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Arnolda R, Howlett K, Chan T, Raleigh J, Hatzimihalis A, Bell A, Fellowes A, Sandhu S, McArthur GA, Fox SB, Dawson SJ, Hewitt C, Jones K, Wong SQ. Clinical validation and implementation of droplet digital PCR for the detection of BRAF mutations from cell-free DNA. Pathology 2022; 54:772-778. [DOI: 10.1016/j.pathol.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
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Zozaya-Valdés E, Wong SQ, Raleigh J, Hatzimihalis A, Ftouni S, Papenfuss AT, Sandhu S, Dawson MA, Dawson SJ. Detection of cell-free microbial DNA using a contaminant-controlled analysis framework. Genome Biol 2021; 22:187. [PMID: 34162397 PMCID: PMC8220693 DOI: 10.1186/s13059-021-02401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/04/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The human microbiome plays an important role in cancer. Accumulating evidence indicates that commensal microbiome-derived DNA may be represented in minute quantities in the cell-free DNA of human blood and could possibly be harnessed as a new cancer biomarker. However, there has been limited use of rigorous experimental controls to account for contamination, which invariably affects low-biomass microbiome studies. RESULTS We apply a combination of 16S-rRNA-gene sequencing and droplet digital PCR to determine if the specific detection of cell-free microbial DNA (cfmDNA) is possible in metastatic melanoma patients. Compared to matched stool and saliva samples, the absolute concentration of cfmDNA is low but significantly above the levels detected from negative controls. The microbial community of plasma is strongly influenced by laboratory and reagent contaminants introduced during the DNA extraction and sequencing processes. Through the application of an in silico decontamination strategy including the filtering of amplicon sequence variants (ASVs) with batch dependent abundances and those with a higher prevalence in negative controls, we identify known gut commensal bacteria, such as Faecalibacterium, Bacteroides and Ruminococcus, and also other uncharacterised ASVs. We analyse additional plasma samples, highlighting the potential of this framework to identify differences in cfmDNA between healthy and cancer patients. CONCLUSIONS Together, these observations indicate that plasma can harbour a low yet detectable level of cfmDNA. The results highlight the importance of accounting for contamination and provide an analytical decontamination framework to allow the accurate detection of cfmDNA for future biomarker studies in cancer and other diseases.
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Affiliation(s)
| | - Stephen Q. Wong
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | | | - Sarah Ftouni
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Anthony T. Papenfuss
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Shahneen Sandhu
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Mark A. Dawson
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Sarah-Jane Dawson
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
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Gherardin NA, Waldeck K, Caneborg A, Martelotto LG, Balachander S, Zethoven M, Petrone PM, Pattison A, Wilmott JS, Quiñones-Parra SM, Rossello F, Posner A, Wong A, Weppler AM, Shannon KF, Hong A, Ferguson PM, Jakrot V, Raleigh J, Hatzimihalis A, Neeson PJ, Deleso P, Johnston M, Chua M, Becker JC, Sandhu S, McArthur GA, Gill AJ, Scolyer RA, Hicks RJ, Godfrey DI, Tothill RW. γδ T Cells in Merkel Cell Carcinomas Have a Proinflammatory Profile Prognostic of Patient Survival. Cancer Immunol Res 2021; 9:612-623. [PMID: 33674358 DOI: 10.1158/2326-6066.cir-20-0817] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022]
Abstract
Merkel cell carcinomas (MCC) are immunogenic skin cancers associated with viral infection or UV mutagenesis. To study T-cell infiltrates in MCC, we analyzed 58 MCC lesions from 39 patients using multiplex-IHC/immunofluorescence (m-IHC/IF). CD4+ or CD8+ T cells comprised the majority of infiltrating T lymphocytes in most tumors. However, almost half of the tumors harbored prominent CD4/CD8 double-negative (DN) T-cell infiltrates (>20% DN T cells), and in 12% of cases, DN T cells represented the majority of T cells. Flow cytometric analysis of single-cell suspensions from fresh tumors identified DN T cells as predominantly Vδ2- γδ T cells. In the context of γδ T-cell inflammation, these cells expressed PD-1 and LAG3, which is consistent with a suppressed or exhausted phenotype, and CD103, which indicates tissue residency. Furthermore, single-cell RNA sequencing (scRNA-seq) identified a transcriptional profile of γδ T cells suggestive of proinflammatory potential. T-cell receptor (TCR) analysis confirmed clonal expansion of Vδ1 and Vδ3 clonotypes, and functional studies using cloned γδ TCRs demonstrated restriction of these for CD1c and MR1 antigen-presenting molecules. On the basis of a 13-gene γδ T-cell signature derived from scRNA-seq analysis, gene-set enrichment on bulk RNA-seq data showed a positive correlation between enrichment scores and DN T-cell infiltrates. An improved disease-specific survival was evident for patients with high enrichment scores, and complete responses to anti-PD-1/PD-L1 treatment were observed in three of four cases with high enrichment scores. Thus, γδ T-cell infiltration may serve as a prognostic biomarker and should be explored for therapeutic interventions.See related Spotlight on p. 600.
