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Naert E, Van Hulle H, De Jaeghere EA, Orije MRP, Roels S, Salihi R, Traen KJ, Watty K, Kinnaer LM, Verstraelen H, Tummers P, Vandecasteele K, Denys HG. Sexual health in Belgian cervical cancer survivors: an exploratory qualitative study. Qual Life Res 2024; 33:1401-1414. [PMID: 38396183 DOI: 10.1007/s11136-024-03603-5] [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] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess experiences of sexuality and of receiving sexual healthcare in cervical cancer (CC) survivors. METHODS A qualitative phenomenological study using semistructured one-on-one interviews was conducted with 15 Belgian CC survivors recruited in 5 hospitals from August 2021 to February 2022. The interviews were audiotaped and transcribed verbatim. Data were analyzed using inductive thematic analysis. COREQ and SRQR reporting guidelines were applied. RESULTS Most participants experienced an altered sexuality after CC treatment with often long-term loss/lack of sex drive, little/no spontaneity, limitation of positions to avoid dyspareunia, less intense orgasms, or no sexual activity at all. In some cases, emotional intimacy became more prominent. Physical (vaginal bleeding, vaginal dryness, dyspareunia, menopausal symptoms) and psychological consequences (guilt, changed self-image) were at the root of the altered sexuality. Treatment-induced menopause reduced sex drive. In premenopausal patients, treatment and/or treatment-induced menopause resulted in the sudden elimination of family planning. Most participants highlighted the need to discuss their altered sexual experience with their partner to grow together toward a new interpretation of sexuality. To facilitate this discussion, most of the participants emphasized the need for greater partner involvement by healthcare providers (HPs). The oncology nurse or sexologist was the preferred HP with whom to discuss sexual health. The preferred timing for information about the sexual consequences of treatment was at treatment completion or during early follow-up. CONCLUSION Both treatment-induced physical and psychological experiences were prominent and altered sexuality. Overall, there was a need for HPs to adopt proactive patient-tailored approaches to discuss sexual health.
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Affiliation(s)
- Eline Naert
- Department of Medical Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium.
| | | | - Emiel A De Jaeghere
- Department of Medical Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Marjolein R P Orije
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sarah Roels
- Department of Radiation Oncology, AZ Sint-Jan, Brugge, Belgium
| | - Rawand Salihi
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Gynaecology, AZ Sint-Lucas, Ghent, Belgium
| | - Koen J Traen
- Department of Gynaecology, OLV Hospital, Aalst, Belgium
| | | | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Hans Verstraelen
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore G Denys
- Department of Medical Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Vergote I, Van Nieuwenhuysen E, O'Cearbhaill RE, Westermann A, Lorusso D, Ghamande S, Collins DC, Banerjee S, Mathews CA, Gennigens C, Cibula D, Tewari KS, Madsen K, Köse F, Jackson AL, Boere IA, Scambia G, Randall LM, Sadozye A, Baurain JF, Gort E, Zikán M, Denys HG, Ottevanger N, Forget F, Mondrup Andreassen C, Eaton L, Chisamore MJ, Viana Nicacio L, Soumaoro I, Monk BJ. Tisotumab Vedotin in Combination With Carboplatin, Pembrolizumab, or Bevacizumab in Recurrent or Metastatic Cervical Cancer: Results From the innovaTV 205/GOG-3024/ENGOT-cx8 Study. J Clin Oncol 2023; 41:5536-5549. [PMID: 37651655 PMCID: PMC10730069 DOI: 10.1200/jco.23.00720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Tissue factor is highly expressed in cervical carcinoma and can be targeted by tisotumab vedotin (TV), an antibody-drug conjugate. This phase Ib/II study evaluated TV in combination with bevacizumab, pembrolizumab, or carboplatin for recurrent or metastatic cervical cancer (r/mCC). METHODS This open-label, multicenter study (ClinicalTrials.gov identifier: NCT03786081) included dose-escalation arms that assessed dose-limiting toxicities (DLTs) and identified the recommended phase II dose (RP2D) of TV in combination with bevacizumab (arm A), pembrolizumab (arm B), or carboplatin (arm C). The dose-expansion