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Zhang X, Ilyas OS, Getz KR, Rozek LS, Taylor JMG, Chinn SB, Wolf GT, Mondul AM. Aspirin use and head and neck cancer survival and recurrence. Cancer Causes Control 2024; 35:605-609. [PMID: 37975972 DOI: 10.1007/s10552-023-01815-7] [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: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) has low 5-year survival, and evidence-based recommendations for tertiary prevention are lacking. Aspirin improves outcomes for cancers at other sites, but its role in HNC tertiary prevention remains understudied. METHODS HNC patients were recruited in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003 to 2014. Aspirin data were collected through medical record review; outcomes (overall mortality, HNC-specific mortality, and recurrence) were collected through medical record review, Social Security Death Index, or LexisNexis. Cox proportional hazards models were used to evaluate the associations between aspirin use at diagnosis (yes/no) and HNC outcomes. RESULTS We observed no statistically significant associations between aspirin and cancer outcome in our HNC patient cohort (n = 1161) (HNC-specific mortality: HR = 0.91, 95% CI = 0.68-1.21; recurrence: HR = 0.94, 95% CI = 0.73-1.19). In analyses stratified by anatomic site, HPV status, and disease stage, we observed no association in any strata examined with the possible exception of a lower risk of recurrence in oropharynx patients (HR = 0.60, 95% CI 0.35-1.04). CONCLUSIONS Our findings do not support a protective association between aspirin use and cancer-specific death or recurrence in HNC patients, with the possible exception of a lower risk of recurrence in oropharynx patients.
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Affiliation(s)
- Xinman Zhang
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Omar S Ilyas
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Kayla R Getz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura S Rozek
- School of Medicine, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeremy M G Taylor
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor Michigan, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor Michigan, USA
| | - Alison M Mondul
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
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Swiecicki PL, Bellile E, Dragovic AF, McHugh J, Udager A, Mierzwa ML, Shah J, Heft Neal M, Rosko A, Malloy KM, Casper K, Chinn SB, Shuman AG, Stucken C, Chepeha DB, Wolf GT, Bradford CR, Eisbruch A, Prince MEP, Worden FP, Spector ME. Upfront neck dissection for treatment selection and improvement in quality of life as a novel treatment paradigm for deintensification in HPV+ OPSCC. Clin Cancer Res 2024:741954. [PMID: 38517480 DOI: 10.1158/1078-0432.ccr-23-3247] [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] [Received: 10/22/2023] [Revised: 12/18/2023] [Accepted: 03/20/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Locoregionally advanced HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has excellent cure rates, although current treatment regimens are accompanied by acute and long-term toxicities. We designed a phase II de-escalation trial for patients with HPV+OPSCC to evaluate the feasibility of an upfront neck dissection to individualize definitive treatment selection to improve quality of life without compromising survival. METHODS Patients with T1-3, N0-2 HPV+ OPSCC underwent an upfront neck dissection with primary tumor biopsy. Patients with a single lymph node less than six centimeters, with no extracapsular spread(ECS), and no primary site adverse features underwent transoral surgery (Arm A). Patients who had two or more positive lymph nodes with no ECS, or those with primary site adverse features were treated with radiation alone (Arm B). Patients who had ECS in any lymph node were treated with chemoradiation (Arm C). The primary endpoint was quality of life at 1 year compared to a matched historical control. RESULTS Thirty-four patients were enrolled and underwent selective neck dissection. Based on pathologic characteristics, 14 patients were assigned to arm A, 10 patients to arm B, and 9 to arm C. A significant improvement was observed in HNQOL compared to historical controls (-2.6 vs -11.9, p=0.034). With a median follow-up of 37 months, the 3-year overall survival was 100% and estimated 3-year estimated progression free survival was 96% (95% CI: 76-99%). CONCLUSION A neck dissection driven treatment paradigm warrants further research as a de-intensification strategy.
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Affiliation(s)
| | - Emily Bellile
- University of Michigan-Ann Arbor, Ann Arbor, United States
| | | | - Jonathan McHugh
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Aaron Udager
- University of Michigan Medical School, Ann Arbor, Michigan, United States
| | | | - Jennifer Shah
- University of Michigan-Ann Arbor, Ann Arbor, United States
| | - Molly Heft Neal
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Kelly M Malloy
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Keith Casper
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Andrew G Shuman
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | | | - Gregory T Wolf
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Avraham Eisbruch
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Mark E P Prince
- University of Michigan-Ann Arbor, ANN ARBOR, Michigan, United States
| | | | - Matthew E Spector
- University of Michigan-Ann Arbor, Pittsburgh, Pennsylvania, United States
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Medeiros MCD, The S, Bellile E, Russo N, Schmitd L, Danella E, Singh P, Banerjee R, Bassis C, Murphy GR, Sartor MA, Lombaert I, Schmidt TM, Eisbruch A, Murdoch-Kinch CA, Rozek L, Wolf GT, Li G, Chen GY, D'Silva NJ. Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer. Microbiome 2023; 11:268. [PMID: 38037123 PMCID: PMC10687843 DOI: 10.1186/s40168-023-01677-w] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Oral squamous cell carcinoma (SCC) is associated with oral microbial dysbiosis. In this unique study, we compared pre- to post-treatment salivary microbiome in patients with SCC by 16S rRNA gene sequencing and examined how microbiome changes correlated with the expression of an anti-microbial protein. RESULTS Treatment of SCC was associated with a reduction in overall bacterial richness and diversity. There were significant changes in the microbial community structure, including a decrease in the abundance of Porphyromonaceae and Prevotellaceae and an increase in Lactobacillaceae. There were also significant changes in the microbial community structure before and after treatment with chemoradiotherapy, but not with surgery alone. In patients treated with chemoradiotherapy alone, several bacterial populations were differentially abundant between responders and non-responders before and after therapy. Microbiome changes were associated with a change in the expression of DMBT1, an anti-microbial protein in human saliva. Additionally, we found that salivary DMBT1, which increases after treatment, could serve as a post-treatment salivary biomarker that links to microbial changes. Specifically, post-treatment increases in human salivary DMBT1 correlated with increased abundance of Gemella spp., Pasteurellaceae spp., Lactobacillus spp., and Oribacterium spp. This is the first longitudinal study to investigate treatment-associated changes (chemoradiotherapy and surgery) in the oral microbiome in patients with SCC along with changes in expression of an anti-microbial protein in saliva. CONCLUSIONS The composition of the oral microbiota may predict treatment responses; salivary DMBT1 may have a role in modulating the oral microbiome in patients with SCC. After completion of treatment, 6 months after diagnosis, patients had a less diverse and less rich oral microbiome. Leptotrichia was a highly prevalent bacteria genus associated with disease. Expression of DMBT1 was higher after treatment and associated with microbiome changes, the most prominent genus being Gemella Video Abstract.
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Affiliation(s)
- Marcell Costa de Medeiros
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Stephanie The
- Cancer Data Science Shared Resource, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Emily Bellile
- Cancer Data Science Shared Resource, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Nickole Russo
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Ligia Schmitd
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Erika Danella
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Priyanka Singh
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Rajat Banerjee
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA
| | - Christine Bassis
- Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 331248109, USA
| | - George R Murphy
- Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA
- Biointerfaces Institute, Ann Arbor, MI, USA
| | - Maureen A Sartor
- Computational Medicine and Bioinformatics, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Isabelle Lombaert
- Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA
- Biointerfaces Institute, Ann Arbor, MI, USA
| | - Thomas M Schmidt
- Microbiology and Immunology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Avi Eisbruch
- Radiation Oncology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Carol Anne Murdoch-Kinch
- Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, 1011 North Michigan St, Indianapolis, IN, USA
| | - Laura Rozek
- Environmental Health Sciences, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Otolaryngology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Gen Li
- Biostatistics, University of Michigan School of Public Health, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Grace Y Chen
- Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 331248109, USA.
| | - Nisha J D'Silva
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Ave, Room G018, Ann Arbor, MI, 48109-1078, USA.
- Pathology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA.
- Rogel Cancer Center, Ann Arbor, MI, USA.
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4
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Maino Vieytes CA, Rozek LS, Wolf GT, Arthur AE. Associations Between Diet Quality and Proinflammatory Cytokines in Newly Diagnosed Head and Neck Cancer Survivors. Curr Dev Nutr 2023; 7:102015. [PMID: 37964946 PMCID: PMC10641111 DOI: 10.1016/j.cdnut.2023.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/16/2023] Open
Abstract
Background Head and neck squamous cell carcinoma (HNSCC) is a class of heterogenous cancers involving the upper aerodigestive tract. We previously demonstrated the utility of a priori diet quality indices for predicting survival after an HNSCC diagnosis. The aim of this analysis was to evaluate the role of those a priori diet quality indices and proinflammatory cytokines in newly diagnosed HNSCC survivors. Methods We analyzed cross-sectional data from a sample (n = 146; mean age 59.6 y; 79.3% male) from the University of Michigan Head and Neck Specialized Program of Research Excellence prospective longitudinal cohort study. Dietary intake was measured at pretreatment using a food frequency questionnaire. Serum samples were also collected at pretreatment. Covariate-adjusted proportional odds and logistic regression models were used to assess the relationship between 6 diet quality indices (Alternative Healthy Eating Index [AHEI]-2010, Alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension [DASH], and 3 low-carbohydrate indices) and serum measures of a panel of 10 inflammatory cytokines and a cytokine summary composite score. Results Higher scores on the AHEI-2010 and DASH diet quality indices were associated with higher odds of lower cytokine value scores for several cytokines and for the cytokine summary composite score (AHEI-2010-odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.10, 2.20; DASH-OR: 1.65; 95% CI 1.15, 2.36). Conclusions Higher scores on the AHEI-2010 and DASH diet quality indices may be associated with lower proinflammatory cytokine levels in HNSCC survivors.
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Affiliation(s)
| | - Laura S. Rozek
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Gregory T. Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Anna E. Arthur
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
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5
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Perez-Pacheco C, Schmitd LB, Furgal A, Bellile EL, Liu M, Fattah A, Gonzalez-Maldonado L, Unsworth SP, Wong SY, Rozek LS, Rao A, Wolf GT, Taylor JMG, Casper K, Mierzwa M, D'Silva NJ. Increased Nerve Density Adversely Affects Outcome in Oral Cancer. Clin Cancer Res 2023; 29:2501-2512. [PMID: 37039710 PMCID: PMC10371054 DOI: 10.1158/1078-0432.ccr-22-3496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Perineural invasion (PNI) in oral cavity squamous cell carcinoma (OSCC) is associated with poor survival. Because of the risk of recurrence, patients with PNI receive additional therapies after surgical resection. Mechanistic studies have shown that nerves in the tumor microenvironment promote aggressive tumor growth. Therefore, in this study, we evaluated whether nerve density (ND) influences tumor growth and patient survival. Moreover, we assessed the reliability of artificial intelligence (AI) in evaluating ND. EXPERIMENTAL DESIGN To investigate whether increased ND in OSCC influences patient outcome, we performed survival analyses. Tissue sections of OSCC from 142 patients were stained with hematoxylin and eosin and IHC stains to detect nerves and tumor. ND within the tumor bulk and in the adjacent 2 mm was quantified; normalized ND (NND; bulk ND/adjacent ND) was calculated. The impact of ND on tumor growth was evaluated in chick chorioallantoic-dorsal root ganglia (CAM-DRG) and murine surgical denervation models. Cancer cells were grafted and tumor size quantified. Automated nerve detection, applying the Halo AI platform, was compared with manual assessment. RESULTS Disease-specific survival decreased with higher intratumoral ND and NND in tongue SCC. Moreover, NND was associated with worst pattern-of-invasion and PNI. Increasing the number of DRG, in the CAM-DRG model, increased tumor size. Reduction of ND by denervation in a murine model decreased tumor growth. Automated and manual detection of nerves showed high concordance, with an F1 score of 0.977. CONCLUSIONS High ND enhances tumor growth, and NND is an important prognostic factor that could influence treatment selection for aggressive OSCC. See related commentary by Hondermarck and Jiang, p. 2342.
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Affiliation(s)
- Cindy Perez-Pacheco
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Ligia B Schmitd
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Allison Furgal
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Emily L Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Min Liu
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Aya Fattah
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Laura Gonzalez-Maldonado
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Shelby P Unsworth
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Sunny Y Wong
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Laura S Rozek
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Arvind Rao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Nisha J D'Silva
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
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6
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Smith JD, Bellile EL, Ellsperman SE, Heft-Neal ME, Mann JE, Birkeland AC, Hoesli RC, Swiecicki PL, Worden FP, Schonewolf C, Shah JL, Mierzwa ML, Rosko AJ, Stucken CL, Chinn SB, Shuman AG, Casper KA, Malloy KM, Prince MEP, Wolf GT, Thomas DG, McHugh JB, Chad Brenner J, Spector ME. Prognostic value of CD103 + tumor-infiltrating lymphocytes and programmed death ligand-1 (PD-L1) combined positive score in recurrent laryngeal squamous cell carcinoma. Oral Oncol 2022; 135:106226. [PMID: 36323071 PMCID: PMC10099383 DOI: 10.1016/j.oraloncology.2022.106226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In an evolving era of immunotherapeutic options for persistent or recurrent laryngeal squamous cell carcinoma (LSCC), there is a need for improved biomarkers of treatment response and survival to inform optimal treatment selection and prognostication. Herein, our primary objective was to explore correlations between tumor infiltrating lymphocytes (TILs) and PD-L1 Combined Positive Score (CPS). Secondarily, we sought to explore their combined association with survival outcomes in patients with persistent or recurrent LSCC treated with salvage surgery. MATERIALS AND METHODS This was a retrospective cohort study at a single academic medical center. Immunohistochemistry staining for TILs and PD-L1 was performed on a tissue microarray of persistent or recurrent LSCC pathologic specimens. Correlations between TIL subsets and PD-L1 CPS were examined using Pearson's correlation coefficient and survival outcomes were analyzed with the Kaplan-Meier method and log-rank tests. RESULTS Only CD103+ TILs showed a statistically significant, weakly-positive correlation with PD-L1 CPS (r2 = 0.264, p < 0.015). No other TIL subsets correlated with PD-L1 CPS in our cohort. The most favorable survival outcomes were seen in patients with pathologic N0 tumors showing high CD103+ TILs and/or high PD-L1 CPS staining. CONCLUSION Among patients with persistent or recurrent LSCC, CD103+ TILs only modestly correlated with PD-L1 CPS. A combined biomarker score incorporating CD103+ TILs and PD-L1 CPS greatly enhanced survival discrimination. This model may have additional utility in predicting the clinical benefit of immunotherapies in persistent or recurrent LSCC in the future.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Emily L Bellile
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Susan E Ellsperman
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Molly E Heft-Neal
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jacqueline E Mann
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew C Birkeland
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Paul L Swiecicki
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Francis P Worden
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew J Rosko
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Chaz L Stucken
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Steven B Chinn
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew G Shuman
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Keith A Casper
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Kelly M Malloy
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Mark E P Prince
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Gregory T Wolf
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Dafydd G Thomas
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - J Chad Brenner
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Matthew E Spector
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States.