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Affiliation(s)
- Nicholas A Gherardin
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Australian Research Council Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Waldeck
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alex Caneborg
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Luciano G Martelotto
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Shiva Balachander
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Zethoven
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Pasquale M Petrone
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Pattison
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sergio M Quiñones-Parra
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Fernando Rossello
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Atara Posner
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Annie Wong
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alison M Weppler
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Angela Hong
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Jeanette Raleigh
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Athena Hatzimihalis
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul J Neeson
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paolo Deleso
- Radiation Oncology Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meredith Johnston
- Radiation Oncology Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Liverpool Hospital, Sydney, New South Wales, Australia
| | - Margaret Chua
- Radiation Oncology Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Juergen C Becker
- German Cancer Consortium (DKTK), Translational Skin Cancer Research, University Medicine Essen, Essen and DKFZ, Heidelberg, Germany
| | - Shahneen Sandhu
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical, Research and The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Rodney J Hicks
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Cancer Imaging Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Dale I Godfrey
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Australian Research Council Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard W Tothill
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Vergara IA, Mintoff CP, Sandhu S, McIntosh L, Young RJ, Wong SQ, Colebatch A, Cameron DL, Kwon JL, Wolfe R, Peng A, Ellul J, Dou X, Fedele C, Boyle S, Arnau GM, Raleigh J, Hatzimihalis A, Szeto P, Mooi J, Widmer DS, Cheng PF, Amann V, Dummer R, Hayward N, Wilmott J, Scolyer RA, Cho RJ, Bowtell D, Thorne H, Alsop K, Cordner S, Woodford N, Leditschke J, O'Brien P, Dawson SJ, McArthur GA, Mann GJ, Levesque MP, Papenfuss AT, Shackleton M. Evolution of late-stage metastatic melanoma is dominated by aneuploidy and whole genome doubling. Nat Commun 2021; 12:1434. [PMID: 33664264 PMCID: PMC7933255 DOI: 10.1038/s41467-021-21576-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 02/14/2018] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Although melanoma is initiated by acquisition of point mutations and limited focal copy number alterations in melanocytes-of-origin, the nature of genetic changes that characterise lethal metastatic disease is poorly understood. Here, we analyze the evolution of human melanoma progressing from early to late disease in 13 patients by sampling their tumours at multiple sites and times. Whole exome and genome sequencing data from 88 tumour samples reveals only limited gain of point mutations generally, with net mutational loss in some metastases. In contrast, melanoma evolution is dominated by whole genome doubling and large-scale aneuploidy, in which widespread loss of heterozygosity sculpts the burden of point mutations, neoantigens and structural variants even in treatment-naïve and primary cutaneous melanomas in some patients. These results imply that dysregulation of genomic integrity is a key driver of selective clonal advantage during melanoma progression.
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Affiliation(s)
- Ismael A Vergara
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Melanoma Institute of Australia, Sydney, Australia
| | | | | | - Lachlan McIntosh
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Mathematics and Statistics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Stephen Q Wong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Daniel L Cameron
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Julia Lai Kwon
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela Peng
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jason Ellul
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Xuelin Dou
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Clare Fedele
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Samantha Boyle
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | - Pacman Szeto
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennifer Mooi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel S Widmer
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Valerie Amann
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Nicholas Hayward
- Melanoma Institute of Australia, Sydney, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Richard A Scolyer
- Melanoma Institute of Australia, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Raymond J Cho
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - David Bowtell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Heather Thorne
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Kathryn Alsop
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Cordner
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Noel Woodford
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Jodie Leditschke
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Patricia O'Brien
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Sarah-Jane Dawson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre of Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Graham J Mann
- Melanoma Institute of Australia, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Mitchell P Levesque
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Anthony T Papenfuss
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Department of Mathematics and Statistics, The University of Melbourne, Parkville, VIC, Australia.
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Mark Shackleton
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
- Department of Oncology, Alfred Health, Melbourne, Australia.
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5
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Weppler AM, Pattison A, Bhave P, De Ieso P, Raleigh J, Hatzimihalis A, Gill AJ, Balachander S, Callahan J, Chua M, Au-Yeung G, McArthur GA, Hicks RJ, Tothill RW, Sandhu S. Clinical, FDG-PET and molecular markers of immune checkpoint inhibitor response in patients with metastatic Merkel cell carcinoma. J Immunother Cancer 2020; 8:e000700. [PMID: 33060145 PMCID: PMC7566424 DOI: 10.1136/jitc-2020-000700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Metastatic Merkel cell carcinoma (mMCC) is an aggressive neuroendocrine malignancy of the skin with a poor prognosis. Immune checkpoint inhibitors (ICIs) have shown substantial efficacy and favorable safety in clinical trials. METHODS Medical records of patients (pts) with mMCC treated with ICIs from August 2015 to December 2018 at Peter MacCallum Cancer Centre in Australia were analyzed. Response was assessed with serial imaging, the majority with FDG-PET/CT scans. RNA sequencing and immunohistochemistry for PD-L1, CD3 and Merkel cell polyomavirus (MCPyV) on tumor samples was performed. RESULTS 23 pts with mMCC were treated with ICIs. A median of 8 cycles (range 1 to 47) were administered, with treatment ongoing in 6 pts. Objective responses (OR) were observed in 14 pts (61%): 10 (44%) complete responses (CR) and 4 (17%) partial responses (PR). Median time to response was 8 weeks (range 6 to 12) and 12-month progression-free survival rate was 39%. Increased OR were seen in pts aged less than 75 (OR 80% vs 46%), no prior history of chemotherapy (OR 64% vs 50%), patients with an immune-related adverse event (OR 100% vs 43%) and in MCPyV-negative tumors (OR 69% vs 43%). Pts with a CR had lower mean metabolic tumor volume on baseline FDG-PET/CT scan (CR: 35.7 mL, no CR: 187.8 mL, p=0.05). There was no correlation between PD-L1 positivity and MCPyV status (p=0.764) or OR (p=0.245). 10 pts received radiation therapy (RT) during ICI: 4 pts started RT concurrently (OR 75%, CR 50%), 3 pts had isolated ICI-resistant lesions successfully treated with RT and 3 pts with multisite progression continued to progress despite RT. Overall, 6 pts (26%) had grade 1-2 immune-related adverse events. CONCLUSION ICIs showed efficacy and safety in mMCC consistent with trial data. Clinical and imaging predictors of response were identified.
