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Grither WR, Hagemann IS, Powell MA, Mullen MM. Attack of the clones: Unveiling subclonal/heterogenous mismatch repair/microsatellite instability status in endometrial cancer. Cancer 2024; 130:339-341. [PMID: 37902951 DOI: 10.1002/cncr.35067] [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] [Indexed: 11/01/2023]
Abstract
Any time there are two or more tests for a given analyte, there will be some degree of disagreement between them. This editorial contextualizes the recent findings by Riedinger and colleagues regarding discordant mismatch repair and microsatellite instability testing in endometrial cancer.
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Affiliation(s)
- Whitney R Grither
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ian S Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri, USA
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Kahaki S, Hagemann IS, Cha KH, Trindade C, Petrick N, Kostelecky N, Borden LE, Atwi D, Fung KM, Chen W. End-to-end deep learning method for predicting hormonal treatment response in women with atypical endometrial hyperplasia or endometrial cancer. J Med Imaging (Bellingham) 2024; 11:017502. [PMID: 38370423 PMCID: PMC10868592 DOI: 10.1117/1.jmi.11.1.017502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Endometrial cancer (EC) is the most common gynecologic malignancy in the United States, and atypical endometrial hyperplasia (AEH) is considered a high-risk precursor to EC. Hormone therapies and hysterectomy are practical treatment options for AEH and early-stage EC. Some patients prefer hormone therapies for reasons such as fertility preservation or being poor surgical candidates. However, accurate prediction of an individual patient's response to hormonal treatment would allow for personalized and potentially improved recommendations for these conditions. This study aims to explore the feasibility of using deep learning models on whole slide images (WSI) of endometrial tissue samples to predict the patient's response to hormonal treatment. Approach We curated a clinical WSI dataset of 112 patients from two clinical sites. An expert pathologist annotated these images by outlining AEH/EC regions. We developed an end-to-end machine learning model with mixed supervision. The model is based on image patches extracted from pathologist-annotated AEH/EC regions. Either an unsupervised deep learning architecture (Autoencoder or ResNet50), or non-deep learning (radiomics feature extraction) is used to embed the images into a low-dimensional space, followed by fully connected layers for binary prediction, which was trained with binary responder/non-responder labels established by pathologists. We used stratified sampling to partition the dataset into a development set and a test set for internal validation of the performance of our models. Results The autoencoder model yielded an AUROC of 0.80 with 95% CI [0.63, 0.95] on the independent test set for the task of predicting a patient with AEH/EC as a responder vs non-responder to hormonal treatment. Conclusions These findings demonstrate the potential of using mixed supervised machine learning models on WSIs for predicting the response to hormonal treatment in AEH/EC patients.
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Affiliation(s)
- Seyed Kahaki
- U.S. Food and Drug Administration (FDA), Center for Devices and Radiological Health, Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
| | - Ian S. Hagemann
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, Missouri, United States
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Kenny H. Cha
- U.S. Food and Drug Administration (FDA), Center for Devices and Radiological Health, Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
| | - Christopher Trindade
- U.S. Food and Drug Administration (FDA), Division of Molecular Genetics and Pathology, Silver Spring, Maryland, United States
| | - Nicholas Petrick
- U.S. Food and Drug Administration (FDA), Center for Devices and Radiological Health, Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
| | - Nicolas Kostelecky
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, Missouri, United States
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, Illinois, United States
| | - Lindsay E. Borden
- University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Oklahoma City, Oklahoma, United States
- University of Oklahoma Health Sciences Center, Department of Pathology, Oklahoma City, Oklahoma, United States
| | - Doaa Atwi
- University of Oklahoma Health Sciences Center, Department of Pathology, Oklahoma City, Oklahoma, United States
| | - Kar-Ming Fung
- University of Oklahoma Health Sciences Center, Department of Pathology, Oklahoma City, Oklahoma, United States
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, United States
| | - Weijie Chen
- U.S. Food and Drug Administration (FDA), Center for Devices and Radiological Health, Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
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3
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Desouki MM, Hagemann IS, Khoury T, Fadare O, Bhargava R, Clark JL, Deavers MT, Jorns JM, Khan A, Cosar EF, Karabakhtsian RG, Klein ME, Pinto A, Ali M. Selective breast/gynecologic pathology fellowship training in the United States: Experience of program directors. Acad Pathol 2024; 11:100103. [PMID: 38380270 PMCID: PMC10877681 DOI: 10.1016/j.acpath.2023.100103] [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: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/11/2023] [Indexed: 02/22/2024] Open
Abstract
Published data on combined breast and gynecologic [breast/gyn] surgical pathology fellowship training programs are limited. Our study aimed to survey the landscape of such fellowships in the United States (US), including specific information about their characteristics and the educational activities therein. Using web searches, we identified programs offering combined breast/gyn surgical pathology fellowship training. We developed a 26-item questionnaire asking program directors to report on the characteristics of their fellowship training structure. The search revealed 25 academic based programs offering one-year combined breast/gyn fellowship training, predominantly located (40 %) in the Northeast area. The following data was obtained: 44 % of the programs were accredited by the ACGME, 82 % required >19 weeks of breast and gyn service, and 69.6 % accepted the common application, 54.5 % of programs require completion of a research project for graduation. An annual average of 3000 breast and 3000 gyn cases appears to be the usual volume of cases. Interestingly, only 36 % of the program directors are graduates of a combined breast/gyn fellowship program. In conclusion, we present the most comprehensive and up-to-date census of combined breast/gyn pathology fellowships in the US. Our study provides valuable information on the current state of combined breast/gyn pathology fellowship training. The information will be helpful to current and prospective trainees, as well as program leaders.
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Affiliation(s)
- Mohamed Mokhtar Desouki
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA, USA
| | - Jennifer L. Clark
- Department of Pathology, UMass Chan Medical School, Worcester, MA, USA
| | | | - Julie M. Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashraf Khan
- Department of Pathology, UMass Chan Medical School-Baystate, Baystate Health, Springfield, MA, USA
| | - Ediz F. Cosar
- Department of Pathology, UMass Chan Medical School-Baystate, Baystate Health, Springfield, MA, USA
| | - Rouzan G. Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Molly E. Klein
- Department of Pathology, University of Minnesota, Indianapolis, MN, USA
| | - Andre Pinto
- Department of Pathology, University of Miami Health System, Miami, FL, USA
| | - Muhammad Ali
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
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4
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Zhu Q, Luo H, Middleton WD, Itani M, Hagemann IS, Hagemann AR, Hoegger MJ, Thaker PH, Kuroki LM, MCourt CK, Mutch DG, Powell MA, Siegel CL. Characterization of adnexal lesions using photoacoustic imaging to improve sonographic O-RADS risk assessment. Ultrasound Obstet Gynecol 2023; 62:891-903. [PMID: 37606287 PMCID: PMC10840885 DOI: 10.1002/uog.27452] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To assess the impact of photoacoustic imaging (PAI) on the assessment of ovarian/adnexal lesion(s) of different risk categories using the sonographic ovarian-adnexal imaging-reporting-data system (O-RADS) in women undergoing planned oophorectomy. METHOD This prospective study enrolled women with ovarian/adnexal lesion(s) suggestive of malignancy referred for oophorectomy. Participants underwent clinical ultrasound (US) examination followed by coregistered US and PAI prior to oophorectomy. Each ovarian/adnexal lesion was graded by two radiologists using the US O-RADS scale. PAI was used to compute relative total hemoglobin concentration (rHbT) and blood oxygenation saturation (%sO2 ) colormaps in the region of interest. Lesions were categorized by histopathology into malignant ovarian/adnexal lesion, malignant Fallopian tube only and several benign categories, in order to assess the impact of incorporating PAI in the assessment of risk of malignancy with O-RADS. Malignant and benign histologic groups were compared with respect to rHbT and %sO2 and logistic regression models were developed based on tumor marker CA125 alone, US-based O-RADS alone, PAI-based rHbT with %sO2 , and the combination of CA125, O-RADS, rHbT and %sO2. Areas under the receiver-operating-characteristics curve (AUC) were used to compare the diagnostic performance of the models. RESULTS There were 93 lesions identified on imaging among 68 women (mean age, 52 (range, 21-79) years). Surgical pathology revealed 14 patients with malignant ovarian/adnexal lesion, two with malignant Fallopian tube only and 52 with benign findings. rHbT was significantly higher in malignant compared with benign lesions. %sO2 was lower in malignant lesions, but the difference was not statistically significant for all benign categories. Feature analysis revealed that rHbT, CA125, O-RADS and %sO2 were the most important predictors of malignancy. Logistic regression models revealed an AUC of 0.789 (95% CI, 0.626-0.953) for CA125 alone, AUC of 0.857 (95% CI, 0.733-0.981) for O-RADS only, AUC of 0.883 (95% CI, 0.760-1) for CA125 and O-RADS and an AUC of 0.900 (95% CI, 0.815-0.985) for rHbT and %sO2 in the prediction of malignancy. A model utilizing all four predictors (CA125, O-RADS, rHbT and %sO2 ) achieved superior performance, with an AUC of 0.970 (95% CI, 0.932-1), sensitivity of 100% and specificity of 82%. CONCLUSIONS Incorporating the additional information provided by PAI-derived rHbT and %sO2 improves significantly the performance of US-based O-RADS in the diagnosis of adnexal lesions. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Q Zhu
- Department of Biomedical Engineering, Washington University, St Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - H Luo
- Department of Biomedical Engineering, Washington University, St Louis, MO, USA
| | - W D Middleton
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - M Itani
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - I S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - A R Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - M J Hoegger
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - P H Thaker
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - L M Kuroki
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - C K MCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - D G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - M A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - C L Siegel
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
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Schab AM, Greenwade MM, Stock E, Lomonosova E, Cho K, Grither WR, Noia H, Wilke D, Mullen MM, Hagemann AR, Hagemann IS, Thaker PH, Kuroki LM, McCourt CK, Khabele D, Powell MA, Mutch DG, Zhao P, Shriver LP, Patti GJ, Longmore GD, Fuh KC. Stromal DDR2 Promotes Ovarian Cancer Metastasis through Regulation of Metabolism and Secretion of Extracellular Matrix Proteins. Mol Cancer Res 2023; 21:1234-1248. [PMID: 37527178 PMCID: PMC10832402 DOI: 10.1158/1541-7786.mcr-23-0347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/19/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023]
Abstract
Ovarian cancer is the leading cause of gynecologic cancer-related deaths. The propensity for metastasis within the peritoneal cavity is a driving factor for the poor outcomes associated with this disease, but there is currently no effective therapy targeting metastasis. In this study, we investigate the contribution of stromal cells to ovarian cancer metastasis and identify normal stromal cell expression of the collagen receptor, discoidin domain receptor 2 (DDR2), that acts to facilitate ovarian cancer metastasis. In vivo, global genetic inactivation of Ddr2 impairs the ability of Ddr2-expressing syngeneic ovarian cancer cells to spread throughout the peritoneal cavity. Specifically, DDR2 expression in mesothelial cells lining the peritoneal cavity facilitates tumor cell attachment and clearance. Subsequently, omentum fibroblast expression of DDR2 promotes tumor cell invasion. Mechanistically, we find DDR2-expressing fibroblasts are more energetically active, such that DDR2 regulates glycolysis through AKT/SNAI1 leading to suppressed fructose-1,6-bisphosphatase and increased hexokinase activity, a key glycolytic enzyme. Upon inhibition of DDR2, we find decreased protein synthesis and secretion. Consequently, when DDR2 is inhibited, there is reduction in secreted extracellular matrix proteins important for metastasis. Specifically, we find that fibroblast DDR2 inhibition leads to decreased secretion of the collagen crosslinker, LOXL2. Adding back LOXL2 to DDR2 deficient fibroblasts rescues the ability of tumor cells to invade. Overall, our results suggest that stromal cell expression of DDR2 is an important mediator of ovarian cancer metastasis. IMPLICATIONS DDR2 is highly expressed by stromal cells in ovarian cancer that can mediate metastasis and is a potential therapeutic target in ovarian cancer.
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Affiliation(s)
- Angela M. Schab
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Molly M. Greenwade
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Elizabeth Stock
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Elena Lomonosova
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Kevin Cho
- Center for Metabolomics and Isotope Tracing, Department of Chemistry, Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Whitney R. Grither
- Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO 63110, USA
| | - Hollie Noia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Daniel Wilke
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Mary M. Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Andrea R. Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Ian S. Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Premal H. Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Lindsay M. Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Carolyn K. McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Dineo Khabele
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Matthew A. Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - David G. Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Peinan Zhao
- Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO 63110, USA
| | - Leah P. Shriver
- Center for Metabolomics and Isotope Tracing, Department of Chemistry, Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Gary J. Patti
- Center for Metabolomics and Isotope Tracing, Department of Chemistry, Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Gregory D. Longmore
- Division of Oncology, Department of Medicine Washington University, St. Louis. MO 63110, USA
- ICCE Institute, Washington University, St. Louis MO 63110, USA
| | - Katherine C. Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology University of California, San Francisco, San Francisco, CA 94143 USA
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Chapagain U, Krigman HR, Hagemann IS, Weiss MC, Sun L. COL1A1::PDGFB fusion-associated uterine sarcoma and response to Imatinib: A case report. Gynecol Oncol Rep 2023; 49:101270. [PMID: 37711974 PMCID: PMC10498399 DOI: 10.1016/j.gore.2023.101270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Uterine sarcomas are rare neoplasms of the uterus, some of which are associated with distinctive gene fusions. COL1A1::PDGFB fusion uterine sarcoma is a recently described entity that shares the same genetic alteration as dermatofibrosarcoma protuberans. These uterine sarcomas have a nonspecific spindle cell sarcoma appearance and are CD34 positive by immunohistochemistry. Accurate diagnosis relies on identification of the characteristic fusion by molecular genetic methods. The importance of diagnosing this entity lies in its potential response to targeted therapy with imatinib, a tyrosine kinase inhibitor successfully used in dermatofibrosarcoma protuberans, but only one prior case of COL1A1::PDGFB fusion uterine sarcoma treated with imatinib has been reported. Here, we describe a case of COL1A1::PDGFB fusion uterine sarcoma with response to imatinib after recurrence, with a brief review of this rare tumor.
