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Limbach KE, Wen W, Xing Q, Yan J, Yim JH. Baicalein activates 5' adenosine monophosphate-activated protein kinase, inhibits the mammalian target of rapamycin, and exhibits antiproliferative effects in pancreatic neuroendocrine tumors in vitro and in vivo. Surgery 2023; 173:12-18. [PMID: 36207198 DOI: 10.1016/j.surg.2022.07.030] [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: 02/23/2022] [Revised: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mammalian target of rapamycin inhibition has been shown to prolong progression-free survival in patients with pancreatic neuroendocrine tumors. The natural compound baicalein indirectly inhibits the mammalian target of rapamycin, but it is unknown if baicalein exhibits such effects at physiologically achievable concentrations or exhibits synergy. METHODS Pancreatic neuroendocrine tumor cell lines were cultured with baicalein, everolimus, and/or a synthetic 5' adenosine monophosphate-activated protein kinase activating agent alone and in combination. Cell viability assays and immunoblotting were performed. Female severe combined immunodeficient-beige mice were injected with BON-1 cells and treated with baicalein and COH-SR4 solutions via oral gavage. Tumor volumes were compared at 30 days. RESULTS Immunoblotting revealed that treatment of baicalein induced 5' adenosine monophosphate-activated protein kinase activation and the mammalian target of rapamycin inhibition. Treatment with baicalein alone led to a significant decrease in the ratio of viable cells compared with controls at 72 hours at concentrations ≥5 μM (P = .021). The addition of COH-SR4 led to significantly greater effect on cell viability than with baicalein alone (P < .001, P < .001). The combination of baicalein with everolimus resulted in significantly lower cell viability than with everolimus alone (P = .005, P < .001). Tumor volume in vivo was significantly decreased with the combination of baicalein and COH-SR4 compared with controls (P = .003). CONCLUSION Baicalein exhibits antiproliferative effects against pancreatic neuroendocrine tumor cell lines at doses ≥5 μM and demonstrates synergy.
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Affiliation(s)
- Kristen E Limbach
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA
| | - Wei Wen
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA
| | - Quanhua Xing
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA
| | - Jin Yan
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA
| | - John H Yim
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA.
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2
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Egelston CA, Guo W, Tan J, Avalos C, Simons DL, Lim MH, Huang YJ, Nelson MS, Chowdhury A, Schmolze DB, Yim JH, Kruper L, Melstrom L, Margolin K, Mortimer JE, Yuan Y, Waisman JR, Lee PP. Tumor-infiltrating exhausted CD8+ T cells dictate reduced survival in premenopausal estrogen receptor-positive breast cancer. JCI Insight 2022; 7:153963. [PMID: 35132960 PMCID: PMC8855819 DOI: 10.1172/jci.insight.153963] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022] Open
Abstract
CD8+ tumor-infiltrating lymphocytes (TILs) are associated with improved survival in triple-negative breast cancer (TNBC) yet have no association with survival in estrogen receptor–positive (ER+) BC. The basis for these contrasting findings remains elusive. We identified subsets of BC tumors infiltrated by CD8+ T cells with characteristic features of exhausted T cells (TEX). Tumors with abundant CD8+ TEX exhibited a distinct tumor microenvironment marked by amplified interferon-γ signaling–related pathways and higher programmed death ligand 1 expression. Paradoxically, higher levels of tumor-infiltrating CD8+ TEX associated with decreased overall survival of patients with ER+ BC but not patients with TNBC. Moreover, high tumor expression of a CD8+ TEX signature identified dramatically reduced survival in premenopausal, but not postmenopausal, patients with ER+ BC. Finally, we demonstrated the value of a tumor TEX signature score in identifying high-risk premenopausal ER+ BC patients among those with intermediate Oncotype DX Breast Recurrence Scores. Our data highlight the complex relationship between CD8+ TILs, interferon-γ signaling, and ER status in BC patient survival. This work identifies tumor-infiltrating CD8+ TEX as a key feature of reduced survival outcomes in premenopausal patients with early-stage ER+ BC.
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Affiliation(s)
| | - Weihua Guo
- Department of Immuno-Oncology, Beckman Research Institute
| | - Jiayi Tan
- Department of Immuno-Oncology, Beckman Research Institute
| | | | - Diana L Simons
- Department of Immuno-Oncology, Beckman Research Institute
| | - Min Hui Lim
- Department of Immuno-Oncology, Beckman Research Institute
| | | | - Michael S Nelson
- Light Microscopy Digital Imaging Core, Beckman Research Institute
| | - Arnab Chowdhury
- Division of Biostatistics, Department of Computational and Quantitative Medicine, Beckman Research Institute; and
| | | | | | | | | | - Kim Margolin
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Joanne E Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - James R Waisman
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Peter P Lee
- Department of Immuno-Oncology, Beckman Research Institute
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Yuan Y, Lee JS, Yost SE, Li SM, Frankel PH, Ruel C, Schmolze D, Robinson K, Tang A, Martinez N, Stewart D, Waisman J, Kruper L, Jones V, Menicucci A, Uygun S, Yoder E, van der Baan B, Yim JH, Yeon C, Somlo G, Mortimer J. Phase II Trial of Neoadjuvant Carboplatin and Nab-Paclitaxel in Patients with Triple-Negative Breast Cancer. Oncologist 2021; 26:e382-e393. [PMID: 33098195 PMCID: PMC7930424 DOI: 10.1002/onco.13574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In this phase II clinical trial, we evaluated the efficacy of the nonanthracycline combination of carboplatin and nab-paclitaxel in early stage triple-negative breast cancer (TNBC). PATIENTS AND METHODS Patients with newly diagnosed stage II-III TNBC (n = 69) were treated with neoadjuvant carboplatin (area under the curve 6) every 28 days for four cycles plus nab-paclitaxel (100 mg/m2 ) weekly for 16 weeks. Pathological complete response (pCR) and residual cancer burden (RCB) were analyzed with germline mutation status, tumor-infiltrating lymphocytes (TILs), TNBC molecular subtype, and GeparSixto immune signature (GSIS). RESULTS Sixty-seven patients were evaluable for safety and response. Fifty-three (79%) patients experienced grade 3/4 adverse events, including grade 3 anemia (43%), neutropenia (39%), leukopenia (15%), thrombocytopenia (12%), fatigue (7%), peripheral neuropathy (7%), neutropenia (16%), and leukopenia (1%). Twenty-four patients (35%) had at least one dose delay, and 50 patients (72%) required dose reduction. Sixty-three (94%) patients completed scheduled treatment. The responses were as follows: 32 of 67 patients (48%) had pCR (RCB 0), 10 of 67 (15%) had RCB I, 19 of 67 (28%) had RCB II, 5 of 67 (7%) had RCB III, and 1 of 67 (2%) progressed and had no surgery. Univariate analysis showed that immune-hot GSIS and DNA repair defect (DRD) were associated with higher pCR with odds ratios of 4.62 (p = .005) and 4.76 (p = .03), respectively, and with RCB 0/I versus RCB II/III with odds ratio 4.80 (p = .01). Immune-hot GSIS was highly correlated with DRD status (p = .03), TIL level (p < .001), and TNBC molecular subtype (p < .001). After adjusting for age, race, stage, and grade, GSIS remained associated with higher pCR and RCB class 0/I versus II/III with odds ratios 7.19 (95% confidence interval [CI], 2.01-25.68; p = .002) and 8.95 (95% CI, 2.09-38.23; p = .003), respectively. CONCLUSION The combination of carboplatin and nab-paclitaxel for early stage high-risk TNBC showed manageable toxicity and encouraging antitumor activity. Immune-hot GSIS is associated with higher pCR rate and RCB class 0/1. This study provides an additional rationale for using nonanthracycline platinum-based therapy for future neoadjuvant trials in early stage TNBCs. Clinical trial identification number: NCT01525966 IMPLICATIONS FOR PRACTICE: Platinum is an important neoadjuvant chemotherapy agent for treatment of early stage triple-negative breast cancer (TNBC). In this study, carboplatin and nab-paclitaxel were well tolerated and highly effective in TNBC, resulting in pathological complete response of 48%. In univariate and multivariate analyses adjusting for age, race, tumor stage and grade, "immune-hot" GeparSixto immune signature (GSIS) and DNA repair defect (DRD) were associated with higher pathological complete response (pCR) and residual cancer burden class 0/1. The association of immune-hot GSIS with higher pCR holds promise for de-escalating neoadjuvant chemotherapy for patients with early stage TNBC. Although GSIS is not routinely used in clinic, further development of this immune signature into a clinically applicable assay is indicated.