arms evaluated TV antitumor activity and safety at RP2D in combination with carboplatin as first-line (1L) treatment (arm D) or with pembrolizumab as 1L (arm E) or second-/third-line (2L/3L) treatment (arm F). The primary end point of dose expansion was objective response rate (ORR). RESULTS A total of 142 patients were enrolled. In dose escalation (n = 41), no DLTs were observed; the RP2D was TV 2 mg/kg plus bevacizumab 15 mg/kg on day 1 once every 3 weeks, pembrolizumab 200 mg on day 1 once every 3 weeks, or carboplatin AUC 5 on day 1 once every 3 weeks. In dose expansion (n = 101), the ORR was 54.5% (n/N, 18/33; 95% CI, 36.4 to 71.9) with 1L TV + carboplatin (arm D), 40.6% (n/N, 13/32; 95% CI, 23.7 to 59.4) with 1L TV + pembrolizumab (arm E), and 35.3% (12/34; 19.7 to 53.5) with 2L/3L TV + pembrolizumab (arm F). The median duration of response was 8.6 months, not reached, and 14.1 months, in arms D, E, and F, respectively. Grade ≥3 adverse events (≥15%) were anemia, diarrhea, nausea, and thrombocytopenia in arm D and anemia in arm F (none ≥15%, arm E). CONCLUSION TV in combination with bevacizumab, carboplatin, or pembrolizumab demonstrated manageable safety and encouraging antitumor activity in treatment-naive and previously treated r/mCC.
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Affiliation(s)
- Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven Cancer Institute, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven Cancer Institute, Leuven, Belgium
| | | | - Anneke Westermann
- Dutch Gynaecological Oncology Group, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Sharad Ghamande
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Dearbhaile C. Collins
- Department of Medical Oncology, Cancer Trials Ireland, Cork University Hospital, Cork, Ireland
| | - Susana Banerjee
- Royal Marsden National Health Service Foundation Trust, Institute of Cancer Research, London, United Kingdom
| | - Cara A. Mathews
- Program in Women's Oncology, Women & Infants Hospital, Legorreta Cancer Center at Alpert Medical School of Brown University, Providence, RI
| | | | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Kristine Madsen
- Centre for Cancer and Organ Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Amanda L. Jackson
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati, OH
| | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Azmat Sadozye
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Jean-François Baurain
- Cliniques Universitaires Saint-Luc and Université Catholique de Louvain and BGOG, Brussels, Belgium
| | - Eelke Gort
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michal Zikán
- First Faculty of Medicine, Bulovka University Hospital, Charles University, Prague, Czech Republic
| | | | | | - Frédéric Forget
- BGOG, Centre Hospitalier de l’Ardenne—Site de Libramont, Libramont-Chevigny, Belgium
| | | | | | | | | | | | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
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Naert E, Decruyenaere A, Bultijnck R, De Jaeghere EA, Orije MRP, Salihi R, Verstraelen H, Tummers P, Denys HG, Vandecasteele K. Vaginal morbidity, sexual functioning, and health-related quality of life in cervical cancer survivors: a cross-sectional multicenter study (VAMOS). Support Care Cancer 2023; 31:703. [PMID: 37975947 DOI: 10.1007/s00520-023-08155-x] [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: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare sexual/vaginal functioning between early cervical cancer (ECC) and locally advanced cervical cancer (LACC) survivors. METHODS VAMOS was a multicenter, cross-sectional, questionnaire, noninferiority study including ECC patients treated with surgery and, if clinically indicated, adjuvant (chemo)radiotherapy and LACC patients treated with neoadjuvant (chemo)radiotherapy followed by surgery. Patient-reported outcomes (PROs) were assessed using the EORTC QLQ-C30, EORTC QLQ-CX24, and Female Sexual Functioning Index (FSFI) questionnaires. Clinical reported outcomes (ClinROs) consisted of vaginal morbidity scored according to the CTCAE v4.0 scoring system. RESULTS One hundred forty-three patients were included. Compared to ECC patients (n = 97), LACC patients (n = 46) were significantly less sexually active in the 4 weeks prior to completion of the questionnaires (65% vs. 41%; p = .005). The primary endpoint was not met: LACC patients reported a higher mean score (more problems) for