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Affiliation(s)
- Udita Chapagain
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Hannah R. Krigman
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Ian S. Hagemann
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Mia C. Weiss
- Division of Medical Oncology, Department of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Lulu Sun
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
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7
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Hagemann IS, Deng W, Zaino RJ, Powell MA, Gunderson Jackson C, Cosgrove C, Mathews C, Pearl ML, Waggoner S, Ghebre R, Lele S, Guntupalli S, Secord AA, Ioffe O, Rasty G, Singh M, Soslow R, Creasman W, Mutch DG. Mixed clear cell/endometrioid and clear cell/serous carcinoma of the uterus are clinicopathologically similar to pure clear cell carcinoma: An NRG Oncology/Gynecologic Oncology Group (GOG-210) study of 311 women. Gynecol Oncol 2023; 177:38-45. [PMID: 37634258 PMCID: PMC10806844 DOI: 10.1016/j.ygyno.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Clear cell carcinoma is a high-risk subtype of endometrial cancer. Some patients have a mixture of clear cell carcinoma with other histologic types (endometrioid or serous) or cannot be neatly assigned to one of these types. Protocol GOG-8032 within GOG-210 was designed to determine whether these tumors differ from pure clear cell carcinoma in stage at diagnosis, initial pattern of spread, or patient survival. METHODS The term "mixed" was applied to tumors with multiple identifiable components, and "indeterminate" was applied to tumors with features intermediate between different histologic types. Three hundred eleven women with pure, mixed, or indeterminate clear cell carcinoma were identified in a larger cohort of patients undergoing hysterectomy for endometrial cancer in GOG-210. Histologic slides were centrally reviewed by expert pathologists. Baseline and follow-up data were analyzed. RESULTS One hundred thirty-six patients had pure clear cell carcinoma and 175 had a mixed or indeterminate clear cell pattern. Baseline clinicopathologic characteristics were similar except for a small difference in age at presentation. Univariate survival analysis confirmed the significance of typical endometrial cancer prognostic factors. Patients in the mixed categories had disease-free and overall survival similar to pure clear cell carcinoma, but the indeterminate clear cell/endometrioid group had longer survival. CONCLUSION In clear cell endometrial cancer, the presence of a definite admixed endometrioid or serous component did not correlate with a significant difference in prognosis. Patients whose tumors had indeterminate clear cell features had better prognosis. Some of these tumors may be endometrioid tumors mimicking clear cell carcinoma.
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Affiliation(s)
- Ian S Hagemann
- Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division; Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Richard J Zaino
- Pennsylvania State University, Hershey, PA, United States of America.
| | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Camille Gunderson Jackson
- University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States of America.
| | - Casey Cosgrove
- Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - Cara Mathews
- Women & Infants Hospital, Providence, RI, United States of America.
| | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, NY, United States of America.
| | | | - Rahel Ghebre
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America.
| | - Shashikant Lele
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Saketh Guntupalli
- University of Colorado Cancer Center, Aurora, CO, United States of America.
| | | | - Olga Ioffe
- University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Golnar Rasty
- University of Toronto, Markham, Ontario, Canada.
| | - Meenakshi Singh
- Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - William Creasman
- Medical University of South Carolina Medical Center, Charleston, SC, United States of America.
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, United States of America.
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8
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Hagemann IS, Bridge JA, Tafe LJ, Hameed MR, Moncur JT, Bellizzi AM, Dolan M, Vasalos P, Kane ME, Souers RJ, Yemelyanova A. Current Laboratory Testing Practices for Assessment of ERBB2/HER2 in Endometrial Serous Carcinoma and Colorectal Carcinoma. Arch Pathol Lab Med 2023; 147:1148-1157. [PMID: 36538387 PMCID: PMC11062402 DOI: 10.5858/arpa.2022-0229-cp] [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] [Accepted: 07/27/2022] [Indexed: 09/29/2023]
Abstract
CONTEXT.— Therapy targeted at human epidermal growth factor receptor 2 (HER2; also known as ERBB2) was used initially for breast and gastroesophageal carcinoma and has more recently been adopted for endometrial serous carcinoma (ESC) and colorectal carcinoma (CRC). There is evidence that predictive biomarker testing algorithms for HER2 must be tumor type specific and that an algorithm validated for one tumor type cannot be applied to another. OBJECTIVE.— To describe current laboratory practices for HER2 assessment in ESC and CRC. DESIGN.— We surveyed laboratories participating in the 2021 College of American Pathologists (CAP) HER2 immunohistochemistry proficiency testing program. RESULTS.— The survey was distributed to 1548 laboratories and returned by 1195, of which 83.5% (998) were in the United States. For ESC, 24.0% (287) of laboratories reported performing in-house testing for HER2 by immunohistochemical staining and/or in situ hybridization; of these, 44.3% (127) performed it reflexively on all cases of ESC. The most common criterion for evaluating HER2 was the American Society of Clinical Oncology/CAP 2018 guideline for breast carcinoma (69.0%; 194 of 281), whereas only 16.0% (45) of laboratories used guidelines specific to ESC. For CRC, 20.2% (239 of 1185) of laboratories performed in-house HER2 testing, and 82.0% of these (196) did the test only at the clinician's request. A plurality (49.4%; 115 of 233) used gastroesophageal cancer guidelines when scoring CRC, 30.0% (70) used the CRC scoring system from the HERACLES trial, and 16.3% (38) used the American Society of Clinical Oncology/CAP 2018 guideline for breast carcinoma. CONCLUSIONS.— Laboratories vary in their approach to HER2 testing in ESC and CRC. Most laboratories did not report using tumor type-specific recommendations for HER2 interpretation. The lack of standardization could present a challenge to evidence-based practice when considering targeted therapy for these diseases.
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Affiliation(s)
- Ian S Hagemann
- From the Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (Hagemann)
| | - Julia A Bridge
- ProPath, Dallas, Texas (Bridge)
- The Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha (Bridge)
| | - Laura J Tafe
- The Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Tafe)
| | - Meera R Hameed
- The Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Hameed)
| | - Joel T Moncur
- The Office of the Director, The Joint Pathology Center, Silver Spring, Maryland (Moncur)
| | - Andrew M Bellizzi
- The Department of Pathology, University of Iowa, Iowa City (Bellizzi)
| | - Michelle Dolan
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Dolan)
| | - Patricia Vasalos
- The Proficiency Testing Department (Vasalos, Kane), College of American Pathologists, Northfield, Illinois
| | - Megan E Kane
- The Proficiency Testing Department (Vasalos, Kane), College of American Pathologists, Northfield, Illinois
| | - Rhona J Souers
- The Biostatistics Department (Souers), College of American Pathologists, Northfield, Illinois
| | - Anna Yemelyanova
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York (Yemelyanova)
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9
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Cheng X, Sun Y, Highkin M, Vemalapally N, Jin X, Zhou B, Prior JL, Tipton AR, Li S, Iliuk A, Achilefu S, Hagemann IS, Edwards JR, Bose R. Breast Cancer Mutations HER2V777L and PIK3CAH1047R Activate the p21-CDK4/6-Cyclin D1 Axis to Drive Tumorigenesis and Drug Resistance. Cancer Res 2023; 83:2839-2857. [PMID: 37272756 PMCID: PMC10527017 DOI: 10.1158/0008-5472.can-22-3558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
In metastatic breast cancer, HER2-activating mutations frequently co-occur with mutations in PIK3CA, TP53, or CDH1. Of these co-occurring mutations, HER2 and PIK3CA are the most commonly comutated gene pair, with approximately 40% of HER2-mutated breast cancers also having activating mutations in PIK3CA. To study the effects of co-occurring HER2 and PIK3CA mutations, we generated genetically engineered mice with the HER2V777L; PIK3CAH1047R transgenes (HP mice) and studied the resulting breast cancers both in vivo as well as ex vivo using cancer organoids. HP breast cancers showed accelerated tumor formation in vivo and increased invasion and migration in in vitro assays. HP breast cancer cells were resistant to the pan-HER tyrosine kinase inhibitor, neratinib, but were effectively treated with neratinib plus the HER2-targeted antibody-drug conjugate trastuzumab deruxtecan. Proteomic and RNA-seq analysis of HP breast cancers identified increased gene expression of cyclin D1 and p21WAF1/Cip1 and changes in cell-cycle markers. Combining neratinib with CDK4/6 inhibitors was another effective strategy for treating HP breast cancers, with neratinib plus palbociclib showing a statistically significant reduction in development of mouse HP tumors as compared to either drug alone. The efficacy of both the neratinib plus trastuzumab deruxtecan and neratinib plus palbociclib combinations was validated using a human breast cancer patient-derived xenograft with very similar HER2 and PIK3CA mutations to the HP mice. Further, these two drug combinations effectively treated spontaneous lung metastasis in syngeneic mice transplanted with HP breast cancer organoids. This study provides valuable preclinical data to support the ongoing phase 1 clinical trials of these drug combinations in breast cancer. SIGNIFICANCE In HER2-mutated breast cancer, PIK3CA mutation activates p21-CDK4/6-cyclin D1 signaling to drive resistance to HER2-targeted therapies, which can be overcome using CDK4/6 inhibitors.
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Affiliation(s)
- Xiaoqing Cheng
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Yirui Sun
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Maureen Highkin
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Nagalaxmi Vemalapally
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Xiaohua Jin
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Brandon Zhou
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Julie L. Prior
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Ashley R. Tipton
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Shunqiang Li
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Anton Iliuk
- Tymora Analytical Operations, 1201 Cumberland Ave. West Lafayette, IN 47906
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110
| | - John R. Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110
| | - Ron Bose
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110
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10
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Kotnik EN, Mullen MM, Spies NC, Li T, Inkman M, Zhang J, Martins-Rodrigues F, Hagemann IS, McCourt CK, Thaker PH, Hagemann AR, Powell MA, Mutch DG, Khabele D, Longmore GD, Mardis ER, Maher CA, Miller CA, Fuh KC. Genetic characterization of primary and metastatic high-grade serous ovarian cancer tumors reveals distinct features associated with survival. Commun Biol 2023; 6:688. [PMID: 37400526 DOI: 10.1038/s42003-023-05026-3] [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: 07/05/2022] [Accepted: 06/07/2023] [Indexed: 07/05/2023] Open
Abstract
High-grade serous ovarian cancer (HGSC) is the most lethal histotype of ovarian cancer and the majority of cases present with metastasis and late-stage disease. Over the last few decades, the overall survival for patients has not significantly improved, and there are limited targeted treatment options. We aimed to better characterize the distinctions between primary and metastatic tumors based on short- or long-term survival. We characterized 39 matched primary and metastatic tumors by whole exome and RNA sequencing. Of these, 23 were short-term (ST) survivors (overall survival (OS) < 3.5 years) and 16 were long-term (LT) survivors (OS > 5 years). We compared somatic mutations, copy number alterations, mutational burden, differential gene expression, immune cell infiltration, and gene fusion predictions between the primary and metastatic tumors and between ST and LT survivor cohorts. There were few differences in RNA expression between paired primary and metastatic tumors, but significant differences between the transcriptomes of LT and ST survivors in both their primary and metastatic tumors. These findings will improve the understanding of the genetic variation in HGSC that exist between patients with different prognoses and better inform treatments by identifying new targets for drug development.
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Affiliation(s)
- Emilee N Kotnik
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Mary M Mullen
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Nicholas C Spies
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8118, St. Louis, MO, USA
| | - Tiandao Li
- Department of Developmental Biology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8103, St. Louis, MO, USA
| | - Matthew Inkman
- Department of Radiation Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8224, St. Louis, MO, USA
| | - Jin Zhang
- Department of Radiation Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8224, St. Louis, MO, USA
| | - Fernanda Martins-Rodrigues
- Division of Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8069, St. Louis, MO, USA
| | - Ian S Hagemann
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8118, St. Louis, MO, USA
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Premal H Thaker
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - David G Mutch
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Dineo Khabele
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA
| | - Gregory D Longmore
- Division of Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8069, St. Louis, MO, USA
- ICCE Institute, Washington University in St. Louis, 660 S. Euclid Ave CB, 8225, St. Louis, MO, USA
| | - Elaine R Mardis
- Institute for Genomic Medicine, Nationwide Children's Hospital, 575 Childrens Crossroad, Columbus, OH, USA
| | - Christopher A Maher
- Division of Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8069, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University in St. Louis, 4444 Forest Park Avenue, CB 8501, St. Louis, MO, USA
- Department of Internal Medicine, Washington University in St. Louis, 660 S. Euclid Ave, MSC 8066-22-6602, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, McKelvey School of Engineering, 1 Brookings Drive, St. Louis, MO, USA
| | - Christopher A Miller
- Division of Oncology, Washington University in St. Louis, 660 S. Euclid Ave CB, 8069, St. Louis, MO, USA
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA.
- Center for Reproductive Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA.
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave Mailstop, 8064, St. Louis, MO, USA.
- Department of Obstetrics and Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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11
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Sawant M, Wilson A, Sridaran D, Mahajan K, O'Conor CJ, Hagemann IS, Luo J, Weimholt C, Li T, Roa JC, Pandey A, Wu X, Mahajan NP. Epigenetic reprogramming of cell cycle genes by ACK1 promotes breast cancer resistance to CDK4/6 inhibitor. Oncogene 2023; 42:2263-2277. [PMID: 37330596 PMCID: PMC10348910 DOI: 10.1038/s41388-023-02747-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/31/2022] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
Hormone receptor-positive, HER2-negative advanced breast cancers exhibit high sensitivity to CDK4/6 inhibitors such as palbociclib. However, most patients inevitably develop resistance, thus identification of new actionable therapeutic targets to overcome the recurrent disease is an urgent need. Immunohistochemical studies of tissue microarray revealed increased activation of non-receptor tyrosine kinase, ACK1 (also known as TNK2) in most of the breast cancer subtypes, independent of their hormone receptor status. Chromatin immunoprecipitation studies demonstrated that the nuclear target of activated ACK1, pY88-H4 epigenetic marks, were deposited at cell cycle genes, CCNB1, CCNB2 and CDC20, which in turn initiated their efficient transcription. Pharmacological inhibition of ACK1 using its inhibitor, (R)-9b dampened CCNB1, CCNB2 and CDC20 expression, caused G2/M arrest, culminating in regression of palbociclib-resistant breast tumor growth. Further, (R)-9b suppressed expression of CXCR4 receptor, which resulted in significant impairment of metastasis of breast cancer cells to lung. Overall, our pre-clinical data identifies activated ACK1 as an oncogene that epigenetically controls the cell cycle genes governing the G2/M transition in breast cancer cells. ACK1 inhibitor, (R)-9b could be a novel therapeutic option for the breast cancer patients that have developed resistance to CDK4/6 inhibitors.
