical recurrence (BCR). Further, TTP expression levels were measured by quantitative real-time PCR (qRT-PCR) in a cohort of prostate tumors from Moffitt Cancer Center patients having long-term follow-up (n=382), and will be correlated to associated clinical data, including BCR. Finally, the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) scores, a clinical tool used to predict prostate cancer outcomes following radical prostatectomy, were calculated along with BCR for the patients in one of the prostate cancer datasets.
RESULTS: Analysis of The Cancer Genome Atlas (TCGA) prostate adenocarcinoma dataset revealed that tumors with low TTP expression have an increased rate of BCR compared to those with high TTP levels (p=0.0096). Further, assessment of the GEO dataset GSE21034 (Taylor et al., Cancer Cell, 2010) established that prostate cancer patients with low Gleason scores (6 and 3+4) have an increased chance of BCR if their tumors express low levels of TTP compared to men with high TTP expressing tumors (p=0.0001). To validate these findings, patients with low Gleason score tumors and decreased levels of TTP in the Moffitt Cancer Center cohort are being analyzed to determine their rate of BCR. In contrast, CAPRA-S scores for low Gleason score tumors in the GSE20134 dataset failed to distinguish if a patient would have BCR (p=0.0511).
CONCLUSIONS: Prostate cancer patients with Gleason score 6 or 3+4, which are currently classified as having a low-risk of dying from prostate cancer, have an increased risk of BCR if their tumor expresses low levels of the tumor suppressor TTP. Our data suggests that TTP may be a biomarker that clearly discriminates which low Gleason score tumors will progress into aggressive disease.
Citation Format: Anders E. Berglund, Travis Gerke, Shivanshu Awasthi, G. Daniel Grass, Hyun Y. Park, John L. Cleveland, Jong Y. Park, Kosj Yamoah, Robert J. Rounbehler. Tristetraprolin is a prognostic biomarker for biochemical recurrence in low Gleason score patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5716. doi:10.1158/1538-7445.AM2017-5716
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Affiliation(s)
| | - Travis Gerke
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - G. Daniel Grass
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Hyun Y. Park
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Jong Y. Park
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Kosj Yamoah
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Pires Da Silva IED, Johnpulle RAN, Banks PD, Grass GD, Smith JL, Everett AS, Goldinger SM, Roberts-Thomson R, Millward M, Glitza IC, Haydu LE, Atkinson V, Wang T, Eroglu Z, Conry RM, Shackleton MJ, Hong A, Long GV, Johnson DB, Menzies AM. Incidence, features and management of radionecrosis (RN) in melanoma patients (pts) treated with cerebral radiotherapy (RT) and anti-PD-1 antibodies (PD1). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9513 Background: Melanoma brain metastases confer poor prognosis, with various treatments used including RT and PD1. While RT and PD1 may have a synergistic effect to improve efficacy, RN may complicate RT, and whether PD1 potentiates this is unknown. We examined the incidence and features of RN and other neurotoxicities in melanoma pts treated with PD1 and whole brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS). Methods: Pts treated with PD1 who received WBRT/SRS during or within 1 year (y) of PD1 who survived > 1y were examined for short and long term neurotoxicity. 2 cohorts were included: (A) consecutive pts fulfilling eligibility criteria from 8 melanoma centers, (B) additional cases of RN from 3 centers. Pt demographics, disease features, treatment details, neurotoxicity, and outcome data were collected. Results: Cohort A included 118 pts, with median follow-up of 24.3 months (mo). Median age was 56yo, 51% had mutant BRAF, 41% elevated LDH and 65% were ECOG 1-2 at PD1 start. 58% had prior ipilimumab and 43% prior MAPK inhibitors. 85% were treated with pembrolizumab, 10% nivolumab and 5% combination ipilimumab/nivolumab. Most pts (82, 69%) had SRS, 22 (19%) had WBRT alone and 14 pts (12%) had both. Median PFS was 24mo and OS was 45.8mo. 21 pts (18%) developed RN, (14/82) 17% after SRS, (2/22) 9% after WBRT and (5/14) 36% after both. With 13 further cases from cohort B (total 34), all had radiological signs on MRI, 78% had neurological symptoms and 56% had pathological confirmation of RN. Median time to symptom onset and to first radiological sign was 9.8mo and 10.8mo, respectively. 52% were treated with steroids and 30% had bevacizumab, with clinical improvement in 64% and 100%, respectively. Updated analysis including clinical variables associated with RN development will be presented, including RT dose and schedule. Conclusions: RN is a significant toxicity in melanoma pts with brain metastases treated with RT and PD1, particularly in long term survivors. Further research to identify those at risk of RN, those who do not require RT, and studies exploring RT and PD1 schedules are required.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Michael Millward
- University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | | | | | | | - Tim Wang
- Crown Princess Mary Cancer Centre Westmead, Sidney, Australia
| | | | | | - Mark J. Shackleton
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Angela Hong
- Melanoma Institute Australia, Sydney, Australia
| | | | | | - Alexander M. Menzies
- Melanoma Institute Australia, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