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Affiliation(s)
- Alison M Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Pattison
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paolo De Ieso
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeanette Raleigh
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Athena Hatzimihalis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, University of Sydney, Sydney, New South Wales, Australia
| | - Shiva Balachander
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Callahan
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Margaret Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - George Au-Yeung
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard W Tothill
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Femia G, Lanlois N, Raleigh J, Gray B, Othman F, Perumal S, Semsarian C, Puranik R. 304 Comparing Conventional Autopsy to Post-Mortem MR and CT in Determining the Cause of Sudden and/or Unexpected Death. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Weppler A, Bhave P, De Ieso P, Chua M, Raleigh J, Hatzimihalis A, Gill A, Balachander S, Callahan J, Pattison A, Caneborg A, Au Yeung G, McArthur G, Hicks R, Tothill R, Sandhu S. Clinical and FDG-PET markers of immune checkpoint inhibitor (ICI) response in patients with metastatic Merkel cell carcinoma (mMCC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Lai-Kwon J, Khoo C, Lo S, Milne D, Mohamed M, Raleigh J, Smith K, Lisy K, Sandhu S, Jefford M. The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors. J Cancer Surviv 2019; 13:503-511. [PMID: 31165342 DOI: 10.1007/s11764-019-00770-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) and BRAF and MEK inhibitors (BMi) have improved survival in metastatic melanoma (MM). However, the experience of long-term responders remains undescribed. This study characterised survivorship issues faced by long-term responders to ICI or BMi. METHODS Patients with MM, aged ≥ 18 years old, ≥ 6 months post-ICI or BMi initiation with an objective response or stable disease. A 72-question survey assessed physical and psychological effects, impact on lifestyle, access to information, satisfaction with care, and availability of supports. RESULTS One hundred and five of 120 (88%) patients completed the survey (ICI 69/BMI 36). For the ICI cohort, 39 (57%) were receiving ongoing treatment, 17 ceased due to toxicity and 13 due to a sustained response. For the BMi cohort, 31 (85%) were receiving ongoing treatment, 4 ceased due to toxicity and 1 due to a sustained complete response. At data cut-off on 18 December 2018, median PFS (range) was 2.5 years (1.3-8.5) for ICI and 3.1 years (0.6-7.3) for BMi. Long-term toxicities included dry/itchy skin (ICI 51, 74%/ BMi 25, 69%), arthralgias (ICI 30, 58%/ BMi 23, 64%) and fatigue (ICI 62, 90%/ BMi 33, 92%). Psychological morbidity was common, including anxiety awaiting results (ICI 50, 72%/ BMi 29, 81%), fear of melanoma recurring or progressing (ICI 56, 81%/ BMi 31, 86%) or death (ICI 44, 64%/ BMi 26, 72%). CONCLUSION MM survivors experience chronic treatment toxicities and frequently report psychological concerns. IMPLICATIONS FOR CANCER SURVIVORS Survivors may benefit from discussions regarding long-term toxicities and tailored psychological supports.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Chloe Khoo
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Donna Milne
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Mustafa Mohamed
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Jeanette Raleigh
- Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Kortnye Smith
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
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9
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Weppler A, Bhave P, De Ieso P, Raleigh J, Hatzimihalis A, Gill AJ, Balachander S, Callahan J, Pattison A, Chua M, Au-Yeung G, McArthur GA, Hicks RJ, Tothill R, Sandhu SK. Clinical and FDG-PET markers of immune checkpoint inhibitor (ICI) response in patients with metastatic Merkel cell carcinoma (mMCC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9540 Background: mMCC is a rare, highly aggressive neuroendocrine cancer with a poor prognosis. ICIs have favourable efficacy and safety in clinical trials. We outline single centre experience utilising ICIs in mMCC. Methods: Medical records of patients (pts) with mMCC treated with ICIs from Aug 2015 to Dec 2018 at Peter MacCallum Cancer Centre in Australia were retrospectively analysed. RNA sequencing and immunohistochemistry for PD-L1, CD3 and Merkel cell polyomavirus (MCPyV) on tumor samples were performed. Baseline tumor volumes and responses were assessed with FDG-PET scans using the Hicks criteria. Results: 23 pts with mMCC were treated with ICIs. Pt characteristics are summarised in Table. A median of 8 cycles (range 1 to 47) were administered, with treatment ongoing in 7 pts. Objective responses (OR) were observed in 14 pts (61%); 10 (44%) complete metabolic responses (CMR) and 4 (17%) partial metabolic responses (PMR). Median time to response was 9 weeks (range 4 to 11) and 12-month progression-free survival (PFS) rate was 32%. Increased OR were seen in pts aged less than 75 (OR 8/10, 80% vs 46%), no prior history of chemotherapy (OR 10/14, 71% vs 44%), pts with an immune-related adverse event (irAE) (OR 6/6, 100% vs 47%) and in MCPyV negative pts (OR 9/11, 82% vs 50%). Pts with a CMR had lower mean-tumor volume on baseline FDG-PET scan (CMR: 35.7mL, no CMR: 187.8mL, p value 0.05). 10 pts received radiation (RT) during ICI: 4 pts started RT concurrently (OR 75%, CMR 50%), 3 pts had isolated ICI-resistant lesions successfully treated with RT and 3 pts with multisite progression continued to progress despite RT. 6 pts (26%) had a Grade 1-2 irAE. Conclusions: ICIs showed efficacy and safety consistent with trial data. Younger age, negative MCPyV status, no prior chemotherapy, lower baseline FDG-PET tumor volume and irAEs are potentially associated with better responses. [Table: see text]