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Affiliation(s)
- Mithila Sawant
- Department of Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Audrey Wilson
- Department of Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Dhivya Sridaran
- Department of Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Kiran Mahajan
- Department of Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
- Division of Urologic Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Christopher J O'Conor
- Department of Pathology and Immunology, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Jingqin Luo
- Siteman Cancer Center, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Cody Weimholt
- Department of Pathology and Immunology, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
- Siteman Cancer Center, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA
| | - Tiandao Li
- Bioinformatics Research Core, Center of Regenerative Medicine, Department of Developmental Biology, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Xinyan Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nupam P Mahajan
- Department of Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA.
- Division of Urologic Surgery, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA.
- Siteman Cancer Center, Washington University in St. Louis, Cancer Research Building, 660 Euclid Ave., St. Louis, MO, 63110, USA.
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12
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Luo H, Li S, Kou S, Lin Y, Hagemann IS, Zhu Q. Enhanced 3D visualization of human fallopian tube morphology using a miniature optical coherence tomography catheter. Biomed Opt Express 2023; 14:3225-3233. [PMID: 37497483 PMCID: PMC10368054 DOI: 10.1364/boe.489708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 07/28/2023]
Abstract
We demonstrate the use of our miniature optical coherence tomography catheter to acquire three-dimensional human fallopian tube images. Images of the fallopian tube's tissue morphology, vasculature, and tissue heterogeneity distribution are enhanced by adaptive thresholding, masking, and intensity inverting, making it easier to differentiate malignant tissue from normal tissue. The results show that normal fallopian tubes tend to have rich vasculature accompanied by a patterned tissue scattering background, features that do not appear in malignant cases. This finding suggests that miniature OCT catheters may have great potential for fast optical biopsy of the fallopian tube.
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Affiliation(s)
- Hongbo Luo
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Shuying Li
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Yixiao Lin
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63130, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Quing Zhu
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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13
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Li S, Luo H, Kou S, Hagemann IS, Zhu Q. Depth-resolved attenuation mapping of the human ovary and fallopian tube using optical coherence tomography. J Biophotonics 2023; 16:e202300002. [PMID: 36916760 PMCID: PMC10656701 DOI: 10.1002/jbio.202300002] [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] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 06/07/2023]
Abstract
Due to the lack of reliable early-diagnostic tools, most ovarian cancers are diagnosed at late stages. Although optical coherence tomography (OCT) has shown promise for identifying diseased ovaries and fallopian tubes at an earlier stage, previous studies either did not provide quantitative scattering mapping or simply used Beer's law to fit the scattering coefficients of each A-line. In this paper, we calculated the pixel-wise attenuation coefficients of ovaries and fallopian tubes in OCT images. Data from 73 freshly excised human ovaries and fallopian tubes from 36 patients have shown that statistical features are statistically different between cancerous ovaries, infundibula, and fimbriae and normal ones.
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Affiliation(s)
- Shuying Li
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
| | - Hongbo Luo
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
- Department of Radiology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
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14
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Hagemann IS, Zehir A, Suarez CJ, Furtado LV, Halley J, Kane M, Mot N, Vasalos P, Moncur JT, Konnick EQ. In silico approaches to proficiency testing: Considerations for continued feasibility. J Mol Diagn 2023:S1525-1578(23)00079-X. [PMID: 37088136 DOI: 10.1016/j.jmoldx.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carlos J Suarez
- Department of Pathology, Stanford University, Stanford, California
| | - Larissa V Furtado
- Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jaimie Halley
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Megan Kane
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Nicole Mot
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Patricia Vasalos
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Joel T Moncur
- Office of the Director, Joint Pathology Center, Silver Spring, MD
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.
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15
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Cheng X, Sun Y, Highkin M, Vemalapally N, Jin X, Zhou B, Prior JL, Tipton AR, Li S, Iliuk A, Achilefu S, Hagemann IS, Edwards J, Bose R. Abstract 5778: Breast cancer mutations HER2V777L and PIK3CAH1047R activate the p21-CDK4/6 -Cyclin D1 axis driving tumorigenesis and drug resistance. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
In metastatic breast cancer, HER2 activating mutations frequently co-occur with mutations in the PIK3CA, TP53, or E-cadherin genes. Of these co-occurring mutations, HER2 and PIK3CA mutations are the most prevalent gene pair, with approximately 40% of HER2 mutated breast cancers also having activating mutations in PIK3CA. To study the effects of co-occurring HER2 and PIK3CA mutations, we bred genetically engineered mice with the (loxP-STOP-loxP) HER2V777L; PIK3CAH1047R transgenes (HP mice) and studied the resulting breast cancers both in vivo as well as ex vivo using breast cancer organoids. HP mice rapidly developed invasive mammary adenocarcinoma at a median time of 2.1 weeks after adenoviral Cre injection into the mammary gland. Organoids from these breast cancers showed increased number of buddings in branching morphogenesis assay and increased migration and invasion in vitro. In vivo, HP breast cancers are resistance to the pan-HER tyrosine kinase inhibitor, neratinib, but are effectively treated by the combination of neratinib plus trastuzumab deruxtecan (T-DXd). Ex vivo, we found strong synergy between neratinib and T-DXd in HP organoids. Proteomic and RNA-seq analysis of HP breast cancers showed increased gene expression of CCND1 (cyclin D1) and CDKN1A (which encodes p21WAF1/Cip1) and changes in cell cycle markers. An increase in p-p53, p-p27, and p-PDK1 in HP organoids was seen. The GSEA analysis showed that the mTOR pathway and the MYC target signature were significantly upregulated in the HP organoid group. As p21 stabilizes the cyclin D1-CDK4/6 complex to further activate CDK4/6, we found CDK4/6 inhibitors inhibit cell proliferation in HP mice-derived organoids. Combining neratinib with CDK4/6 inhibitors was another effective strategy for HP breast cancers with neratinib plus palbociclib showing a statistically significant reduction in mouse HP tumors as compared to either drug alone. We validated both the neratinib plus T-DXd and neratinib plus palbociclib combinations using a human breast cancer patient-derived xenograft that has HER2 and PIK3CA mutations very similar to our transgenic mouse. This study provides valuable preclinical evidence for these drug combinations, which are being tested in phase 1 clinical trials.
Citation Format: Xiaoqing Cheng, Yirui Sun, Maureen Highkin, Nagalaxmi Vemalapally, Xiaohua Jin, Brandon Zhou, Julie L. Prior, Ashley R. Tipton, Shunqiang Li, Anton Iliuk, Samuel Achilefu, Ian S. Hagemann, John Edwards, Ron Bose. Breast cancer mutations HER2V777L and PIK3CAH1047R activate the p21-CDK4/6 -Cyclin D1 axis driving tumorigenesis and drug resistance. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5778.
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Affiliation(s)
| | - Yirui Sun
- 1Washington University in St. Louis, St. Louis, MO
| | | | | | - Xiaohua Jin
- 1Washington University in St. Louis, St. Louis, MO
| | - Brandon Zhou
- 1Washington University in St. Louis, St. Louis, MO
| | | | | | - Shunqiang Li
- 1Washington University in St. Louis, St. Louis, MO
| | - Anton Iliuk
- 2Tymora Analytical Operations, West Lafayette, IL
| | | | | | - John Edwards
- 1Washington University in St. Louis, St. Louis, MO
| | - Ron Bose
- 1Washington University in St. Louis, St. Louis, MO
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16
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Kahaki S, Hagemann IS, Cha K, Trindade CJ, Petrick N, Kostelecky N, Chen W. Weakly Supervised Deep Learning for Predicting the Response to Hormonal Treatment of Women with Atypical Endometrial Hyperplasia: A Feasibility Study. Proc SPIE Int Soc Opt Eng 2023; 12471:124710T. [PMID: 37159719 PMCID: PMC10164282 DOI: 10.1117/12.2652912] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy in the US and complex atypical hyperplasia (CAH) is considered a high-risk precursor to EC. Treatment options for CAH and early-stage EC include hormone therapies and hysterectomy with the former preferred by certain patients, e.g., for fertility preservation or poor surgical candidates. Accurate prediction of response to hormonal treatment would allow for personalized and potentially improved recommendations for the treatment of these conditions. In this study, we investigate the feasibility of utilizing weakly supervised deep learning models on whole slide images of endometrial tissue samples for the prediction of patient response to hormonal treatment. We curated a clinical whole-slide-image (WSI) dataset of 112 patients from two clinical sites. We developed an end-to-end machine learning model using WSIs of endometrial specimens for the prediction of hormonal treatment response among women with CAH/EC. The model takes patches extracted from pathologist-annotated CAH/EC regions as input and utilizes an unsupervised deep learning architecture (Autoencoder or ResNet50) to embed the images into a low-dimensional space, followed by fully connected layers for binary prediction. Our autoencoder model yielded an AUC of 0.79 with 95% CI [0.61, 0.98] on a hold-out test set in the task of predicting a patient with CAH/EC as a responder vs non-responder to hormonal treatment. Our results, demonstrate the potential for using weakly supervised machine learning models on WSIs for predicting response to hormonal treatment of CAH/EC patients.
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Affiliation(s)
- Seyed Kahaki
- Division of Imaging, Diagnostics, and Software Reliability, U.S. Food and Drug Administration (FDA), MD
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Kenny Cha
- Division of Imaging, Diagnostics, and Software Reliability, U.S. Food and Drug Administration (FDA), MD
| | - Christopher J Trindade
- Division of Molecular Genetics and Pathology, U.S. Food and Drug Administration (FDA), MD
| | - Nicholas Petrick
- Division of Imaging, Diagnostics, and Software Reliability, U.S. Food and Drug Administration (FDA), MD
| | - Nicolas Kostelecky
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Weijie Chen
- Division of Imaging, Diagnostics, and Software Reliability, U.S. Food and Drug Administration (FDA), MD
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17
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Ademuyiwa FO, Northfelt DW, O'Connor T, Levine E, Luo J, Tao Y, Hoog J, Laury ML, Summa T, Hammerschmidt T, Guo Z, Frith A, Weilbaecher K, Opyrchal M, Aft R, Clifton K, Suresh R, Bagegni N, Hagemann IS, Iglesia MD, Ma CX. A phase II study of palbociclib plus letrozole plus trastuzumab as neoadjuvant treatment for clinical stages II and III ER+ HER2+ breast cancer (PALTAN). NPJ Breast Cancer 2023; 9:1. [PMID: 36609389 PMCID: PMC9822956 DOI: 10.1038/s41523-022-00504-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
Patients with ER+/HER2+ breast cancer (BC) are less likely to achieve pathological complete response (pCR) after chemotherapy with dual HER2 blockade than ER-/HER2+ BC. Endocrine therapy plus trastuzumab is effective in advanced ER+/HER2+ BC. Inhibition of CDK4/6 and HER2 results in synergistic cell proliferation reduction. We combined palbociclib, letrozole, and trastuzumab (PLT) as a chemotherapy-sparing regimen. We evaluated neoadjuvant PLT in early ER+/HER2+ BC. Primary endpoint was pCR after 16 weeks. Research biopsies were performed for whole exome and RNA sequencing, PAM50 subtyping, and Ki67 assessment for complete cell cycle arrest (CCCA: Ki67 ≤ 2.7%). After 26 patients, accrual stopped due to futility. pCR (residual cancer burden-RCB 0) was 7.7%, RCB 0/I was 38.5%. Grade (G) 3/4 treatment-emergent adverse events occurred in 19. Among these, G3/4 neutropenia was 50%, hypertension 26.9%, and leucopenia 7.7%. Analysis indicated CCCA in 85% at C1 day 15 (C1D15), compared to 27% at surgery after palbociclib was discontinued. Baseline PAM50 subtyping identified 31.2% HER2-E, 43.8% Luminal B, and 25% Luminal A. 161 genes were differentially expressed comparing C1D15 to baseline. MKI67, TK1, CCNB1, AURKB, and PLK1 were among the genes downregulated, consistent with CCCA at C1D15. Molecular Signatures Database gene-sets analyses demonstrated downregulated processes involved in proliferation, ER and mTORC1 signaling, and DNA damage repair at C1D15, consistent with the study drug's mechanisms of action. Neoadjuvant PLT showed a pCR of 7.7% and an RCB 0/I rate of 38.5%. RNA sequencing and Ki67 data indicated potent anti-proliferative effects of study treatments. ClinicalTrials.gov- NCT02907918.