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Abuodeh Y, Ahmed K, Echevarria M, Naghavi A, Grass GD, Robinson TJ, Tomblyn M, Shah B, Chavez J, Bello C, El-Haddad G, Harrison L, Kim S. Priming radioimmunotherapy with external beam radiation in patients with relapsed low grade non-Hodgkin lymphoma. Ther Adv Hematol 2017; 8:129-138. [PMID: 28491264 DOI: 10.1177/2040620717693574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the outcomes of priming salvage radioimmunotherapy (RIT) with a low dose of external beam radiotherapy (EBRT) in patients with relapsed low grade non-Hodgkin lymphoma (LG-NHL). METHODS Patients who received salvage RIT with or without 2 × 2 Gy EBRT between March 2009 and February 2013 were retrospectively reviewed at a single institution. Planning target volume (PTV) for EBRT was created by adding a 1-2 cm expansion to the gross tumor volume depending on the anatomical location. Kaplan-Meier method via log-rank was employed to analyze the endpoints freedom from progression (FFP) and overall survival (OS). RESULTS We identified 22 patients who received salvage RIT without chemotherapy with a median follow up of 34 months. Of these, 9 (41%) patients were treated with EBRT immediately prior to RIT, and 13 (59%) received salvage RIT alone. Median FFP was not reached in patients who underwent combination treatment, while it was 9 months for patients treated with RIT alone (p = 0.02). OS for all patients at 36 months was 80.3% with no significant difference between the two groups (p = 0.88). On univariate analysis, the addition of EBRT was associated with improved FFP [hazard ratio (HR) = 4.17; 95% confidence interval (CI), 1.24-19.1; p = 0.02)]. No long term toxicities were reported in both groups. CONCLUSIONS RIT outcomes and effects were improved with addition of low-dose EBRT immediately prior to it, in the treatment of relapsed LG-NHL with no additional toxicity. This study is hypothesis-generating and the findings should be validated in prospective studies.
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Affiliation(s)
- Yazan Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michelle Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Arash Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Timothy J Robinson
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Bijal Shah
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julio Chavez
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Celeste Bello
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ghassan El-Haddad
- Department of Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louis Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sungjune Kim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Naghavi AO, Echevarria MI, Grass GD, Strom TJ, Abuodeh YA, Ahmed KA, Kim Y, Trotti AM, Harrison LB, Yamoah K, Caudell JJ. Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer 2016; 122:3529-3537. [PMID: 27479362 DOI: 10.1002/cncr.30212] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients covered by Medicaid insurance appear to have poorer cancer outcomes. Herein, the authors sought to test whether Medicaid was associated with worse outcomes among patients with head and neck cancer (HNC). METHODS The records of 1698 patients with squamous cell HNC without distant metastatic disease were retrospectively reviewed from an institutional database between 1998 and 2011. At the time of diagnosis, insurance status was categorized as Medicaid, Medicare/other government insurance, or private insurance. Outcomes including locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox regression multivariate analysis (MVA). RESULTS The median follow-up for all patients was 35 months. Medicaid patients comprised 11% of the population; the remaining patients were privately insured (56%) or had Medicare/government insurance (34%). On MVA, Medicaid patients were younger, were current smokers, had higher tumor T and N classifications, and experienced a longer time from diagnosis to treatment initiation (all P<.005). Medicaid insurance status was associated with a deficit of 13% in LRC (69% vs 82%) and 26% in OS (46% vs 72%) at 3 years (all with P<.001). A time from diagnosis to treatment initiation of >45 days was found to be associated with worse 3-year LRC (77% vs 83%; P = .009) and OS (68% vs 71%; P = .008). On MVA, Medicaid remained associated with a deficit in LRC (P = .002) and OS (P<.001). CONCLUSIONS Patients with Medicaid insurance more often present with locally advanced HNC and experience a higher rate of treatment delays compared with non-Medicaid patients. Medicaid insurance status appears to be independently associated with deficits in LRC and OS. Improvements in the health care system, such as expediting treatment initiation, may improve the outcomes of patients with HNC. Cancer 2016;122:3529-3537. © 2016 American Cancer Society.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Abstract
Radiation therapy (RT) is a cornerstone in oncologic management and is employed in various curative and palliative scenarios for local-regional control. RT is thought to locally control tumor cells by direct physical DNA damage or indirect insults from reactive oxygen species. Therapeutic effects apart from those observed at the treatment target, that is, abscopal effect, have been observed for several decades, though the underlying mechanisms regulating this phenomenon have been unclear. Accumulating evidence now suggests that the immune system is a major determinant in regulating the abscopal effect. It is now evident that RT may also enhance immunologic responses to tumors by creating an in situ vaccine by eliciting antigen release from dying tumor cells. Harnessing the specificity and dynamic nature of the immune system to target tumors in conjunction with RT is an emerging field with much promise. To optimize this approach, it is important to systematically evaluate the intricacies of the host immune system, the new generation of immunotherapeutics and the RT approach. Here we will discuss the current biologic mechanisms thought to regulate the RT-induced abscopal effect and how these may be translated to the clinical setting.