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Affiliation(s)
- Yuan Yuan
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Jin Sun Lee
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Susan E. Yost
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Sierra Min Li
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Christopher Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Kim Robinson
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Aileen Tang
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Norma Martinez
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - James Waisman
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Laura Kruper
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Veronica Jones
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | | | - Sahra Uygun
- Agendia Precision OncologyIrvineCaliforniaUSA
| | - Erin Yoder
- Agendia Precision OncologyIrvineCaliforniaUSA
| | | | - John H. Yim
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Christina Yeon
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - George Somlo
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
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Wen W, Han ES, Dellinger TH, Lu LX, Wu J, Jove R, Yim JH. Synergistic Anti-Tumor Activity by Targeting Multiple Signaling Pathways in Ovarian Cancer. Cancers (Basel) 2020; 12:E2586. [PMID: 32927828 PMCID: PMC7564386 DOI: 10.3390/cancers12092586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
More effective therapy is needed to improve the survival of patients with advanced and recurrent ovarian cancer. Preclinical and early clinical studies with single molecular targeted agents have shown limited antitumor activity in ovarian cancer, likely due to compensation by alternative growth/survival pathways. An emerging strategy in overcoming resistance is to combine inhibitors targeting multiple pathways. In this study, we used a novel strategy of combining several FDA-approved targeted drugs, including sunitinib, dasatinib, and everolimus, in human ovarian cancers. Combination of the tyrosine kinase inhibitor sunitinib with the SRC inhibitor dasatinib showed synergistic anti-tumor activity in human ovarian cancer cells. The increased activity was associated with inhibition of the STAT3, SRC, and MAPK signaling pathways, but not AKT signaling. To inhibit the PI3K/AKT/mTOR pathway, we added the mTOR inhibitor everolimus, which further increased anti-tumor activity in cells. Combined treatment with sunitinib, dasatinib, and everolimus also resulted in greater inhibition of human ovarian tumor growth in mice. Furthermore, the triple combination also synergistically increased the anti-tumor activity of paclitaxel, both in vitro and in vivo. Taken together, our results demonstrate that simultaneous inhibition of several signaling pathways results in better anti-tumor activity compared to inhibiting any of these signaling pathways alone.
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Affiliation(s)
- Wei Wen
- Department of Surgery, City of Hope National Med Center, Duarte, CA 91010, USA; (E.S.H.); (T.H.D.); (L.X.L.)
- Department of Molecular Medicine, City of Hope National Med Center, Duarte, CA 91010, USA;
| | - Ernest S. Han
- Department of Surgery, City of Hope National Med Center, Duarte, CA 91010, USA; (E.S.H.); (T.H.D.); (L.X.L.)
| | - Thanh H. Dellinger
- Department of Surgery, City of Hope National Med Center, Duarte, CA 91010, USA; (E.S.H.); (T.H.D.); (L.X.L.)
| | - Leander X. Lu
- Department of Surgery, City of Hope National Med Center, Duarte, CA 91010, USA; (E.S.H.); (T.H.D.); (L.X.L.)
| | - Jun Wu
- Department of Comparative Medicine, City of Hope National Med Center, Duarte, CA 91010, USA;
| | - Richard Jove
- Department of Molecular Medicine, City of Hope National Med Center, Duarte, CA 91010, USA;
| | - John H. Yim
- Department of Surgery, City of Hope National Med Center, Duarte, CA 91010, USA; (E.S.H.); (T.H.D.); (L.X.L.)
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Nelson RA, Bostanci Z, Jones V, Mortimer J, Polverini A, Taylor L, Yee L, Yim JH, Kruper L. Insurance Status Predicts Survival in Women with Breast Cancer: Results of Breast and Cervical Cancer Treatment Program in California. Ann Surg Oncol 2020; 27:2177-2187. [PMID: 31965375 PMCID: PMC8838883 DOI: 10.1245/s10434-019-08116-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND PURPOSE The Breast and Cervical Cancer Treatment Program (BCCTP) Act, passed by Congress in 2000, provides time-limited coverage to uninsured breast or cervical cancer patients. We examine survival differences between BCCTP cases and insured controls. METHODS Stage I-III breast cancer patients, covered under California's BCCTP from 2005 to 2009 (N = 6343), were 1:1 matched with California Cancer Registry controls on age, race/ethnicity, and cancer stage. Overall and disease-specific (OS and DSS) survival were compared using multivariate regression. RESULTS BCCTP cases were more often unmarried [odds ratio (OR) 2.47, 95% confidence interval (CI) 2.30-2.66], with poorly/undifferentiated tumors (OR 1.26, CI 1.13-1.40), classified as ER negative (OR 1.10, CI 1.02-1.20) and/or PR negative (OR 1.09, CI 1.01-1.17). Cases were more likely to undergo mastectomy (OR 1.13, CI 1.05-1.21) or no surgery (OR 1.64, CI 1.31-2.05) versus lumpectomy. Cases were also more likely to undergo radiation (OR 1.11, CI 1.03-1.19). Endocrine therapy rates were marginally lower in cases (OR 0.93, CI 0.86-1.00). OS and DSS were shorter in BCCTP cases on multivariate analysis (HR 1.29, CI 1.17-1.42 and HR 1.27, CI 1.14-1.42, respectively). When stratified by socioeconomic status (SES), cases had significantly shorter OS and DSS except in the lowest quintile. When stratified by stage, cases had significantly shorter OS and DSS, except for stage I. CONCLUSIONS The BCCTP provides uninsured breast cancer patients with comprehensive and timely care. Although our results suggest that BCCTP delivers quality care, BCCTP patients have shorter survival rates, even after accounting for SES and stage differences. Further assistance to vulnerable populations is warranted, including longer duration of treatment coverage, and surveillance adhering to NCCN compliant surveillance programs.
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Affiliation(s)
- Rebecca A Nelson
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Zeynep Bostanci
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Veronica Jones
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Amy Polverini
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Lesley Taylor
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Lisa Yee
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - John H Yim
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Laura Kruper
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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6
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Wang L, Simons DL, Lu X, Tu TY, Avalos C, Chang AY, Dirbas FM, Yim JH, Waisman J, Lee PP. Breast cancer induces systemic immune changes on cytokine signaling in peripheral blood monocytes and lymphocytes. EBioMedicine 2020; 52:102631. [PMID: 31981982 PMCID: PMC6992943 DOI: 10.1016/j.ebiom.2020.102631] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background It is increasingly recognized that cancer progression induces systemic immune changes in the host. Alterations in number and function of immune cells have been identified in cancer patients’ peripheral blood and lymphoid organs. Recently, we found dysregulated cytokine signaling in peripheral blood T cells from breast cancer (BC) patients, even those with localized disease. Methods We used phosphoflow cytometry to determine the clinical significance of cytokine signaling responsiveness in peripheral blood monocytes from non-metastatic BC patients at diagnosis. We also examined the correlation between cytokine signaling in peripheral monocytes and the number of tumor-infiltrating macrophages in paired breast tumors. Findings Our results show that cytokine (IFNγ) signaling may also be dysregulated in peripheral blood monocytes at diagnosis, specifically in BC patients who later relapsed. Some patients exhibited concurrent cytokine signaling defects in monocytes and lymphocytes at diagnosis, which predict the risk of future relapse in two independent cohorts of BC patients. Moreover, IFNγ signaling negatively correlates with expression of CSF1R on monocytes, thus modulating their ability to infiltrate into tumors. Interpretation Our results demonstrate that tumor-induced systemic immune changes are evident in peripheral blood immune cells for both myeloid and lymphoid lineages, and point to cytokine signaling responsiveness as important biomarkers to evaluate the overall immune status of BC patients. Funding This study was supported by the Department of Defense Breast Cancer Research Program (BCRP), The V Foundation, Stand Up to Cancer (SU2C), and Breast Cancer Research Foundation (BCRF).