sexual/vaginal functioning than ECC patients, with a non-clinically relevant mean difference of 6.38 ([95% CI: - 6.41, 19.17]; p = .570 for noninferiority). Regarding the secondary endpoints, the prevalence of sexual dysfunction between the two groups did not differ significantly (p = 0.124). Compared to ECC patients, LACC patients did not have significantly more vaginal morbidity (adjusted odds ratio [OR] 1.51 [95% CI: 0.22, 10.29]; p = .674). Moreover, there was poor agreement between any vaginal morbidity and sexual dysfunction (Cohen's kappa of 0.17). CONCLUSION Compared to ECC survivors, LACC survivors were significantly less sexually active and reported equivalent or worse sexual/vaginal functioning, although the proportion of patients with sexual dysfunction was similar. Clinical assessment of vaginal morbidity was poorly correlated with sexual dysfunction.
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Affiliation(s)
- Eline Naert
- Department of Medical Oncology, Ghent University Hospital, 9000, Ghent, Belgium.
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium.
| | - Alexander Decruyenaere
- Department of Medical Oncology, Ghent University Hospital, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Renée Bultijnck
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Emiel A De Jaeghere
- Department of Medical Oncology, Ghent University Hospital, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Marjolein R P Orije
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Rawand Salihi
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, 9000, Ghent, Belgium
- Department of Gynaecology, AZ Sint-Lucas, Ghent, Belgium
| | - Hans Verstraelen
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics & Gynaecology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Hannelore G Denys
- Department of Medical Oncology, Ghent University Hospital, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, 9000, Ghent, Belgium
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De Jaeghere EA, Tuyaerts S, Van Nuffel AMT, Belmans A, Bogaerts K, Baiden-Amissah R, Lippens L, Vuylsteke P, Henry S, Trinh XB, van Dam PA, Aspeslagh S, De Caluwé A, Naert E, Lambrechts D, Hendrix A, De Wever O, Van de Vijver KK, Amant F, Vandecasteele K, Denys HG. Pembrolizumab, radiotherapy, and an immunomodulatory five-drug cocktail in pretreated patients with persistent, recurrent, or metastatic cervical or endometrial carcinoma: Results of the phase II PRIMMO study. Cancer Immunol Immunother 2023; 72:475-491. [PMID: 35960332 PMCID: PMC9870976 DOI: 10.1007/s00262-022-03253-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023]
Abstract
A phase II study (PRIMMO) of patients with pretreated persistent/recurrent/metastatic cervical or endometrial cancer is presented. Patients received an immunomodulatory five-drug cocktail (IDC) consisting of low-dose cyclophosphamide, aspirin, lansoprazole, vitamin D, and curcumin starting 2 weeks before radioimmunotherapy. Pembrolizumab was administered three-weekly from day 15 onwards; one of the tumor lesions was irradiated (8Gyx3) on days 15, 17, and 19. The primary endpoint was the objective response rate per immune-related response criteria (irORR) at week 26 (a lower bound of the 90% confidence interval [CI] of > 10% was considered efficacious). The prespecified 43 patients (cervical, n = 18; endometrial, n = 25) were enrolled. The irORR was 11.1% (90% CI 2.0-31.0) in cervical cancer and 12.0% (90% CI 3.4-28.2) in endometrial cancer. Median duration of response was not reached in both cohorts. Median interval-censored progression-free survival was 4.1 weeks (95% CI 4.1-25.7) in cervical cancer and 3.6 weeks (95% CI 3.6-15.4) in endometrial cancer; median overall survival was 39.6 weeks (95% CI 15.0-67.0) and 37.4 weeks (95% CI 19.0-50.3), respectively. Grade ≥ 3 treatment-related adverse events were reported in 10 (55.6%) cervical cancer patients and 9 (36.0%) endometrial cancer patients. Health-related quality of life was generally stable over time. Responders had a significantly higher proportion of peripheral T cells when compared to nonresponders (p = 0.013). In conclusion, PRIMMO did not meet its primary objective in both cohorts; pembrolizumab, radiotherapy, and an IDC had modest but durable antitumor activity with acceptable but not negligible toxicity.Trial registration ClinicalTrials.gov (identifier NCT03192059) and EudraCT Registry (number 2016-001569-97).