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Affiliation(s)
- Alison Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paolo De Ieso
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | | | - Anthony J. Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St. Leonards, Australia
| | - Shiva Balachander
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | | | - Andrew Pattison
- Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Margaret Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Grant A. McArthur
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | | | | | - Shahneen Kaur Sandhu
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
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Tan L, Sandhu S, Lee RJ, Li J, Callahan J, Ftouni S, Dhomen N, Middlehurst P, Wallace A, Raleigh J, Hatzimihalis A, Henderson MA, Shackleton M, Haydon A, Mar V, Gyorki DE, Oudit D, Dawson MA, Hicks RJ, Lorigan P, McArthur GA, Marais R, Wong SQ, Dawson SJ. Prediction and monitoring of relapse in stage III melanoma using circulating tumor DNA. Ann Oncol 2019; 30:804-814. [PMID: 30838379 PMCID: PMC6551451 DOI: 10.1093/annonc/mdz048] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The advent of effective adjuvant therapies for patients with resected melanoma has highlighted the need to stratify patients based on risk of relapse given the cost and toxicities associated with treatment. Here we assessed circulating tumor DNA (ctDNA) to predict and monitor relapse in resected stage III melanoma. PATIENTS AND METHODS Somatic mutations were identified in 99/133 (74%) patients through tumor tissue sequencing. Personalized droplet digital PCR (ddPCR) assays were used to detect known mutations in 315 prospectively collected plasma samples from mutation-positive patients. External validation was performed in a prospective independent cohort (n = 29). RESULTS ctDNA was detected in 37 of 99 (37%) individuals. In 81 patients who did not receive adjuvant therapy, 90% of patients with ctDNA detected at baseline and 100% of patients with ctDNA detected at the postoperative timepoint relapsed at a median follow up of 20 months. ctDNA detection predicted patients at high risk of relapse at baseline [relapse-free survival (RFS) hazard ratio (HR) 2.9; 95% confidence interval (CI) 1.5-5.6; P = 0.002] and postoperatively (HR 10; 95% CI 4.3-24; P < 0.001). ctDNA detection at baseline [HR 2.9; 95% CI 1.3-5.7; P = 0.003 and postoperatively (HR 11; 95% CI 4.3-27; P < 0.001] was also associated with inferior distant metastasis-free survival (DMFS). These findings were validated in the independent cohort. ctDNA detection remained an independent predictor of RFS and DMFS in multivariate analyses after adjustment for disease stage and BRAF mutation status. CONCLUSION Baseline and postoperative ctDNA detection in two independent prospective cohorts identified stage III melanoma patients at highest risk of relapse and has potential to inform adjuvant therapy decisions.
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Affiliation(s)
- L Tan
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - S Sandhu
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - R J Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
| | - J Li
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - J Callahan
- Peter MacCallum Cancer Centre, Melbourne
| | - S Ftouni
- Peter MacCallum Cancer Centre, Melbourne
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - P Middlehurst
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - A Wallace
- Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Manchester, UK
| | - J Raleigh
- Peter MacCallum Cancer Centre, Melbourne
| | | | - M A Henderson
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | | | | | - V Mar
- The Alfred Hospital, Melbourne
| | - D E Gyorki
- Peter MacCallum Cancer Centre, Melbourne; Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - D Oudit
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - M A Dawson
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia; Centre for Cancer Research, The University of Melbourne, Melbourne, Australia
| | - R J Hicks
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - P Lorigan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - G A McArthur
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
| | - S Q Wong
- Peter MacCallum Cancer Centre, Melbourne
| | - S-J Dawson
- Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia; Centre for Cancer Research, The University of Melbourne, Melbourne, Australia.