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Affiliation(s)
- Lei Wang
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Diana L Simons
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Xuyang Lu
- Department of Biostatistics, UCLA, Los Angeles, CA 90095, USA
| | - Travis Y Tu
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Christian Avalos
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Andrew Y Chang
- Department of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
| | | | - John H Yim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - James Waisman
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Peter P Lee
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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7
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Lee JS, Yost SE, Blanchard S, Schmolze D, Yin HH, Pillai R, Robinson K, Tang A, Martinez N, Portnow J, Wen W, Yim JH, Brauer HA, Ren Y, Luu T, Mortimer J, Yuan Y. Phase I clinical trial of the combination of eribulin and everolimus in patients with metastatic triple-negative breast cancer. Breast Cancer Res 2019; 21:119. [PMID: 31703728 PMCID: PMC6839083 DOI: 10.1186/s13058-019-1202-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alteration of the PI3K/AKT/mTOR pathway is a common genomic abnormality detected in triple-negative breast cancer (TNBC). Everolimus acts synergistically with eribulin in TNBC cell lines and xenograft models. This phase I trial was designed to test the safety and tolerability of combining eribulin and everolimus in patients with metastatic TNBC. METHODS The primary objective of this study was to evaluate the safety and toxicities of the combination. Patients with metastatic TNBC who had up to four lines of prior chemotherapies were enrolled. The combination of eribulin and everolimus was tested using three dosing levels: A1 (everolimus 5 mg daily; eribulin 1.4 mg/m2 days 1 and 8 every 3 weeks), A2 (everolimus 7.5 mg daily; eribulin 1.4 mg/m2, days 1 and 8 every 3 weeks), and B1 (everolimus 5 mg daily; eribulin 1.1 mg/m2 days 1 and 8 every 3 weeks). RESULTS Twenty-seven patients with median age 55 years were enrolled. Among 8 evaluable patients who received dose level A1, 4 had dose-limiting toxicities (DLTs). Among 3 evaluable patients treated with dose level A2, 2 had DLTs. Among 12 evaluable patients who received dose level B1, 4 had DLTs. The DLTs were neutropenia, stomatitis, and hyperglycemia. Over the study period, 59% had a ≥ grade 3 toxicity, 44% had ≥ grade 3 hematologic toxicities, and 22% had grade 4 hematologic toxicities. The most common hematological toxicities were neutropenia, leukopenia, and lymphopenia. Thirty-three percent had grade 3 non-hematologic toxicities. The most common non-hematological toxicities were stomatitis, hyperglycemia, and fatigue. The median number of cycles completed was 4 (range 0-8). Among 25 eligible patients, 9 patients (36%) achieved the best response as partial response, 9 (36%) had stable disease, and 7 (28%) had progression. The median time to progression was 2.6 months (95% CI [2.1, 4.0]), and median overall survival (OS) was 8.3 months (95% CI [5.5, undefined]). CONCLUSION Eribulin 1.1 mg/m2 days 1 and 8 every 3 weeks with everolimus 5 mg daily was defined as the highest dose with acceptable toxicity (RP2D). The combination is safe, and efficacy is modest. A post hoc analysis showed that participants that used dexamethasone mouthwash stayed on treatment for one additional cycle. TRIAL REGISTRATION ClinicalTrials.gov, NCT02120469. Registered 18 April 2014.
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Affiliation(s)
- Jin Sun Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Susan E Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Suzette Blanchard
- Department of Biostatistics, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Hongwei Holly Yin
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Kim Robinson
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Aileen Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Norma Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Wei Wen
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - John H Yim
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | | | - Yuqi Ren
- NanoString Technologies, Inc., Seattle, WA, USA
| | | | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center and Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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8
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Egelston CA, Avalos C, Tu TY, Rosario A, Wang R, Solomon S, Srinivasan G, Nelson MS, Huang Y, Lim MH, Simons DL, He TF, Yim JH, Kruper L, Mortimer J, Yost S, Guo W, Ruel C, Frankel PH, Yuan Y, Lee PP. Resident memory CD8+ T cells within cancer islands mediate survival in breast cancer patients. JCI Insight 2019; 4:130000. [PMID: 31465302 DOI: 10.1172/jci.insight.130000] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022] Open
Abstract
CD8+ tumor-infiltrating lymphocytes (TILs) correlate with relapse-free survival (RFS) in most cancer types, including breast cancer. However, subset composition, functional status, and spatial location of CD8+ TILs in relation to RFS in human breast tumors remain unclear. Spatial tissue analysis via quantitative immunofluorescence showed that infiltration of CD8+ T cells into cancer islands was more significantly associated with RFS than CD8+ T cell infiltration into either tumor stroma or total tumor. Localization into cancer islands within tumors is mediated by expression of the integrin CD103, which is a marker for tissue-resident memory T cells (TRMs). Analysis of fresh tumor samples revealed that CD8+ TRMs are functionally similar to other CD8+ TILs, suggesting that the basis of their protective effect is their spatial distribution rather than functional differences. Indeed, CD103+ TRMs, as compared with CD103-CD8+ TILs, are enriched within cancer islands, and CD8+ TRM proximity to cancer cells drives the association of CD8+ TIL densities with RFS. Together, these findings reveal the importance of cancer island-localized CD8+ TRMs in surveillance of the breast tumor microenvironment and as a critical determinant of RFS in patients with breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christopher Ruel
- Department of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Paul H Frankel
- Department of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California, USA
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9
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Wen W, Marcinkowski E, Luyimbazi D, Luu T, Xing Q, Yan J, Wang Y, Wu J, Guo Y, Tully D, Han ES, Yost SE, Yuan Y, Yim JH. Eribulin Synergistically Increases Anti-Tumor Activity of an mTOR Inhibitor by Inhibiting pAKT/pS6K/pS6 in Triple Negative Breast Cancer. Cells 2019; 8:cells8091010. [PMID: 31480338 PMCID: PMC6770784 DOI: 10.3390/cells8091010] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
Unlike other breast cancer subtypes, patients with triple negative breast cancer (TNBC) have poor outcomes and no effective targeted therapies, leaving an unmet need for therapeutic targets. Efforts to profile these tumors have revealed the PI3K/AKT/mTOR pathway as a potential target. Activation of this pathway also contributes to resistance to anti-cancer agents, including microtubule-targeting agents. Eribulin is one such microtubule-targeting agent that is beneficial in treating taxane and anthracycline refractory breast cancer. In this study, we compared the effect of eribulin on the PI3K/AKT/mTOR pathway with other microtubule-targeting agents in TNBC. We found that the phosphorylation of AKT was suppressed by eribulin, a microtubule depolymerizing agent, but activated by paclitaxel, a microtubule stabilizing agent. The combination of eribulin and everolimus, an mTOR inhibitor, resulted in an increased reduction of p-S6K1 and p-S6, a synergistic inhibition of cell survival in vitro, and an enhanced suppression of tumor growth in two orthotopic mouse models. These findings provide a preclinical foundation for targeting both the microtubule cytoskeleton and the PI3K/AKT/mTOR pathway in the treatment of refractory TNBC.
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Affiliation(s)
- Wei Wen
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Emily Marcinkowski
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - David Luyimbazi
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Thehang Luu
- Department of Medical Oncology and Molecular Therapy, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Quanhua Xing
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Jin Yan
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Yujun Wang
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Jun Wu
- Department of Comparative Medicine, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Yuming Guo
- Department of Comparative Medicine, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Dylan Tully
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Ernest S Han
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Susan E Yost
- Department of Medical Oncology and Molecular Therapy, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Yuan Yuan
- Department of Medical Oncology and Molecular Therapy, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - John H Yim
- Division of Surgery, Beckman Research Institute, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA 91010, USA.