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7
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Schmitd LB, Perez-Pacheco C, Bellile EL, Wu W, Casper K, Mierzwa M, Rozek LS, Wolf GT, Taylor JM, D'Silva NJ. Spatial and Transcriptomic Analysis of Perineural Invasion in Oral Cancer. Clin Cancer Res 2022; 28:3557-3572. [PMID: 35819260 PMCID: PMC9560986 DOI: 10.1158/1078-0432.ccr-21-4543] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Perineural invasion (PNI), a common occurrence in oral squamous cell carcinomas, is associated with poor survival. Consequently, these tumors are treated aggressively. However, diagnostic criteria of PNI vary and its role as an independent predictor of prognosis has not been established. To address these knowledge gaps, we investigated spatial and transcriptomic profiles of PNI-positive and PNI-negative nerves. EXPERIMENTAL DESIGN Tissue sections from 142 patients were stained with S100 and cytokeratin antibodies. Nerves were identified in two distinct areas: tumor bulk and margin. Nerve diameter and nerve-to-tumor distance were assessed; survival analyses were performed. Spatial transcriptomic analysis of nerves at varying distances from tumor was performed with NanoString GeoMx Digital Spatial Profiler Transcriptomic Atlas. RESULTS PNI is an independent predictor of poor prognosis among patients with metastasis-free lymph nodes. Patients with close nerve-tumor distance have poor outcomes even if diagnosed as PNI negative using current criteria. Patients with large nerve(s) in the tumor bulk survive poorly, suggesting that even PNI-negative nerves facilitate tumor progression. Diagnostic criteria were supported by spatial transcriptomic analyses of >18,000 genes; nerves in proximity to cancer exhibit stress and growth response changes that diminish with increasing nerve-tumor distance. These findings were validated in vitro and in human tissue. CONCLUSIONS This is the first study in human cancer with high-throughput gene expression analysis in nerves with striking correlations between transcriptomic profile and clinical outcomes. Our work illuminates nerve-cancer interactions suggesting that cancer-induced injury modulates neuritogenesis, and supports reclassification of PNI based on nerve-tumor distance rather than current subjective criteria.
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Affiliation(s)
- Ligia B. Schmitd
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Cindy Perez-Pacheco
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Emily L. Bellile
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Weisheng Wu
- Bioinformatics Core, University of Michigan, Ann Arbor, Michigan
| | - Keith Casper
- Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Laura S. Rozek
- Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Gregory T. Wolf
- Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeremy M.G. Taylor
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
- Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nisha J. D'Silva
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
- Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
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8
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Swiecicki PL, Bellile E, Casper K, Chinn SB, Dragovic AF, Jolly S, Kupfer R, Malloy KM, Mierzwa ML, Shuman AG, Spector ME, Srinivasan A, Stucken C, Bradford CR, Eisbruch A, Carey TE, Prince ME, Wolf GT, Worden FP. Randomized trial of laryngeal organ preservation evaluating two cycles of induction chemotherapy with platinum, docetaxel, and a novel Bcl-xL inhibitor. Head Neck 2022; 44:1509-1519. [PMID: 35416374 PMCID: PMC10681682 DOI: 10.1002/hed.27043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Single cycle induction chemotherapy (IC) with platinum and 5-flurouracil (PF) and treatment based on clinical response predicts organ preservation in laryngeal cancer. Other agents offer intriguing alternatives with potentially increased ease of administration, reduced risk for severe toxicities, and increased platinum sensitivity. METHODS We report the results of a phase II bioselection trial in advanced resectable laryngeal cancer utilizing an IC regimen of two cycles of platinum plus docetaxel (TP) with a Bcl-2 inhibitor. The primary endpoint was organ preservation rate at 12 weeks post chemoradiation. RESULTS Fifty-four patients were enrolled. Response to IC was 72%. The organ preservation rate was 59% with a laryngectomy free survival of 46%. Induction related grade ≥3 toxicities were observed in 56% of patients with two grade 5 events. CONCLUSIONS Two cycles of TP IC plus a Bcl-2 inhibitor did not improve laryngeal preservation compared to a single cycle of PF.
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Affiliation(s)
- Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven Bennett Chinn
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleksandar F Dragovic
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shruti Jolly
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robbi Kupfer
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Lynn Mierzwa
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew G Shuman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz Stucken
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol Rossier Bradford
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Avraham Eisbruch
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory T Wolf
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis P Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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9
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Getz KR, Bellile E, Zarins KR, Chinn SB, Taylor JMG, Rozek LS, Wolf GT, Mondul AM. The association between inflammatory biomarkers and statin use among patients with head and neck squamous cell carcinoma. Head Neck 2022; 44:1393-1403. [PMID: 35338544 PMCID: PMC9088158 DOI: 10.1002/hed.27040] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TILs) and cytokines are associated with prognosis among patients with head and neck squamous cell carcinoma (HNSCC). Statins (cholesterol-lowering drugs) may improve HNSCC prognosis, particularly in human papillomavirus (HPV)-positive cases, but the mechanism remains unclear. METHODS Statin use was collected from medical records for HNSCC cases (2008-2014). TILs were counted in tumor tissue, and a total weighted score (TILws) was created. Cytokines were measured in blood. The associations between statins and biomarkers were estimated using logistic (biomarker categories: <median, ≥median) and linear regression models (log-transformed continuous biomarkers) adjusted for age, smoking, and comorbidities. RESULTS We observed a positive association between statins and TILs among HPV-positive patients (TILws odds ratio [OR] = 2.80; 95% CI = 1.03-7.61), but no association among HPV-negative patients. We observed no association between statins and cytokines. CONCLUSIONS Statins may influence TILs in HPV-positive patients. This may be the mechanism through which they improve prognosis in HPV-positive HNSCC patients.
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Affiliation(s)
- Kayla R Getz
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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10
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Chang CM, Chen MM, Bellile EL, Rozek LS, Carey TE, Spector ME, Wolf GT, Taylor JM, Chinn SB. Impact of Nodal Metastases in HPV-negative Oropharyngeal Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1554-1563. [PMID: 35579907 DOI: 10.1158/1055-9965.epi-21-0776] [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] [Received: 06/23/2021] [Revised: 01/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The updated American Joint Committee on Cancer (AJCC) 8th Edition staging manual restructured nodal classification and staging by placing less prognostic emphasis on nodal metastases for HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). However, there was no change for HPV-negative OPSCC. The purpose of our study is to examine the impact of nodal metastases on survival in HPV-negative OPSCC. METHODS HPV-negative OPSCC were queried from the NCDB and SEER databases. Univariable and multivariable models were utilized to determine the impact of nodal status on overall survival. These patients were reclassified according to AJCC 8 HPV-positive criteria (TNM8+) and risk stratification was quantified with C-statistics. RESULTS There were 11,147 cases of HPV-negative OPSCC in the NCDB and 3,613 cases in SEER that were included in the nodal classification analysis. Unlike non-oropharyngeal malignancies, increased nodal stage is not clearly associated with survival for patients with OPSCC independent of HPV status. When the TNM8+ was applied to HPV-negative patients, there was improved concordance in the NCDB cohort, 0.561 {plus minus} 0.004 to 0.624 {plus minus} 0.004 (difference +0.063) and the SEER cohort, 0.561 {plus minus} 0.008 to 0.625 {plus minus} 0.008 (difference +0.065). CONCLUSIONS We demonstrated a reduced impact of nodal metastasis on OPSCC survival, independent of HPV-status and specific to OPSCC. IMPACT We demonstrate, that when nodal staging is de-emphasized as a part of overall staging, we see improved concordance and risk stratification for HPV-negative OPSCC. The exact mechanism of this differential impact remains unknown but offers a novel area of study.
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Affiliation(s)
- Clifford M Chang
- New York University Langone Health, New York, New York, United States
| | | | - Emily L Bellile
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Laura S Rozek
- University of Michigan-Ann Arbor, Ann Arbor, United States
| | - Thomas E Carey
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Matthew E Spector
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Gregory T Wolf
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Steven B Chinn
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
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11
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Maino Vieytes CA, Rodriguez-Zas SL, Madak-Erdogan Z, Smith RL, Zarins KR, Wolf GT, Rozek LS, Mondul AM, Arthur AE. Adherence to a priori-Defined Diet Quality Indices Throughout the Early Disease Course Is Associated With Survival in Head and Neck Cancer Survivors: An Application Involving Marginal Structural Models. Front Nutr 2022; 9:791141. [PMID: 35548563 PMCID: PMC9083460 DOI: 10.3389/fnut.2022.791141] [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: 10/08/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
No studies, to date, have scrutinized the role of a priori dietary patterns on prognosis following a head and neck squamous cell carcinoma (HNSCC) diagnosis. The purpose of this analysis was to evaluate the associations between adherence to six a priori defined diet quality indices (including AHEI-2010, aMED, DASH, and three low-carbohydrate indices) throughout the first 3 years of observation and all-cause and cancer-specific mortalities in 468 newly diagnosed HNSCC patients from the University of Michigan Head and Neck Specialized Program of Research Excellence (UM-SPORE). The dietary intake data were measured using a food frequency questionnaire administered at three annual time points commencing at study entry. Deaths and their causes were documented throughout the study using various data sources. Marginal structural Cox proportional hazards models were used to evaluate the role of diet quality, as a time-varying covariate, on mortality. There were 93 deaths from all causes and 74 cancer-related deaths adjudicated throughout the observation period. There was a strong inverse association between adherence to the AHEI-2010, all-cause mortality (HRQ5–Q1:0.07, 95% CI:0.01–0.43, ptrend:0.04), and cancer-specific mortality (HRQ5–Q1:0.15, 95% CI:0.02–1.07, ptrend:0.04). Other more modest associations were noted for the low-carbohydrate indices. In sum, higher adherence to the AHEI-2010 and a plant-based low-carbohydrate index throughout the first 3 years since diagnosis may bolster survival and prognosis in newly diagnosed patients with HNSCC.
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Affiliation(s)
- Christian A Maino Vieytes
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Sandra L Rodriguez-Zas
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Zeynep Madak-Erdogan
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Rebecca L Smith
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States.,Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Anna E Arthur
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
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12
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Heft Neal ME, Smith JD, Birkeland AC, Haring CT, Chinn SB, Shuman AG, Casper KA, Malloy KM, Stucken CL, Mclean SA, Rosko AJ, Mierzwa ML, Shah J, Schonewolf C, Swiecicki PL, Worden FP, Wolf GT, Bradford CR, Prince MEP, Chad Brenner J, Spector ME. Tumor-Infiltrating Lymphocytes in Patients With Advanced Laryngeal Cancer Undergoing Bioselection. Otolaryngol Head Neck Surg 2022; 166:498-505. [PMID: 34030495 PMCID: PMC8613299 DOI: 10.1177/01945998211013765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bioselection to assess tumor response after induction chemotherapy has been introduced as an alternative treatment strategy to total laryngectomy for patients with advanced larynx squamous cell carcinoma (LSCC). Tumor-infiltrating lymphocytes (TILs) have proven to serve as prognostic biomarkers in head and neck cancer but have not been evaluated as a way to select patients for treatment paradigms. The aim of this study is to evaluate the role of pretreatment TILs in patients with advanced LSCC undergoing the bioselection paradigm. STUDY DESIGN Retrospective study. SETTING Tertiary care hospital. METHODS Patients with advanced LSCC treated with bioselection and available tissue were included (N = 76). Patients were stratified into CD8-low and CD8-high cohorts by using the median TIL count. Kaplan-Meier survival analysis and multivariate cox regression were performed with SPSS version 26 (IBM). RESULTS After controlling for tobacco use, tumor site, and stage, a high CD8 TIL count was an independent predictor of improved 5-year disease-specific survival (hazard ratio, 0.17 [95% CI, 0.03-0.84]; P = .03). CD8 TIL counts did not predict response to induction chemotherapy; however, subgroup analysis of patients treated with chemoradiation therapy revealed that CD8 TIL count was significantly associated with degree of response (P = .012). CONCLUSION These findings support prior data published by our group showing that TILs are predictive of disease-specific survival in patients with head and neck cancer. CD8 TIL counts were significantly associated with degree of clinical response after induction chemotherapy. These results suggest that pretreatment assessment of tumor-infiltrating CD8 cells could be useful in selecting patients.
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Affiliation(s)
- Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Scott A Mclean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Francis P Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH
| | - Mark EP Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
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13
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Nathan CA, Khandelwal AR, Wolf GT, Rodrigo JP, Mäkitie AA, Saba NF, Forastiere AA, Bradford CR, Ferlito A. TP53 mutations in head and neck cancer. Mol Carcinog 2022; 61:385-391. [PMID: 35218075 DOI: 10.1002/mc.23385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
Head and neck squamous cell carcinomas (HNSCCs) arising in the mucosal linings of the upper aerodigestive tract are highly heterogeneous, aggressive, and multifactorial tumors affecting more than half a million patients worldwide each year. Classical etiological factors for HNSCC include alcohol, tobacco, and human papillomavirus (HPV) infection. Current treatment options for HNSCCs encompass surgery, radiotherapy, chemotherapy, or combinatorial remedies. Comprehensive integrative genomic analysis of HNSCC has identified mutations in TP53 gene as the most frequent of all somatic genomic alterations. TP53 mutations are associated with either loss of wild-type p53 function or gain of functions that promote invasion, metastasis, genomic instability, and cancer cell proliferation. Interestingly, disruptive TP53 mutations in tumor DNA are associated with aggressiveness and reduced survival after surgical treatment of HNSCC. This review summarizes the current evidence and impact of TP53 mutations in HNSCC.