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Affiliation(s)
- Foluso O Ademuyiwa
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | | | - Tracey O'Connor
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Ellis Levine
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Jingqin Luo
- Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO, 63110, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Yu Tao
- Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO, 63110, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jeremy Hoog
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Marie L Laury
- Genome Technology Access Center at the McDonnell Genome Institute at Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Tracy Summa
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Trish Hammerschmidt
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Zhanfang Guo
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ashley Frith
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Katherine Weilbaecher
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Mateusz Opyrchal
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rebecca Aft
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Katherine Clifton
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rama Suresh
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Nusayba Bagegni
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Michael D Iglesia
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Cynthia X Ma
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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18
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Ademuyiwa FO, Gao F, Street CR, Chen I, Northfelt DW, Wesolowski R, Arora M, Brufsky A, Dees EC, Santa-Maria CA, Connolly RM, Force J, Moreno-Aspitia A, Herndon JM, Carmody M, Davies SR, Larson S, Pfaff KL, Jones SM, Weirather JL, Giobbie-Hurder A, Rodig SJ, Liu Z, Hagemann IS, Sharon E, Gillanders WE. A randomized phase 2 study of neoadjuvant carboplatin and paclitaxel with or without atezolizumab in triple negative breast cancer (TNBC) - NCI 10013. NPJ Breast Cancer 2022; 8:134. [PMID: 36585404 PMCID: PMC9803651 DOI: 10.1038/s41523-022-00500-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Atezolizumab with chemotherapy has shown improved progression-free and overall survival in patients with metastatic PD-L1 positive triple negative breast cancer (TNBC). Atezolizumab with anthracycline- and taxane-based neoadjuvant chemotherapy has also shown increased pathological complete response (pCR) rates in early TNBC. This trial evaluated neoadjuvant carboplatin and paclitaxel with or without atezolizumab in patients with clinical stages II-III TNBC. The co-primary objectives were to evaluate if chemotherapy and atezolizumab increase pCR rate and tumor infiltrating lymphocyte (TIL) percentage compared to chemotherapy alone in the mITT population. Sixty-seven patients (ages 25-78 years; median, 52 years) were randomly assigned - 22 patients to Arm A, and 45 to Arm B. Median follow up was 6.6 months. In the modified intent to treat population (all patients evaluable for the primary endpoints who received at least one dose of combination therapy), the pCR rate was 18.8% (95% CI 4.0-45.6%) in Arm A, and 55.6% (95% CI 40.0-70.4%) in Arm B (estimated treatment difference: 36.8%, 95% CI 8.5-56.6%; p = 0.018). Grade 3 or higher treatment-related adverse events occurred in 62.5% of patients in Arm A, and 57.8% of patients in Arm B. One patient in Arm B died from recurrent disease during the follow-up period. TIL percentage increased slightly from baseline to cycle 1 in both Arm A (mean ± SD: 0.6% ± 21.0%) and Arm B (5.7% ± 15.8%) (p = 0.36). Patients with pCR had higher median TIL percentages (24.8%) than those with non-pCR (14.2%) (p = 0.02). Although subgroup analyses were limited by the small sample size, PD-L1-positive patients treated with chemotherapy and atezolizumab had a pCR rate of 75% (12/16). The addition of atezolizumab to neoadjuvant carboplatin and paclitaxel resulted in a statistically significant and clinically relevant increased pCR rate in patients with clinical stages II and III TNBC. (Funded by National Cancer Institute).
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Affiliation(s)
| | - Feng Gao
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | | | - Ina Chen
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | | | - Robert Wesolowski
- Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Mili Arora
- UC Davis Comprehensive Cancer Center, Sacramento, CA, 95817, USA
| | - Adam Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - E Claire Dees
- University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
| | - Cesar A Santa-Maria
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, 21287, USA
| | | | - Jeremy Force
- Duke University School of Medicine, Durham, NC, 27710, USA
| | | | - John M Herndon
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Madelyn Carmody
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Sherri R Davies
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Sarah Larson
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Kathleen L Pfaff
- Cancer Immune Monitoring and Analysis Center, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Stephanie M Jones
- Cancer Immune Monitoring and Analysis Center, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Jason L Weirather
- Cancer Immune Monitoring and Analysis Center, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Anita Giobbie-Hurder
- Cancer Immune Monitoring and Analysis Center, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Scott J Rodig
- Cancer Immune Monitoring and Analysis Center, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Zheng Liu
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Ian S Hagemann
- Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, MD, 20892, USA
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19
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Anurag M, Jaehnig EJ, Krug K, Lei JT, Bergstrom EJ, Kim BJ, Vashist TD, Huynh AMT, Dou Y, Gou X, Huang C, Shi Z, Wen B, Korchina V, Gibbs RA, Muzny DM, Doddapaneni H, Dobrolecki LE, Rodriguez H, Robles AI, Hiltke T, Lewis MT, Nangia JR, Nemati Shafaee M, Li S, Hagemann IS, Hoog J, Lim B, Osborne CK, Mani D, Gillette MA, Zhang B, Echeverria GV, Miles G, Rimawi MF, Carr SA, Ademuyiwa FO, Satpathy S, Ellis MJ. Proteogenomic Markers of Chemotherapy Resistance and Response in Triple-Negative Breast Cancer. Cancer Discov 2022; 12:2586-2605. [PMID: 36001024 PMCID: PMC9627136 DOI: 10.1158/2159-8290.cd-22-0200] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/18/2022] [Revised: 06/08/2022] [Accepted: 08/18/2022] [Indexed: 01/12/2023]
Abstract
Microscaled proteogenomics was deployed to probe the molecular basis for differential response to neoadjuvant carboplatin and docetaxel combination chemotherapy for triple-negative breast cancer (TNBC). Proteomic analyses of pretreatment patient biopsies uniquely revealed metabolic pathways, including oxidative phosphorylation, adipogenesis, and fatty acid metabolism, that were associated with resistance. Both proteomics and transcriptomics revealed that sensitivity was marked by elevation of DNA repair, E2F targets, G2-M checkpoint, interferon-gamma signaling, and immune-checkpoint components. Proteogenomic analyses of somatic copy-number aberrations identified a resistance-associated 19q13.31-33 deletion where LIG1, POLD1, and XRCC1 are located. In orthogonal datasets, LIG1 (DNA ligase I) gene deletion and/or low mRNA expression levels were associated with lack of pathologic complete response, higher chromosomal instability index (CIN), and poor prognosis in TNBC, as well as carboplatin-selective resistance in TNBC preclinical models. Hemizygous loss of LIG1 was also associated with higher CIN and poor prognosis in other cancer types, demonstrating broader clinical implications. SIGNIFICANCE Proteogenomic analysis of triple-negative breast tumors revealed a complex landscape of chemotherapy response associations, including a 19q13.31-33 somatic deletion encoding genes serving lagging-strand DNA synthesis (LIG1, POLD1, and XRCC1), that correlate with lack of pathologic response, carboplatin-selective resistance, and, in pan-cancer studies, poor prognosis and CIN. This article is highlighted in the In This Issue feature, p. 2483.
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Affiliation(s)
- Meenakshi Anurag
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eric J. Jaehnig
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Karsten Krug
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Jonathan T. Lei
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Erik J. Bergstrom
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Beom-Jun Kim
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Tanmayi D. Vashist
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Anh Minh Tran Huynh
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Yongchao Dou
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Xuxu Gou
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Chen Huang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Zhiao Shi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Bo Wen
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Viktoriya Korchina
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Richard A. Gibbs
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Donna M. Muzny
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | | | - Lacey E. Dobrolecki
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Henry Rodriguez
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, Maryland
| | - Ana I. Robles
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, Maryland
| | - Tara Hiltke
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, Maryland
| | - Michael T. Lewis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Julie R. Nangia
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Maryam Nemati Shafaee
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Shunqiang Li
- Siteman Comprehensive Cancer Center and Washington University School of Medicine, St. Louis, Missouri
| | - Ian S. Hagemann
- Siteman Comprehensive Cancer Center and Washington University School of Medicine, St. Louis, Missouri
| | - Jeremy Hoog
- Siteman Comprehensive Cancer Center and Washington University School of Medicine, St. Louis, Missouri
| | - Bora Lim
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - C. Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - D.R. Mani
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Michael A. Gillette
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Bing Zhang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Gloria V. Echeverria
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - George Miles
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Mothaffar F. Rimawi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Steven A. Carr
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Foluso O. Ademuyiwa
- Siteman Comprehensive Cancer Center and Washington University School of Medicine, St. Louis, Missouri
| | - Shankha Satpathy
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Matthew J. Ellis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Sun L, Schroeder MC, Hagemann IS, Pfeifer JD, Schwarz JK, Grigsby PW, Markovina S, Lin AJ. Expression of Potential Biomarker Targets by Immunohistochemistry in Cervical Carcinomas. Int J Gynecol Pathol 2022; 41:628-635. [PMID: 35067601 DOI: 10.1097/pgp.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There have been few clinically useful targetable biomarkers in uterine cervical carcinomas. Estrogen receptor (ER), HER2, and fibroblast activation protein (FAP) are potential therapeutic or theranostic targets in other gynecologic and genitourinary carcinoma types. We determined the immunohistochemical expression patterns of these markers in treatment-naive cervical carcinoma, and whether expression correlated with clinical outcomes after definitive chemoradiation therapy. Tissue microarrays were created from 71 patient samples taken before therapy (57 squamous cell carcinomas and 14 nonsquamous cell carcinomas) and stained for ER, HER2, and FAP. ER was positive in 25/70 cases (36%). Of 66 tumors with evaluable HER2 staining, only 1 had positive (3+) staining (3%, positive for HER2 amplification by fluorescence in situ hybridization), and 1 had equivocal (2+) staining (negative for amplification by fluorescence in situ hybridization). The remainder were negative for HER2 overexpression. FAP expression was widely variably in the tumor stroma. ER positivity and FAP expression did not correlate with cervical recurrence, pelvic recurrence, distant recurrence, or cancer death. In conclusion, HER2 amplification is very rare in nonmetastatic treatment-naive cervical carcinomas, but if present, could represent a target for antibody therapy. ER and FAP were expressed in a subset of tumors, but expression did not correlate with clinical outcomes. These immunohistochemical markers do not demonstrate prognostic significance in treatment-naive cervical cancer, but they may have utility in targeted therapy or imaging.
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21
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Leng X, Kou S, Lin Y, Hagemann AR, Hagemann IS, Thaker PH, Kuroki LM, McCourt CK, Mutch DG, Siegel C, Powell MA, Zhu Q. Quantification of ovarian lesion and fallopian tube vasculature using optical-resolution photoacoustic microscopy. Sci Rep 2022; 12:15850. [PMID: 36151126 PMCID: PMC9508221 DOI: 10.1038/s41598-022-19778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity in the pathological and clinical manifestations of ovarian cancer is a major hurdle impeding early and accurate diagnosis. A host of imaging modalities, including Doppler ultrasound, MRI, and CT, have been investigated to improve the assessment of ovarian lesions. We hypothesized that pathologic conditions might affect the ovarian vasculature and that these changes might be detectable by optical-resolution photoacoustic microscopy (OR-PAM). In our previous work, we developed a benchtop OR-PAM and demonstrated it on a limited set of ovarian and fallopian tube specimens. In this study, we collected data from over 50 patients, supporting a more robust statistical analysis. We then developed an efficient custom analysis pipeline for characterizing the vascular features of the samples, including the mean vessel diameter, vascular density, global vascular directionality, local vascular definition, and local vascular tortuosity/branchedness. Phantom studies using carbon fibers showed that our algorithm was accurate within an acceptable error range. Between normal ovaries and normal fallopian tubes, we observed significant differences in five of six extracted vascular features. Further, we showed that distinct subsets of vascular features could distinguish normal ovaries from cystic, fibrous, and malignant ovarian lesions. In addition, a statistically significant difference was found in the mean vascular tortuosity/branchedness values of normal and abnormal tubes. The findings support the proposition that OR-PAM can help distinguish the severity of tubal and ovarian pathologies.
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Affiliation(s)
- Xiandong Leng
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Sitai Kou
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Yixiao Lin
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Andrea R Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Premal H Thaker
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lindsay M Kuroki
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Carolyn K McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Quing Zhu
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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22
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He M, Skaria P, Kreutz K, Chen L, Hagemann IS, Carter EB, Mysorekar IU, Nelson DM, Pfeifer J, Dehner LP. Histopathology of Third Trimester Placenta from SARS-CoV-2-Positive Women. Fetal Pediatr Pathol 2022; 41:403-412. [PMID: 33040615 DOI: 10.1080/15513815.2020.1828517] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: This study aims to investigate whether maternal SARS-CoV-2 status affects placental pathology. Methods: A retrospective case-control study was conducted by reviewing charts and slides of placentas delivered between April 1 to July 24, 2020. Clinical history of "COVID-19" was searched in Pathology Database (CoPath). Controls were matched with SARS-CoV-2-negative women with singleton deliveries in the 3rd-trimester. Pathological features were extracted from placental pathology reports. Results: Twenty-one 3rd trimester placentas from SARS-CoV-2-positive women were identified and compared to 20 placentas from SARS-CoV-2-negative women. There were no significant differences in individual or group gross or microscopic pathological features. Within the SARS-CoV-2+ group, there are no differences between symptomatic and asymptomatic women. Conclusion: Placentas from SARS-CoV-2-positive women do not demonstrate a specific pathological pattern. Pregnancy complicated with COVID-19 during the 3rd trimester does not have a demonstrable effect on placental structure and pathology.