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Affiliation(s)
- Emiel A. De Jaeghere
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Sandra Tuyaerts
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, Leuven, Belgium
- Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
- Laboratory for Medical and Molecular Oncology (LMMO), VUB, Brussels, Belgium
| | | | - Ann Belmans
- Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Regina Baiden-Amissah
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, Leuven, Belgium
| | - Lien Lippens
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Vuylsteke
- Department of Hemato-Oncology, Centre Hospitalier Universitaire Université Catholique de Louvain Namur (Sainte-Elisabeth), Namur, Belgium
| | - Stéphanie Henry
- Department of Hemato-Oncology, Centre Hospitalier Universitaire Université Catholique de Louvain Namur (Sainte-Elisabeth), Namur, Belgium
| | - Xuan Bich Trinh
- Department of Gynecologic Oncology and Senology, University Hospital Antwerp, Edegem, Belgium
- Multidisciplinary Oncologic Centre Antwerp (MOCA), University Hospital Antwerp, Edegem, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Edegem, Belgium
| | - Peter A. van Dam
- Department of Gynecologic Oncology and Senology, University Hospital Antwerp, Edegem, Belgium
- Multidisciplinary Oncologic Centre Antwerp (MOCA), University Hospital Antwerp, Edegem, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Edegem, Belgium
| | - Sandrine Aspeslagh
- Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
| | - Alex De Caluwé
- Department of Radiation Oncology, Jules Bordet Institute, Brussels, Belgium
- Department of Radiation Oncology, General Hospital Sint-Maarten, Mechlin, Belgium
| | - Eline Naert
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | | | - An Hendrix
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Olivier De Wever
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Koen K. Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute and Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Frédéric Amant
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute and Amsterdam Medical Center, Amsterdam, The Netherlands
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore G. Denys
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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5
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De Jaeghere EA, Laloo F, Lippens L, Van Bockstal M, De Man K, Naert E, Van Dorpe J, Van de Vijver K, Tummers P, Makar A, De Visschere PJL, De Wever O, Amant F, Denys HG, Vandecasteele K. Splenic 18F-FDG uptake on baseline PET/CT is associated with oncological outcomes and tumor immune state in uterine cervical cancer. Gynecol Oncol 2020; 159:335-343. [PMID: 32859399 DOI: 10.1016/j.ygyno.2020.08.001] [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: 04/25/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The spleen represents an important contributor to tumor immune escape, but the relevance of increased splenic metabolic activity remains to be fully elucidated. METHODS We retrospectively measured the spleen-to-liver standard uptake value (SLR) on 18F-FDG PET/CT examinations of 92 consecutive patients with FIGO stage IB1 to IVA cervical cancer and integrated the results with survival, response to treatment, tumor immune infiltrate, and baseline characteristics. RESULTS SLRmax > 0.92 (p = .026) and SLRmean > 0.94 (p = .005) were significantly associated with decreased DFS in univariable analysis. Multivariable models were built using best subset selection; ΔSLRmax and either SLRmax or SLRmean were consistently selected, strongly reinforcing the association between SLR variables and DFS in relation to potential confounders (all models p ≤ .002). Independent associations were found for SLRmax using multivariable Cox regression models for DFS (all p ≤ .003). Further, uni- and multivariable analyses demonstrated the negative impact of higher SLR values on pathological complete response. A statistically significant higher proportion of patients with high SLRmax had a dense infiltrate of CD20+ (p = .036) and CD68+ (p = .015) immune cells, as well as PD-L1+ tumor cells (p = .019) as compared to those with low SLRmax. Finally, high SLRmax status was neither associated with systemic inflammatory markers (except for an increased white blood cell count; p = .038), nor with clinically overt infection. CONCLUSION This hypothesis-generating study provides the first evidence that increased splenic metabolic activity is a negative prognostic and predictive biomarker in locally advanced cervical cancer. In addition, it might help to discriminate immunologically 'hot' from 'cold' cervical tumors.