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Affiliation(s)
- Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA
| | - Alok R Khandelwal
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Juan P Rodrigo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Arlene A Forastiere
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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14
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Taha HM, Rozek LS, Chen X, Li Z, Zarins KR, Slade AN, Wolf GT, Arthur AE. Risk of Disease Recurrence and Mortality Varies by Type of Fat Consumed before Cancer Treatment in a Longitudinal Cohort of Head and Neck Squamous Cell Carcinoma Patients. J Nutr 2022; 152:1298-1305. [PMID: 35170737 PMCID: PMC9071333 DOI: 10.1093/jn/nxac032] [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: 10/14/2021] [Revised: 11/08/2021] [Accepted: 02/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The associations between specific types of fat and head and neck squamous cell carcinoma (HNSCC) recurrence and mortality rates have not yet been examined. OBJECTIVES The purpose of this study was to determine how intakes of various fat subtypes before cancer treatment are associated with recurrence and mortality in adults diagnosed with HNSCC. METHODS This was a secondary analysis longitudinal cohort study of data collected from 476 newly diagnosed patients with HNSCC. Patients completed baseline FFQs and epidemiologic health surveys. Recurrence and mortality events were collected annually. Fat intakes examined included long-chain fatty acids (LCFAs), unsaturated fatty acids (FAs), PUFAs, ω-3 (n-3) PUFAs, ω-6 (n-6) PUFAs, MUFAs, animal fats, vegetable fats, saturated FAs, and trans fats. Associations between fat intake (categorized into tertiles) and time to event were tested using multivariable Cox proportional hazards models, adjusting for age, sex, smoking status, human papillomavirus status, tumor site, cancer stage, and total caloric intake. Intake of fats was compared with the lowest tertile. RESULTS During the study period, there were 115 recurrent and 211 death events. High LCFA intake was associated with a reduced all-cause mortality risk (HR: 0.55; 95% CI: 0.34, 0.91; P-trend = 0.02). High unsaturated FA intake was associated with a reduced all-cause mortality risk (HR: 0.62; 95% CI: 0.40, 0.97; P-trend = 0.04) and HNSCC-specific mortality risk (HR: 0.51; 95% CI: 0.29, 0.90; P-trend = 0.02). High intakes of ω-3 PUFAs (HR: 0.56; 95% CI: 0.35, 0.91; P-trend = 0.02) and ω-6 PUFAs (HR: 0.57; 95% CI: 0.34, 0.94; P-trend = 0.02) were significantly associated with a reduced all-cause mortality risk. There were no significant associations between other fat types and recurrence or mortality risk. CONCLUSIONS In this prospective survival cohort of 476 newly diagnosed patients with HNSCC, our data suggest that HNSCC prognosis may vary depending on the fat types consumed before cancer treatment. Clinical intervention trials should test these associations.
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Affiliation(s)
- Hania M Taha
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA,Augusta Victoria Hospital, The Lutheran World Federation, East Jerusalem, Palestine
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA,Department of Otolaryngology, University of Michigan Medical School of Public Health, Ann Arbor, MI, USA
| | - Xi Chen
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Zonggui Li
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alexander N Slade
- Department of Radiation Oncology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan Medical School of Public Health, Ann Arbor, MI, USA
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15
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Rabinowits G, Migden MR, Schlesinger TE, Ferris RL, Freeman M, Guild V, Koyfman S, Pavlick AC, Swanson N, Wolf GT, Dinehart SM. Evidence-Based Consensus Recommendations for the Evolving Treatment of Patients with High-Risk and Advanced Cutaneous Squamous Cell Carcinoma. JID Innov 2021; 1:100045. [PMID: 34909742 PMCID: PMC8659794 DOI: 10.1016/j.xjidi.2021.100045] [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: 12/07/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Cutaneous squamous cell carcinoma is the second most common skin cancer in the United States. Currently, there is no standardized management approach for patients with cutaneous squamous cell carcinoma who develop metastatic or locally advanced disease and are not candidates for curative surgery or curative radiation. To address this issue, the Expert Cutaneous Squamous Cell Carcinoma Leadership program convened an expert steering committee to develop evidence-based consensus recommendations on the basis of a large, structured literature review. Consensus was achieved through modified Delphi methodology. The steering committee included five dermatologists, three medical oncologists, two head and neck surgeons, one radiation oncologist, and a patient advocacy group representative. The steering committee aligned on the following clinical topics: diagnosis and identification of patients considered not candidates for surgery; staging systems and risk stratification in cutaneous squamous cell carcinoma; the role of radiation therapy, surgery, and systemic therapy in the management of advanced disease, with a focus on immunotherapy; referral patterns; survivorship care; and inclusion of the patient’s perspective. Consensus was achieved on 34 recommendations addressing 12 key clinical questions. The Expert Cutaneous Squamous Cell Carcinoma Leadership steering committee’s evidence-based consensus recommendations may provide healthcare professionals with practically oriented guidance to help optimize outcomes for patients with advanced cutaneous squamous cell carcinoma.
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Affiliation(s)
- Guilherme Rabinowits
- Division of Hematology Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Michael R Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Todd E Schlesinger
- Dermatology & Laser Center of Charleston, Summerville, South Carolina, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Morganna Freeman
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna C Pavlick
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York City, New York, USA
| | - Neil Swanson
- Oregon Health & Science University, Portland, Oregon, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott M Dinehart
- Arkansas Dermatology & Skin Cancer Center, Little Rock, Arkansas, USA
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16
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Gong W, Donnelly CR, Heath BR, Bellile E, Donnelly LA, Taner HF, Broses L, Brenner JC, Chinn SB, Ji RR, Wen H, Nör JE, Wang J, Wolf GT, Xie Y, Lei YL. Cancer-specific type-I interferon receptor signaling promotes cancer stemness and effector CD8+ T-cell exhaustion. Oncoimmunology 2021; 10:1997385. [PMID: 34858725 PMCID: PMC8632299 DOI: 10.1080/2162402x.2021.1997385] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Type-I interferon (IFN-I) signaling is critical to maintaining antigen-presenting cell function for anti-tumor immunity. However, recent studies have suggested that IFN-I signaling may also contribute to more aggressive phenotypes, raising the possibility that IFN-I downstream signaling in cancer and myeloid cells may exert dichotomous functions.We analyzed the clinicopathologic correlation of cancer-specific IFN-I activation in 195 head and neck squamous cell carcinoma patients. We also characterized the immune impact of IFN-I receptor (IFNAR1)-deficiency in syngeneic tumor models using biochemistry, flow cytometry, and single-cell RNA-Seq. We stained HNSCC tissue microarrays with a sensitive IFN-I downstream signaling activation marker, MX1, and quantitated cancer cell-specific MX1 staining. Kaplan-Meier analysis revealed that MX1-high tumors exhibited worse survival, a phenotype that depends on the number of CD8+ intratumoral T-cells. We found that cancer-specific IFNAR1 engagement promotes cancer stemness and higher expression levels of suppressive immune checkpoint receptor ligands in cancer-derived exosomes. Notably, mice bearing Ifnar1-deficient tumors exhibited lower tumor burden, increased T-cell infiltration, reduced exhausted CD4+PD1high T-cells, and increased effector population CD8+IFN-γ+ T-cells. Then, we performed single-cell RNA-sequencing and discovered that cancer-specific IFN-I signaling not only restricts effector cells expansion but also dampens their functional fitness.The beneficial role of IFN-I activation is largely dependent on the myeloid compartment. Cancer-specific IFN-I receptor engagement promotes cancer stemness and the release of cancer-derived exosomes with high expression levels of immune checkpoint receptor ligands. Cancer-specific IFN-I activation is associated with poor immunogenicity and worse clinical outcomes in HNSCC.
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Affiliation(s)
- Wang Gong
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Christopher R Donnelly
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Blake R Heath
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Lorenza A Donnelly
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Craniofacial and Surgical Services, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Hülya F Taner
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luke Broses
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ru-Rong Ji
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Haitao Wen
- Department of Microbial Infection and Immunity, Ohio State University, Columbus, Ohio, USA
| | - Jacques E Nör
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Cariology, Restorative Science and Endodontics, University of Michigan, Ann Arbor, MI, USA
| | - Jie Wang
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Gregory T Wolf
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Yuying Xie
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Yu Leo Lei
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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17
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Liu S, Bellile E, Nguyen A, Zarins K, Rozek L, Wolf GT, Sartor M. Characterization of the immune response in patients with cancer of the oral cavity after neoadjuvant immunotherapy with the IRX-2 regimen. Oral Oncol 2021; 123:105587. [PMID: 34717154 PMCID: PMC8982160 DOI: 10.1016/j.oraloncology.2021.105587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE IRX-2 is a homologous cell-derived multi-cytokine biologic with multifaceted immune modulatory effects that has been shown to induce increased lymphocyte infiltration into primary tumors in oral cavity carcinoma. Our objective was to characterize tumor immune gene expression and epigenomic changes after neoadjuvant IRX-2 immunotherapy in patients with squamous cell carcinoma of the oral cavity. METHODS A randomized phase II trial was conducted of the IRX regimen 3 weeks prior to surgery for previously untreated patients with Stage II-IV oral cavity carcinoma. The treatment regimen consisted of low dose (300 mg/m2) cyclophosphamide (day 1) followed by 10 days of regional perilymphatic IRX-2 cytokine injections and daily oral indomethacin, zinc and omeprazole (Regimen 1) compared to the identical regimen without the IRX-2 cytokines (Regimen 2). The NanoString immune panel (730 genes) and Infinium MethylationEPIC BeadChip were performed to assess the gene expression and DNA methylation signatures, respectively, in pre- and post-immunotherapy tumor samples. RESULTS A total of 51 and 79 immune-related genes were found upregulated and downregulated, respectively, in the samples from Regimen 1 patients after treatment, while 51 and 56 were found upregulated and downregulated in the samples for Regimen 2. When comparing the changes between the two regimens, we identified 9 genes significantly different, including DMBT1, a potential tumor suppressor, functioning in tumor invasion of head and neck cancer. The exploration of DNA methylation showed slight overall hypermethylation after treatment in both regimens, especially for Regimen 1 immune responders, and methylation-based cell type deconvolution demonstrated high concordance with tumor infiltrating T lymphocyte cell counts. CONCLUSION While a consistent patient response after treatment was observed, most changes were similar between regimens, indicating a subtle, targeted, or patient-specific effect of IRX-2 cytokines. Change in DMBT1 expression was a unique finding that will require further study to better understand its significance.
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Affiliation(s)
- Siyu Liu
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ariane Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Katie Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA,Corresponding authors: To whom correspondence should be addressed: Laura Rozek, Address: 1415 Washington Heights, Ann Arbor, MI 48109; ; Gregory Wolf, Address: 1903 Taubman, Box 5312, Ann Arbor, MI 48109; ; Maureen Sartor, Address: 100 Washtenaw Ave, Ann Arbor, MI 48109;
| | - Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA,Corresponding authors: To whom correspondence should be addressed: Laura Rozek, Address: 1415 Washington Heights, Ann Arbor, MI 48109; ; Gregory Wolf, Address: 1903 Taubman, Box 5312, Ann Arbor, MI 48109; ; Maureen Sartor, Address: 100 Washtenaw Ave, Ann Arbor, MI 48109;
| | - Maureen Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA,Corresponding authors: To whom correspondence should be addressed: Laura Rozek, Address: 1415 Washington Heights, Ann Arbor, MI 48109; ; Gregory Wolf, Address: 1903 Taubman, Box 5312, Ann Arbor, MI 48109; ; Maureen Sartor, Address: 100 Washtenaw Ave, Ann Arbor, MI 48109;
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18
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Herzog AE, Warner KA, Zhang Z, Bellile E, Bhagat MA, Castilho RM, Wolf GT, Polverini PJ, Pearson AT, Nör JE. The IL-6R and Bmi-1 axis controls self-renewal and chemoresistance of head and neck cancer stem cells. Cell Death Dis 2021; 12:988. [PMID: 34689150 PMCID: PMC8542035 DOI: 10.1038/s41419-021-04268-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 06/08/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022]
Abstract
Despite major progress in elucidating the pathobiology of head and neck squamous cell carcinoma (HNSCC), the high frequency of disease relapse correlates with unacceptably deficient patient survival. We previously showed that cancer stem-like cells (CSCs) drive tumorigenesis and progression of HNSCC. Although CSCs constitute only 2–5% of total tumor cells, CSCs contribute to tumor progression by virtue of their high tumorigenic potential and their resistance to chemo-, radio-, and immunotherapy. Not only are CSCs resistant to therapy, but cytotoxic agents actually enhance cancer stemness by activating transcription of pluripotency factors and by inducing expression of Bmi-1, a master regulator of stem cell self-renewal. We hypothesized therapeutic inhibition of interleukin-6 receptor (IL-6R) suppresses Bmi-1 to overcome intrinsic chemoresistance of CSCs. We observed that high Bmi-1 expression correlates with decreased (p = 0.04) recurrence-free survival time in HNSCC patients (n = 216). Blockade of IL-6R by lentiviral knockdown or pharmacologic inhibition with a humanized monoclonal antibody (Tocilizumab) is sufficient to inhibit Bmi-1 expression, secondary sphere formation, and to decrease the CSC fraction even in Cisplatin-resistant HNSCC cells. IL-6R inhibition with Tocilizumab abrogates Cisplatin-mediated increase in CSC fraction and induction of Bmi-1 in patient-derived xenograft (PDX) models of HNSCC. Notably, Tocilizumab inhibits Bmi-1 and suppresses growth of xenograft tumors generated with Cisplatin-resistant HNSCC cells. Altogether, these studies demonstrate that therapeutic blockade of IL-6R suppresses Bmi-1 function and inhibits cancer stemness. These results suggest therapeutic inhibition of IL-6R might be a viable strategy to overcome the CSC-mediated chemoresistance typically observed in HNSCC patients.
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Affiliation(s)
- Alexandra E Herzog
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Kristy A Warner
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Zhaocheng Zhang
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Meera A Bhagat
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Rogerio M Castilho
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Peter J Polverini
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, MI, USA
| | - Alexander T Pearson
- Department of Hematology/Oncology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. .,University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
| | - Jacques E Nör
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA. .,Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA. .,Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, MI, USA. .,University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
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19
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Beesley LJ, Shuman AG, Mierzwa ML, Bellile EL, Rosen BS, Casper KA, Ibrahim M, Dermody SM, Wolf GT, Chinn SB, Spector ME, Baatenburg de Jong RJ, Dronkers EAC, Taylor JMG. Development and Assessment of a Model for Predicting Individualized Outcomes in Patients With Oropharyngeal Cancer. JAMA Netw Open 2021; 4:e2120055. [PMID: 34369988 PMCID: PMC8353539 DOI: 10.1001/jamanetworkopen.2021.20055] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Recent insights into the biologic characteristics and treatment of oropharyngeal cancer may help inform improvements in prognostic modeling. A bayesian multistate model incorporates sophisticated statistical techniques to provide individualized predictions of survival and recurrence outcomes for patients with newly diagnosed oropharyngeal cancer. OBJECTIVE To develop a model for individualized survival, locoregional recurrence, and distant metastasis prognostication for patients with newly diagnosed oropharyngeal cancer, incorporating clinical, oncologic, and imaging data. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, a data set was used comprising 840 patients with newly diagnosed oropharyngeal cancer treated at a National Cancer Institute-designated center between January 2003 and August 2016; analysis was performed between January 2019 and June 2020. Using these data, a bayesian multistate model was developed that can be used to obtain individualized predictions. The prognostic performance of the model was validated using data from 447 patients treated for oropharyngeal cancer at Erasmus Medical Center in the Netherlands. EXPOSURES Clinical/oncologic factors and imaging biomarkers collected at or before initiation of first-line therapy. MAIN OUTCOMES AND MEASURES Overall survival, locoregional recurrence, and distant metastasis after first-line cancer treatment. RESULTS Of the 840 patients included in the National Cancer Institute-designated center, 715 (85.1%) were men and 268 (31.9%) were current smokers. The Erasmus Medical Center cohort comprised 300 (67.1%) men, with 350 (78.3%) current smokers. Model predictions for 5-year overall survival demonstrated good discrimination, with area under the curve values of 0.81 for the model with and 0.78 for the model without imaging variables. Application of the model without imaging data in the independent Dutch validation cohort resulted in an area under the curve of 0.75. This model possesses good calibration and stratifies patients well in terms of likely outcomes among many competing events. CONCLUSIONS AND RELEVANCE In this prognostic study, a multistate model of oropharyngeal cancer incorporating imaging biomarkers appeared to estimate and discriminate locoregional recurrence from distant metastases. Providing personalized predictions of multiple outcomes increases the information available for patients and clinicians. The web-based application designed in this study may serve as a useful tool for generating predictions and visualizing likely outcomes for a specific patient.