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Affiliation(s)
- Mai He
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Priya Skaria
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Kasey Kreutz
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ian S Hagemann
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ebony B Carter
- Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Indira U Mysorekar
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.,Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - D Michael Nelson
- Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - John Pfeifer
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Louis P Dehner
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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23
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Ademuyiwa FO, Northfelt D, O'Connor T, Levine E, Luo J, Tao Y, Hoog J, Laury M, Summa T, Hammerschmidt T, Guo Z, Frith A, Weilbaecher K, Opyrchal M, Aft R, Clifton K, Suresh R, Bagegni N, Hagemann IS, Ma CX. Abstract P2-13-01: Phase 2 study of neoadjuvant palbociclib, letrozole, and trastuzumab in patients with ER+ HER2+ breast cancer (PALTAN). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Patients (pts) with ER+ HER2+ breast cancer (BC) are less likely to achieve pathological complete response (pCR) after neoadjuvant chemotherapy with dual HER2 blockade than pts with ER- HER2+ BC. Endocrine therapy (ET) plus trastuzumab is effective in advanced ER+ HER2+ BC, but pCR rate is low in the neoadjuvant setting. Inhibition of CDK4/6 and HER2 results in synergistic reduction in cell proliferation in preclinical studies. We therefore combined ET with CDK4/6 inhibition and trastuzumab in ER+ HER2+ BC as a chemotherapy-sparing regimen. Methods We evaluated the efficacy of palbociclib, letrozole, trastuzumab (PLT) in the neoadjuvant setting for pts with stages II or III ER+ HER2+ BC. Primary endpoint was pCR after 16 weeks of therapy. We assumed null of 15% pCR and pCR ≥ 30% warrants further investigation. To achieve 80% power at 1-sided 0.05 significance, 48 pts were to be enrolled. Evaluable population included pts who completed Cycle (C) 1 unless discontinued due to treatment-emergent adverse events (TEAEs) prior to completing C1. All who received one dose on study were considered evaluable for toxicity. Biopsies were collected at baseline (BL), C1 day 15 (C1D15), and surgery for RNA sequencing and central Ki67 assessment, for PAM50 subtype distribution, complete cell cycle arrest (CCCA: Ki67 ≤2.7%) at C1D15 and surgery, and treatment induced signaling changes. Results Accrual stopped early due to futility. 26 pts accrued were evaluable for efficacy and toxicity. pCR (residual cancer burden- [RCB] 0) was 7.7% (95% CI 0.9 - 25.1%) and RCB 0/I was 38.5% (95% CI 20.2 - 59.4%). TEAEs (n= 337) were seen in all pts (71.5% grade [G] 1, 19.3% G2, 8.6% G3, 0.6% G4); the most common were leukopenia (7.7%), neutropenia (7.1%), anemia (5.9%). G3/4 TEAEs occurred in 19 pts (73.1%). Among the 19, incidence of G3/4 neutropenia was 50%, hypertension 26.9%, leucopenia 7.7%. TEAEs (hypertension, ventricular tachycardia, pulmonary edema) leading to treatment discontinuation were reported in 1 pt. Two pts had at least one SAE. No treatment-related deaths occurred. Pt reported outcomes using NCI PRO-CTCAE revealed no differences in appetite, nausea, respiratory symptoms, edema, palpitations, rashes and dry skin, or concentration from BL to end of C4. Pts had worsening hair loss from BL to end of C4. Ki67 analysis indicated CCCA in 78% at C1D15, compared to 18% at surgery after only P had been discontinued approximately 4 weeks prior to surgery. RNA sequencing was performed on available biopsies collected at BL (N=16), C1D15 (N=5), and surgery (N=2) from 16 pts. Among 16 BL samples, PAM50 subtyping identified 5 (31.3%) basal-like, 2 (12.5%) HER2-E, 6 (37.5%) Lum B, and 3 (18.8%) normal. Subtype switching to Lum A at C1D15 (N=3, 1 each with HER2-E, Lum B, and normal at BL) or normal (N=2, 1 basal and 1 HER2-E at BL) was observed. 161 genes were differentially expressed (FDR p<0.05); 145 downregulated and 16 upregulated comparing C1D15 to BL. MKI67, TK1, CCNB1, AURKB, PLK1 were among the downregulated genes, consistent with CCCA for majority of the samples at C1D15 by Ki67. Analysis of the Molecular Signatures Database Hallmark gene-sets comparing C1D15 and BL samples demonstrated downregulated biological processes involved in proliferation (E2F targets, G2M checkpoint, MYC targets, mitotic spindle), signaling (Estrogen response, mTORC1 signaling), and DNA damage (DNA repair) at C1D15, consistent with the mechanisms of action of the study drugs. E2F targets were higher in BL samples of RCB II/III, compared to RCB I (FDR p=0.042). Conclusions PALTAN did not meet its primary endpoint of pCR. Neoadjuvant PLT showed a pCR of 7.7% but was well tolerated. RNA sequencing and Ki67 data indicated potent anti-proliferative effects of study treatments, despite significant heterogeneity of intrinsic subtypes. Clinical trial information: NCT02907918.
Citation Format: Foluso O Ademuyiwa, Donald Northfelt, Tracey O'Connor, Ellis Levine, Jingqin Luo, Yu Tao, Jeremy Hoog, Marie Laury, Tracy Summa, Trish Hammerschmidt, Zhanfang Guo, Ashley Frith, Katherine Weilbaecher, Mateusz Opyrchal, Rebecca Aft, Katherine Clifton, Rama Suresh, Nusayba Bagegni, Ian S Hagemann, Cynthia X Ma. Phase 2 study of neoadjuvant palbociclib, letrozole, and trastuzumab in patients with ER+ HER2+ breast cancer (PALTAN) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-01.
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Affiliation(s)
| | | | | | | | | | - Yu Tao
- Washington University, Saint Louis, MO
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24
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Hassan MM, Cyr AE, Hagemann IS. Estimating the Breast Cancer Risk Conferred by Germline Mutations. Clin Chem 2021; 68:382-384. [DOI: 10.1093/clinchem/hvab252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Muhammad M Hassan
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Amy E Cyr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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25
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Lee JS, Chang J, Hagemann IS, Bennett DL. Malignant Phyllodes Tumor: Imaging Features With Histopathologic Correlation. J Breast Imaging 2021; 3:703-711. [PMID: 38424928 DOI: 10.1093/jbi/wbab065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 03/02/2024]
Abstract
Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast that commonly present as rapidly enlarging, palpable masses. Phyllodes tumors may be classified as benign, borderline, or malignant on the basis of histopathologic analysis. Although malignant PT cannot be distinguished from benign PT on the basis of imaging findings alone, studies suggest that malignant PT tend to be larger and irregular in shape, and they are less likely to have circumscribed margins. If biopsy results are indeterminate, excisional biopsy should be performed. Malignant PT can be difficult to distinguish histologically from sarcomas and spindle cell metaplastic breast carcinoma; the distinction is important for prognosis and treatment. Malignant PT are treated surgically with wide local excision, without a clear role for adjuvant radiation or chemotherapy in most cases. Nearly one-third of malignant PT recur locally, usually within a few years after initial diagnosis. Distant metastatic disease is rare, and the five-year overall survival rate of malignant PT is close to 80%. The purpose of this article is to review the clinical presentation, imaging appearance, histopathology, and management of malignant PT.
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Affiliation(s)
- Jane S Lee
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, MO, USA
| | - Jodie Chang
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Ian S Hagemann
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, MO, USA
| | - Debbie L Bennett
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
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26
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Mullen MM, Lomonosova E, Toboni MD, Oplt A, Cybulla E, Blachut B, Zhao P, Noia H, Wilke D, Rankin EB, Kuroki LM, Hagemann AR, Hagemann IS, McCourt CK, Thaker PH, Mutch DG, Powell MA, Mosammaparast N, Vindigni A, Fuh KC. GAS6/AXL Inhibition Enhances Ovarian Cancer Sensitivity to Chemotherapy and PARP Inhibition through Increased DNA Damage and Enhanced Replication Stress. Mol Cancer Res 2021; 20:265-279. [PMID: 34670865 DOI: 10.1158/1541-7786.mcr-21-0302] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/16/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
Over 80% of women with high-grade serous ovarian cancer (HGSOC) develop tumor resistance to chemotherapy and die of their disease. There are currently no FDA-approved agents to improve sensitivity to first-line platinum- and taxane-based chemotherapy or to PARP inhibitors. Here, we tested the hypothesis that expression of growth arrest-specific 6 (GAS6), the ligand of receptor tyrosine kinase AXL, is associated with chemotherapy response and that sequestration of GAS6 with AVB-S6-500 (AVB-500) could improve tumor response to chemotherapy and PARP inhibitors. We found that GAS6 levels in patient tumor and serum samples collected before chemotherapy correlated with ovarian cancer chemoresponse and patient survival. Compared with chemotherapy alone, AVB-500 plus carboplatin and/or paclitaxel led to decreased ovarian cancer-cell survival in vitro and tumor burden in vivo. Cells treated with AVB-500 plus carboplatin had more DNA damage, slower DNA replication fork progression, and fewer RAD51 foci than cells treated with carboplatin alone, indicating AVB-500 impaired homologous recombination (HR). Finally, treatment with the PARP inhibitor olaparib plus AVB-500 led to decreased ovarian cancer-cell survival in vitro and less tumor burden in vivo. Importantly, this effect was seen in HR-proficient and HR-deficient ovarian cancer cells. Collectively, our findings suggest that GAS6 levels could be used to predict response to carboplatin and AVB-500 could be used to treat platinum-resistant, HR-proficient HGSOC. IMPLICATIONS: GAS6/AXL is a novel target to sensitize ovarian cancers to carboplatin and olaparib. Additionally, GAS6 levels can be associated with response to carboplatin treatment.
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Affiliation(s)
- Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Elena Lomonosova
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Michael D Toboni
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Alyssa Oplt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Emily Cybulla
- Division of Hematology and Oncology, Department of Medicine, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri.,Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Barbara Blachut
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Peinan Zhao
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Hollie Noia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Wilke
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Erinn B Rankin
- Department of Obstetrics and Gynecology, Stanford Medicine, Stanford University, Stanford, California. Department of Radiation Oncology, Stanford Medicine, Stanford University, Stanford, California
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Ian S Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri.,Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Nima Mosammaparast
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Alessandro Vindigni
- Division of Hematology and Oncology, Department of Medicine, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri.
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Abstract
OBJECTIVES We aimed to test the hypothesis that in retroperitoneal dedifferentiated liposarcoma (DDLS) the presence of the dedifferentiated (DD) component at the resection margin is associated with adverse outcome. METHODS We retrospectively searched the archive for primary resections of retroperitoneal DDLS performed at our institution between 1990 and 2017. Slides were rereviewed for diagnosis, Fédération Nationale des Centres de Lutte Contre le Cancer grade, myogenic differentiation, and the presence of the well-differentiated (WD) or DD component at the resection margin. The medical records were reviewed for patient age, sex, tumor size, tumor focality, adjuvant/neoadjuvant therapy, local recurrence, distant metastases, local recurrence-free survival (LRFS), overall survival (OS), and follow-up duration. RESULTS The presence of the DD component at the resection margin was associated with worse LRFS compared with cases without the DD component at the margin (P = .002). However, OS was not significantly affected (P = .11). CONCLUSIONS LRFS is significantly shorter in cases with the DD component at the margin compared with cases without DD tumor at the margin, while there is no association with OS. We recommend reporting the presence or absence of DD tumor at the margin in retroperitoneal DDLS, as it adds meaningful prognostic information.
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Affiliation(s)
- Carina A Dehner
- Department of Pathology and Immunology, Washington University, St Louis, MO, USA
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University, St Louis, MO, USA
| | - John S A Chrisinger
- Department of Pathology and Immunology, Washington University, St Louis, MO, USA
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28
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Sun L, Wu A, Bean GR, Hagemann IS, Lin CY. Molecular Testing in Breast Cancer: Current Status and Future Directions. J Mol Diagn 2021; 23:1422-1432. [PMID: 34454106 DOI: 10.1016/j.jmoldx.2021.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022] Open
Abstract
Molecular testing in breast cancer is a rapidly developing field that is becoming increasingly integral to patient care. This article provides an overview of currently available molecular assays and testing modalities that have prognostic, predictive, and therapeutic value. These include multigene assays for invasive breast cancer (Oncotype DX, MammaPrint, Prosigna, and Breast Cancer Index) and ductal carcinoma in situ (Oncotype DX DCIS and DCISionRT) and companion tests to detect PIK3CA mutations and NTRK fusions. The various assays related to immune checkpoint inhibitors, consisting of immunohistochemistry with anti-programmed death-ligand 1 antibodies SP142 and 22C3 and detection of microsatellite instability, mismatch repair deficiency, and tumor mutational burden are also discussed. Finally, the practical utility and hopeful promise of next-generation sequencing panels and circulating tumor (cell-free) DNA assays are evaluated. This review should serve as a useful and practical reference for practicing pathologists, molecular pathologists, clinicians, and researchers.
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Affiliation(s)
- Lulu Sun
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ariel Wu
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
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29
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Hagemann IS, Elliott R, Kalof A, Keung ES, Patil N, Peterson JEG. Advancing Fellowship Training in Selective Pathology: Design and Implementation of the Milestones 2.0. Arch Pathol Lab Med 2021; 146:501-506. [PMID: 34324625 DOI: 10.5858/arpa.2021-0112-oa] [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] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Program requirements for Selective Pathology fellowships in the United States were established by the Accreditation Council for Graduate Medical Education (ACGME) in 2011 to govern fellowships providing advanced training in surgical pathology, focused anatomic pathology, or focused clinical pathology. Selective Pathology entered the ACGME's Next Accreditation System in 2015 with the introduction of the Selective Pathology Milestones 1.0, a set of benchmarks for evaluating fellow progress in each of the 6 ACGME core competencies. In 2019, the ACGME convened a work group for a planned periodic update to these milestones. OBJECTIVE.— To summarize changes to the Selective Pathology milestones. DESIGN.— The study design featured expert opinion and survey. RESULTS.— The Patient Care milestones for anatomic pathology-focused fellowships contain a renewed emphasis on both gross and microscopic examination, whereas for clinical pathology-focused fellowships, the emphasis is on interpretation of laboratory assays. The milestones for the non-Patient Care, non-Medical Knowledge competencies have been updated to a harmonized set of milestones designed to extend across all specialties and subspecialties. New to the milestones program is a supplemental guide that provides examples, suggested assessment tools, and references to aid in implementation. Public comments were supportive of the changes. CONCLUSIONS.— The Milestones 2.0 are set for implementation in July 2021. Updates in the new milestones are aimed at facilitating training and harmonizing evaluation across subspecialties.
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Affiliation(s)
- Ian S Hagemann
- From the Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (Hagemann)
| | - Robin Elliott
- the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Elliott)
| | - Alexandra Kalof
- the Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (Kalof)
| | - Elaine S Keung
- the Department of Pathology, Uniformed Services University, Bethesda, Maryland (Keung)
| | - Ninad Patil
- the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Patil)
| | - Jo Elle G Peterson
- the Department of Pathology, University of Oklahoma, Oklahoma City (Peterson)
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30
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Kotnik EN, Spies NC, Li T, Inkman M, Zhang J, Martins-Rodrigues F, Hagemann IS, McCourt CK, Thaker PH, Hagemann AR, Powell MA, Mutch DG, Maher CA, Miller CA, Fuh KC. Abstract 2202: Genetic characterization of metastasis and prognosis in high-grade serous ovarian cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
High-grade serous ovarian cancer (HGSC) is the most lethal histotype of ovarian cancer and is highly prone to metastasis, with the majority of patients presenting at advanced stages of disease. There are few targeted treatment options for HGSC patients, especially for women with high metastatic tumor burdens. In order to identify potential genetic targets in metastatic disease, we characterized the genomic and transcriptomic alterations of metastatic tumors in HGSC patients. In this study, matched normal tissue, primary, and metastatic tumors from 23 HGSC short-term (ST) survivors (overall survival [OS] <3.5 years) and 14 long-term (LT) survivors (OS >5 years) underwent whole exome and RNA sequencing. We compared somatic mutations, copy number alternations, mutational burdens, differential expression, immune cell fractions, and gene fusion predictions between the primary and metastatic tumors of the ST and LT survival groups.