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11
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Lai-Kwon J, Khoo C, Lo S, Milne D, Mohamed M, Raleigh J, Smith K, Lisy K, Sandhu S, Jefford M. The survivorship experience of patients with metastatic melanoma on long-term immune checkpoint inhibitors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Tan L, Sandhu S, Lee R, Li J, Callahan J, Raleigh J, Hatzimihalis A, Middlehurst P, Henderson M, Shackleton M, Haydon A, Gyorki D, Oudit D, Hicks R, Lorigan P, McArthur G, Marais R, Wong S, Dawson SJ. Circulating tumour DNA analysis predicts relapse following resection in stage II and III melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Khoo CCH, Lai-Kwon JE, Lo S, Milne D, Mohamed MA, Raleigh J, Smith KM, Jefford M, Sandhu SK. Survivorship experience for patients (pts) with metastatic melanoma (MM) on long-term targeted therapy (TT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Serigne Lo
- Melanoma Institute Australia, Sydney, Australia
| | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Michael Jefford
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shahneen Kaur Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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14
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Lai-Kwon JE, Khoo CCH, Lo S, Milne D, Mohamed MA, Raleigh J, Smith KM, Sandhu SK, Jefford M. Survivorship experience for patients (pts) with metastatic melanoma (MM) on immunotherapy (IT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Serigne Lo
- Melanoma Institute Australia, Sydney, Australia
| | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Shahneen Kaur Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Jefford
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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Othman F, Raleigh J, Femia J, Semsarian C, Gray B, Langlois N, Puranik R. Utility of Postmortem CT and MR in the Diagnosis of Unexpected Death. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Sandhu SK, Wong SQ, Vergara IA, Raleigh J, Callahan J, Ftouni S, Hatzimihalis A, Devbarna S, Doig K, Colebatch A, MirArnau G, Cullinane C, Gyorki DE, Kee D, Brady BM, Shackleton MJ, Papenfuss A, Hicks RJ, McArthur GA, Dawson SJ. Circulating tumor DNA (ctDNA) to track responses and to capture the genomic heterogeneity of metastatic melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Sarah Ftouni
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Ken Doig
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Damien Kee
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | | | | | | | | | - Grant A. McArthur
- Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, Australia
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17
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Williams KH, Viera de Ribeiro AJ, Prakoso E, Veillard AS, Shackel NA, Bu Y, Brooks B, Cavanagh E, Raleigh J, McLennan SV, McCaughan GW, Bachovchin WW, Keane FM, Zekry A, Twigg SM, Gorrell MD. Lower serum fibroblast activation protein shows promise in the exclusion of clinically significant liver fibrosis due to non-alcoholic fatty liver disease in diabetes and obesity. Diabetes Res Clin Pract 2015; 108:466-72. [PMID: 25836944 DOI: 10.1016/j.diabres.2015.02.024] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/28/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Non-alcoholic fatty liver disease (NAFLD) is common in diabetes and obesity but few have clinically significant liver fibrosis. Improved risk-assessment is needed as the commonly used clinical-risk algorithm, the NAFLD fibrosis score (NFS), is often inconclusive. AIMS To determine whether circulating fibroblast activation protein (cFAP), which is elevated in cirrhosis, has value in excluding significant fibrosis, particularly combined with NFS. METHODS cFAP was measured in 106 with type 2 diabetes who had transient elastography (Cohort 1) and 146 with morbid obesity who had liver biopsy (Cohort 2). RESULTS In Cohort 1, cFAP (per SD) independently associated with median liver stiffness (LSM) ≥ 10.3 kPa with OR of 2.0 (95% CI 1.2-3.4), p=0.006. There was 0.12 OR (95% CI 0.03-0.61) of LSM ≥ 10.3 kPa for those in the lowest compared with the highest FAP tertile (p=0.010). FAP levels below 730 pmol AMC/min/mL had 95% NPV for LSM ≥ 10.3 kPa and reclassified 41% of 64 subjects from NFS 'indeterminate-risk' to 'low-risk'. In Cohort 2, cFAP (per SD), associated with 1.7 fold (95% CI 1.1-2.8) increased odds of significant fibrosis (F ≥ 2), p=0.021, and low cFAP reclassified 49% of 73 subjects from 'indeterminate-risk' to 'low-risk'. CONCLUSIONS Lower cFAP, when combined with NFS, may have clinical utility in excluding significant fibrosis in diabetes and obesity.
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Affiliation(s)
- K H Williams
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
| | - A J Viera de Ribeiro
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - E Prakoso
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - A S Veillard
- NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
| | - N A Shackel
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - Y Bu
- Inflammation and Infection Research Centre, School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia.
| | - B Brooks
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Sydney Nursing School, Building M02, The University of Sydney, NSW 2006, Australia.
| | - E Cavanagh
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - J Raleigh
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - S V McLennan
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia.
| | - G W McCaughan
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - W W Bachovchin
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - F M Keane
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - A Zekry
- Inflammation and Infection Research Centre, School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia; The St George Hospital, Gray Street, Kogarah, NSW 2217, Australia.
| | - S M Twigg
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia.
| | - M D Gorrell
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
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18
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Ferrão PT, Cullinane C, Raleigh J, Srinivasa S, Levin W, Johnstone RW, McArthur GA. Abstract 2499: Single agent activity of checkpoint kinase inhibitor PF-477736, in a MYC-driven lymphoma model. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-2499] [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
CHK1 and CHK2 are protein kinases that function as effectors of cell cycle checkpoint arrest following DNA damage. Small molecule inhibitors with specificity for CHK1 such as PF-477736 (Blasina et al, 2008 Mol Cancer Ther 7:2394) and others with specificity for CHK1 and CHK2, are currently in phase 1 clinical evaluation in combination with chemotherapeutic agents known to induce DNA damage. We therefore hypothesized that inhibitors of CHK1/CHK2 may have single agent activity in tumours with oncogene-induced DNA damage.
Cell lines derived from Eμ-MYC driven murine lymphomas display intrinsic DNA damage detected by γH2AX foci staining. Within 2 hours of 500nM PF-477736 treatment, a dramatic increase in the intensity of γH2AX staining and proportion of cells with γH2AX staining, was observed in all Eμ-MYC lines. An increase in mitotic cells detected by expression of phospho-Histone3, was also observed in all Eμ-MYC lines with a high proportion displaying features of aberrant mitosis, demonstrating inhibition of the S and/or G2/M checkpoints resulting in premature entry to mitosis. Early apoptosis was detected in 6 separate Eμ-MYC lines expressing functional p53, following treatment in vitro (>50% Annexin V positive cells 4 hrs after 500nM PF-477736). Subsequent cell death assessed as the proportion of PI positive cells, was observed in all cell lines expressing functional p53 (IC50 200-500nM at 16 hrs).