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10
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Wen W, Han ES, Dellinger TH, Wu J, Guo Y, Buettner R, Horne DA, Jove R, Yim JH. Increasing Antitumor Activity of JAK Inhibitor by Simultaneous Blocking Multiple Survival Signaling Pathways in Human Ovarian Cancer. Transl Oncol 2019; 12:1015-1025. [PMID: 31141756 PMCID: PMC6542771 DOI: 10.1016/j.tranon.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022] Open
Abstract
Many signaling pathways, including the JAK/STAT3 pathway, are aberrantly activated and associated with ovarian cancer growth and progression. However, inhibition of STAT3 pathway alone was not sufficient to effectively block human ovarian cancer cell survival in vitro, which could be due to the activation and compensation of multiple survival pathways. In this study, we investigated a strategy that can enhance antitumor activity of JAK/STAT3 inhibitor by combining with inhibitors targeting other growth and survival pathways. We found that the in vitro activity of JAKi was remarkably increased when additional survival pathway was blocked. Blocking SRC pathway with SRC inhibitor (SRCi) increased the efficacy of JAKi more effectively than blocking AKT or MAPK pathway. The increased activity of JAKi in combination with SRCi is synergistic and associated with attenuation of p-STAT3, p-SRC, p-AKT and p-MAPK and increased inhibition of p-AKT. Simultaneous blockade of multiple survival pathways by combining JAKi with both AKT inhibitor (AKTi) and MEK inhibitor (MEKi) also resulted in a synergistic inhibition of cell survival. Furthermore, the combined treatment of JAKi and SRCi led to an increased apoptosis and greater inhibition of tumor growth and ascites formation. Taken together, our results demonstrate that the antitumor efficacy of JAKi is improved most effectively when combined with SRCi, providing a potential combination strategy for the treatment of advanced ovarian cancer.
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Affiliation(s)
- Wei Wen
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010; Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010.
| | - Ernest S Han
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - Thanh H Dellinger
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - Jun Wu
- Department of Comparative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - Yuming Guo
- Department of Comparative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - Ralf Buettner
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - David A Horne
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - Richard Jove
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010
| | - John H Yim
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd., Duarte, CA 91010.
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11
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Yuan Y, Wen W, Yost SE, Xing Q, Yan J, Han ES, Mortimer J, Yim JH. Combination therapy with BYL719 and LEE011 is synergistic and causes a greater suppression of p-S6 in triple negative breast cancer. Sci Rep 2019; 9:7509. [PMID: 31101835 PMCID: PMC6525251 DOI: 10.1038/s41598-019-43429-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/13/2018] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
A third of patients with triple negative breast cancer (TNBC) have relapsed disease within 2-5 years from initial diagnosis, leaving an unmet need for therapeutic targets. TNBC frequently harbors alterations of the PI3K/AKT/mTOR pathway, but single agent PI3K/AKT/mTOR inhibitors have not shown marked efficacy. In this study, we investigated a strategy to improve efficacy of PI3K-α inhibitor BYL719 (alpelisib) in TNBC. While BYL719 is effective at inhibiting cell proliferation in T47D, a triple positive cell line, it had limited activity in TNBC. This may be partially due to persistent phosphorylation of RB, and incomplete inhibition of p-S6 in TNBC, since the inhibitory effect of BYL719 on p-RB and p-S6 was significantly reduced in TNBC compared to T47D cells. Addition of the CDK4/6 inhibitor LEE011 to BYL719 caused a simultaneous reduction of p-RB and p-S6, and a more complete inhibition of p-S6, leading to decreased expression of the pro-survival protein MCL-1, an induction of apoptosis, and an enhanced reduction of tumor growth in a PDX model of TNBC. These findings suggest that inhibition of p-RB and p-S6 is important for an effective response to the treatment of TNBC, and provides a strong rationale for clinical development of combination therapy with BYL719 and LEE011 for treatment of metastatic TNBC with intact RB.Presentation: This study was presented in part as an abstract at the 2016 San Antonio Breast Cancer Symposium (P3-03-15) and the 2018 Cancer Research and Targeted Therapy in London.
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Affiliation(s)
- Yuan Yuan
- Department of Medical Oncology & Molecular Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA.
| | - Wei Wen
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Susan E Yost
- Department of Medical Oncology & Molecular Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Quanhua Xing
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Jin Yan
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Ernest S Han
- Division of Gynecologic Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology & Molecular Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - John H Yim
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA.
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12
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Egelston CA, Avalos C, Tu TY, Simons DL, Jimenez G, Jung JY, Melstrom L, Margolin K, Yim JH, Kruper L, Mortimer J, Lee PP. Human breast tumor-infiltrating CD8 + T cells retain polyfunctionality despite PD-1 expression. Nat Commun 2018; 9:4297. [PMID: 30327458 PMCID: PMC6191461 DOI: 10.1038/s41467-018-06653-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Functional CD8+ T cells in human tumors play a clear role in clinical prognosis and response to immunotherapeutic interventions. PD-1 expression in T cells involved in chronic infections and tumors such as melanoma often correlates with a state of T-cell exhaustion. Here we interrogate CD8+ tumor-infiltrating lymphocytes (TILs) from human breast and melanoma tumors to explore their functional state. Despite expression of exhaustion hallmarks, such as PD-1 expression, human breast tumor CD8+ TILs retain robust capacity for production of effector cytokines and degranulation capacity. In contrast, melanoma CD8+ TILs display dramatic reduction of cytokine production and degranulation capacity. We show that CD8+ TILs from human breast tumors can potently kill cancer cells via bi-specific antibodies. Our data demonstrate that CD8+ TILs in human breast tumors retain polyfunctionality, despite PD-1 expression, and suggest that they may be harnessed for effective immunotherapies. Expression of the checkpoint molecule programmed cell death protein 1 (PD-1) is considered a marker of T cells exhaustion. Here the authors show that CD8T cells isolated from breast cancer patients are perfectly functional despite PD-1 expression while those isolated from melanoma patients are not.
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Affiliation(s)
- Colt A Egelston
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Christian Avalos
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Travis Y Tu
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Diana L Simons
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Grecia Jimenez
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Jae Y Jung
- Department of Dermatologic Oncology, Norton Cancer Institute, Louisville, KY, 40202, USA
| | - Laleh Melstrom
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Kim Margolin
- Department of Medical Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - John H Yim
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Laura Kruper
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Joanne Mortimer
- Department of Medical Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Peter P Lee
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA.
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13
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Blenman KRM, He TF, Frankel PH, Ruel NH, Schwartz EJ, Krag DN, Tan LK, Yim JH, Mortimer JE, Yuan Y, Lee PP. Sentinel lymph node B cells can predict disease-free survival in breast cancer patients. NPJ Breast Cancer 2018; 4:28. [PMID: 30155518 PMCID: PMC6107630 DOI: 10.1038/s41523-018-0081-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/07/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Tumor invasion into draining lymph nodes, especially sentinel lymph nodes (SLNs), is a key determinant of prognosis and treatment in breast cancer as part of the TNM staging system. Using multicolor histology and quantitative image analysis, we quantified immune cells within SLNs from a discovery cohort of 76 breast cancer patients. We found statistically more in situ CD3+ T cells in tumor negative vs. tumor positive nodes (mean of 8878 vs. 6704, respectively, p = 0.006), but no statistical difference in CD20+ B cells or CD1a+ dendritic cells. In univariate analysis, a reduced hazard was seen with a unit increase in log CD3 with HR 0.49 (95% CI 0.30–0.80) and log CD20 with HR 0.37 (95% CI 0.22–0.62). In multivariate analysis, log CD20 remained significant with HR 0.42 (95% CI 0.25–0.69). When restricted to SLN tumor negative patients, increased log CD20 was still associated with improved DFS (HR = 0.26, 95% CI 0.08–0.90). The CD20 results were validated in a separate cohort of 21 patients (n = 11 good outcome, n = 10 poor outcome) with SLN negative triple-negative breast cancer (TNBC) (“good” mean of 7011 vs. “poor” mean of 4656, p = 0.002). Our study demonstrates that analysis of immune cells within SLNs, regardless of tumor invasion status, may provide additional prognostic information, and highlights B cells within SLNs as important in preventing future recurrence. B cells within the tumor-draining lymph nodes may have an important biological role in preventing relapse of breast cancer. A team led by Peter Lee from City of Hope in Duarte, California, USA, quantified the levels of three populations of immune cells—T cells, B cells and dendritic cells—within sentinel lymph nodes biopsied from a cohort of 76 patients. They found that larger numbers of T cells and B cells were both linked to longer progression-free survival in the women. However, after statistically accounting for correlations between the two immune cell types, the researchers concluded that B cells had the dominant beneficial effect on survival times. They validated the finding that high B-cell counts are a prognostic indicator of better outcomes in a separate cohort of 21 women with triple-negative breast cancer.