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Affiliation(s)
| | - Andrew G. Shuman
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | | | | | - Keith A. Casper
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | - Sarah M. Dermody
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Gregory T. Wolf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Steven B. Chinn
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Emilie A. C. Dronkers
- Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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20
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Haring CT, Ellsperman SE, Edwards BM, Kileny P, Kovatch D, Mannarelli GR, Meloch MA, Miller C, Pitts C, Prince MEP, Bradford CR, Wolf GT, Casper KA, Malloy KM, Chinn SB, Shuman AG, McKean EL, VanKoevering KK, Stucken CL, McLean SA, Marentette LJ, Rosko AJ, Spector ME. Assessment of Intraoperative Nerve Monitoring Parameters Associated With Facial Nerve Outcome in Parotidectomy for Benign Disease. JAMA Otolaryngol Head Neck Surg 2021; 145:1137-1143. [PMID: 31045218 DOI: 10.1001/jamaoto.2019.1041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate postoperative facial nerve weakness in parotid surgery, but published data are lacking on normative values for these parameters or cutoff values to prognosticate facial nerve outcomes. Objective To identify intraoperative facial nerve monitoring parameters associated with postoperative weakness and to evaluate cutoff values for these parameters under which normal nerve function is more likely. Design, Setting, and Participants This retrospective case series of 222 adult patients undergoing parotid surgery for benign disease performed with intraoperative nerve monitoring was conducted at an academic medical institution from September 13, 2004, to October 30, 2014. The data analysis was conducted from May 2018 to January 2019. Main Outcomes and Measures The main outcome measure was facial nerve weakness. Receiver operating characteristic curves were generated to define optimal cut point to maximize the sensitivity and specificity of the stimulation threshold, mechanical events, and spasm events associated with facial nerve weakness. Results Of 222 participants, 121 were women and 101 were men, with a mean (SD) age of 51 (16) years. The rate of temporary facial nerve paresis of any nerve branch was 45%, and the rate of permanent paralysis was 1.3%. The mean predissection threshold was 0.22 milliamperes (mA) (range, 0.1-0.6 mA) and the mean postdissection threshold was 0.24 mA (range, 0.08-1.0 mA). The average number of mechanical events was 9 (range, 0-66), and mean number of spontaneous spasm events was 1 (range, 0-12). Both the postdissection threshold (area under the curve [AUC], 0.69; 95% CI, 0.62-0.77) and the number of mechanical events (AUC, 0.58; 95% CI, 0.50-0.66) were associated with early postoperative facial nerve outcome. The number of spasm events was not associated with facial nerve outcome. The optimal cutoff value for the threshold was 0.25 mA, and the optimal cutoff for number of mechanical events was 8. If a threshold of greater than 0.25 mA was paired with more than 8 mechanical events, there was a 77% chance of postoperative nerve weakness. Conversely, if a threshold was 0.25 mA or less and there were 8 mechanical events or less, there was 69% chance of normal postoperative nerve function. No parameters were associated with permanent facial nerve injury. Conclusions and Relevance Postdissection threshold and the number of mechanical events are associated with immediate postoperative facial nerve function. Accurate prediction of facial nerve function may provide anticipatory guidance to patients and may provide surgeons with intraoperative feedback allowing adjustment in operative techniques and perioperative management.
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Affiliation(s)
- Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Susan E Ellsperman
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Bruce M Edwards
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Paul Kileny
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Deborah Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Gregory R Mannarelli
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Melanie A Meloch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Claire Miller
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Crystal Pitts
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | | | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
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21
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Getz KR, Bellile E, Zarins KR, Rullman C, Chinn SB, Taylor JM, Rozek LS, Wolf GT, Mondul AM. Statin use and head and neck squamous cell carcinoma outcomes. Int J Cancer 2021; 148:2440-2448. [PMID: 33320960 PMCID: PMC8203748 DOI: 10.1002/ijc.33441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/04/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/02/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a morbid cancer with poor outcomes. Statins possess anticancer properties such as immunomodulatory and anti-inflammatory effects. The objective of our study is to identify the association between statin use among untreated HNSCC patients and overall death, disease-specific death and recurrence. HNSCC patients were recruited to participate in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003 to 2014. Statin use data were collected through medical record review. Participants were considered a statin user if they used a statin at or after diagnosis. Outcome data were collected through medical record review, Social Security Death Index or LexisNexis. Our analytic cohort included 1638 participants. Cox proportional hazard models were used to estimate the association between ever statin use and HNSCC outcomes. Statin use was seen in 36.0% of participants. We observed a statistically significant inverse association between ever using a statin and overall death (HR = 0.75, 95% CI = 0.63-0.88) and HNSCC-specific death (HR = 0.79, 95% CI = 0.63-0.99) and a nonstatistically significant inverse association for recurrence (HR = 0.85, 95% CI = 0.70-1.04). When investigating the association between statin use and HNSCC outcomes utilizing interaction terms between statin use and human papillomavirus (HPV), statistically significant interactions for HNSCC-specific death and recurrence were identified (HNSCC-specific death: HPV-positive HR = 0.41, 95% CI = 0.21-0.84; HPV-negative HR = 1.04, 95% CI = 0.71-1.51; p-int=0.02; recurrence: HPV-positive HR = 0.49, 95% CI = 0.29-0.84; HPV-negative HR = 1.03, 95% CI = 0.74-1.43; p=int-0.02). Statin use may be protective for adverse outcomes in HNSCC patients, particularly those with HPV-positive disease. If true, these findings could have a meaningful impact on tertiary prevention for this cancer.
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Affiliation(s)
- Kayla R. Getz
- Department of Epidemiology, University of Michigan School
of Public Health, Ann Arbor, Michigan
| | - Emily Bellile
- Department of Biostatistics, University of Michigan School
of Public Health, Ann Arbor, Michigan
| | - Katie R. Zarins
- Department of Environmental Health Sciences, University of
Michigan School of Public Health, Ann Arbor, Michigan
| | - Cailey Rullman
- Department of Epidemiology, University of Michigan School
of Public Health, Ann Arbor, Michigan
| | - Steven B. Chinn
- Department of Otolaryngology-Head and Neck Surgery,
University of Michigan, Ann Arbor Michigan
| | - Jeremy M.G. Taylor
- Department of Biostatistics, University of Michigan School
of Public Health, Ann Arbor, Michigan
| | - Laura S. Rozek
- Department of Environmental Health Sciences, University of
Michigan School of Public Health, Ann Arbor, Michigan
- Department of Otolaryngology-Head and Neck Surgery,
University of Michigan, Ann Arbor Michigan
| | - Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery,
University of Michigan, Ann Arbor Michigan
| | - Alison M. Mondul
- Department of Epidemiology, University of Michigan School
of Public Health, Ann Arbor, Michigan
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22
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Rodrigo JP, Sánchez-Canteli M, López F, Wolf GT, Hernández-Prera JC, Williams MD, Willems SM, Franchi A, Coca-Pelaz A, Ferlito A. Tumor-Infiltrating Lymphocytes in the Tumor Microenvironment of Laryngeal Squamous Cell Carcinoma: Systematic Review and Meta-Analysis. Biomedicines 2021; 9:biomedicines9050486. [PMID: 33925205 PMCID: PMC8145951 DOI: 10.3390/biomedicines9050486] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023] Open
Abstract
The presence of tumor-infiltrating lymphocytes (TIL) in the tumor microenvironment has been demonstrated to be of prognostic value in various cancers. In this systematic review and meta-analysis, we investigated the prognostic value of TIL in laryngeal squamous cell carcinoma (LSCC). We performed a systematic search in PubMed for publications that investigated the prognostic value of TIL in LSCC. A meta-analysis was performed including all studies assessing the association between TIL counts in hematoxylin-eosin (HE)-stained sections, for CD8+ and/or CD3+/CD4+ TIL and overall survival (OS) or disease-free survival (DFS). The pooled meta-analysis showed a favorable prognostic role for stromal TIL in HE sections for OS (HR 0.57, 95% CI 0.36–0.91, p = 0.02), and for DFS (HR 0.56, 95% CI 0.34–0.94, p = 0.03). High CD8+ TIL were associated with a prolonged OS (HR 0.62, 95% CI 0.4–0.97, p = 0.04) and DFS (HR 0.73, 95% CI 0.34–0.94, p = 0.002). High CD3+/CD4+ TIL demonstrated improved OS (HR 0.32, 95% CI 0.16–0.9, p = 0.03) and DFS (HR 0.23, 95% CI 0.10–0.53, p = 0.0005). This meta-analysis confirmed the favorable prognostic significance of TIL in LSCC. High stromal TIL evaluated in HE sections and intra-tumoral and stromal CD3+, CD4+ and/or CD8+ TIL might predict a better clinical outcome.
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Affiliation(s)
- Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (M.S.-C.); (F.L.); (A.C.-P.)
- IUOPA-University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Mario Sánchez-Canteli
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (M.S.-C.); (F.L.); (A.C.-P.)
- IUOPA-University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (M.S.-C.); (F.L.); (A.C.-P.)
- IUOPA-University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA;
| | | | - Michelle D. Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Stefan M. Willems
- Department of Pathology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (M.S.-C.); (F.L.); (A.C.-P.)
- IUOPA-University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125 Padua, Italy;
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23
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Burgin SJM, Spector ME, Pearson AT, Bellile E, Vainshtein JM, Rosko A, Mclean SA, Bradford CR, Wolf GT, Prince ME, Worden FP, Eisbruch A, Chepeha DB. Long-term neck and shoulder function among survivors of oropharyngeal squamous cell carcinoma treated with chemoradiation as assessed with the neck dissection impairment index. Head Neck 2021; 43:1621-1628. [PMID: 33580560 DOI: 10.1002/hed.26636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Of interest is the long-term neck and shoulder impairment of patients treated with primary chemoradiotherapy (CRT). This is important for counseling patients regarding treatment decisions when discussing primary CRT. METHODS A cross-sectional study to identify factors that contribute to neck and shoulder dysfunction in patients treated with primary CRT. We utilized the neck dissection impairment index (NDII). Eighty-seven patients treated between 2003 and 2010, who were free of disease, responded; 24 of these 87 underwent post-CRT neck dissection. Mean interval since completion of CRT was over 5 years (62.7 months). Mean age, 63.5 years, male:female 75:12. RESULTS Mean NDII score was 87.4 (SD 22.1, range 5-100). Multiple linear regression revealed worse NDII scores for patients with larger pre-CRT gross tumor nodal volume (GTVnodal), controlled for age, sex, body mass index (BMI), and the presence of neck dissection (p = 0.02). There were significant associations with increasing GTVnodal and "low" scores for components of the NDII that assessed neck pain (p = 0.02), neck stiffness (p = 0.01), lifting heavy objects (p = 0.02), reaching overhead (p = 0.02), and ability to do work (p = 0.02). Physical therapy (PT) was evaluated as an "anchor" but it was prescribed "as needed." Regression revealed participation in PT was associated with higher GTVnodal, lower BMI, presence of neck dissection, and female sex (p = 0.00007). CONCLUSION GTVnodal was an independent predictor of neck and shoulder impairment. High GTVnodal was associated with increased pain and stiffness, and increased difficulty lifting heavy objects, reaching overhead, overall ability to perform work-related tasks and was associated with participation in post-treatment PT.
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Affiliation(s)
- Sarah J M Burgin
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | - Emily Bellile
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeffrey M Vainshtein
- Department of Radiation Oncology, White Plains Hospital, White Plains, New York, USA
| | - Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Scott A Mclean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
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24
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Heft Neal ME, Gao RW, Brennan JR, Haring CT, Chinn SB, Shuman AG, Casper KA, Malloy KM, Stucken CL, Mclean SA, Chad Brenner J, Lyden T, Blakely A, Mierzwa ML, Shah J, Schonewolf C, Swiecicki PL, Worden FP, Wolf GT, Bradford CR, Prince MEP, Rosko AJ, Spector ME. Functional outcomes and tracheostomy dependence following salvage oropharyngeal surgery. Oral Oncol 2021; 113:105034. [PMID: 33041214 PMCID: PMC10471134 DOI: 10.1016/j.oraloncology.2020.105034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Purpose: Salvage surgical treatment of oropharyngeal cancer is associated with significant morbidity. We aim to identify predictive factors of functional outcomes to improve patient selection and counseling when contemplating salvage oropharyngectomy. Methods: Patients with a history of radiation requiring salvage oropharyngeal surgery were identified. Primary outcomes were determined at one year post-salvage surgery and included Gastric tube (G-tube) dependence, dietary restrictions, tracheostomy dependence, and speech intelligibility. Multivariate analyses were performed to identify predictors of the primary outcomes. Results: At one year, 45% (22/49) of patients had a G-tube, 68% (33/48) had dietary restrictions, 10% (5/49) remained tracheostomy dependent, and 15% (4/26) had difficulty with speech intelligibility. On univariate analysis, pre-operative G-tube (83% vs. 40%, p=0.04), reconstruction with a free flap (54% vs. 0%, p=0.005), and bony resection (69% vs. 36%, p=0.04) were significantly associated with G-tube dependence at one year. On multivariate analysis, concurrent bony resection remained a significant predictor of G-tube dependence (HR 5.4, 95% CI 1.2–24, p=0.03). Predictors of dietary restriction included free-flap reconstruction (78% vs. 25%, HR 0.13, 95% CI 0.02–0.87, p=0.04) and recurrence after two years (85% vs. 48%, HR 4.9, 95% CI 1.2–21, p=0.03). Supraglottic laryngectomy was significantly associated with tracheostomy dependence on univariate (67% vs. 7%, p=0.001) and multivariate analysis (HR 44.4, 95% CI 2.0–986, p=0.02). Conclusion and Relevance: Functional outcomes are suboptimal after salvage oropharyngectomy. Specific patient and disease factors are independently associated with worse speech and swallowing outcomes and may aid in pre-operative patient selection, risk stratification, and shared decision-making.