Enforced expression of anti-apoptotic protein Bcl-2 by retroviral transduction abrogated cell death at up to 3μM PF-477736. Two separate Eμ-MYC lines expressing spontaneously arising mutant forms of p53, and three separate Eμ-MYC lines derived on a p53 null background, were relatively insensitive to PF-477736 (IC50>1μM at 16hrs), indicating that functional p53 is necessary to mediate apoptosis/death following accumulation of DNA damage due to CHK1 inhibition. Treatment with AZD7762 a CHK1/2 inhibitor, also resulted in death of Eμ-MYC lines in vitro, (IC50 200nM-2μM at 16 hrs), however the variation in sensitivity could not be attributed to p53 status.
Treatment of C57Bl/6 mice transplanted with an Eμ-MYC line expressing functional p53, resulted in a dramatic increase in the proportion of apoptotic/dead cells in the established lymphomas within 6 hours following 20mg/kg PF-477736 i.p. A significant decrease in the wbc of 5 mice, from an average 48.2×106 wbc/ml pre-treatment to 31.8×106 at 16 hours post PF-477736 (P=0.0053), compared to vehicle treated mice (51.1×106 pre-treatment and 60.4×106 post-treatment), together with a lower average spleen weight of the PF-477736 treated mice (0.52g) compared to vehicle treated mice (0.68g), was observed.
We propose that checkpoint kinase inhibitors will be beneficial as therapeutic agents able to specifically exploit tumours containing intrinsic DNA damage that are reliant on checkpoints for maintenance of genomic integrity, such as in “MYC-driven cancers”.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2499.
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Redmond NE, van Soest RWM, Kelly M, Raleigh J, Travers SAA, McCormack GP. Reassessment of the classification of the Order Haplosclerida (Class Demospongiae, Phylum Porifera) using 18S rRNA gene sequence data. Mol Phylogenet Evol 2006; 43:344-52. [PMID: 17188001 DOI: 10.1016/j.ympev.2006.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 09/08/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Affiliation(s)
- N E Redmond
- Molecular Evolution and Systematics Laboratory, Martin Ryan Marine Science Institute, Zoology Department, National University of Ireland, Galway, Ireland.
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McArthur GA, Raleigh J, Blasina A, Cullinane C, Dorow D, Conus N, Hicks RJ, Kornmann J, Chen E, McCarthy TJ, Anderes K. Imaging with FLT-PET demonstrates that PF-477736, an inhibitor of CHK1 kinase, overcomes a cell cycle checkpoint induced by gemcitabine in PC-3 xenografts. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3045] [Citation(s) in RCA: 6] [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] [Indexed: 11/20/2022] Open
Abstract
3045 Background: The development of strategies to monitor the molecular and cellular response to novel agents that target the cell cycle is vital to provide proof of mechanism and biological activity of these compounds. The protein kinase CHK1 is activated following DNA damage in the S and G2-phases of the cell cycle and mediates cell cycle arrest. In vitro studies demonstrate that inhibition of CHK1 can overcome cell cycle arrest induced by DNA damage and enhance cytotoxic activity of DNA damaging agents. In vivo studies show that combining DNA damaging agents with a CHK1 inhibitor potentiates antitumor activity. We hypothesize that functional imaging with 18F-fluorine-L-thymidine (FLT), a PET-tracer where tumor uptake is maximal in the S and G2 phases of the cell cycle can be used to non-invasively monitor the induction and therapeutic inhibition of a cell cycle checkpoint in vivo. Methods: Nude mice harbouring PC-3 xenografts were treated with vehicle controls, gemcitabine, the CHK1-inhibitor PF-477736 or gemcitabine + PF-477736. FLT-PET scans were performed and tumors harvested for ex-vivo biomarkers to assess S-phase, M-phase and DNA-repair. Results: Gemcitabine induced a 8.3 ±0.8 fold increase in tumoral uptake of FLT at 21 hours that correlated with a 3.3 ±0.2-fold increase in thymidine kinase activity and S-phase arrest as demonstrated by BrdU incorporation and elevated expression of cyclin-A. Treatment with PF-477736 at 17 hours after gemcitabine abrogated the early FLT-flare at 21 hours by 82% (p<0.001). This was associated with both an increased fraction of cells in mitosis and G1-phase of the cell cycle as determined by phos-histone H3 and flow cytometry. Furthermore, the combination of gemcitabine and PF-477736 enhanced DNA damage as measured by phos-gamma-H2AX and significantly delayed tumor growth when compared to tumors treated with gemcitabine alone. Conclusion: These data clearly indicate that the CHK1-inhibitor PF-477736 can overcome the cell cycle checkpoint induced by gemcitabine and increase associated DNA damage in tumors in-vivo. The PET studies indicate that functional imaging with FLT-PET is a promising strategy to monitor responses to therapeutic agents that target cell cycle checkpoints. [Table: see text]
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Affiliation(s)
- G. A. McArthur
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - J. Raleigh
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - A. Blasina
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - C. Cullinane
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - D. Dorow
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - N. Conus
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - R. J. Hicks
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - J. Kornmann