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Affiliation(s)
- Kim R M Blenman
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA.,8Present Address: Department of Dermatology, Yale University, New Haven, CT USA
| | - Ting-Fang He
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Paul H Frankel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Nora H Ruel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Erich J Schwartz
- 3Department of Pathology, Stanford University, Stanford, CA USA.,9Present Address: Department of Pathology, Beaumont Health, Farmington Hills, MI USA
| | - David N Krag
- 4Department of Surgery, University of Vermont College of Medicine, Burlington, VT USA
| | - Lee K Tan
- 5Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John H Yim
- 6Department of Surgery, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Joanne E Mortimer
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Yuan Yuan
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Peter P Lee
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
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14
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Yim JH, Choi AH, Li AX, Qin H, Chang S, Tong SWT, Chu P, Kim BW, Schmolze D, Lew R, Ibrahim Y, Poroyko VA, Salvatierra S, Baker A, Wang J, Wu X, Pfeifer GP, Fong Y, Hahn MA. Identification of Tissue-Specific DNA Methylation Signatures for Thyroid Nodule Diagnostics. Clin Cancer Res 2018; 25:544-551. [PMID: 30093451 DOI: 10.1158/1078-0432.ccr-18-0841] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/01/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Thyroid cancer is frequently difficult to diagnose due to an overlap of cytologic features between malignant and benign nodules. This overlap leads to unnecessary removal of the thyroid in patients without cancer. While providing some improvement over cytopathologic diagnostics, molecular methods frequently fail to provide a correct diagnosis for thyroid nodules. These approaches are based on the difference between cancer and adjacent thyroid tissue and assume that adjacent tissues are the same as benign nodules. However, in contrast to adjacent tissues, benign thyroid nodules can contain genetic alterations that can be found in cancer.Experimental Design: For the development of a new molecular diagnostic test for thyroid cancer, we evaluated DNA methylation in 109 thyroid tissues by using genome-wide single-base resolution DNA methylation analysis. The test was validated in a retrospective cohort containing 65 thyroid nodules. RESULTS By conducting reduced representation bisulfite sequencing in 109 thyroid specimens, we found significant differences between adjacent tissue, benign nodules, and cancer. These tissue-specific signatures are strongly linked to active enhancers and cancer-associated genes. Based on these signatures, we developed a new epigenetic approach for thyroid diagnostics. According to the validation cohort, our test has an estimated specificity of 97% [95% confidence interval (CI), 81-100], sensitivity of 100% (95% CI, 87-100), positive predictive value of 97% (95% CI, 83-100), and negative predictive value of 100% (95% CI, 86-100). CONCLUSIONS These data show that epigenetic testing can provide outstanding diagnostic accuracy for thyroid nodules.See related commentary by Mitmaker et al., p. 457.
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Affiliation(s)
- John H Yim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Audrey H Choi
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arthur X Li
- Department of Information Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Hanjun Qin
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Sue Chang
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sun-Wing T Tong
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Peiguo Chu
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Byung-Wook Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ryan Lew
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yasmine Ibrahim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Valeriy A Poroyko
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sylvana Salvatierra
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Alysha Baker
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jinhui Wang
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Xiwei Wu
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Gerd P Pfeifer
- Center for Epigenetics, Van Andel Research Institute, Grand Rapids, Michigan
| | - Yuman Fong
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Maria A Hahn
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California.
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15
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Kauffmann RM, Hamner JB, Ituarte PHG, Yim JH. Age greater than 60 years portends a worse prognosis in patients with papillary thyroid cancer: should there be three age categories for staging? BMC Cancer 2018; 18:316. [PMID: 29566662 PMCID: PMC5865378 DOI: 10.1186/s12885-018-4181-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/06/2018] [Indexed: 02/08/2023] Open
Abstract
Background Age is an important prognostic factor in papillary thyroid cancer (PTC), with better survival observed in patients < 45 years of age, regardless of stage. Although the impact of increasing age on PTC-related survival is well-known, previous studies have focused on survival relative to age 45 years only. As the number of patients entering their 7th decade of life increases, PTC-related survival in this demographic becomes increasingly important. Survival in patients ≥ 60 years specifically compared to other groups has not previously been examined. We sought to determine whether age ≥ 60 years is an adverse prognostic factor for disease-specific survival and recurrence in patients with PTC. Methods The California Cancer Registry database was linked to inpatient and ambulatory patient records from the Office of Statewide Health Planning and Development for the years 2000–2011. This linked database was queried for patients diagnosed with papillary thyroid cancer and treated with surgery. We then identified prognostic factors related to both 5-year and 10-year disease-specific survival and disease-free survival in patients ≤ 45, 45–59, and ≥ 60 years. Multivariable Cox proportional hazard models were created to test the effect of age ≥ 60 on disease-specific and disease-free survival, controlling for clinical, treatment, and demographic factors. Results The final cohort included 15,675 patients. Of the group, 46.3% were between 18 and 44 years of age, 33.6% were 45–59 years, and 20.1% were ≥ 60. Univariate analysis showed that compared to other groups, patients ≥ 60 were more likely to be male (p < 0.001), present with tumors > 5 cm (p < 0.001), more likely to have metastatic disease (p < 0.001), less likely to receive radioactive iodine (p < 0.001), and more likely to receive external beam radiation therapy (p < 0.001). In multivariable Cox proportional hazards models for 5 and 10-year disease-free survival, age ≥ 60 was associated with higher risk of disease at 5 and 10-years (HR 2.3 and 1.9 respectively, p < 0.001). Similar results were observed for 5 and 10-year disease-specific survival (HR 38.0 and 30.0 respectively, p < 0.001) after controlling for gender, race, co-morbidity, stage, surgical procedure, radioactive iodine, insurance, and hospital volume. Conclusions Patients ≥ 60 years of age have worse DSS and DFS after a diagnosis of PTC, across all stages of disease. Given that patients over the age of 45 years have progressively worse survival as they age, these data support having three age groups, 18–44 years of age, 45–59 years, and ≥ 60 as an independent predictor of survival and recurrence to current staging guidelines.
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Affiliation(s)
- Rondi M Kauffmann
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - J Blair Hamner
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - Philip H G Ituarte
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - John H Yim
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA.
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Bostanci Z, Wang X, Ottesen R, Nikowitz J, Jones VC, Springer L, Lai L, Taylor L, Vito CA, Paz IB, Niland J, Kruper L, Yim JH. Abstract P5-22-12: Oncological safety of nipple-areola sparing mastectomy in comparison with skin sparing and total mastectomy: Results from a NCI-designated comprehensive cancer center. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-22-12] [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
Nipple-areola sparing mastectomy (NSM) may be offered to some women with breast cancer as an alternative to skin sparing (SSM) or total mastectomy (TM) with excellent cosmetic results and acceptable recurrence risk. The aim of this study is to determine the local/regional recurrence rate of NSM in comparison to SSM and TM at our institution and to determine the factors that may be associated with risk of recurrence. Women who underwent NSM (n=148), SSM (n=660) or TM (n=443) at City of Hope National Medical Center between May 2007 and December 2014 for Stage 0-III breast cancer were identified retrospectively. Exclusions were: women with inflammatory breast cancer and those who had mastectomy for recurrent breast cancer. Overall survival (OS) and disease free survival (DFS) were analyzed using Cox regression controlling for age, race/ethnicity, stage, histology, grade, hormone receptor and Her2 receptor status. There were total of 165 NSMs, 704 SSMs and 466 TMs performed for cancer, accounting for the patients with bilateral cancers. The median follow up time was 38, 58 and 55 months for NSM, SSM and TM, respectively. Median (range) age at diagnosis was 49 (23-74) for NSM, 51 (23-90) for SSM and 59 (26-92) for TM. In the NSM group, 76% of patients had invasive ductal cancer (IDC) and 15% had ductal carcinoma in-situ (DCIS); this was comparable to 73% and 13% in the SSM group and 78% and 9% in the TM group, respectively. The majority of patients who underwent NSM had Stage II disease (45%), which was similar to SSM (43%) and TM (44%). Only 3% of NSM patients had Stage III disease compared to 17% of SSM patients and 29% of TM patients. Most of the patients in all 3 surgical groups received adjuvant chemotherapy (NSM 59%; SSM 52%; TM 51%). Of patients who underwent NSM, 20% received neoadjuvant chemotherapy, compared with 29% of SSM patients and 35% of TM patients. The local/regional recurrence rate per breast was 12/165 (7.3%) for NSM, 23/704 (3.3%) for SSM and 11/466 (2.4%) for TM (n=11). Median time to recurrence was 20, 26 and 16 months for NSM, SSM and TM, respectively. Of the NSMs performed only 1 recurrence occurred at the nipple-areolar complex (0.6%), 9 recurrences were at the chest wall (5.5%) and 2 were at the axilla (1.2%). Eight recurrences after NSM had DCIS in addition to IDC at the time of initial diagnosis while 2 had pure DCIS, 1 had pure IDC and 1 had invasive lobular cancer. There were 8 recurrences with estrogen receptor (ER) and progesterone receptor (PR) positivity at the time of initial diagnosis, that converted to ER+, PR-. One third of recurrences after NSM had multifocal disease. There was no significant difference found in adjusted overall survival (p=0.49) and adjusted disease free survival (p=0.10) among NSM, SSM and TM patients. Even though there is higher rate of local/regional recurrence with NSM, there is no difference in overall and disease-free survival at our institution. Presence of DCIS may be an important factor for recurrence. From these data we conclude that NSM is an oncologically acceptable alternative to SSM and TM, with excellent cosmetic results.