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Affiliation(s)
- Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Rebecca W Gao
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Scott A Mclean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Teresa Lyden
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Anna Blakely
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Frank P Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States.
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25
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Luo X, Donnelly CR, Gong W, Heath BR, Hao Y, Donnelly LA, Moghbeli T, Tan YS, Lin X, Bellile E, Kansy BA, Carey TE, Brenner JC, Cheng L, Polverini PJ, Morgan MA, Wen H, Prince ME, Ferris RL, Xie Y, Young S, Wolf GT, Chen Q, Lei YL. HPV16 drives cancer immune escape via NLRX1-mediated degradation of STING. J Clin Invest 2020; 130:1635-1652. [PMID: 31874109 DOI: 10.1172/jci129497] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
The incidence of human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma (HNSCC) has surpassed that of cervical cancer and is projected to increase rapidly until 2060. The coevolution of HPV with transforming epithelial cells leads to the shutdown of host immune detection. Targeting proximal viral nucleic acid-sensing machinery is an evolutionarily conserved strategy among viruses to enable immune evasion. However, E7 from the dominant HPV subtype 16 in HNSCC shares low homology with HPV18 E7, which was shown to inhibit the STING DNA-sensing pathway. The mechanisms by which HPV16 suppresses STING remain unknown. Recently, we characterized the role of the STING/type I interferon (IFN-I) pathway in maintaining immunogenicity of HNSCC in mouse models. Here we extended those findings into the clinical domain using tissue microarrays and machine learning-enhanced profiling of STING signatures with immune subsets. We additionally showed that HPV16 E7 uses mechanisms distinct from those used by HPV18 E7 to antagonize the STING pathway. We identified NLRX1 as a critical intermediary partner to facilitate HPV16 E7-potentiated STING turnover. The depletion of NLRX1 resulted in significantly improved IFN-I-dependent T cell infiltration profiles and tumor control. Overall, we discovered a unique HPV16 viral strategy to thwart host innate immune detection that can be further exploited to restore cancer immunogenicity.
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Affiliation(s)
- Xiaobo Luo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Christopher R Donnelly
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Oral Health Sciences PhD Program, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Wang Gong
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Blake R Heath
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Yuning Hao
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Lorenza A Donnelly
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Toktam Moghbeli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Yee Sun Tan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Xin Lin
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Emily Bellile
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Benjamin A Kansy
- Department of Otolaryngology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Thomas E Carey
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery
| | - J Chad Brenner
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Peter J Polverini
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Oral Health Sciences PhD Program, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Pathology, and
| | - Meredith A Morgan
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Haitao Wen
- Department of Microbial Infection and Immunity, Ohio State University College of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mark E Prince
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery
| | - Robert L Ferris
- Department of Otolaryngology, Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yuying Xie
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Simon Young
- Department of Oral & Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gregory T Wolf
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu L Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Oral Health Sciences PhD Program, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery
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26
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Liu S, de Medeiros MC, Fernandez EM, Zarins KR, Cavalcante RG, Qin T, Wolf GT, Figueroa ME, D'Silva NJ, Rozek LS, Sartor MA. 5-Hydroxymethylation highlights the heterogeneity in keratinization and cell junctions in head and neck cancers. Clin Epigenetics 2020; 12:175. [PMID: 33203436 PMCID: PMC7672859 DOI: 10.1186/s13148-020-00965-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is the sixth most prevalent cancer worldwide, with human papillomavirus (HPV)-related HNSCC rising to concerning levels. Extensive clinical, genetic and epigenetic differences exist between HPV-associated HNSCC and HPV-negative HNSCC, which is often linked to tobacco use. However, 5-hydroxymethylation (5hmC), an oxidative derivative of DNA methylation and its heterogeneity among HNSCC subtypes, has not been studied. RESULTS We characterized genome-wide 5hmC profiles in HNSCC by HPV status and subtype in 18 HPV(+) and 18 HPV(-) well-characterized tumors. Results showed significant genome-wide hyper-5hmC in HPV(-) tumors, with both promoter and enhancer 5hmC able to distinguish meaningful tumor subgroups. We identified specific genes whose differential expression by HPV status is driven by differential hydroxymethylation. CDKN2A (p16), used as a key biomarker for HPV status, exhibited the most extensive hyper-5hmC in HPV(+) tumors, while HPV(-) tumors showed hyper-5hmC in CDH13, TIMP2, MMP2 and other cancer-related genes. Among the previously reported two HPV(+) subtypes, IMU (stronger immune response) and KRT (more keratinization), the IMU subtype revealed hyper-5hmC and up-regulation of genes in cell migration, and hypo-5hmC with down-regulation in keratinization and cell junctions. We experimentally validated our key prediction of higher secreted and intracellular protein levels of the invasion gene MMP2 in HPV(-) oral cavity cell lines. CONCLUSION Our results implicate 5hmC in driving differences in keratinization, cell junctions and other cancer-related processes among tumor subtypes. We conclude that 5hmC levels are critical for defining tumor characteristics and potentially used to define clinically meaningful cancer patient subgroups.
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Affiliation(s)
- Siyu Liu
- Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Ave., Ann Arbor, MI, 48109-2218, USA
| | | | - Evan M Fernandez
- Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Ave., Ann Arbor, MI, 48109-2218, USA
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - Tingting Qin
- Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Ave., Ann Arbor, MI, 48109-2218, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Maria E Figueroa
- Department of Human Genetics and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Nisha J D'Silva
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Ave., Ann Arbor, MI, 48109-2218, USA. .,Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, USA.
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27
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Wolf GT, Liu S, Bellile E, Sartor M, Rozek L, Thomas D, Nguyen A, Zarins K, McHugh JB. Tumor infiltrating lymphocytes after neoadjuvant IRX-2 immunotherapy in oral squamous cell carcinoma: Interim findings from the INSPIRE trial. Oral Oncol 2020; 111:104928. [PMID: 32738599 DOI: 10.1016/j.oraloncology.2020.104928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES IRX-2 is a primary-cell-derived immune-restorative consisting of multiple human cytokines that act to overcome tumor-mediated immunosuppression and provide an in vivo tumor vaccination to increase tumor infiltrating lymphocytes (TILs). A randomized phase II trial was conducted of the IRX regimen 3 weeks prior to surgery consisting of an initial dose of cyclophosphamide followed by 10 days of regional perilymphatic IRX-2 cytokine injections and daily oral indomethacin, zinc and omeprazole (Regimen 1) compared to the identical regimen without IRX-2 cytokines (Regimen 2). METHODS A total of 96 patients with previously untreated, stage II-IV oral cavity SCC were randomized 2:1 to experimental (1) or control (2) regimens (64:32). Paired biopsy and resection specimens from 62 patients were available for creation of tissue microarray (n = 39), and multiplex immunohistology (n = 54). Increases in CD8+ TIL infiltrate scores of at least 10 cells/mm2 were used to characterize immune responders (IR). RESULTS Regimen 1 was associated with significant increases in CD8+ infiltrates (p = 0.01) compared to Regimen 2. In p16 negative cancers (n = 26), significant increases in CD8+ and overall TILs were evident in Regimen 1 (p = 0.004, and 0.04 respectively). IRs were more frequent in Regimen 1 (74% vs 31%, p = 0.01). Multiplex immunohistology for PD-L1 expression confirmed an increase in PD-L1 H score for Regimen 1 compared to Regimen 2 (p = 0.11). CONCLUSIONS The findings demonstrate significant increases in TILs after perilymphatic IRX-2 injections. Three quarters of patients showed significant immune responses to IRX-2. (NCT02609386).
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Affiliation(s)
- Gregory T Wolf
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States.
| | - Siyu Liu
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Emily Bellile
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Maureen Sartor
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Laura Rozek
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Dafydd Thomas
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Ariane Nguyen
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katie Zarins
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jonathan B McHugh
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
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28
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Qin T, Koneva LA, Liu Y, Zhang Y, Arthur AE, Zarins KR, Carey TE, Chepeha D, Wolf GT, Rozek LS, Sartor MA. Significant association between host transcriptome-derived HPV oncogene E6* influence score and carcinogenic pathways, tumor size, and survival in head and neck cancer. Head Neck 2020; 42:2375-2389. [PMID: 32406560 DOI: 10.1002/hed.26244] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/18/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) oncogenes E6, E7, and shorter isoforms of E6 (E6*) are known carcinogenic factors in head and neck squamous cell carcinoma (HNSCC). Little is known regarding E6* functions. METHODS We analyzed RNA-seq data from 68 HNSCC HPV type 16-positive tumors to determine host genes and pathways associated with E6+E7 expression (E6E7) or the percent of full-length E6 (E6%FL). Influence scores of E6E7 and E6%FL were used to test for associations with clinical variables. RESULTS For E6E7, we recapitulated all major known affected pathways and revealed additional pathways. E6%FL was found to affect mitochondrial processes, and E6%FL influence score was significantly associated with overall survival and tumor size. CONCLUSIONS HPV E6E7 and E6* result in extensive, dose-dependent compensatory effects and dysregulation of key cancer pathways. The switch from E6 to E6* promotes oxidative phosphorylation, larger tumor size, and worse prognosis, potentially serving as a prognostic factor for HPV-positive HNSCC.
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Affiliation(s)
- Tingting Qin
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Lada A Koneva
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.,Kennedy Institute of Rheumatology, University of Oxford, United Kingdom
| | - Yidan Liu
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.,Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanxiao Zhang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.,Ludwig Institute for Cancer Research, La Jolla, CA, USA
| | - Anna E Arthur
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.,Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas Chepeha
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Otolaryngology/Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Gregory T Wolf
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
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29
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Swiecicki PL, Li P, Bellile E, Stucken C, Malloy K, Shuman A, Spector ME, Chinn S, Casper K, McLean S, Moyer J, Chepeha D, Wolf GT, Prince M, Bradford C, Nyati M, Eisbruch A, Worden FP, Jolly S, Mierzwa M. Paired phase II trials evaluating cetuximab and radiotherapy for low risk HPV associated oropharyngeal cancer and locoregionally advanced squamous cell carcinoma of the head and neck in patients not eligible for cisplatin. Head Neck 2020; 42:1728-1737. [PMID: 31989702 DOI: 10.1002/hed.26085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Alternative therapeutic strategies are needed for localized oropharyngeal carcinoma. Cetuximab represents a potential option for those ineligible for cisplatin or, until recently, an agent for de-escalation in low risk HPV+ oropharyngeal carcinoma (OPSCC). Our objective was to define the toxicity and efficacy of cetuximab-radiotherapy. METHODS We conducted paired phase II trials evaluating cetuximab-radiotherapy in two cohorts (a) low risk HPV+ OPSCC and (b) cisplatin ineligible. The mean follow-up was 48 months. RESULTS Forty-two patients were enrolled in cohort A with a 2-year disease free survival (DFS) of 81%. Twenty-one patients were enrolled in cohort B prior to closure due to adverse outcomes with a 2-year DFS of 37%. Severe toxicities were seen in 60% of patients, 30% required enteral nutrition. CONCLUSION Among cisplatin ineligible patients, cetuximab treatment engendered poor outcomes. Rates of severe toxicities were on par with platinum-based regimens suggesting that cetuximab is not a benign treatment.
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Affiliation(s)
- Paul L Swiecicki
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
| | - Pin Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Emily Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Chaz Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kelly Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Keith Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jeffery Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
| | - Carol Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mukesh Nyati
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Francis P Worden
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Radiation Oncology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
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Farlow JL, Birkeland AC, Hardenbergh A, Lyden T, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 2020; 277:1459-1465. [PMID: 31989269 DOI: 10.1007/s00405-020-05809-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/29/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation. METHODS Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations. RESULTS Median time from radiation to laryngectomy was 2.8 years (range 0.5-27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002-0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period. CONCLUSIONS Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew C Birkeland
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA
| | - Anna Hardenbergh
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Teresa Lyden
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - J Chad Brenner
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Steven B Chinn
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Chaz L Stucken
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Kelly M Malloy
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Keith A Casper
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Mark E P Prince
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Carol R Bradford
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Gregory T Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Rosko
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| | - Matthew E Spector
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
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Spector ME, Bellile E, Amlani L, Zarins K, Smith J, Brenner JC, Rozek L, Nguyen A, Thomas D, McHugh JB, Taylor JMG, Wolf GT. Prognostic Value of Tumor-Infiltrating Lymphocytes in Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2019; 145:1012-1019. [PMID: 31486841 DOI: 10.1001/jamaoto.2019.2427] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Biomarkers that reflect prognosis and cellular immunity in patients with head and neck squamous cell carcinoma (HNSCC) are a prerequisite for improving individualized treatment that limits the intensity and morbidity of conventional treatment and may be useful in the introduction of new immunotherapy regimens. Objective To determine if specific classes of tumor-infiltrating lymphocytes (TILs) in pretreatment biopsy specimens have prognostic value for outcomes in a large training and validation cohort of patients with HNSCC. Design, Setting, and Participants In this prospective, epidemiologic study with a median follow-up of 47.5 months, in 464 previously untreated patients with available tissue for construction of tissue microarray, HNSCC disease sites included oral cavity (228), oropharynx (147), larynx (74), and hypopharynx (15). The training cohort consisted of 241 patients and the validation cohort consisted of 223 patients. Overall tumor stage was I (55), II (69), III (71), or IV (269). Patients were enrolled between November 2008 to October 2014. Data were analyzed between October 2018 to April 2019. Main Outcomes and Measures Semiquantitative levels of CD4, CD8, and FoxP3 lymphocytes were assessed by immunohistologic analysis and correlations with clinical prognostic factors, initial treatment modality, and overall survival (OS) and disease-specific (DSS) survival were determined. A principal component analysis was performed to generate a combined TIL-weighted sum score (TILws). Results Of the 464 participants, 135 (29%) were women; mean (SD) age was 61.1 (11.8) years. Higher CD8 counts were associated with improved OS in both training and validation sets (HR, 0.94; 95% CI, 0.90-0.98; and HR, 0.97; 95% CI, 0.95-0.99, respectively). Higher TILws levels were associated with improved OS and DSS in both the training set (HR, 0.91; 95% CI, 0.86-0.96; and HR, 0.93; 95% CI, 0.87-0.99, respectively) and validation set (HR, 0.96; 95% CI, 0.93-0.99; and HR, 0.94; 95% CI, 0.89-0.99, respectively). A multivariable Cox model controlling for batch, age, clinical stage, disease site, comorbidities, HPV status, and smoking, showed that higher TILws levels were associated with improved OS and DSS (HR, 0.94; 95% CI, 0.92-0.97; and HR, 0.94; 95% CI, 0.90-0.98, respectively). When grouped by treatment (surgery vs chemoradiation) and tested for interaction, treatment was found to be an effect modifier for CD4 levels and OS. Low CD4 levels were showed greater association with decreased survival in the chemoradiation cohort than the surgery cohort. Conclusions and Relevance The findings from this large cohort study suggest that levels of TILs are an independent prognostic factor in patients with HNSCC. Subsets of TILs and combined TIL scores may be clinically useful predictive and prognostic factors.