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - E. Chen
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - T. J. McCarthy
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
| | - K. Anderes
- Peter MacCallum Cancer Centre, East Melbourne, Australia; Pfizer Oncology, La Jolla, CA; Pfizer Global Clinical Technology, Groton, CT
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Haustermans K, Hofland I, Van de Pavert L, Geboes K, Varia M, Raleigh J, Begg AC. Diffusion limited hypoxia estimated by vascular image analysis: comparison with pimonidazole staining in human tumors. Radiother Oncol 2000; 55:325-33. [PMID: 10869747 DOI: 10.1016/s0167-8140(00)00206-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess diffusion limited hypoxia in human tumors using image analysis of vasculature and to compare it with the bioreductive marker pimonidazole as an independent method. MATERIALS AND METHODS To set up the method, nine rectal adenocarcinomas and ten squamous cell carcinomas were analyzed. To validate the method, ten squamous cell carcinomas of the cervix were analyzed from patients who were injected with pimonidazole and biopsied approximately 24 h later. Sections of the rectal and esophageal tumors were stained for vasculature, while cervix tumor sections were double stained for vasculature and pimonidazole. Tumor areas were delineated on digitized images, and the proportion of tumor tissue greater than a fixed distance from the nearest blood vessel (called diffusion limited fraction, DLF) was then calculated. The proportion of tumor area stained for pimonidazole was also measured. RESULTS There was a wide variation between tumors in both the vascular-derived DLF and in the pimonidazole-stained fraction. Average DLFs varied between 1.5 and 92% for different tumors, with significant differences between them. The area stained by pimonidazole was significantly smaller than DLF for all tumors. The correlation between pimonidazole area and DLF was significant in three of seven tumors containing > or = 3 images. When images from all tumors (n=123) were analyzed together, the correlation was highly significant (r=0.47, P<0.0001). CONCLUSION The vascular derived DLF correlates significantly with pimonidazole staining, but there was large scatter. Both methods may underestimate perfusion limited hypoxia.
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Affiliation(s)
- K Haustermans
- Division of Experimental Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, The, Amsterdam, Netherlands
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22
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Rosmorduc O, Wendum D, Corpechot C, Galy B, Sebbagh N, Raleigh J, Housset C, Poupon R. Hepatocellular hypoxia-induced vascular endothelial growth factor expression and angiogenesis in experimental biliary cirrhosis. Am J Pathol 1999; 155:1065-73. [PMID: 10514389 PMCID: PMC1867037 DOI: 10.1016/s0002-9440(10)65209-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We tested the potential role of vascular endothelial growth factor (VEGF) and of fibroblast growth factor-2 (FGF-2) in the angiogenesis associated with experimental liver fibrogenesis induced by common bile duct ligation in Sprague-Dawley rats. In normal rats, VEGF and FGF-2 immunoreactivities were restricted to less than 3% of hepatocytes. One week after bile duct ligation, hypoxia was demonstrated by the immunodetection of pimonidazole adducts unevenly distributed throughout the lobule. After 2 weeks, hypoxia and VEGF expression were detected in >95% of hepatocytes and coexisted with an increase in periportal vascular endothelial cell proliferation, as ascertained by Ki67 immunolabeling. Subsequently, at 3 weeks the density of von Willebrand-labeled vascular section in fibrotic areas significantly increased. Semiquantitative reverse transcription polymerase chain reaction showed that VEGF(120) and VEGF(164) transcripts, that correspond to secreted isoforms, increased within 2 weeks, while VEGF(188) transcripts remained unchanged. FGF-2 mainly consisting of a 22-kd isoform, according to Western blot, was identified by immunohistochemistry in 49% and 100% of hepatocytes at 3 and 7 weeks, respectively. Our data provide evidence that in biliary-type liver fibrogenesis, angiogenesis is stimulated primarily by VEGF in response to hepatocellular hypoxia while FGF-2 likely contributes to the maintenance of angiogenesis at later stages.
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Affiliation(s)
- O Rosmorduc
- Service d'Hépatogastroentérologie, INSERM U 402, Paris, France.
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23
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Thurman RG, Bradford BU, Iimuro Y, Adachi Y, Wall C, Frankenberg MV, Ikejima K, Kono H, Enomoto N, Arteel G, Zhong Z, Lemasters JJ, Raleigh J, Kadiiska M, Stefanovic B, Tsukamoto H, Lin M, Brenner D, Forman DT, Gallucci RM, Luster M, Mason R. INCREASED LIVER INJURY IN FEMALE RATS IS DUE TO HYPOXIA-REOXYGENATION TRIGGERED BY ENDOTOXIN AND KUPFFER CELLS. Alcohol Clin Exp Res 1998. [DOI: 10.1111/j.1530-0277.1998.tb04341.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Read JW, Raleigh J. Diagnostic ultrasound. Aust Fam Physician 1992; 21:582-7. [PMID: 1520128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Significant growth in the technology and clinical application of diagnostic ultrasound has occurred over the past decade. The non cardiac aspects of these recent developments are briefly discussed and illustrated.