Citation Format: Bostanci Z, Wang X, Ottesen R, Nikowitz J, Jones VC, Springer L, Lai L, Taylor L, Vito CA, Paz IB, Niland J, Kruper L, Yim JH. Oncological safety of nipple-areola sparing mastectomy in comparison with skin sparing and total mastectomy: Results from a NCI-designated comprehensive cancer center [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-12.
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Affiliation(s)
- Z Bostanci
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - X Wang
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - R Ottesen
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - J Nikowitz
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - VC Jones
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Springer
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Lai
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Taylor
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - CA Vito
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - IB Paz
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - J Niland
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Kruper
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
| | - JH Yim
- City of Hope National Medical Center, Duarte, CA; Breast Cancer Unit, Peking University Cancer Hospital & Institute, Beijing, China
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Han ES, Wen W, Dellinger TH, Wu J, Lu SA, Jove R, Yim JH. Ruxolitinib synergistically enhances the anti-tumor activity of paclitaxel in human ovarian cancer. Oncotarget 2018; 9:24304-24319. [PMID: 29849942 PMCID: PMC5966246 DOI: 10.18632/oncotarget.24368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/19/2018] [Indexed: 02/06/2023] Open
Abstract
Treatment for ovarian cancer remains challenging despite a high initial response rate to first line platinum-taxane treatment. Most patients eventually experience recurrence and require further treatment. Persistent activation of STAT3 is associated with cancer growth and progression and is also involved in cell resistance to platinum and taxane treatment. Targeting JAK/STAT3, therefore, could be a potential novel therapeutic approach for treating advanced and chemoresistant ovarian cancer. We investigated the therapeutic potential of ruxolitinib, a JAK1/JAK2 inhibitor that has been FDA-approved for the treatment of myelofibrosis, to treat ovarian cancer either alone or in combination with conventional chemotherapy agents. We show that ruxolitinib inhibits STAT3 activation and ovarian tumor growth both in ovarian cancer cells and in an ovarian cancer mouse model. In addition, ruxolitinib significantly increases the anti-tumor activity of chemotherapy agents, including paclitaxel, cisplatin, carboplatin, doxorubicin and topotecan in ovarian cancer cells. Evaluation of the combination index (CI) shows that ruxolitinib synergistically interacts with paclitaxel in all three human ovarian cancer cells. Finally, our results demonstrate that combination of ruxolitinib and paclitaxel leads to a greater reduction of tumor growth compared to single treatment of either agent in a tumor mouse model that represents late stage ovarian cancer with peritoneal metastasis and ascites formation. Taken together, our findings provide a foundation for clinical trials with ruxolitinib, either as a single agent or in combination with paclitaxel, for the treatment of recurrent and advanced ovarian cancer.
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Affiliation(s)
- Ernest S Han
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Wei Wen
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.,Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Thanh H Dellinger
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Jun Wu
- Department of Comparative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Selena A Lu
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Richard Jove
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.,Current/Present address: Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - John H Yim
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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Kanaya N, Somlo G, Wu J, Frankel P, Kai M, Liu X, Wu SV, Nguyen D, Chan N, Hsieh MY, Kirschenbaum M, Kruper L, Vito C, Badie B, Yim JH, Yuan Y, Hurria A, Peiguo C, Mortimer J, Chen S. Characterization of patient-derived tumor xenografts (PDXs) as models for estrogen receptor positive (ER+HER2- and ER+HER2+) breast cancers. J Steroid Biochem Mol Biol 2017; 170:65-74. [PMID: 27154416 PMCID: PMC5094906 DOI: 10.1016/j.jsbmb.2016.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/11/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 12/18/2022]
Abstract
The research was to appraise the utility of the patient-derived tumor xenografts (PDXs) as models of estrogen receptor positive (ER+HER2- and ER+HER2+) breast cancers. We compared protein expression profiles by Reverse Phase Protein Array (RPPA) in tumors that resulted in PDXs compared to those that did not. Our overall PDX intake rate for ER+ breast cancer was 9% (9/97). The intake rate for ER+HER2+ tumors (3/16, 19%) was higher than for ER+HER2- tumors (6/81, 7%). Heat map analyses of RPPA data showed that ER+HER2- tumors were divided into 2 groups by luminal A/B signature [protein expression of ER, AR, Bcl-2, Bim (BCL2L11), GATA3 and INPP4b], and this expression signature was also associated with the rate of PDX intake. Cell survival pathways such as the PI3K/AKT signaling and RAS/ERK pathways were more activated in the specimens that could be established as PDX in both classes. Expression of the ER protein itself may have a bearing on the potential success of an ER+ PDX model. In addition, HER2 and its downstream protein expressions were up-regulated in the ER+HER2+ patient tumors that were successfully established as PDX models. Moreover, the comparison of RPPA data between original and PDX tumors suggested that the selection/adaptation process required to grow the tumors in mice is unavoidable for generation of ER+ PDX models, and we identified differences between patient tumor samples and paired PDX tumors. A better understanding of the biological characteristics of ER+PDX would be the key to using PDX models in assessing treatment strategies in a preclinical setting.
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Affiliation(s)
- Noriko Kanaya
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - George Somlo
- Department of Medical Oncology, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Jun Wu
- Department of Comparative Medicine, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Paul Frankel
- Department of Information Sciences, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Masaya Kai
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Xueli Liu
- Department of Information Sciences, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Shang Victoria Wu
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Duc Nguyen
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Nymph Chan
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Meng-Yin Hsieh
- Department of Comparative Medicine, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Michele Kirschenbaum
- Clinical Trials Office, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Laura Kruper
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Courtney Vito
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Behnam Badie
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - John H Yim
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Yuan Yuan
- Department of Medical Oncology, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Arti Hurria
- Department of Medical Oncology, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Chu Peiguo
- Department of Pathology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Shiuan Chen
- Department of Cancer Biology, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA.