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Affiliation(s)
- Matthew E Spector
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
| | - Emily Bellile
- Center for Cancer Biostatistics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lahin Amlani
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Katie Zarins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Joshua Smith
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
| | - J Chad Brenner
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
| | - Laura Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Ariane Nguyen
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
| | - Daffyd Thomas
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Jeremy M G Taylor
- Center for Cancer Biostatistics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
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Maino Vieytes CA, Mondul AM, Li Z, Zarins KR, Wolf GT, Rozek LS, Arthur AE. Dietary Fiber, Whole Grains, and Head and Neck Cancer Prognosis: Findings from a Prospective Cohort Study. Nutrients 2019; 11:nu11102304. [PMID: 31569808 PMCID: PMC6835374 DOI: 10.3390/nu11102304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
No studies, to date, have examined the relationship between dietary fiber and recurrence or survival after head and neck cancer diagnosis. The aim of this study was to determine whether pretreatment intake of dietary fiber or whole grains predicted recurrence and survival outcomes in newly diagnosed head and neck cancer (HNC) patients. This was a prospective cohort study of 463 participants baring a new head and neck cancer diagnosis who were recruited into the study prior to the initiation of any cancer therapy. Baseline (pre-treatment) dietary and clinical data were measured upon entry into the study cohort. Clinical outcomes were ascertained at annual medical reviews. Cox proportional hazard models were fit to examine the relationships between dietary fiber and whole grain intakes with recurrence and survival. There were 112 recurrence events, 121 deaths, and 77 cancer-related deaths during the study period. Pretreatment dietary fiber intake was inversely associated with risk of all-cause mortality (hazard ratio (HR): 0.37, 95% confidence interval (CI): 0.14–0.95, ptrend = 0.04). No statistically significant associations between whole grains and prognostic outcomes were found. We conclude that higher dietary fiber intake, prior to the initiation of treatment, may prolong survival time, in those with a new HNC diagnosis.
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Affiliation(s)
- Christian A Maino Vieytes
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48103, USA.
| | - Zonggui Li
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48103, USA.
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48103, USA.
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48103, USA.
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48103, USA.
| | - Anna E Arthur
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
- Carle Cancer Center, Carle Foundation Hospital, Urbana, IL 61801, USA.
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Heft Neal ME, Brennan J, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy. Ann Surg Oncol 2019; 27:451-457. [PMID: 31538289 DOI: 10.1245/s10434-019-07841-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. For patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. This study aimed to determine predictors, prevalence, and distribution of nodal disease in patients treated with salvage oropharyngectomy. METHODS In a case series with data collection at a single tertiary academic National Cancer Institute (NCI)-designated comprehensive cancer center, this study analyzed patients treated with prior radiation or chemoradiation who had persistent, recurrent, or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n = 95). Clinical and oncologic characteristics and treatment outcomes were collected, and statistical analyses were performed. RESULTS The overall rate of nodal positivity was 21% (24/95), and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level 2 were the most common areas harboring positive nodes. Bivariate analysis showed female sex (p = 0.01), initial overall stage (p = 0.02), and N status (p = 0.03), as well as recurrent overall and T stage (p = 0.05) to be predictors of nodal disease. In the multivariate analysis, recurrent T stage continued to be significantly predictive of pathologic nodal disease. Both computed tomography (CT) and positron emission tomography-CT were moderately accurate in predicting nodal disease in the salvage setting (area under the curve, 0.79 and 0.80, respectively). CONCLUSION Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identified factors predictive of nodal disease in patients undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting.
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Affiliation(s)
- M E Heft Neal
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J Brennan
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J C Brenner
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - A G Shuman
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S B Chinn
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C L Stucken
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K M Malloy
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J S Moyer
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K A Casper
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S A McLean
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E P Prince
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C R Bradford
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - G T Wolf
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - D B Chepeha
- Head and Neck Surgical Oncology and Reconstructive Microsurgery, Department of Otolaryngology, Department of Surgical Oncology, University of Toronto, Toronto, ON, USA
| | - A J Rosko
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E Spector
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Crowder SL, Sarma KP, Mondul AM, Chen YT, Li Z, Pepino MY, Zarins KR, Wolf GT, Rozek LS, Arthur AE. Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:1652-1659. [PMID: 31315911 DOI: 10.1158/1055-9965.epi-19-0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/07/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dietary inflammatory potential could impact the presence and severity of chronic adverse treatment effects among patients with head and neck cancer. The objective of this study was to determine whether pretreatment dietary patterns are associated with nutrition impact symptoms (NIS) as self-reported 1 year after diagnosis. METHODS This was a longitudinal study of 336 patients with newly diagnosed head and neck cancer enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence. Principal component analysis was utilized to derive pretreatment dietary patterns from food frequency questionnaire data. Burden of seven NIS was self-reported 1 year after diagnosis. Associations between pretreatment dietary patterns and individual symptoms and a composite NIS summary score were examined with multivariable logistic regression models. RESULTS The two dietary patterns that emerged were prudent and Western. After adjusting for age, smoking status, body mass index, tumor site, cancer stage, calories, and human papillomavirus status, significant inverse associations were observed between the prudent pattern and difficulty chewing [OR 0.44; 95% confidence interval (CI), 0.21-0.93; P = 0.03], dysphagia of liquids (OR 0.38; 95% CI, 0.18-0.79; P = 0.009), dysphagia of solid foods (OR 0.46; 95% CI, 0.22-0.96; P = 0.03), mucositis (OR 0.48; 95% CI, 0.24-0.96; P = 0.03), and the NIS summary score (OR 0.45; 95% CI, 0.22-0.94; P = 0.03). No significant associations were observed between the Western pattern and NIS. CONCLUSIONS Consumption of a prudent diet before treatment may help reduce the risk of chronic NIS burden among head and neck cancer survivors. IMPACT Dietary interventions are needed to test whether consumption of a prudent dietary pattern before and during head and neck cancer treatment results in reduced NIS burden.
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Affiliation(s)
- Sylvia L Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Kalika P Sarma
- Carle Cancer Center, Carle Foundation Hospital, Urbana, Illinois
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Yi Tang Chen
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zonggui Li
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - M Yanina Pepino
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Anna E Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois. .,Carle Cancer Center, Carle Foundation Hospital, Urbana, Illinois
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Swiecicki P, Bellile E, Casper K, Malloy KM, Kupfer R, Spector ME, Shuman A, Chinn SB, Stucken C, Srinivasan A, Owen D, Dragovic AF, Mierzwa M, Jolly S, Bradford CR, Eisbruch A, Carey TE, Prince ME, Wolf GT, Worden FP. A randomized trial of laryngeal organ preservation evaluating two cycles of induction chemotherapy with platinum, docetaxel, and a novel Bcl-xL inhibitor. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
6066 Background: Laryngeal bio-selection with induction chemotherapy (platinum + 5-FU infusion: PF) has been demonstrated to result in impressive rates of survival and organ preservation with moderate toxicities. We sought to reduce the toxicity of PF by substituting docetaxel (T) for 5-FU and improve the tumor response rate with the addition of the Bcl-xL inhibitor AT-101. Methods: Pts with advanced stage laryngeal cancer were treated with 1 cycle of T 75 mg/m2 + platinum (P) (cisplatin 100 mg/m2 or carboplatin AUC 6) and were randomized 2:1 to the addition of AT-101. Patients with a CR proceeded to chemoradiation (CRT) with concurrent weekly P. All pts with PR or NR underwent a second cycle of induction with TP + AT-101. Pts with a > 50% response (CR or PR) after the second cycle of induction chemotherapy underwent CRT. Pts with a ≤ 50% response (NR) underwent laryngectomy. PET-CT was performed 12 weeks after CRT. Pts with residual disease underwent salvage laryngectomy (SL). Results: 54 eligible pts were enrolled; 46 M, 8 F; median age 59; 26 T4; stage III 16, stage IV 38; site: 2 hypopharyngeal, 39 supraglottic, 11 glottic, 2 subglottic. After cycle 1 of induction, 2/54 (4%) died prior to assessment by DL and 2 were removed from protocol due to adverse events (AEs). 29/50 pts (58%) had ≥ 50% response, 3 of which had CR; 2 proceeded to CRT & 1 received a 2nd cycle of IC. 21/50 pts (42%) had < 50% response. A total of 48 pts received cycle 2 of IC. After the 2nd cycle, a total of 39/50 pts (78%) had ≥ 50% response & received CRT. No difference in response was seen with addition of AT-101. 11/50 pts (22%) had < 50% response- 8 had laryngectomy & 3 refused. Following CRT, 10 pts underwent SL, 2 for residual disease & 8 late SL. The organ preservation rate was 31/50 (62%). The most common grade 3/4 toxicities associated with IC were nausea 9%, neutropenia 9%, & infection 7%. 1 pt died of CNS hemorrhage unrelated to therapy & 1 from sepsis. The median follow-up time is 28 months. The 2 yr laryngectomy-free survival is 54% (95% CI:38-68) & 2 yr overall survival is 81% (95% CI: 64-90). Conclusions: AT-101 did not improve responses to P. Treatment with 2 cycles of IC with PT produced similar response rates to our institutional controls, but organ preservation was somewhat less following treatment with weekly P + RT. Toxicities were overall improved with this treatment strategy. Clinical trial information: NCT01633541.
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Affiliation(s)
- Paul Swiecicki
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Emily Bellile
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Keith Casper
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Kelly M Malloy
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Robbi Kupfer
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Andrew Shuman
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Chaz Stucken
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Dawn Owen
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Shruti Jolly
- University of Michigan/Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | - Mark E Prince
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Risch Z, Bellile E, Townsend R, Swiecicki P, Casper K, Malloy KM, Hogikyan ND, Spector ME, Shuman A, Stucken C, Chinn SB, Chepeha DB, Jolly S, Mierzwa ML, Bradford CR, Eisbruch A, Carey TE, Prince ME, Wolf GT, Worden FP. Association of low neutrophil-to-lymphocyte ratios (NLR) and high lymphocyte-to-monocyte ratios (LMR) with overall survival and response to induction chemotherapy (IC) when used to select patients (pts) with locally advanced squamous cell of the larynx (LSCC) for combined chemoradiation (CRT). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17539 Background: University of Michigan Cancer Center (UMCC) protocol 9520 treated pts with stage III/IV LSCC with 1 cycle of cisplatin & 5-FU (PF) to select pts for definitive therapy. Pts whose tumors attained a ≥ 50% response after 1 cycle of PF underwent CRT. Those who had a < 50% response to IC were treated with total laryngectomy + RT. Correlative science from UMCC 9520 demonstrated that an increased percentage of CD4+ cells predicted response to PF & suggested improved survival. Published retrospective data also has demonstrated that lower NLR & higher LMR are associated with improved prognosis in p16- SCC of the oropharynx & pyriform sinus, while cancers with higher NLR & lower LMR have a worse prognosis. Similar to our previous correlative analysis, this study is also a secondary analysis of the predictive value of NLR & LMR in a prospective trial of bio-selective IC. Methods: NLR & LMR were calculated from pre-treatment CBC for all pts (N = 87) enrolled onto UMCC 9520. Results: All 87 pts received IC with PF. 65/87 (75%) responded to IC & received CRT. Results of response to IC compared the NLR & LMR ratios by logistic regression analysis & was used to create NLR & LMR cut points. Among pts with LMR ≥ 3, the response rate (RR) was 89% while the RR was 64% with LMR < 3 (p = 0.008). Among pts with NLR < 4.7, the RR was 79% while the RR of pts with > 4.7 was 58% (p = 0.06). Overall & disease specific survivals were greater in pts with LMR ≥ 3, (log rank p = 0.04, p = 0.03, respectively). Conclusions: Higher LMR & lower NLR are associated with favorable responses to IC & LMR ≥ 3 is associated with improved survival. This data correlates strongly with our published results from UMCC 9520, whereby elevated circulating CD4+ lymphocytes predict response to IC & survival. This important information may help direct the design of future laryngeal preservation protocols.
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Affiliation(s)
| | - Emily Bellile
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Paul Swiecicki
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Keith Casper
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Kelly M Malloy
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Andrew Shuman
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Chaz Stucken
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Shruti Jolly
- University of Michigan/Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | | | - Mark E Prince
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Douglas KG, Crowder SL, Rozek LS, Wolf GT, Arthur A. Associations between pretreatment body mass index and presence of post-treatment nutrition impact symptoms in head and neck cancer survivors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17547] [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
e17547 Background: The objective of this study was to determine if pre-treatment body mass index (BMI) is associated with the presence of self-reported, nutrition impact symptoms (NIS) 1-year post-treatment in head and neck cancer (HNC) survivors. We hypothesize that higher pre-treatment BMI may be associated with fewer reported NIS post treatment. Methods: This was a longitudinal study of 430 HNC survivors recruited from the University of Michigan Head and Neck Specialized Program of Research Excellence (HN-SPORE) study. Participants completed a pre-treatment health questionnaire which included self-reported height and weight. NIS were assessed at 1-year post-treatment using a Likert scale ranging from 1 (not at all) vs 5 (extremely) bothered by symptoms. Eight individual NIS were assessed (trismus, xerostomia, bothered chewing, dysphagia liquids, dysphagia solids, taste changes, mucositis, and shoulder or neck pain). Individual symptoms were summed to create a symptom summary score. Self-reported pre-treatment height and weight were used to calculate BMI in kg/m2. BMI was categorized as 1) underweight, 2) normal weight, 3) overweight and 4) obese. Pearson partial correlations between pre-treatment BMI status and individual post-treatment NIS and post-treatment NIS summary score were examined. Covariates included age, sex, tumor site, disease stage, smoking, alcohol consumption, and HPV status. Results: BMI was significantly inversely associated with bothered chewing, dysphagia liquids, dysphagia solids, taste alterations, and shoulder pain (p < 0.05). BMI was also significantly inversely correlated with the overall symptom summary score. Conclusions: Higher pre-treatment BMI may be associated with reduced risk of post-diagnosis symptom burden in HNC survivors. Funding: NIH/NCI P50CA097248; Hatch project 1011487; Carle-Illinois Cancer Scholars for Translational and Applied Research Fellowship.