We confirmed that tumors of LT survivors were more likely to have BRCA1 alterations and more copy-altered segments when compared to tumors of ST survivors. There was a higher percentage of shared variants between the primary and metastatic tumors for ST survivors compared to LT survivors. ST survivors also had a greater mutational burden and more predicted gene fusions than LT. We observed few differentially expressed genes between primary and metastatic tumors, but we did observe significant differences between the transcriptomes of LT and ST survivors' tumors. Overall, we observed that HGSC primary and metastatic tumors had similar genomic and transcriptomic landscapes, but we identified genetic characteristics specific to metastatic tumors that correlate with survival.
Citation Format: Emilee N. Kotnik, Nicholas C. Spies, Tiandao Li, Matthew Inkman, Jin Zhang, Fernanda Martins-Rodrigues, Ian S. Hagemann, Carolyn K. McCourt, Premal H. Thaker, Andrea R. Hagemann, Matthew A. Powell, David G. Mutch, Christopher A. Maher, Christopher A. Miller, Katherine C. Fuh. Genetic characterization of metastasis and prognosis in high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2202.
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Affiliation(s)
| | | | - Tiandao Li
- Washington University in St. Louis, St. Louis, MO
| | | | - Jin Zhang
- Washington University in St. Louis, St. Louis, MO
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31
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Gavrielides MA, Miller M, Hagemann IS, Abdelal H, Alipour Z, Chen JF, Salari B, Sun L, Zhou H, Seidman JD. Clinical Decision Support for Ovarian Carcinoma Subtype Classification: A Pilot Observer Study With Pathology Trainees. Arch Pathol Lab Med 2021; 144:869-877. [PMID: 31816269 DOI: 10.5858/arpa.2019-0390-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Clinical decision support (CDS) systems could assist less experienced pathologists with certain diagnostic tasks for which subspecialty training or extensive experience is typically needed. The effect of decision support on pathologist performance for such diagnostic tasks has not been examined. OBJECTIVE.— To examine the impact of a CDS tool for the classification of ovarian carcinoma subtypes by pathology trainees in a pilot observer study using digital pathology. DESIGN.— Histologic review on 90 whole slide images from 75 ovarian cancer patients was conducted by 6 pathology residents using: (1) unaided review of whole slide images, and (2) aided review, where in addition to whole slide images observers used a CDS tool that provided information about the presence of 8 histologic features important for subtype classification that were identified previously by an expert in gynecologic pathology. The reference standard of ovarian subtype consisted of majority consensus from a panel of 3 gynecologic pathology experts. RESULTS.— Aided review improved pairwise concordance with the reference standard for 5 of 6 observers by 3.3% to 17.8% (for 2 observers, increase was statistically significant) and mean interobserver agreement by 9.2% (not statistically significant). Observers benefited the most when the CDS tool prompted them to look for missed histologic features that were definitive for a certain subtype. Observer performance varied widely across cases with unanimous and nonunanimous reference classification, supporting the need for balancing data sets in terms of case difficulty. CONCLUSIONS.— Findings showed the potential of CDS systems to close the knowledge gap between pathologists for complex diagnostic tasks.
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Affiliation(s)
- Marios A Gavrielides
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Meghan Miller
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Ian S Hagemann
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Heba Abdelal
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Zahra Alipour
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Jie-Fu Chen
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Behzad Salari
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Lulu Sun
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Huifang Zhou
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
| | - Jeffrey D Seidman
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Engineering and Science Laboratories (Dr Gavrielides and Ms Miller), and the Office of In Vitro Diagnostics and Radiological Health, Division of Molecular Genetics and Pathology (Dr Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; the Department of Bioengineering, University of Maryland, College Park (Ms Miller); and the Departments of Pathology and Immunology (Drs Hagemann, Abdelal, Alipour, Chen, Salari, Sun, and Zhou) and Obstetrics and Gynecology (Dr Hagemann), Washington University School of Medicine, St Louis, Missouri. Ms Miller is currently with PCTEST Engineering Laboratory, Columbia, Maryland
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Zhu Q, Ademuyiwa FO, Young C, Appleton C, Covington MF, Ma C, Sanati S, Hagemann IS, Mostafa A, Uddin KMS, Grigsby I, Frith AE, Hernandez-Aya LF, Poplack SS. Early Assessment Window for Predicting Breast Cancer Neoadjuvant Therapy using Biomarkers, Ultrasound, and Diffuse Optical Tomography. Breast Cancer Res Treat 2021; 188:615-630. [PMID: 33970392 DOI: 10.1007/s10549-021-06239-y] [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: 01/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer response to neoadjuvant therapy (NAT). METHODS This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P < 0.05 considered statistically significant. Logistic regression was used for ROC analysis. RESULTS Thirty-eight patients (mean age = 47, range 24-71 years) successfully completed the study, including 15 HER2 + of which 11 were ER + ; 12 ER + or PR + /HER2-, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC = 0.941 (95% CI 0.869-1.0). Similarly an AUC of 0.910 (95% CI 0.810-1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC = 0.974 (95% CI 0.933-1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status. CONCLUSION The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle. CLINICAL TRIAL REGISTRATION NUMBER NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 , Registration time: September 7, 2016.
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Affiliation(s)
- Quing Zhu
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA. .,Washington University School of Medicine in St Louis, St. Louis, USA.
| | - Foluso O Ademuyiwa
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Catherine Young
- Washington Baylor Scott & White Health, Medical Center, Texas, Dallas, USA
| | - Catherine Appleton
- Diagnostic Imaging Associates, Ltd. St. Luke's Hospital, Chesterfield, USA
| | - Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, USA
| | - Cynthia Ma
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Souzan Sanati
- Pathology, Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ian S Hagemann
- Washington University School of Medicine in St Louis, St. Louis, USA
| | - Atahar Mostafa
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - K M Shihab Uddin
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - Isabella Grigsby
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Ashley E Frith
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | | | - Steven S Poplack
- Washington University School of Medicine in St Louis, St. Louis, USA.,Radiology, Stanford University, Stanford, USA
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Hagemann IS. Sequence Now, Later, or Never? Clin Chem 2021; 66:883-885. [PMID: 32628757 DOI: 10.1093/clinchem/hvaa053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/17/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Ian S Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO.,Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO
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Arudra SKC, Garvey LC, Hagemann IS. In-laboratory breast specimen radiography reduces tissue block utilization and improves turnaround time of pathologic examination. BMC Med Imaging 2021; 21:59. [PMID: 33757455 PMCID: PMC7988919 DOI: 10.1186/s12880-021-00589-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background This study was performed to determine whether in-laboratory specimen radiography reduces turnaround time or block utilization in surgical pathology.
Methods Specimens processed during a 48-day trial of an in-lab cabinet radiography device (Faxitron) were compared to a control group of specimens imaged in the mammography suite during a prior 1-year period, and to a second group of specimens not undergoing imaging of any type. Results Cases imaged in the mammography suite had longer turnaround time than cases not requiring imaging (by 1.15 days for core biopsies, and 1.73 days for mastectomies; p < 0.0001). In contrast, cases imaged in-lab had turnaround time that was no longer than unimaged cases (p > 0.05 for core biopsies, lumpectomies and mastectomies). Mastectomies imaged in-lab required submission of fewer blocks than controls not undergoing any imaging (mean reduction of 10.6 blocks). Conclusions Availability of in-lab radiography resulted in clinically meaningful improvements in turnaround time and economically meaningful reductions in block utilization.
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Affiliation(s)
- Sri Krishna Chaitanya Arudra
- Department of Pathology and Immunology, Washington University School of Medicine, 425 S. Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, USA
| | - Laura C Garvey
- Department of Pathology and Immunology, Washington University School of Medicine, 425 S. Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, 425 S. Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, USA.
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Gavrielides MA, Ronnett BM, Vang R, Barak S, Lee E, Staats PN, Jenson E, Skaria P, Sheikhzadeh F, Miller M, Hagemann IS, Petrick N, Seidman JD. Pathologist Concordance for Ovarian Carcinoma Subtype Classification and Identification of Relevant Histologic Features Using Microscope and Whole Slide Imaging: A Multisite Observer Study. Arch Pathol Lab Med 2021; 145:1516-1525. [PMID: 33635941 DOI: 10.5858/arpa.2020-0579-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Despite several studies focusing on the validation of whole slide imaging (WSI) across organ systems or subspecialties, the use of WSI for specific primary diagnosis tasks has been underexamined. OBJECTIVE.— To assess pathologist performance for the histologic subtyping of individual sections of ovarian carcinomas using the light microscope and WSI. DESIGN.— A panel of 3 experienced gynecologic pathologists provided reference subtype diagnoses for 212 histologic sections from 109 ovarian carcinomas based on optical microscopy review. Two additional attending pathologists provided diagnoses and also identified the presence of a set of 8 histologic features important for ovarian tumor subtyping. Two experienced gynecologic pathologists and 2 fellows reviewed the corresponding WSI images for subtype classification and feature identification. RESULTS.— Across pathologists specialized in gynecologic pathology, concordance with the reference diagnosis for the 5 major ovarian carcinoma subtypes was significantly higher for a pathologist reading on microscope than each of 2 pathologists reading on WSI. Differences were primarily due to more frequent classification of mucinous carcinomas as endometrioid with WSI. Pathologists had generally low agreement in identifying histologic features important to ovarian tumor subtype classification, with either optical microscopy or WSI. This result suggests the need for refined histologic criteria for identifying such features. Interobserver agreement was particularly low for identifying intracytoplasmic mucin with WSI. Inconsistencies in evaluating nuclear atypia and mitoses with WSI were also observed. CONCLUSIONS.— Further research is needed to specify the reasons for these diagnostic challenges and to inform users and manufacturers of WSI technology.
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Affiliation(s)
- Marios A Gavrielides
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories (Gavrielides and Petrick)
| | - Brigitte M Ronnett
- the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Russell Vang
- the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Stephanie Barak
- the Department of Pathology, The George Washington University, Washington, District of Columbia (Barak, Lee)
| | - Elsie Lee
- Gavrielides is currently at AstraZeneca, Gaithersburg, Maryland.,the Department of Pathology, The George Washington University, Washington, District of Columbia (Barak, Lee)
| | - Paul N Staats
- the Department of Pathology, University of Maryland School of Medicine, Baltimore (Staats)
| | - Erik Jenson
- Lee is currently at HNL Lab Medicine, Allentown, Pennsylvania.,the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Priya Skaria
- the Departments of Pathology and Immunology (Skaria and Hagemann), Washington University School of Medicine, St Louis, Missouri
| | - Fahime Sheikhzadeh
- Jenson is now with Hospital Pathology Associates, Minneapolis/St Paul, Minnesota.,the Electrical and Computer Engineering Department, University of British Columbia, Vancouver, Canada (Sheikhzadeh)
| | - Meghan Miller
- and the Department of Bioengineering, University of Maryland, College Park (Miller)
| | - Ian S Hagemann
- the Departments of Pathology and Immunology (Skaria and Hagemann), Washington University School of Medicine, St Louis, Missouri.,and Obstetrics and Gynecology (Hagemann), Washington University School of Medicine, St Louis, Missouri
| | - Nicholas Petrick
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories (Gavrielides and Petrick)
| | - Jeffrey D Seidman
- and the Division of Molecular Genetics and Pathology, Office of In Vitro Diagnostics and Radiological Health (Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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Hagemann IS, Deng W, Zaino RJ, Powell MA, Gunderson C, Cosgrove C, Mathews C, Pearl ML, Waggoner S, Ghebre R, Lele S, Guntupalli S, Secord AA, Ioffe O, Park K, Rasty G, Singh M, Soslow R, Creasman W, Mutch DG. The presence of an endometrioid component does not alter the clinicopathologic profile or survival of patients with uterine serous cancer: A gynecologic oncology group (GOG/NRG) study of 934 women. Gynecol Oncol 2021; 160:660-668. [PMID: 33423806 DOI: 10.1016/j.ygyno.2020.12.040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. METHODS 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. RESULTS The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. CONCLUSIONS There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases. NCT#: NCT00340808.
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Affiliation(s)
- Ian S Hagemann
- Washington University School of Medicine, St. Louis, MO, USA.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | | | | | - Camille Gunderson
- University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, USA.
| | - Casey Cosgrove
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, NY, USA.
| | | | - Rahel Ghebre
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | | | | | | | - Olga Ioffe
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Kay Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | | | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - William Creasman
- Medical University of South Carolina Medical Center, Charleston, SC, USA.
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA.