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Chung B, Esmaeili AA, Gopalakrishna-Pillai S, Murad JP, Andersen ES, Kumar Reddy N, Srinivasan G, Armstrong B, Chu C, Kim Y, Tong T, Waisman J, Yim JH, Badie B, Lee PP. Human brain metastatic stroma attracts breast cancer cells via chemokines CXCL16 and CXCL12. NPJ Breast Cancer 2017. [PMID: 28649646 PMCID: PMC5460196 DOI: 10.1038/s41523-017-0008-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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] [Indexed: 01/06/2023] Open
Abstract
The tumor microenvironment is composed of heterogeneous populations of cells, including cancer, immune, and stromal cells. Progression of tumor growth and initiation of metastasis is critically dependent on the reciprocal interactions between cancer cells and stroma. Through RNA-Seq and protein analyses, we found that cancer-associated fibroblasts derived from human breast cancer brain metastasis express significantly higher levels of chemokines CXCL12 and CXCL16 than fibroblasts from primary breast tumors or normal breast. To further understand the interplay between cancer cells and cancer-associated fibroblasts from each site, we developed three-dimensional organoids composed of patient-derived primary or brain metastasis cancer cells with matching cancer-associated fibroblasts. Three-dimensional CAF aggregates generated from brain metastasis promote migration of cancer cells more effectively than cancer-associated fibroblast aggregates derived from primary tumor or normal breast stromal cells. Treatment with a CXCR4 antagonist and/or CXCL16 neutralizing antibody, alone or in combination, significantly inhibited migration of cancer cells to brain metastatic cancer-associated fibroblast aggregates. These results demonstrate that human brain metastasis cancer-associated fibroblasts potently attract breast cancer cells via chemokines CXCL12 and CXCL16, and blocking CXCR6-CXCL16/CXCR4-CXCL12 receptor–ligand interactions may be an effective therapy for preventing breast cancer brain metastasis. Breast cancer metastases to the brain secrete signaling molecules that promote additional cancer cells to migrate there. Peter P. Lee and colleagues from the City of Hope in Duarte, California, USA, analyzed protein and gene expression levels in brain metastases, and showed that it is the stromal cells (support cells such as fibroblasts), rather than the cancer cells themselves, that are the source of these homing signals. When compared against stromal cells derived from primary breast tumors or healthy breast tissue, they found that the stromal cells that had lodged themselves in the brain expressed the highest levels of CXCL12 and CXCL16, two chemokines involved in cell movement. Using three-dimensional aggregates, the researchers showed that these metastatic stromal cells promoted cancer cells migration more potently than stromal cells from primary tumors or normal breast tissues. Blocking the chemokine activity or that of its receptor impaired cancer cell movement, suggesting a possible therapeutic strategy for preventing brain metastasis in patients with breast cancer. These results highlight the importance of the tumor microenvironment and stromal cells in the metastasis process of breast cancer.
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Affiliation(s)
- Brile Chung
- Department of Immuno-Oncology, City of Hope, Duarte, CA USA
| | - Ali A Esmaeili
- Department of Immuno-Oncology, City of Hope, Duarte, CA USA
| | | | - John P Murad
- Department of Immuno-Oncology, City of Hope, Duarte, CA USA
| | | | | | | | | | - Caleb Chu
- Department of Immuno-Oncology, City of Hope, Duarte, CA USA
| | - Young Kim
- Department of Pathology, City of Hope, Duarte, CA USA
| | - Tommy Tong
- Department of Pathology, City of Hope, Duarte, CA USA
| | - James Waisman
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA USA
| | - John H Yim
- Department of Surgery, City of Hope, Duarte, CA USA
| | - Behnam Badie
- Department of Surgery, City of Hope, Duarte, CA USA
| | - Peter P Lee
- Department of Immuno-Oncology, City of Hope, Duarte, CA USA
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Raoof M, Yuan Y, Wen W, Yan J, Xing Q, Han E, Yim JH. Inhibition of the PI3K Pathway by T-DM1 and its Maytansinoid-Conjugate. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.011] [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: 11/24/2022]
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21
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Yim JH, Jeong KH, Kim JY, Cho YH, Bae SJ, Shin MK. Pilot study on the correlation between skin auto-fluorescence and serum antioxidant enzyme: skin auto-fluorescence is negatively associated with levels of malondialdehyde. Skin Res Technol 2016; 23:149-154. [PMID: 27511708 DOI: 10.1111/srt.12313] [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] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Various methods have been used to objectively record skin changes. However, estimating the intrinsic and extrinsic aging of skin remains a challenge. Our objective was to study intrinsic skin aging with respect to patient age and extrinsic photo-aging of human dorsal (photo-exposed) and volar (photo-protected) forearm in vivo through skin auto-fluorescence (AF). We also examined the correlations between serum antioxidant enzyme, malondialdehyde(MDA), and skin AF. METHODS 37 healthy volunteers were enrolled. We measured skin AF and its heterogeneity on the dorsal and volar forearms. We also examined serum concentration of catalase, superoxide dismutase, vitamin E, and MDA levels in every participant. RESULTS In photo-protected areas, skin AF intensity in the 40 years or older group was significantly higher compared to the group less than 40 years-old. On the other hand, heterogeneity value was significantly higher in the less than 40 years-old group in photo-protected area. With respect to serum antioxidant enzyme and MDA level, only MDA level showed a negative correlation with skin AF intensity in photo-exposed area. CONCLUSION We determined that skin AF intensity of the photo-protected area reflects intrinsic skin aging. In addition, degree of photo-aging could be indirectly inferred by skin AF of photo-exposed area and serum MDA level.
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Affiliation(s)
- J H Yim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - K H Jeong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - J Y Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Seoul, Korea
| | - Y H Cho
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Seoul, Korea
| | - S J Bae
- Korea Electrotechnology Research Institute, Ansan, Korea
| | - M K Shin
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
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22
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Yim JH, Jeong KH, Shin MK. Comparative study of skin autofluorescence expression in atopic dermatitis and psoriasis: A prospective in vivo study. Skin Res Technol 2016; 23:169-175. [PMID: 27511797 DOI: 10.1111/srt.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Treatment of atopic dermatitis (AD) and psoriasis requires their differentiation from other eczematoid dermatitis and a determination of disease severity. However, both can be clinically difficult and the findings subjectively interpreted. We investigated the utility of in vivo autofluorescence (AF) measurements for diagnosis of both diseases, and determination of severity. MATERIALS AND METHODS Thirty patients with AD and 30 with psoriasis were recruited, together with sex- and age-matched patients with healthy skin. AF intensity was measured using the EcoSkin® fluorescence video dermatoscope. In AD and psoriasis patients, AF in non-sun-exposed lesional and non-lesional skin was measured. To identify the locations that reflect characteristics of AD, AF was also measured at the other sites in the patients with AD. RESULTS AD was associated with lower AF and psoriasis with higher AF intensity peaking around 620 nm. In addition, skin AF intensity of each disease was associated with severity of lesion. CONCLUSIONS Non-invasive measurement of skin AF in vivo can aid in diagnosis of AD and psoriasis as well as in treatment monitoring.
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Affiliation(s)
- J H Yim
- Department of Dermatology, College of Medicaine, Kyung Hee University, Seoul, Korea
| | - K H Jeong
- Department of Dermatology, College of Medicaine, Kyung Hee University, Seoul, Korea
| | - M K Shin
- Department of Dermatology, College of Medicaine, Kyung Hee University, Seoul, Korea
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23
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Choi AH, Lew R, O’Leary M, Fong Y, Yim JH, Hahn MA. Abstract 2775: Characterization of transcriptional and epigenetic signatures of benign thyroid adenomas: Can we improve preoperative diagnosis of thyroid nodules. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2775] [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
Introduction: It has been estimated that as many as 50,000 patients in the United States receive unnecessary thyroidectomies due to the inability to distinguish benign thyroid nodules from malignant ones. Up to 30% of fine needle aspirates performed for thyroid nodules diagnosis are indeterminate due to overlapping cytological features between benign and malignant nodules. At present, commercially-available diagnostic tests for thyroid nodules are based on the molecular differences observed between thyroid cancer compared to normal thyroid tissue. However, the molecular signature of benign thyroid nodules is neither well-characterized nor included in currently available diagnostic panels. The objective of this study was to determine whether thyroid adenomas (TA) are distinct from normal thyroid tissue and papillary thyroid cancer (PTC).
Methods: Whole transcriptome analysis was used to assess differences in transcriptional activity in 9 TA and 12 PTC tissue pairs (with matched normal adjacent thyroid tissue from the same patients). In order to evaluate epigenetic alterations associated with TA development, we used reduced representation bisulfite sequencing (RRBS) in 114 thyroid specimens (40 PTC, 28 TA and 46 matching adjacent thyroid tissues). This approach provides single base resolution of DNA methylation genome wide.
Results: According to our data, transcriptome activity divided analyzed specimens into three separate groups: PTC, TA and adjacent thyroid tissues. TA demonstrated a unique transcriptional pattern, distinct from both normal adjacent thyroid tissue and PTC. Similar results were obtained by analysis of epigenetic alterations in these tissues. According to the clustering analysis of DNA methylation patterns, the majority (18 of 28) of benign nodules forms a separate cluster, distinct from adjacent normal thyroid and PTC tissue clusters. Within this group, 14 of 28 TA demonstrated a distinct DNA methylation signature associated with TA-specific hypermethylation. In fact, only 4 of 28 TA demonstrated a DNA methylation signature similar to normal thyroid tissue, suggesting that the majority of TA is not equivalent to normal thyroid.