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Affiliation(s)
- J W Read
- St Vincent's Medical Centre, Darlinghurst, New South Wales
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25
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Moore D, Zeman E, Massenburg G, Rouse B, Raleigh J. Use of a spheroid model to study chemotherapy and radiation effects on proliferating and hypoxic tumor cell populations. Gynecol Oncol 1992. [DOI: 10.1016/0090-8258(92)90535-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Abstract
Neurotoxicity induced by misonidazole (MISO) and desmethylmisonidazole (DMM) has become the dose limiting factor in clinical work. In 1981, we reported a preliminary study suggestive that Dexamethasone (DEXA) does have a protective effect against peripheral neuropathies (PN) resulting from toxicity of misonidazole. Furthermore, in that study we have observed that DEXA did not alter the plasma pharmacokinetics of misonidazole. We are presently investigating the use of DEXA (2 mg t.i.d. during treatment), with escalating doses of MISO in an attempt to modify its neurotoxicity. To date, 16 patients have been registered to receive total doses of MISO ranging from 13.5 to 17.5 gm/M2 given in 9 equally divided doses over 3 weeks. DEXA, 2 mg t.i.d. is given 3 days prior to the first dose and continues for the duration of therapy. All patients receive palliative radiation. No toxicity was seen at the total dose of 13.5 gm/M2. One grade I PN occurred in the first four patients receiving 15.5 gm/M2. Six additional patients were entered at this dose level and no further incidence of PN was observed. Patients are being entered at the next step of 17.5 gm/M2.
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Urtasun RC, Tanasichuk H, Fulton D, Agboola O, Turner AR, Koziol D, Raleigh J. High dose misonidazole with dexamethasone rescue: a possible approach to circumvent neurotoxicity. Int J Radiat Oncol Biol Phys 1982; 8:365-9. [PMID: 7107353 DOI: 10.1016/0360-3016(82)90641-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
With a view to modifying misonidazole (MISO) neurotoxicity, we initiated a randomized clinical study to assess a possible drug interaction and toxicity protection when dexamethasone (DXM) is administered concomittantly with MISO. The ongoing study consists of: 1. Pharmacokinetic evaluation; 2. Assessment of toxicity. Fourteen patients undergoing radiation therapy for different types of malignant neoplasia (excluding brain tumors) have been randomized to receive either MISO alone, or DXM one week prior and during treatment with MISO. Five of seven patients receiving MISO alone developed peripheral neuropathies while only one out of 7 patients that received MISO with DXM coverage developed a transient and mild neuropathy. Pharmacokinetic evaluation of MISO in plasma and urine of those patients receiving DXM has shown no evidence of drug interaction. It is postulated that the mechanism of action of DXM is at the nerve cell membrane level, restoring and stabilizing cell surface properties. In future studies we will investigate the use of DXM with increasing doses of MISO above the recommended maximum dose of 12 gm/m2, hoping to achieve a higher tumor tissue level of MISO while avoiding unacceptable toxicity. The effect of Allopurinol on the plasma kinetics of MISO was studied in four additional patients, observing also no evidence of drug interaction.
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Urtasun RC, Tanasichuk H, Fulton D, Raleigh J, Rabin HR, Turner R, Koziol D, Agboola O. Pharmacokinetic interaction of BCNU and misonidazole in humans. Int J Radiat Oncol Biol Phys 1982; 8:381-6. [PMID: 7107356 DOI: 10.1016/0360-3016(82)90644-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although considerable laboratory in vitro and in vivo evidence is now available suggesting that misonidazole (MISO) enhances chemotherapy tumor responses, experience with human tumors is limited. Further, the mechanism of this enhancement is not definitely known. One possible mechanism is that MISO alters the pharmacokinetics of the chemotherapeutic agent, vice versa or both. We studied a group of patients with recurrent malignant gliomas, following radiotherapy. After proven recurrence, they were treated with i.v. BCNU in combination with oral MISO in an 8 week cycle. Our aims were: 1. To obtain a second remission; 2. To assess the toxicity of this combination; 3. To assess the plasma pharmacokinetics of each drug alone and in combination. Six patients entered the protocol. Four of six patients obtained either a partial or subpartial response. Prolonged moderate myelosuppression was observed in 2/6 patients after 3 cycles; 2/6 patients experienced seizures after the first cycle of chemotherapy for the first time in the course of their disease. The plasma pharmacokinetic data indicates no evidence of a MISO-BCNU drug interaction.
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Haromy TP, Raleigh J, Sundaralingam M. Enzyme-bound conformations of nucleotide substrates. X-ray structure and absolute configuration of 8,5'-cycloadenosine monohydrate. Biochemistry 1980; 19:1718-22. [PMID: 7378372 DOI: 10.1021/bi00549a031] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Iseman MD, Albert R, Locks M, Raleigh J, Sutton F, Farer LS. American Thoracic Society. Medical Section of the American Lung Association. Guidelines for short-course tuberculosis chemotherapy. Am Rev Respir Dis 1980; 121:611-4. [PMID: 7416589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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31
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Raleigh J, Reddy J, Friedlander D, Hope R. Type V hyperlipoproteinaemia: a family study. N Z Med J 1975; 82:300-1. [PMID: 174035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Family screening for hyperlipoproteinaemia was undertaken when a patient presented with myocardial infarction in association with Type V hyperlipoproteinaemia. The clinical features of this unusual form of hyperlipoproteinaemia are discussed together with its frequency in the general population and in relatives of affected patients.
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Greenstock CL, Raleigh J, McDonald E, Whitehouse R. Nucleotide radical oxidation and addition reactions with cellular radiosensitizers. Biochem Biophys Res Commun 1973; 52:276-83. [PMID: 4712195 DOI: 10.1016/0006-291x(73)90984-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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