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Uppaluri R, Campbell KM, Egloff AM, Zolkind P, Skidmore ZL, Nussenbaum B, Paniello RC, Rich JT, Jackson R, Pipkorn P, Michel LS, Ley J, Oppelt P, Dunn GP, Barnell EK, Spies NC, Lin T, Li T, Mulder DT, Hanna Y, Cirlan I, Pugh TJ, Mudianto T, Riley R, Zhou L, Jo VY, Stachler MD, Hanna GJ, Kass J, Haddad R, Schoenfeld JD, Gjini E, Lako A, Thorstad W, Gay HA, Daly M, Rodig SJ, Hagemann IS, Kallogjeri D, Piccirillo JF, Chernock RD, Griffith M, Griffith OL, Adkins DR. Correction: Neoadjuvant and Adjuvant Pembrolizumab in Resectable Locally Advanced, Human Papillomavirus-unrelated Head and Neck Cancer: A Multicenter, Phase II Trial. Clin Cancer Res 2021; 27:357. [PMID: 33397681 DOI: 10.1158/1078-0432.ccr-20-4484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yang C, Zhang L, Love-Gregory L, Sun L, Hagemann IS, Cao D. Identification of novel ALK rearrangements in gynecologic clear cell carcinoma. Int J Cancer 2020; 148:459-468. [PMID: 33034056 DOI: 10.1002/ijc.33330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022]
Abstract
Clear cell carcinomas (CCCs) of the gynecologic tract are aggressive tumors with high resistance rate to conventional platinum-based chemotherapies. Currently, the molecular features of these tumors remain largely unknown and there is no targeted therapy available. The aim of our study was to identify anaplastic lymphoma kinase (ALK) translocations, a potential molecular target for therapy. Ninety-seven patients with gynecologic CCC (62 ovarian, 27 uterine corpus and 8 uterine cervical) were screened for ALK rearrangement and ALK copy number gain using an ALK break-apart fluorescence in situ hybridization probe. The genomic landscape of all cases with ALK rearrangements and 10 random cases with ALK copy number gain was queried using a hybrid capture-based DNA next-generation sequencing assay and an Illumina Fusion RNA assay. Findings were then correlated with ALK immunohistochemistry (clone D5F3) expression. ALK rearrangement was detected in 5% (5/97) and ALK copy number gain in 79% (77/97) of gynecologic CCCs. Next-generation sequencing in ALK-rearranged CCCs identified a novel BABAM2-ALK fusion in one case. ALK translocation partners were not identified in the remaining cases. Our findings show that ALK fusion, which is targetable in other cancers, may be a pathogenetic mechanism in a small number of gynecologic CCCs.
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Affiliation(s)
- Chen Yang
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lingxin Zhang
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Latisha Love-Gregory
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lulu Sun
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ian S Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dengfeng Cao
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Grither WR, Dickson BC, Fuh KC, Hagemann IS. Detection of a somatic GREB1-NCOA1 gene fusion in a uterine tumor resembling ovarian sex cord tumor (UTROSCT). Gynecol Oncol Rep 2020; 34:100636. [PMID: 32964092 PMCID: PMC7490989 DOI: 10.1016/j.gore.2020.100636] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023] Open
Abstract
Uterine tumor resembling ovarian sex cord tumor is a rare mesenchymal neoplasm. UTROSCT harbors recurrent rearrangements between NCOA1-3 and ESR1 or GREB1. RNA-sequencing can identify these rearrangements to support the diagnosis.
Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare uterine neoplasm of uncertain malignant potential. We present the case of a 69-year-old woman who underwent hysterectomy for postmenopausal bleeding and was found to have a myometrial UTROSCT. RNA-sequencing identified a somatic GREB1–NCOA1 fusion, supporting the diagnosis. Next-generation sequencing is increasingly being adopted in diagnostic pathology laboratories. This report highlights the value of RNA-sequencing in identifying rare fusion events to support pathologic diagnoses.
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Affiliation(s)
- Whitney R Grither
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brendan C Dickson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Katherine C Fuh
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian S Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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40
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Uppaluri R, Campbell KM, Egloff AM, Zolkind P, Skidmore ZL, Nussenbaum B, Paniello RC, Rich JT, Jackson R, Pipkorn P, Michel LS, Ley J, Oppelt P, Dunn GP, Barnell EK, Spies NC, Lin T, Li T, Mulder DT, Hanna Y, Cirlan I, Pugh TJ, Mudianto T, Riley R, Zhou L, Jo VY, Stachler MD, Hanna GJ, Kass J, Haddad R, Schoenfeld JD, Gjini E, Lako A, Thorstad W, Gay HA, Daly M, Rodig SJ, Hagemann IS, Kallogjeri D, Piccirillo JF, Chernock RD, Griffith M, Griffith OL, Adkins DR. Neoadjuvant and Adjuvant Pembrolizumab in Resectable Locally Advanced, Human Papillomavirus-Unrelated Head and Neck Cancer: A Multicenter, Phase II Trial. Clin Cancer Res 2020; 26:5140-5152. [PMID: 32665297 DOI: 10.1158/1078-0432.ccr-20-1695] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Pembrolizumab improved survival in patients with recurrent or metastatic head and neck squamous-cell carcinoma (HNSCC). The aims of this study were to determine if pembrolizumab would be safe, result in pathologic tumor response (pTR), and lower the relapse rate in patients with resectable human papillomavirus (HPV)-unrelated HNSCC. PATIENTS AND METHODS Neoadjuvant pembrolizumab (200 mg) was administered and followed 2 to 3 weeks later by surgical tumor ablation. Postoperative (chemo)radiation was planned. Patients with high-risk pathology (positive margins and/or extranodal extension) received adjuvant pembrolizumab. pTR was quantified as the proportion of the resection bed with tumor necrosis, keratinous debris, and giant cells/histiocytes: pTR-0 (<10%), pTR-1 (10%-49%), and pTR-2 (≥50%). Coprimary endpoints were pTR-2 among all patients and 1-year relapse rate in patients with high-risk pathology (historical: 35%). Correlations of baseline PD-L1 and T-cell infiltration with pTR were assessed. Tumor clonal dynamics were evaluated (ClinicalTrials.gov NCT02296684). RESULTS Thirty-six patients enrolled. After neoadjuvant pembrolizumab, serious (grades 3-4) adverse events and unexpected surgical delays/complications did not occur. pTR-2 occurred in eight patients (22%), and pTR-1 in eight other patients (22%). One-year relapse rate among 18 patients with high-risk pathology was 16.7% (95% confidence interval, 3.6%-41.4%). pTR ≥10% correlated with baseline tumor PD-L1, immune infiltrate, and IFNγ activity. Matched samples showed upregulation of inhibitory checkpoints in patients with pTR-0 and confirmed clonal loss in some patients. CONCLUSIONS Among patients with locally advanced, HPV-unrelated HNSCC, pembrolizumab was safe, and any pathologic response was observed in 44% of patients with 0% pathologic complete responses. The 1-year relapse rate in patients with high-risk pathology was lower than historical.
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Affiliation(s)
- Ravindra Uppaluri
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. .,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katie M Campbell
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri.,McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Ann Marie Egloff
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul Zolkind
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Zachary L Skidmore
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Randal C Paniello
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jason T Rich
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan Jackson
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Loren S Michel
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica Ley
- Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Oppelt
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Gavin P Dunn
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Erica K Barnell
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri.,McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Nicholas C Spies
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Tianxiang Lin
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Tiantian Li
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - David T Mulder
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Youstina Hanna
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Iulia Cirlan
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Tenny Mudianto
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Riley
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Liye Zhou
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vickie Y Jo
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew D Stachler
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jason Kass
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert Haddad
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation-Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Evisa Gjini
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ana Lako
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wade Thorstad
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Radiation-Oncology, Washington University School of Medicine, St. Louis, Massachusetts
| | - Hiram A Gay
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Radiation-Oncology, Washington University School of Medicine, St. Louis, Massachusetts
| | - Mackenzie Daly
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Radiation-Oncology, Washington University School of Medicine, St. Louis, Massachusetts
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Immuno-Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca D Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Malachi Griffith
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri.,McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Obi L Griffith
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri.,McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas R Adkins
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
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Zeng Y, Nandy S, Rao B, Li S, Hagemann AR, Kuroki LK, McCourt C, Mutch DG, Powell MA, Hagemann IS, Zhu Q. Histogram analysis of en face scattering coefficient map predicts malignancy in human ovarian tissue. J Biophotonics 2019; 12:e201900115. [PMID: 31304678 PMCID: PMC7982142 DOI: 10.1002/jbio.201900115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/22/2019] [Accepted: 07/11/2019] [Indexed: 05/18/2023]
Abstract
Ovarian cancer is a heterogeneous disease at the molecular and histologic level. Optical coherence tomography (OCT) is able to map ovarian tissue optical properties and heterogeneity, which has been proposed as a feature to aid in diagnosis of ovarian cancer. In this manuscript, depth-resolved en face scattering maps of malignant ovaries, benign ovaries, and benign fallopian tubes obtained from 20 patients are provided to visualize the heterogeneity of ovarian tissues. Six features are extracted from histograms of scattering maps. All features are able to statistically distinguish benign from malignant ovaries. Two prediction models were constructed based on these features: a logistic regression model (LR) and a support vector machine (SVM). The optimal set of features is mean scattering coefficient and scattering map entropy. The LR achieved a sensitivity and specificity of 97.0% and 97.8%, and SVM demonstrated a sensitivity and specificity of 99.6% and 96.4%. Our initial results demonstrate the feasibility of using OCT as an "optical biopsy tool" for detecting the microscopic scattering changes associated with neoplasia in human ovarian tissue.
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Affiliation(s)
- Yifeng Zeng
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Sreyankar Nandy
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Bin Rao
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Shuying Li
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Andrea R. Hagemann
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay K. Kuroki
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Carolyn McCourt
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - David G. Mutch
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A. Powell
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Correspondence Dr. Quing Zhu, Department of Biomedical Engineering, Washington University, St. Louis, MO 63110.
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42
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Rao B, Leng X, Zeng Y, Lin Y, Chen R, Zhou Q, Hagemann AR, Kuroki LM, McCourt CK, Mutch DG, Powell MA, Hagemann IS, Zhu Q. Optical Resolution Photoacoustic Microscopy of Ovary and Fallopian Tube. Sci Rep 2019; 9:14306. [PMID: 31586106 PMCID: PMC6778126 DOI: 10.1038/s41598-019-50743-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022] Open
Abstract
Ovarian cancer is the leading cause of death among gynecological cancers, but is poorly amenable to preoperative diagnosis. In this study, we investigate the feasibility of "optical biopsy," using high-optical-resolution photoacoustic microscopy (OR-PAM) to quantify the microvasculature of ovarian and fallopian tube tissue. The technique is demonstrated using excised human ovary and fallopian tube specimens imaged immediately after surgery. Quantitative parameters are derived using Amira software. The parameters include three-dimensional vascular segment count, total volume and length, which are associated with tumor angiogenesis. Qualitative results of OR-PAM demonstrate that malignant ovarian tissue has larger and more tortuous blood vessels as well as smaller vessels of different sizes, while benign and normal ovarian tissue has smaller vessels of uniform size. Quantitative analysis shows that malignant ovaries have greater tumor vessel volume, length and number of segments, as compared with benign and normal ovaries. The vascular pattern of benign fallopian tube is different than that of benign ovarian tissue. Our initial results demonstrate the potential of OR-PAM as an imaging tool for fast assessment of ovarian tissue and fallopian tube and could avoid unnecessary surgery if the risk of the examined ovary is extremely low.
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Affiliation(s)
- Bin Rao
- Biomedical Engineering, Washington University, St Louis, MO, 63130, USA
- Applied Bioptics LLC, St Louis, MO, 63146, USA
| | - Xiandong Leng
- Biomedical Engineering, Washington University, St Louis, MO, 63130, USA
| | - Yifeng Zeng
- Biomedical Engineering, Washington University, St Louis, MO, 63130, USA
| | - Yixiao Lin
- Biomedical Engineering, Washington University, St Louis, MO, 63130, USA
| | - Ruimin Chen
- Department of Biomedical Engineering and Ophthalmology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Ophthalmology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Andrea R Hagemann
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lindsay M Kuroki
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Carolyn K McCourt
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David G Mutch
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew A Powell
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Quing Zhu
- Biomedical Engineering, Washington University, St Louis, MO, 63130, USA.
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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43
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Nandy S, Mostafa A, Hagemann IS, Powell MA, Amidi E, Robinson K, Mutch DG, Siegel C, Zhu Q. Evaluation of Ovarian Cancer: Initial Application of Coregistered Photoacoustic Tomography and US. Radiology 2018; 289:740-747. [PMID: 30204078 PMCID: PMC6283286 DOI: 10.1148/radiol.2018180666] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 03/21/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 01/19/2023]
Abstract
Purpose To assess transvaginal coregistered photoacoustic tomography (PAT) and pulse-echo US for diagnosis of ovarian cancer based on functional parameters provided by PAT. Materials and Methods Between February 2017 and December 2017, 26 ovarian masses from 16 participants were successfully imaged in vivo by multispectral photoacoustic imaging, including nine invasive epithelial ovarian cancers (six serous carcinomas and three endometroid adenocarcinomas), three other tumors (two borderline serous tumors and one sex cord-stromal tumor), and 14 benign and normal (hereafter referred to as benign/normal) ovaries. The relative total hemoglobin concentration (rHbT) and mean oxygen saturation (sO2) shown at PAT were used to characterize the ovaries identified at US. Results The average rHbT was 1.9 times higher for invasive epithelial cancers than for the benign/normal ovaries (P = .01). Additionally, the rHbT distribution was extensive in invasive epithelial cancers, but was scattered in benign/normal ovaries. However, the rHbT of two borderline serous tumors and one stromal tumor was in the same range as that of benign/normal ovaries. The mean sO2 of invasive epithelial cancers, and of the borderline and stromal tumors, was 8.2% lower than that of benign/normal ovaries (P = .003). Discussion Invasive epithelial ovarian cancers showed higher and extensive tumor vascularity and lower oxygen saturation than benign and normal ovaries. Two borderline noninvasive serous and one stromal tumor showed low oxygen saturation compared with benign and normal ovaries. ©RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Ian S. Hagemann
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - Matthew A. Powell
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - Eghbal Amidi
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - Kathryn Robinson
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - David G. Mutch
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - Cary Siegel
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
| | - Quing Zhu
- From the Department of Biomedical Engineering, Washington University,
One Brookings Dr, Mail Box 1097, St Louis, MO 63130 (S.N., A.M., E.A., Q.Z.);
Department of Pathology & Immunology (I.S.H.), Department of Obstetrics and
Gynecology (I.S.H., M.A.P., D.G.M.), and Mallinckrodt Institute of Radiology
(K.R., C.S., Q.Z.), Washington University School of Medicine, St Louis,
Mo
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Quinn JM, Greenwade MM, Palisoul ML, Opara G, Massad K, Guo L, Zhao P, Beck-Noia H, Hagemann IS, Hagemann AR, McCourt CK, Thaker PH, Powell MA, Mutch DG, Fuh KC. Therapeutic Inhibition of the Receptor Tyrosine Kinase AXL Improves Sensitivity to Platinum and Taxane in Ovarian Cancer. Mol Cancer Ther 2018; 18:389-398. [PMID: 30478151 DOI: 10.1158/1535-7163.mct-18-0537] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/11/2018] [Accepted: 11/13/2018] [Indexed: 02/03/2023]
Abstract
Ovarian cancer, one of the deadliest malignancies in female cancer patients, is characterized by recurrence and poor response to cytotoxic chemotherapies. Fewer than 30% of patients with resistant disease will respond to additional chemotherapy treatments. This study aims to determine whether and how inhibition of the receptor tyrosine kinase AXL can restore sensitivity to first-line platinum and taxane therapy in ovarian cancer. AXL staining was quantified in a patient tissue microarray and correlated with chemoresponse of patients. We used small hairpin RNAs to knock down AXL expression and the small-molecule inhibitor BGB324 to inhibit AXL and assessed sensitivity of cell lines and primary patient-derived cells to chemotherapy. We quantified platinum accumulation by inductivity-coupled plasma phase mass spectrometry. Finally, we treated chemoresistant patient-derived xenografts with chemotherapy, BGB324, or chemotherapy plus BGB324 and monitored tumor burden. AXL expression was higher in chemoresistant patient tumors and cell lines than in chemosensitive tumors and cell lines. AXL staining significantly predicted chemoresponse. Knockdown and inhibition of AXL dose-dependently improved response to paclitaxel and carboplatin in both cell lines and primary cells. AXL inhibition increased platinum accumulation by 2-fold (*, P < 0.05). In vivo studies indicated that AXL inhibition enhanced the ability of chemotherapy to prevent tumor growth (****, P < 0.0001). AXL contributes to platinum and taxane resistance in ovarian cancer, and inhibition of AXL improves chemoresponse and accumulation of chemotherapy drugs. This study supports continued investigation into AXL as a clinical target.