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Affiliation(s)
- Katherine G. Douglas
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Sylvia L. Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Laura S. Rozek
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Anna Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
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Sanchez K, Martel M, Chang SC, Wu Y, Sun Z, Nyberg R, Redmond WL, Pucilowska J, Aliabadi-Wahle S, Imatani J, Conlin AK, Bernard B, Shah M, Wadell D, Laxague DR, Wen L, Li Q, Wolf GT, Urba WJ, Page DB. Evaluation of immunotherapy (I-O)-associated immune cell (IC) dynamics and PD-L1 expression using multispectral immunohistochemistry (mIHC) and single-cell hierarchical regression modeling in early-stage breast cancer (ESBC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12070] [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
e12070 Background: In triple negative breast cancer (TNBC), anti-PD-L1 is associated with gains in overall survival, however only in tumors with > 1% PD-L1+ ICs. Locoregional cytokine therapy is being evaluated as a method of priming and redirecting ICs to tumors, which may increase I-O benefit particularly in PD-L1 negative tumors. We report a sensitive method of quantifying I-O-related changes in PD-L1 and ICs using mIHC and single-cell hierarchical regression, which controls for within-tumor and across-patient PD-L1/IC heterogeneity. Methods: Pre-treatment and resection tissues from a phase Ib trial of locoregional cytokines (IRX-2, n = 16 subjects) in ESBC were analyzed. IRX-2 contains immunostimulatory cytokines (GM-CSF, IL-2, IFN-α, INF-γ, and IL-12) and was injected in peri-areolar tissue, which communicates directly with tumor-draining lymphatics. Specimens were analyzed for 1) H&E stromal TILs score; 2) clinical PD-L1 IC expression (Ventana SP142, 2 blinded pathologists); and 3) mIHC (PerkinElmer Vectra). InForm software was used to obtain geospatial outputs of tumor cells (CK+) and ICs (CD3, CD8, CD163) across multiple regions of interest (mean:18; range: 9-32). Mixed-effects modeling was used to evaluate for changes in PD-L1, ICs, and IC/tumor distance metrics. Results: PD-L1 and IC quantity by mIHC was highly concordant with clinical PD-L1 IC classification (JT test = 211, p < .001) and TIL score (r = 0.77). Cytokine therapy was associated with higher PD-L1 IC classification in 9/13 tumors, and increased PD-L1 ICs by mIHC in 14/15 (+337%, 95% CI: 120,769%). After adjusting for heterogeneity, cytokine therapy increased CD3+CD8+ ICs (+173%, CI: 93,287%) and CD3+CD8- ICs (+120%, CI: 21,301%). Therapy was also associated with increased effector-helper T-cell clustering (nearest-neighbor distance, -40%, CI: -29,-50%) and effector cell tumor localization (stromal-tumor interface CD8+ density +90%, Cl: 74, 305%). Conclusions: Our method is concordant with clinical PD-L1 and sTILs scores, and can additionally quantify IC and IC distances. This assay may allow for comparative I-O assessments with increased resolution, and will be used in a randomized phase II trial of pembrolizumab, chemo +/- IRX-2 in stage II/III TNBC.
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Affiliation(s)
- Katherine Sanchez
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - Maritza Martel
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | | | - Yaping Wu
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - Zhaoyu Sun
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - Richard Nyberg
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - William L Redmond
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - Joanna Pucilowska
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | | | - James Imatani
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | | | - Brady Bernard
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - Monil Shah
- Brooklyn ImmunoTherapeutics, New York, NY
| | | | | | - Lu Wen
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Qiao Li
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Walter John Urba
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | - David B. Page
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
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Wen L, Wolf GT, Shah M, Page DB, Sadowski-Mason L, Prince M, Moyer J, Chang AE, Li Q. IRX-2 therapy with PD-L1 blockade in immunocompetent animal model. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
e14149 Background: Multiple therapeutic components in IRX-2 including IL-2, IL-1, IFN-γ, TNFα, IL-6, GM-CSF, and IL-8 work synergistically to activate various immune cells including T cells, dendritic cells, and natural killer cells to recognize and kill tumors. Previous Phase 1 and Phase 2a clinical trials in head and neck cancer with IRX-2 have shown a benign safety profile. Immunologically stimulating host immunity using IRX-2, while simultaneously blocking PD-1/PD-L1-mediated immune suppression, may have the potential to enhance the outcome of current immunotherapy using IRX-2 alone. Methods: Healthy C3H mice were inoculated with SCC7 murine head and neck cancer cells. Fourteen days after inoculation, the tumor-bearing mice were treated with subcutaneous injection of IRX-2 once a week for 3 weeks, followed with anti-mPD-L1(i.p.) injection after each IRX-2 administration. Tumor size and survival were monitored for the therapeutic efficacy evaluation. Two weeks after the last IRX-2 administration, all mice were sacrificed and spleen, blood and residual tumor samples were harvested for immune function assays. Results: High levels of PD-L1 were expressed on SCC7 cell line and fresh tumors. The FCM data suggested that PD-L1 was preferentially expressed on the ALDHhigh SCC7 cancer stem cells. IRX-2 alone significantly inhibited SCC7 tumor growth, and the anti-tumor efficacy of IRX-2 was significantly enhanced by anti-mPD-L1 injection in a dose dependent manner in the immunocompetent hosts. Serum IgG from animals subjected to IRX-2 plus anti-mPD-L1 treatment mediated significantly (p < 0.05) higher cytotoxicity on SCC7 cells via ADCC than the IgG from animals treated with IRX-2 alone. CD8+ lymphocytes isolated from purified, activated and expanded CD3+ splenic T cells harvested from the animals subjected to IRX-2+anti-mPD-L1 treatment mediated significantly (p < 0.05) higher cytotoxicity than those subjected to IRX-2 or anti-PD-L1 mono-therapy against SCC7 tumor cells. Conclusions: Co-administration of IRX-2 and anti-PD-L1 promoted more powerful antitumor immunity with both B cell and T cell modulation. The combination treatment increased the specific IgG production that could kill tumor cells via ADCC, and enhanced the T cell CTL activity. Therefore, IRX-2 therapy plus anti-PD-L1 administration may represent a promising novel strategy to treat cancer patients.
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Affiliation(s)
- Lu Wen
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Monil Shah
- Brooklyn ImmunoTherapeutics, New York, NY
| | - David B. Page
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, OR
| | | | - Mark Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | | | | | - Qiao Li
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Taha HM, Rozek LS, Chen YT, Slade AN, Wolf GT, Arthur A. Risk of mortality varies by type of fat consumed in a longitudinal cohort of head and neck cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6056] [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
6056 Background: Dietary interventions have promise for improving cancer outcomes, but remain an understudied area of cancer care. The relationship between head and neck squamous cell carcinoma (HNSCC) mortality and dietary fat intake has not yet been examined. The objective of this study was to determine how pre- and post-treatment intake of various types of fat are associated with disease-specific and all-cause mortality in adults diagnosed with HNSCC. Methods: Our sample included 472 newly diagnosed HNSCC patients recruited into the University of Michigan Head and Neck Specialized Program of Research Excellence (HN-SPORE) between 2008 and 2012. Participants completed pre-treatment and post-treatment Food Frequency Questionnaires (FFQs) and health surveys. Multivariable Cox Proportional Hazards models were used to test the associations between both the type and quantity of fat intake (categorized into tertiles: low, medium and high intake) and time to mortality, after adjusting for relevant covariates. Fat types included animal, vegetable, medium-chain-fatty-acids (MCFA), long-chain-fatty-acids (LCFA), unsaturated, saturated, and trans. Results: During the study period, there were 144 total deaths and 97 cancer-specific deaths. In considering pre-treatment dietary intake, compared to low intake levels of LCFA, high intake was associated with a reduced risk of all-cause mortality (HR: 0.57; 95% CI: 0.34–0.94). High intakes of unsaturated-fats were associated with a reduced risk of HNSCC-specific mortality compared to low intake (HR 0.52; 95% CI: 0.29–0.93). Considering post-treatment dietary variables, medium (HR: 0.21; 95% CI: 0.08–0.49) and high (HR: 0.41; 95% CI: 0.21–0.78) total fat intakes were associated with reduced risk of all-cause mortality compared to low intake. Medium (HR: 0.25; 95% CI: 0.08–0.67) and high (HR: 0.26; 95% CI: 0.09–0.67) total fat intakes were associated with reduced risk of HNSCC-specific mortality compared to low intake. Conclusions: Our data suggest that HNSCC prognosis may vary depending on both the type and quantity of fats consumed, specifically total fat and long chain fatty acids. Clinical intervention trials are needed to further examine this hypothesis.
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Affiliation(s)
- Hania M. Taha
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Laura S. Rozek
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Yi Tang Chen
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
| | | | | | - Anna Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
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Hawkins PG, Mierzwa ML, Bellile E, Jackson WC, Malloy KM, Chinn SB, Spector ME, Shuman AG, Stucken CL, McLean SA, Bradford CR, Prince ME, Carey TE, Worden FP, Swiecicki PL, Taylor JMG, Wolf GT, Eisbruch A, Casper KA. Impact of American Joint Committee on Cancer Eighth Edition clinical stage and smoking history on oncologic outcomes in human papillomavirus-associated oropharyngeal squamous cell carcinoma. Head Neck 2019; 41:857-864. [PMID: 30775826 PMCID: PMC6420360 DOI: 10.1002/hed.25336] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/15/2017] [Revised: 01/22/2018] [Accepted: 05/07/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the AJCC eighth edition clinical staging system for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma and to further understand how clinical stage and smoking history affect oncologic outcomes. The purpose of this study was to present the understanding of how clinical stage and smoking history affect oncologic outcomes in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) is critical for selecting patients for treatment deintensification. METHODS Kaplan-Meier and Cox regression were used to evaluate overall survival (OS), locoregional recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS). Concordance statistics (C-indices) were used to compare discriminating ability. RESULTS The OS and DRFS but not LRFS were significantly distributed using the American Joint Committee on Cancer (AJCC) seventh and eighth editions criteria. The C-indices for OS, LRFS, and DRFS were 0.57, 0.54, and 0.60, respectively, using the AJCC seventh edition, and 0.63, 0.53, and 0.65, respectively, using the AJCC eighth edition. On multivariate analysis, 1 + pack-year smoking history correlated with OS (hazard ratio [HR] 1.96; 95% confidence interval [CI] 1.2-3.1; P < .01) but not LRFS or DRFS. CONCLUSION These results support implementation of the AJCC eighth edition for HPV-associated oropharyngeal SCC. Clinical stage may be more important than smoking history in selection for deintensification.
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Affiliation(s)
- Peter G. Hawkins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle L. Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - William C. Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M. Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B. Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew E. Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G. Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chaz L. Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott A. McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Carol R. Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E. Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas E. Carey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Francis P. Worden
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Paul L. Swiecicki
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | - Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Keith A. Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
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Rozek LS, Virani S, Bellile EL, Taylor JMG, Sartor MA, Zarins KR, Virani A, Cote C, Worden FP, Mark MEP, McLean SA, Duffy SA, Yoo GH, Saba NF, Shin DM, Kucuk O, Wolf GT. Soy Isoflavone Supplementation Increases Long Interspersed Nucleotide Element-1 (LINE-1) Methylation in Head and Neck Squamous Cell Carcinoma. Nutr Cancer 2019; 71:772-780. [PMID: 30862188 PMCID: PMC6513708 DOI: 10.1080/01635581.2019.1577981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/08/2018] [Revised: 11/13/2018] [Accepted: 12/26/2018] [Indexed: 12/20/2022]
Abstract
AIM Soy isoflavones have been suggested as epigenetic modulating agents with effects that could be important in carcinogenesis. Hypomethylation of LINE-1 has been associated with head and neck squamous cell carcinoma (HNSCC) development from oral premalignant lesions and with poor prognosis. To determine if neoadjuvant soy isoflavone supplementation could modulate LINE-1 methylation in HNSCC, we undertook a clinical trial. METHODS Thirty-nine patients received 2-3 weeks of soy isoflavone supplements (300 mg/day) orally prior to surgery. Methylation of LINE-1, and 6 other genes was measured by pyrosequencing in biopsy, resection, and whole blood (WB) specimens. Changes in methylation were tested using paired t tests and ANOVA. Median follow up was 45 months. RESULTS LINE-1 methylation increased significantly after soy isoflavone (P < 0.005). Amount of change correlated positively with days of isoflavone taken (P = 0.04). Similar changes were not seen in corresponding WB samples. No significant changes in tumor or blood methylation levels were seen in the other candidate genes. CONCLUSION This is the first demonstration of in vivo increases in tissue-specific global methylation associated with soy isoflavone intake in patients with HNSCC. Prior associations of LINE-1 hypomethylation with genetic instability, carcinogenesis, and prognosis suggest that soy isoflavones maybe potential chemopreventive agents in HNSCC.