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Abstract
Major determinants that influence negative outcome in cancer patients are the abilities of cancer cells to resist current therapies and to invade surrounding host tissue, consequently leading to local and metastatic dissemination. Hyaluronan (HA), a prominent constituent of the tumor microenvironment, not only provides structural support but also interacts with cell surface receptors, especially CD44, that influence cooperative signaling pathways leading to chemoresistance and invasiveness. CD147 (emmprin; basigin) is a member of the Ig superfamily that has also been strongly implicated in chemoresistance and invasiveness. CD147 both regulates HA synthesis and interacts with the HA receptors, CD44, and LYVE-1. Increased CD147 expression induces formation of multiprotein complexes containing CD44 (or LYVE-1) as well as members of the membrane-type matrix metalloproteinase, receptor tyrosine kinase, ABC drug transporter, or monocarboxylate transporter families, which become assembled in specialized lipid raft domains along with CD147 itself. In each case, multivalent HA-receptor interactions are essential for formation or stabilization of the lipid raft complexes and for downstream signaling pathways or transporter activities that are driven by these complexes. We conclude that cooperativity between HA, HA receptors, and CD147 may be a major driver of the interconnected pathways of invasiveness and chemoresistance widely critical to malignancy.
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Affiliation(s)
- G Daniel Grass
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Lu Dai
- Department of Medicine, Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Zhiqiang Qin
- Department of Microbiology, Immunology & Parasitology, Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Chris Parsons
- Department of Medicine, Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA; Department of Microbiology, Immunology & Parasitology, Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Bryan P Toole
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.
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Grass GD, Cooper SL, Armeson K, Garrett-Mayer E, Sharma A. Cervical esophageal cancer: a population-based study. Head Neck 2014; 37:808-14. [PMID: 24616217 DOI: 10.1002/hed.23678] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 07/01/2013] [Revised: 01/08/2014] [Accepted: 03/06/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to present our analysis of outcomes, prognostic factors, and treatment for cervical esophageal carcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A query of the SEER database from 1998 to 2008 was performed for patients with nonmetastatic adenocarcinoma or squamous cell carcinoma (SCC) of the cervical esophagus. Disease-specific survival (DSS) rates were calculated using Kaplan-Meier method, and predictive factors were analyzed by Cox proportional hazards regression. RESULTS We identified 362 patients; 92% of the patients had SCC, 16% received no definitive therapy, 5% received surgery, 71% received radiation therapy (RT), and 8% received both. Chemotherapy data were not available. Median DSS was 49 months for adenocarcinoma and 15 months for SCC. On multivariate analysis, histology (p = .02), RT (p < .001), and surgery plus RT (p < .001) were associated with DSS. CONCLUSION Survival in patients with cervical esophageal carcinoma remains poor. Further studies should define the use of RT, surgery, and chemotherapy.