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Affiliation(s)
- Jeanne M Quinn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Molly M Greenwade
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Marguerite L Palisoul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory Opara
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Katina Massad
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Lei Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Peinan Zhao
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Hollie Beck-Noia
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri. .,Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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45
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Nandy S, Hagemann IS, Powell MA, Siegel C, Zhu Q. Quantitative multispectral ex vivo optical evaluation of human ovarian tissue using spatial frequency domain imaging. Biomed Opt Express 2018; 9:2451-2456. [PMID: 29761000 PMCID: PMC5946801 DOI: 10.1364/boe.9.002451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 05/13/2023]
Abstract
About 85-90% of all ovarian cancers are carcinomas; these manifest clinically as mass-forming epithelial proliferations involving the ovary. In this study, a visible light spatial frequency domain imaging (SFDI) system was used for multispectral ex vivo imaging and quantitative evaluation of freshly excised benign and malignant human ovarian tissues. A total of 14 ovaries from 11 patients undergoing oophorectomy were investigated. Using a logistic regression model with seven significant spectral and spatial features extracted from SFDI images, a sensitivity of 94.06% and specificity of 93.53% were achieved for prediction of histologically confirmed invasive carcinoma.
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Affiliation(s)
- Sreyankar Nandy
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ian S. Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Matthew A. Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Divine LM, Nguyen MR, Meller E, Desai RA, Arif B, Rankin EB, Bligard KH, Meyerson C, Hagemann IS, Massad M, Thaker PH, Hagemann AR, McCourt CK, Powell MA, Mutch DG, Fuh KC. AXL modulates extracellular matrix protein expression and is essential for invasion and metastasis in endometrial cancer. Oncotarget 2018; 7:77291-77305. [PMID: 27764792 PMCID: PMC5340229 DOI: 10.18632/oncotarget.12637] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/24/2016] [Indexed: 11/29/2022] Open
Abstract
The receptor tyrosine kinase AXL promotes migration, invasion, and metastasis. Here, we evaluated the role of AXL in endometrial cancer. High immunohistochemical expression of AXL was found in 76% (63/83) of advanced-stage, and 77% (82/107) of high-grade specimens and correlated with worse survival in uterine serous cancer patients. In vitro, genetic silencing of AXL inhibited migration and invasion but had no effect on proliferation of ARK1 endometrial cancer cells. AXL-deficient cells showed significantly decreased expression of phospho-AKT as well as uPA, MMP-1, MMP-2, MMP-3, and MMP-9. In a xenograft model of human uterine serous carcinoma with AXL-deficient ARK1 cells, there was significantly less tumor burden than xenografts with control ARK1 cells. Together, these findings underscore the therapeutic potentials of AXL as a candidate target for treatment of metastatic endometrial cancer.
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Affiliation(s)
- Laura M Divine
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mai R Nguyen
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Meller
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Riva A Desai
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Batool Arif
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Erinn B Rankin
- Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, CA, USA
| | - Katherine H Bligard
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cherise Meyerson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian S Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Massad
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Premal H Thaker
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea R Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn K McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matt A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine C Fuh
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.,Center for Reproductive Health Sciences (CRepHS), Washington University in St. Louis, St. Louis, MO, USA
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47
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Dandulakis MG, Mattis AJ, Hagemann AR, Hagemann IS. Cervical clear cell adenocarcinoma with an exceptionally low proliferation index: Report of a case. Gynecol Oncol Rep 2018; 23:16-19. [PMID: 29326971 PMCID: PMC5760463 DOI: 10.1016/j.gore.2017.12.006] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/29/2017] [Accepted: 12/30/2017] [Indexed: 12/03/2022] Open
Abstract
A histologically low-grade cervical clear cell lesion was observed. Proliferating cells were seen only at the periphery of this lesion. Due to its low proliferation index, this may represent a precursor of clear cell carcinoma. Further definition of such lesions may allow for more minimal management.
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Affiliation(s)
- Mary G Dandulakis
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Aidas J Mattis
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Andrea R Hagemann
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ian S Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States.,Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
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48
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Ma CX, Suman V, Goetz MP, Northfelt D, Burkard ME, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tevaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Barnell EK, Skidmore ZL, Feng YY, Krysiak K, Hoog J, Guo Z, Nehring L, Wisinski KB, Mardis E, Hagemann IS, Vij K, Sanati S, Al-Kateb H, Griffith OL, Griffith M, Doyle L, Erlichman C, Ellis MJ. A Phase II Trial of Neoadjuvant MK-2206, an AKT Inhibitor, with Anastrozole in Clinical Stage II or III PIK3CA-Mutant ER-Positive and HER2-Negative Breast Cancer. Clin Cancer Res 2017; 23:6823-6832. [PMID: 28874413 PMCID: PMC6392430 DOI: 10.1158/1078-0432.ccr-17-1260] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 02/01/2023]
Abstract
Purpose: Hyperactivation of AKT is common and associated with endocrine resistance in estrogen receptor-positive (ER+) breast cancer. The allosteric pan-AKT inhibitor MK-2206 induced apoptosis in PIK3CA-mutant ER+ breast cancer under estrogen-deprived condition in preclinical studies. This neoadjuvant phase II trial was therefore conducted to test the hypothesis that adding MK-2206 to anastrozole induces pathologic complete response (pCR) in PIK3CA mutant ER+ breast cancer.Experimental Design: Potential eligible patients with clinical stage II/III ER+/HER2- breast cancer were preregistered and received anastrozole (goserelin if premenopausal) for 28 days in cycle 0 pending tumor PIK3CA sequencing. Patients positive for PIK3CA mutation in the tumor were eligible to start MK-2206 (150 mg orally weekly, with prophylactic prednisone) on cycle 1 day 2 (C1D2) and to receive a maximum of four 28-day cycles of combination therapy before surgery. Serial biopsies were collected at preregistration, C1D1 and C1D17.Results: Fifty-one patients preregistered and 16 of 22 with PIK3CA-mutant tumors received study drug. Three patients went off study due to C1D17 Ki67 >10% (n = 2) and toxicity (n = 1). Thirteen patients completed neoadjuvant therapy followed by surgery. No pCRs were observed. Rash was common. MK-2206 did not further suppress cell proliferation and did not induce apoptosis on C1D17 biopsies. Although AKT phosphorylation was reduced, PRAS40 phosphorylation at C1D17 after MK-2206 persisted. One patient acquired an ESR1 mutation at surgery.Conclusions: MK-2206 is unlikely to add to the efficacy of anastrozole alone in PIK3CA-mutant ER+ breast cancer and should not be studied further in the target patient population. Clin Cancer Res; 23(22); 6823-32. ©2017 AACR.
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Affiliation(s)
- Cynthia X Ma
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Vera Suman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Donald Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Mark E Burkard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Foluso Ademuyiwa
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Naughton
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Margenthaler
- Section of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Aft
- Section of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Richard Gray
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Amye Tevaarwerk
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lee Wilke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tufia Haddad
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Tina Hieken
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica K Barnell
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Zachary L Skidmore
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Yan-Yang Feng
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Kilannin Krysiak
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Jeremy Hoog
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Zhanfang Guo
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Leslie Nehring
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kari B Wisinski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elaine Mardis
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Kiran Vij
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Souzan Sanati
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Hussam Al-Kateb
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Obi L Griffith
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Malachi Griffith
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Laurence Doyle
- Cancer Therapy Evaluation Program, NCI, Bethesda, Maryland
| | | | - Matthew J Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas.
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49
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Palisoul ML, Quinn JM, Schepers E, Hagemann IS, Guo L, Reger K, Hagemann AR, McCourt CK, Thaker PH, Powell MA, Mutch DG, Fuh KC. Inhibition of the Receptor Tyrosine Kinase AXL Restores Paclitaxel Chemosensitivity in Uterine Serous Cancer. Mol Cancer Ther 2017; 16:2881-2891. [PMID: 28904132 DOI: 10.1158/1535-7163.mct-17-0587] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/11/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Uterine serous cancer (USC) is aggressive, and the majority of recurrent cases are chemoresistant. Because the receptor tyrosine kinase AXL promotes invasion and metastasis of USC and is implicated in chemoresistance in other cancers, we assessed the role of AXL in paclitaxel resistance in USC, determined the mechanism of action, and sought to restore chemosensitivity by inhibiting AXL in vitro and in vivo We used short hairpin RNAs and BGB324 to knock down and inhibit AXL. We assessed sensitivity of USC cell lines to paclitaxel and measured paclitaxel intracellular accumulation in vitro in the presence or absence of AXL. We also examined the role of the epithelial-mesenchymal transition (EMT) in AXL-mediated paclitaxel resistance. Finally, we treated USC xenografts with paclitaxel, BGB324, or paclitaxel plus BGB324 and monitored tumor burden. AXL expression was higher in chemoresistant USC patient tumors and cell lines than in chemosensitive tumors and cell lines. Knockdown or inhibition of AXL increased sensitivity of USC cell lines to paclitaxel in vitro and increased cellular accumulation of paclitaxel. AXL promoted chemoresistance even in cells that underwent the EMT in vitro Finally, in vivo studies of combination treatment with BGB324 and paclitaxel showed a greater than 51% decrease in tumor volume after 2 weeks of treatment when compared with no treatment or single-agent treatments (P < 0.001). Our results show that AXL expression mediates chemoresistance independent of EMT and prevents accumulation of paclitaxel. This study supports the continued investigation of AXL as a clinical target, particularly in chemoresistant USC. Mol Cancer Ther; 16(12); 2881-91. ©2017 AACR.
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Affiliation(s)
- Marguerite L Palisoul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Jeanne M Quinn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Emily Schepers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Lei Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Kelsey Reger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri. .,Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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50
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Zhang X, Kim S, Hundal J, Herndon JM, Li S, Petti AA, Soysal SD, Li L, McLellan MD, Hoog J, Primeau T, Myers N, Vickery TL, Sturmoski M, Hagemann IS, Miller CA, Ellis MJ, Mardis ER, Hansen T, Fleming TP, Goedegebuure SP, Gillanders WE. Breast Cancer Neoantigens Can Induce CD8 + T-Cell Responses and Antitumor Immunity. Cancer Immunol Res 2017; 5:516-523. [PMID: 28619968 DOI: 10.1158/2326-6066.cir-16-0264] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/06/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
Next-generation sequencing technologies have provided insights into the biology and mutational landscape of cancer. Here, we evaluate the relevance of cancer neoantigens in human breast cancers. Using patient-derived xenografts from three patients with advanced breast cancer (xenografts were designated as WHIM30, WHIM35, and WHIM37), we sequenced exomes of tumor and patient-matched normal cells. We identified 2,091 (WHIM30), 354 (WHIM35), and 235 (WHIM37) nonsynonymous somatic mutations. A computational analysis identified and prioritized HLA class I-restricted candidate neoantigens expressed in the dominant tumor clone. Each candidate neoantigen was evaluated using peptide-binding assays, T-cell cultures that measure the ability of CD8+ T cells to recognize candidate neoantigens, and preclinical models in which we measured antitumor immunity. Our results demonstrate that breast cancer neoantigens can be recognized by the immune system, and that human CD8+ T cells enriched for prioritized breast cancer neoantigens were able to protect mice from tumor challenge with autologous patient-derived xenografts. We conclude that next-generation sequencing and epitope-prediction strategies can identify and prioritize candidate neoantigens for immune targeting in breast cancer. Cancer Immunol Res; 5(7); 516-23. ©2017 AACR.
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Affiliation(s)
- Xiuli Zhang
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel Kim
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jasreet Hundal
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - John M Herndon
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Shunqiang Li
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Allegra A Petti
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Savas D Soysal
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Lijin Li
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Mike D McLellan
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Jeremy Hoog
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Tina Primeau
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Nancy Myers
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tammi L Vickery
- Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
| | - Mark Sturmoski
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Chris A Miller
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew J Ellis
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.,Lester and Sue Smith Breast Care Center, Oncology/Medicine and MCB, Baylor College of Medicine, Houston, Texas
| | - Elaine R Mardis
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Ted Hansen
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy P Fleming
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - S Peter Goedegebuure
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - William E Gillanders
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. .,The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
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