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Affiliation(s)
- Laura S Rozek
- a University of Michigan , Ann Arbor , Michigan, USA
| | - Shama Virani
- a University of Michigan , Ann Arbor , Michigan, USA
| | | | | | | | | | - A Virani
- a University of Michigan , Ann Arbor , Michigan, USA
| | - C Cote
- a University of Michigan , Ann Arbor , Michigan, USA
| | | | | | | | | | - George H Yoo
- c Karmanos Cancer Institute , Wayne State University , Detroit , Michigan 48201, USA
| | - Nabil F Saba
- d Winship Cancer Institute , Emory University , Atlanta , Georgia, USA
| | - Dong M Shin
- d Winship Cancer Institute , Emory University , Atlanta , Georgia, USA
| | - Omer Kucuk
- d Winship Cancer Institute , Emory University , Atlanta , Georgia, USA
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Farlow JL, Birkeland AC, Rosko AJ, VanKoevering K, Haring CT, Smith JD, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy. Ann Surg Oncol 2019; 26:2542-2548. [PMID: 30830535 DOI: 10.1245/s10434-019-07270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined. METHODS A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed. RESULTS PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38-0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31-0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11-0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up). CONCLUSIONS PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kyle VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
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Mann JE, Smith JD, Birkeland AC, Bellile E, Swiecicki P, Mierzwa M, Chinn SB, Shuman AG, Malloy KM, Casper KA, McLean SA, Moyer JS, Wolf GT, Bradford CR, Prince ME, Carey TE, McHugh JB, Spector ME, Brenner JC. Analysis of tumor-infiltrating CD103 resident memory T-cell content in recurrent laryngeal squamous cell carcinoma. Cancer Immunol Immunother 2019; 68:213-220. [PMID: 30361882 PMCID: PMC6375747 DOI: 10.1007/s00262-018-2256-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 05/19/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recurrent laryngeal squamous cell carcinomas (LSCCs) are associated with poor outcomes, without reliable biomarkers to identify patients who may benefit from adjuvant therapies. Given the emergence of tumor-infiltrating lymphocytes (TIL) as a biomarker in head and neck squamous cell carcinoma, we generated predictive models to understand the utility of CD4+, CD8+ and/or CD103+ TIL status in patients with advanced LSCC. METHODS Tissue microarrays were constructed from salvage laryngectomy specimens of 183 patients with recurrent/persistent LSCC and independently stained for CD4+, CD8+, and CD103+ TIL content. Cox proportional hazards regression analysis was employed to assess combinations of CD4+, CD8+, and CD103+ TIL levels for prediction of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) in patients with recurrent/persistent LSCC. RESULTS High tumor CD103+ TIL content was associated with significantly improved OS, DSS, and DFS and was a stronger predictor of survival in recurrent/persistent LSCC than either high CD8+ or CD4+ TIL content. On multivariate analysis, an "immune-rich" phenotype, in which tumors were enriched for both CD103+ and CD4+ TILs, conferred a survival benefit (OS hazard ratio: 0.28, p = 0.0014; DSS hazard ratio: 0.09, p = 0.0015; DFS hazard ratio: 0.18, p = 0.0018) in recurrent/persistent LSCC. CONCLUSIONS An immune profile driven by CD103+ TIL content, alone and in combination with CD4+ TIL content, is a prognostic biomarker of survival in patients with recurrent/persistent LSCC. Predictive models described herein may thus prove valuable in prognostic stratification and lead to personalized treatment paradigms for this patient population.
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Affiliation(s)
- Jacqueline E Mann
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Paul Swiecicki
- Department of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Jeffery S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Thomas E Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA.
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA.
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.
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Beesley LJ, Hawkins PG, Amlani LM, Bellile EL, Casper KA, Chinn SB, Eisbruch A, Mierzwa ML, Spector ME, Wolf GT, Shuman AG, Taylor JMG. Individualized survival prediction for patients with oropharyngeal cancer in the human papillomavirus era. Cancer 2019; 125:68-78. [PMID: 30291798 PMCID: PMC6309492 DOI: 10.1002/cncr.31739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Accurate, individualized prognostication in patients with oropharyngeal squamous cell carcinoma (OPSCC) is vital for patient counseling and treatment decision making. With the emergence of human papillomavirus (HPV) as an important biomarker in OPSCC, calculators incorporating this variable have been developed. However, it is critical to characterize their accuracy prior to implementation. METHODS Four OPSCC calculators were identified that integrate HPV into their estimation of 5-year overall survival. Treatment outcomes for 856 patients with OPSCC who were evaluated at a single institution from 2003 through 2016 were analyzed. Predicted survival probabilities were generated for each patient using each calculator. Calculator performance was assessed and compared using Kaplan-Meier plots, receiver operating characteristic curves, concordance statistics, and calibration plots. RESULTS Correlation between pairs of calculators varied, with coefficients ranging from 0.63 to 0.90. Only 3 of 6 pairs of calculators yielded predictions within 10% of each other for at least 50% of patients. Kaplan-Meier curves of calculator-defined risk groups demonstrated reasonable stratification. Areas under the receiver operating characteristic curve ranged from 0.74 to 0.80, and concordance statistics ranged from 0.71 to 0.78. Each calculator demonstrated superior discriminatory ability compared with clinical staging according to the seventh and eighth editions of the American Joint Committee on Cancer staging manual. Among models, the Denmark calculator was found to be best calibrated to observed outcomes. CONCLUSIONS Existing calculators exhibited reasonable estimation of survival in patients with OPSCC, but there was considerable variability in predictions for individual patients, which limits the clinical usefulness of these calculators. Given the increasing role of personalized treatment in patients with OPSCC, further work is needed to improve accuracy and precision, possibly through the identification and incorporation of additional biomarkers.
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Affiliation(s)
- Lauren J Beesley
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Peter G Hawkins
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lahin M Amlani
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily L Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
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Smith JD, Birkeland AC, Rosko AJ, Hoesli RC, Foltin SK, Swiecicki P, Mierzwa M, Chinn SB, Shuman AG, Malloy KM, Casper KA, McLean SA, Wolf GT, Bradford CR, Prince ME, Brenner JC, Spector ME. Mutational profiles of persistent/recurrent laryngeal squamous cell carcinoma. Head Neck 2018; 41:423-428. [PMID: 30548484 DOI: 10.1002/hed.25444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/22/2018] [Accepted: 09/06/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We sought to describe targeted DNA sequencing data of persistent/recurrent laryngeal squamous cell carcinoma (LSCC) and to compare gene-specific alteration frequencies with that of primary, untreated LSCC specimens from The Cancer Genome Atlas (TCGA). METHODS The tumors of 21 patients with persistent/recurrent LSCC were subjected to targeted DNA sequencing using the Ion AmpliSeq Comprehensive Cancer Panel. Gene-specific alteration frequencies were compared (Chi-Square test) to primary, untreated LSCC sequencing data from TCGA using the cBioPortal platform. RESULTS Persistent/recurrent LSCC was characterized by a high rate of inactivating alterations in TP53 (38.1%) and CDKN2A (33%), amplification events of CCND1 (19.1%), and ERBB2 (14.3%), and NOTCH1 (19.1%) mutations. Comparison of primary vs persistent/recurrent LSCC revealed significant differences in alteration frequencies of eight critical genes: BAP1, CDKN2A, DCUN1D1, MSH2, MTOR, PIK3CA, TET2, and TP53. CONCLUSIONS Our results provide preliminary support for a distinct mutational profile of persistent/recurrent LSCC that requires validation in larger cohorts.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan K Foltin
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paul Swiecicki
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
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Wolf GT, Winter W, Bellile E, Nguyen A, Donnelly CR, McHugh JB, Thomas D, Amlani L, Rozek L, Lei YL. Histologic pattern of invasion and epithelial-mesenchymal phenotype predict prognosis in squamous carcinoma of the head and neck. Oral Oncol 2018; 87:29-35. [PMID: 30527240 PMCID: PMC6293994 DOI: 10.1016/j.oraloncology.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/11/2018] [Accepted: 10/06/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Disruption of E-cadherin function and increased expression of vimentin and the transcriptional oncogene, SOX2, are thought to characterize epithelial to mesenchymal transition (EMT) in HNSCC that contributes to invasive and metastatic behavior. To determine if such changes relate to prognosis or host immune response, expression of these markers and correlations with clinical characteristics, histologic worst pattern of invasion (WPOI) and tumor infiltrating lymphocytes (TIL) and survival were assessed. METHODS Immunohistologic expression of markers was determined in tissue microarrays from 274 previously untreated HNSCC patients. Expression was correlated with levels of TILs in microcores and WPOI in biopsy specimens. Correlations were assessed by Kruskal-Wallis testing and Spearman correlation coefficients where appropriate. Overall and relapse-free survival were analyzed with Cox proportional hazards models. Median follow up was 60.0 months. RESULTS Loss of E-cadherin expression was significantly associated with low or absent SOX2 expression (R = 0.433, p < 0.0001). SOX2 expression and low grade WPOI were significantly associated with favorable overall (OS) and relapse free (RFS) survival in multivariable analysis. E-cadherin expression did not correlate with TILs, however WPOI score correlated indirectly with CD4, CD8, and FoxP3 levels. When grouped by primary treatment, lower grades (1, 2) of WPOI predicted improved RFS and OS in patients treated with primary surgery but not for patients treated with chemoradiation. CONCLUSION The findings suggest that SOX2 expression and WPOI are significant prognostic factors and that WPOI correlates with decreased T cell infiltration. The combination of markers and TILs might be useful in selecting patients for primary surgery.
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Affiliation(s)
- Gregory T Wolf
- Departments of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48176, United States.
| | - William Winter
- Departments of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48176, United States
| | - Emily Bellile
- Departments of Biostatistics, University of Michigan, Ann Arbor, MI 48176, United States
| | - Ariane Nguyen
- Departments of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48176, United States
| | - C R Donnelly
- Departments of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI 48176, United States
| | - Jonathan B McHugh
- Departments of Pathology, University of Michigan, Ann Arbor, MI 48176, United States
| | - Dafydd Thomas
- Departments of Pathology, University of Michigan, Ann Arbor, MI 48176, United States
| | - Lahin Amlani
- Departments of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48176, United States
| | - Laura Rozek
- Departments of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48176, United States
| | - Yu L Lei
- Departments of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI 48176, United States
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Qin T, Zhang Y, Zarins KR, Jones TR, Virani S, Peterson LA, McHugh JB, Chepeha D, Wolf GT, Rozek LS, Sartor MA. Expressed HNSCC variants by HPV-status in a well-characterized Michigan cohort. Sci Rep 2018; 8:11458. [PMID: 30061624 PMCID: PMC6065423 DOI: 10.1038/s41598-018-29599-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/12/2018] [Indexed: 12/16/2022] Open
Abstract
While whole-exome DNA sequencing is the most common technology to study genetic variants in tumors in known exonic regions, RNA-seq is cheaper, covers most of the same exonic regions, and is often more readily available. In this study, we show the utility of mRNA-seq-based variant analysis combined with targeted gene sequencing performed on both tumor and matched blood as an alternative when exome data is unavailable. We use the approach to study expressed variant profiles in the well-characterized University of Michigan (UM) head and neck squamous carcinoma (HNSCC) cohort (n = 36). We found that 441 out of 455 (~97%) identified cancer genes with an expressed variant in the UM cohort also harbor a somatic mutation in TCGA. Fourteen (39%) patients had a germline variant in a cancer-related Fanconi Anemia (FA) pathway gene. HPV-positive patients had more nonsynonymous, rare, and damaging (NRD) variants in those genes than HPV-negative patients. Moreover, the known mutational signatures for DNA mismatch repair and APOBEC activation were attributive to the UM expressed NRD variants, and the APOBEC signature contribution differed by HPV status. Our results provide additional support to certain TCGA findings and suggest an association of expressed variants in FA/DNA repair pathways with HPV-associated HNSCC tumorigenesis. These results will benefit future studies on this and other cohorts by providing the genetic variants of key cancer-related genes.
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Affiliation(s)
- Tingting Qin
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Yanxiao Zhang
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Ludwig Institute for Cancer Research, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tamara R Jones
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Shama Virani
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lisa A Peterson
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Wolf GT, Moyer JS, Kaplan MJ, Newman JG, Egan JE, Berinstein NL, Whiteside TL. IRX-2 natural cytokine biologic for immunotherapy in patients with head and neck cancers. Onco Targets Ther 2018; 11:3731-3746. [PMID: 29988729 PMCID: PMC6029613 DOI: 10.2147/ott.s165411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is an immunosuppressive malignancy characterized by tumor-driven immune-system abnormalities that contribute to disease progression. For patients with surgically resectable HNSCC, treatment is often curative surgery followed by irradiation or chemoradiation in high-risk settings to reduce the risk of recurrence. Poor survival and considerable morbidity of current treatments suggest the need for new therapeutic modalities that can improve outcomes. Defects in antitumor immunity of HNSCC patients include suppressed dendritic cell (DC) maturation, deficient antigen-presenting cell function, compromised natural killer (NK)-cell cytotoxicity, increased apoptosis of activated T lymphocytes, and impaired immune-cell migration to tumor sites. Strategies for relieving immunosuppression and restoring antitumor immune functions could benefit HNSCC patients. IRX-2 is a primary cell-derived biologic consisting of physiologic levels of T-helper type 1 cytokines produced by stimulating peripheral blood mononuclear cells of normal donors with phytohemagglutinin. The primary active components in IRX-2 are IL2, IL1β, IFNγ, and TNFα. In vitro, IRX-2 acts on multiple immune-system cell types, including DCs, T cells, and NK cells, to overcome tumor-mediated immunosuppression. In clinical settings, IRX-2 is administered as part of a 21-day neoadjuvant regimen, which includes additional pharmacologic agents (low-dose cyclophosphamide, indomethacin, and zinc) to promote anticancer immunoresponses. In a Phase IIA trial in 27 patients with surgically resectable, previously untreated HNSCC, neoadjuvant IRX-2 increased infiltration of T cells, B cells, and DCs into tumors and was associated with radiological reductions in tumor size. Event-free survival was 64% at 2 years, and overall 5-year survival was 65%. Follow-up and data analysis are under way in the multicenter, randomized, Phase IIB INSPIRE trial evaluating the IRX-2 regimen as a stand-alone therapy for activating the immune system to recognize and attack tumors.
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Affiliation(s)
- Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI,
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI,
| | - Michael J Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
| | - Jason G Newman
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Theresa L Whiteside
- Department of Immunology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Abstract
The recent Food and Drug Administration's approval of monoclonal antibodies targeting immune checkpoint receptors (ICRs) for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) offers exciting promise to improve patient outcome and reduce morbidities. A favorable response to ICR blockade relies on an extensive collection of preexisting tumor-specific T cells in the tumor microenvironment (TME). ICR blockade reinvigorates exhausted CD8+ T cells and enhances immune killing. However, resistance to ICR blockade is observed in about 85% of patients with HNSCC, therefore highlighting the importance of characterizing the mechanisms underlying HNSCC immune escape and exploring combinatorial strategies to sensitize hypoimmunogenic cold HNSCC to ICR inhibition. Cancer vaccines are designed to bypass the cold TME and directly deliver cancer antigens to antigen-presenting cells (APCs); these vaccines epitomize a priming strategy to synergize with ICR inhibitors. Cancer cells are ineffective antigen presenters, and poor APC infiltration as well as the M2-like polarization in the TME further dampens antigen uptake and processing, both of which render ineffective innate and adaptive immune detection. Cancer vaccines directly activate APC and expand the tumor-specific T-cell repertoire. In addition, cancer vaccines often contain an adjuvant, which further improves APC function, promotes epitope spreading, and augments host intrinsic antitumor immunity. Thus, the vaccine-induced immune priming generates a pool of effectors whose function can be enhanced by ICR inhibitors. In this review, we summarize the major HNSCC immune evasion strategies, the ongoing effort toward improving HNSCC vaccines, and the current challenges limiting the efficacy of cancer vaccines.
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Affiliation(s)
- Y S Tan
- 1 Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
- 2 University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - K Sansanaphongpricha
- 3 Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - M E P Prince
- 2 University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- 4 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - D Sun
- 3 Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - G T Wolf
- 2 University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- 4 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Y L Lei
- 1 Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
- 2 University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- 4 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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