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Affiliation(s)
- G Daniel Grass
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - S Lewis Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Anand Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
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Grass GD, Tolliver LB, Bratoeva M, Toole BP. CD147, CD44, and the epidermal growth factor receptor (EGFR) signaling pathway cooperate to regulate breast epithelial cell invasiveness. J Biol Chem 2013; 288:26089-26104. [PMID: 23888049 DOI: 10.1074/jbc.m113.497685] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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] Open
Abstract
The immunoglobulin superfamily glycoprotein CD147 (emmprin; basigin) is associated with an invasive phenotype in various types of cancers, including malignant breast cancer. We showed recently that up-regulation of CD147 in non-transformed, non-invasive breast epithelial cells is sufficient to induce an invasive phenotype characterized by membrane type-1 matrix metalloproteinase (MT1-MMP)-dependent invadopodia activity (Grass, G. D., Bratoeva, M., and Toole, B. P. (2012) Regulation of invadopodia formation and activity by CD147. J. Cell Sci. 125, 777-788). Here we found that CD147 induces breast epithelial cell invasiveness by promoting epidermal growth factor receptor (EGFR)-Ras-ERK signaling in a manner dependent on hyaluronan-CD44 interaction. Furthermore, CD147 promotes assembly of signaling complexes containing CD147, CD44, and EGFR in lipid raftlike domains. We also found that oncogenic Ras regulates CD147 expression, hyaluronan synthesis, and formation of CD147-CD44-EGFR complexes, thus forming a positive feedback loop that may amplify invasiveness. Last, we showed that malignant breast cancer cells are heterogeneous in their expression of surface-associated CD147 and that high levels of membrane CD147 correlate with cell surface EGFR and CD44 levels, activated EGFR and ERK1, and activated invadopodia. Future studies should evaluate CD147 as a potential therapeutic target and disease stratification marker in breast cancer.
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Affiliation(s)
- G Daniel Grass
- From the Department of Regenerative Medicine and Cell Biology and
| | | | - Momka Bratoeva
- From the Department of Regenerative Medicine and Cell Biology and
| | - Bryan P Toole
- From the Department of Regenerative Medicine and Cell Biology and; the Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina 29425.
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Wilkerson BA, Grass GD, Wing SB, Argraves WS, Argraves KM. Sphingosine 1-phosphate (S1P) carrier-dependent regulation of endothelial barrier: high density lipoprotein (HDL)-S1P prolongs endothelial barrier enhancement as compared with albumin-S1P via effects on levels, trafficking, and signaling of S1P1. J Biol Chem 2012; 287:44645-53. [PMID: 23135269 PMCID: PMC3531779 DOI: 10.1074/jbc.m112.423426] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Indexed: 12/25/2022] Open
Abstract
Sphingosine 1-phosphate (S1P) is a blood-borne lysosphingolipid that acts to promote endothelial cell (EC) barrier function. In plasma, S1P is associated with both high density lipoproteins (HDL) and albumin, but it is not known whether the carriers impart different effects on S1P signaling. Here we establish that HDL-S1P sustains EC barrier longer than albumin-S1P. We showed that the sustained barrier effects of HDL-S1P are dependent on signaling by the S1P receptor, S1P1, and involve persistent activation of Akt and endothelial NOS (eNOS), as well as activity of the downstream NO target, soluble guanylate cyclase (sGC). Total S1P1 protein levels were found to be higher in response to HDL-S1P treatment as compared with albumin-S1P, and this effect was not associated with increased S1P1 mRNA or dependent on de novo protein synthesis. Several pieces of evidence indicate that long term EC barrier enhancement activity of HDL-S1P is due to specific effects on S1P1 trafficking. First, the rate of S1P1 degradation, which is proteasome-mediated, was slower in HDL-S1P-treated cells as compared with cells treated with albumin-S1P. Second, the long term barrier-promoting effects of HDL-S1P were abrogated by treatment with the recycling blocker, monensin. Finally, cell surface levels of S1P1 and levels of S1P1 in caveolin-enriched microdomains were higher after treatment with HDL-S1P as compared with albumin-S1P. Together, the findings reveal S1P carrier-specific effects on S1P1 and point to HDL as the physiological mediator of sustained S1P1-PI3K-Akt-eNOS-sGC-dependent EC barrier function.
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Affiliation(s)
- Brent A. Wilkerson
- From the Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina 29425
| | - G. Daniel Grass
- From the Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina 29425
| | - Shane B. Wing
- From the Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina 29425
| | - W. Scott Argraves
- From the Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina 29425
| | - Kelley M. Argraves
- From the Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina 29425
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Abstract
A defining feature of malignant tumor progression is cellular penetration through the basement membrane and interstitial matrices that separate various cellular compartments. Accumulating evidence supports the notion that invasive cells employ specialized structures termed invadopodia to breach these structural barriers. Invadopodia are actin-based, lipid-raft-enriched membrane protrusions containing membrane-type-1 matrix metalloproteinase (MT1-MMP; also known as matrix metalloproteinase 14; MMP14) and several signaling proteins. CD147 (emmprin, basigin), an immunoglobulin superfamily protein that is associated with tumor invasion and metastasis, induces the synthesis of various matrix metalloproteinases in many systems. In this study we show that upregulation of CD147 is sufficient to induce MT1-MMP expression, invasiveness and formation of invadopodia-like structures in non-transformed, non-invasive, breast epithelial cells. We also demonstrate that CD147 and MT1-MMP are in close proximity within these invadopodia-like structures and co-fractionate in membrane compartments with the properties of lipid rafts. Moreover, manipulation of CD147 levels in invasive breast carcinoma cells causes corresponding changes in MT1-MMP expression, invasiveness and invadopodia formation and activity. These findings indicate that CD147 regulates invadopodia formation and activity, probably through assembly of MT1-MMP-containing complexes within lipid-raft domains of the invadopodia.