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Affiliation(s)
- Emiel A De Jaeghere
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium.
| | - Frederiek Laloo
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Lien Lippens
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | | | - Kathia De Man
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Eline Naert
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Pieter J L De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Olivier De Wever
- Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Frédéric Amant
- Centers Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Hannelore G Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiation Oncology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
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De Jaeghere EA, Bouche G, Hoebeke P, Holbrouck PM, Denys HG. The nocebo effect and tobacco control-First, do no harm? Med Hypotheses 2020; 139:109615. [PMID: 32078961 DOI: 10.1016/j.mehy.2020.109615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 01/09/2023]
Abstract
Since tobacco remains a leading cause of global morbidity and mortality, emphasis needs to be given to preventive approaches to tobacco consumption. Environmental and policy strategies with fear appeals are important contributors to reductions in smoking prevalence. Fear appeals are persuasive messages-often using graphic and emotionally evocative imagery and language-that attempt to scare their audiences into tobacco cessation. While the intentions of fear appeals are benign, their effects are not necessarily so; here, we argue that some fear appeals carry a significant risk of backfiring by eliciting nocebo effects among its viewers. In this context, it is important to recognize that there is currently no justification for disregarding potential nocebo effects. Therefore, we should improve our understanding of nocebo effects in the field of preventive medicine, as well as the impact of strategies aimed at mitigating their negative health effects.
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Affiliation(s)
- Emiel A De Jaeghere
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Gauthier Bouche
- Anticancer Fund, Boechoutlaan 221, B-1853 Strombeek-Bever, Belgium
| | - Piet Hoebeke
- Urology, Department of Human Structure and Repair, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Piet M Holbrouck
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Hannelore G Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
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De Jaeghere EA, Gremonprez FB, Tummers PG, Willaert WC, Ceelen WP, Amant FC, Denys HG. Treatment of Ovarian Cancer With Intraperitoneal Platinum: Heating Up the Debate. J Clin Oncol 2019; 37:3169-3170. [PMID: 31553679 DOI: 10.1200/jco.19.01179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Emiel A De Jaeghere
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Félix B Gremonprez
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Philippe G Tummers
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Wouter C Willaert
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Wim P Ceelen
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Frédéric C Amant
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Hannelore G Denys
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
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De Jaeghere EA, Denys HG, De Wever O. Fibroblasts Fuel Immune Escape in the Tumor Microenvironment. Trends Cancer 2019; 5:704-723. [PMID: 31735289 DOI: 10.1016/j.trecan.2019.09.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 02/08/2023]
Abstract
Immune escape is central to the persistence of most, if not all, solid tumors and poses a critical obstacle to successful cancer (immuno)therapy. Cancer-associated fibroblasts (CAFs) constitute the most prevalent, yet heterogeneous, component of the tumor stroma, where they 'cool down' the immune microenvironment. The central role played by CAFs, both as a physical barrier and source of immunosuppressive molecules, sets them as a target to enhance immunotherapy of cancer. We outline the current understanding of how CAFs fuel immune escape, as well as their potential clinical applications. Whether these therapeutics really have clinically significant activity remains to be seen, but the outlook is positive.
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Affiliation(s)
- Emiel A De Jaeghere
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Gynecologic Pelvic Oncology Network Ghent (GYPON), Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Hannelore G Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Gynecologic Pelvic Oncology Network Ghent (GYPON), Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Olivier De Wever
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Gynecologic Pelvic Oncology Network Ghent (GYPON), Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
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