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Affiliation(s)
- G Daniel Grass
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
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Slomiany MG, Dai L, Tolliver LB, Grass GD, Zeng Y, Toole BP. Inhibition of Functional Hyaluronan-CD44 Interactions in CD133-positive Primary Human Ovarian Carcinoma Cells by Small Hyaluronan Oligosaccharides. Clin Cancer Res 2009; 15:7593-7601. [PMID: 19996211 DOI: 10.1158/1078-0432.ccr-09-2317] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE: CD44 is one of the most common markers used for identification of highly tumorigenic subpopulations of human carcinoma cells, but little is known about the function of CD44 or its major ligand, hyaluronan, in these cells. The purpose of this study was to investigate the involvement of hyaluronan and its interaction with CD44 in the properties of a tumorigenic subpopulation of primary ovarian carcinoma cells. EXPERIMENTAL DESIGN: A tumorigenic subpopulation was identified in ascites fluids from ovarian carcinoma patients by expression of high CD133 levels. Treatment with small hyaluronan oligosaccharides, which dissociate constitutive hyaluronan polymer-CD44 interactions, was used to test the importance of hyaluronan-CD44 interaction in assembly of multidrug and monocarboxylate transporters and receptor tyrosine kinases in the plasma membrane of cells with high CD133 levels, and in the tumorigenic capacity of the CD133-high subpopulation. RESULTS: Although total CD44 levels were similar in cells with high or low CD133 expression, CD44 was present in close association with transporters, receptor tyrosine kinases, and emmprin (CD147) in the plasma membrane of cells with high CD133 levels. Treatment with small hyaluronan oligosaccharides reduced association of the transporters and receptor tyrosine kinases with CD44 in the plasma membrane, diminished drug transporter activity, and inhibited i.p. tumorigenesis in these cells. CONCLUSIONS: We conclude that hyaluronan-CD44 interaction plays an important role in the properties of highly tumorigenic cells by stabilizing oncogenic complexes in their plasma membrane, and that treatment with hyaluronan-CD44 antagonists provides a logical therapeutic approach for abrogating the properties of these cells. (Clin Cancer Res 2009;15(24):7593-601).
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Affiliation(s)
- Mark G Slomiany
- Authors' Affiliation: Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
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Slomiany MG, Grass GD, Robertson AD, Yang XY, Maria BL, Beeson C, Toole BP. Hyaluronan, CD44, and emmprin regulate lactate efflux and membrane localization of monocarboxylate transporters in human breast carcinoma cells. Cancer Res 2009; 69:1293-301. [PMID: 19176383 DOI: 10.1158/0008-5472.can-08-2491] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [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
Interactions of hyaluronan with CD44 in tumor cells play important cooperative roles in various aspects of malignancy and drug resistance. Emmprin (CD147; basigin) is a cell surface glycoprotein of the immunoglobulin superfamily that is highly up-regulated in malignant cancer cells and stimulates hyaluronan production, as well as several downstream signaling pathways. Emmprin also interacts with various monocarboxylate transporters (MCT). Malignant cancer cells use the glycolytic pathway and require MCTs to efflux lactate that results from glycolysis. Glycolysis and lactate secretion contribute to malignant cell behaviors and drug resistance in tumor cells. In the present study, we find that perturbation of endogenous hyaluronan, using small hyaluronan oligosaccharides, rapidly inhibits lactate efflux from breast carcinoma cells; down-regulation of emmprin, using emmprin small interfering RNA, also results in decreased efflux. In addition, we find that CD44 coimmunoprecipitates with MCT1, MCT4, and emmprin and colocalizes with these proteins at the plasma membrane. Moreover, after treatment of the cells with hyaluronan oligosaccharides, CD44, MCT1, and MCT4 become localized intracellularly whereas emmprin remains at the cell membrane. Together, these data indicate that constitutive interactions among hyaluronan, CD44, and emmprin contribute to regulation of MCT localization and function in the plasma membrane of breast carcinoma cells.
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Affiliation(s)
- Mark G Slomiany
- Departments of Cell Biology and Anatomy, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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