Conclusion: According to whole transcriptome analysis and genome wide analysis of DNA methylation, TA is frequently associated with specific transcriptional and DNA methylation signatures compared to normal thyroid tissue and PTC. These data indicate that the majority of thyroid adenomas are associated with a unique molecular pathway that is distinct from PTC development. Use of the adenoma-specific molecular signature can be an essential factor in the improvement of PTC diagnostic panels, helping to reduce unnecessary thyroidectomies.
Citation Format: Audrey H. Choi, Ryan Lew, Michael O’Leary, Yuman Fong, John H. Yim, Maria A. Hahn. Characterization of transcriptional and epigenetic signatures of benign thyroid adenomas: Can we improve preoperative diagnosis of thyroid nodules. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2775.
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Zhang K, Han ES, Dellinger TH, Lu J, Nam S, Anderson RA, Yim JH, Wen W. Cinnamon extract reduces VEGF expression via suppressing HIF-1α gene expression and inhibits tumor growth in mice. Mol Carcinog 2016; 56:436-446. [PMID: 27253180 DOI: 10.1002/mc.22506] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 01/17/2023]
Abstract
Although many anti-VEGF agents are available for cancer treatment, side effects of these agents limit their application for cancer treatment and prevention. Here we studied the potential use of a diet-based agent as an inhibitor for VEGF production. Using a VEGF reporter assay, our data showed that an extract from cinnamon (CE) was a potent inhibitor of VEGF production in human cancer cells and suggested inhibition might be mediated through the suppression of HIF-1α gene expression and protein synthesis. Furthermore, CE treatment was found to inhibit expression and phosphorylation of STAT3 and AKT, which are key factors in the regulation of HIF-1α expression, and significantly reduce angiogenesis potential of cancer cells by migration assay. Consistent with these results, we observed significant suppression of VEGF expression, blood vessel formation, and tumor growth in a human ovarian tumor model in mice treated with CE. Cinnamaldehyde, a major component in cinnamon, was identified as one active component in CE that inhibits VEGF expression. Taken together, our findings provide a novel mechanism underlying anti-angiogenic and anti-tumor actions of CE and support the potential use of CE in cancer prevention and treatment. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Keqiang Zhang
- Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, California.,Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
| | - Ernest S Han
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
| | - Thanh H Dellinger
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
| | - Jianming Lu
- Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, California.,Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
| | - Sangkil Nam
- Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, California
| | - Richard A Anderson
- U.S. Department of Agriculture, Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, Beltsville, Maryland
| | - John H Yim
- Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
| | - Wei Wen
- Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, California.,Department of Surgery, Beckman Research Institute of City of Hope, Duarte, California
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Armstrong MJ, Stang MT, Liu Y, Yan J, Pizzoferrato E, Yim JH. IRF-1 inhibits NF-κB activity, suppresses TRAF2 and cIAP1 and induces breast cancer cell specific growth inhibition. Cancer Biol Ther 2016; 16:1029-41. [PMID: 26011589 DOI: 10.1080/15384047.2015.1046646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Interferon Regulatory Factor (IRF)-1, originally identified as a transcription factor of the human interferon (IFN)-β gene, mediates tumor suppression and may inhibit oncogenesis. We have shown that IRF-1 in human breast cancer cells results in the down-regulation of survivin, tumor cell death, and the inhibition of tumor growth in vivo in xenogeneic mouse models. In this current report, we initiate studies comparing the effect of IRF-1 in human nonmalignant breast cell and breast cancer cell lines. While IRF-1 in breast cancer cells results in growth inhibition and cell death, profound growth inhibition and cell death are not observed in nonmalignant human breast cells. We show that TNF-α or IFN-γ induces IRF-1 in breast cancer cells and results in enhanced cell death. Abrogation of IRF-1 diminishes TNF-α and IFN-γ-induced apoptosis. We test the hypothesis that IRF-1 augments TNF-α-induced apoptosis in breast cancer cells. Potential signaling networks elicited by IRF-1 are investigated by evaluating the NF-κB pathway. TNF-α and/or IFN-γ results in decreased presence of NF-κB p65 in the nucleus of breast cancer cells. While TNF-α and/or IFN-γ can induce IRF-1 in nonmalignant breast cells, a marked change in NF-κB p65 is not observed. Moreover, the ectopic expression of IRF-1 in breast cancer cells results in caspase-3, -7, -8 cleavage, inhibits NF-κB activity, and suppresses the expression of molecules involved in the NF-κB pathway. These data show that IRF-1 in human breast cancer cells elicits multiple signaling networks including intrinsic and extrinsic cell death and down-regulates molecules involved in the NF-κB pathway.
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Key Words
- Ad, adenovirus
- Cdk, cyclin-dependent kinase
- DISC, death-inducing signaling complex
- DMEM, Dulbecco's Modified Eagle's Medium
- DR, death receptor
- EGFP, enhanced green fluorescent protein
- ER, estrogen receptor
- FADD, fas-associated death domain
- FBS, Fetal Bovine Serum
- FITC, fluorescein isothiocyanate
- FLICE, fas-associated death domain protein interleukin-1 β-converting enzyme
- IAP
- IFN-β, interferon-β
- IFN-γ, interferon-gamma
- IKK, IκB, kinase complex
- IRF-1
- IRF-1, interferon regulatory factor-1
- IκB, Inhibitory kappaB
- MOI, multiplicity of infection
- MTT, methylthiazoltetrazolium
- NEMO, NF-κB essential modulator
- NF-κB
- NF-κB, nuclear factor of kappa Beta
- RIP1, receptor interacting protein 1
- SCID, severe combined immunodeficiency
- STAT, signal transducer and activator of transcription
- Smac/DIABLO, Second mitochondria-derived activator of caspase/Direct IAP-binding protein with low pI
- TNF-α, tumor necrosis factor-α
- TNFR, tumor necrosis factor receptor
- TRADD, TNF receptor associated protein with a death domain
- TRAF2, tumor necrosis factor receptor-associated factor 2
- TRAIL, tumor necrosis factor-related apoptosis-inducing ligand
- XIAP, X-linked inhibitor of apoptosis protein
- apoptosis
- breast cancer
- cFLIP, cellular FLICE inhibitory protein
- cIAP1, c-inhibitor of apoptosis
- p53
- siRNA, small interfering RNA
- tumor suppressor
- β-gal, β-galactosidase
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Affiliation(s)
- Michaele J Armstrong
- a Department of Surgery; University of Pittsburgh School of Medicine ; Pittsburgh , PA , USA
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26
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Shinde AM, Zhai J, Yu KW, Frankel P, Yim JH, Luu T, Kruper L, Vito C, Shaw S, Vora NL, Kirschenbaum M, Somlo G. Pathologic complete response rates in triple-negative, HER2-positive, and hormone receptor-positive breast cancers after anthracycline-free neoadjuvant chemotherapy with carboplatin and paclitaxel with or without trastuzumab. Breast 2015; 24:18-23. [PMID: 25467313 PMCID: PMC4596816 DOI: 10.1016/j.breast.2014.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/05/2014] [Revised: 10/11/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) is considered a surrogate for improved survival. Platinum-containing NCT, particularly in patients with HER2+ and triple-negative breast cancers (TNBC) may increase pCR rates. METHODS Tumor characteristics, pCR rates (no invasive disease in breast and lymph nodes), toxicities, and survival in patients who received carboplatin, a taxane, and trastuzumab (HER2+ disease) between April 2009 and December 2011, were reviewed. RESULTS Thirty eight patients (39 tumors) completed a median of 4 cycles of NCT. Eighteen of 39 (46%) tumors were HER2+, 8/18 (44%) responded with pCR; 13/18 HER2+ tumors were HR+ (72%) and 4/13 (31%) had a pCR. Ten of 39 (26%) tumors were TNBC; 6/10 (60%) had a pCR. At a median of 25-months no recurrences were observed in patients with pCR. CONCLUSIONS Prospective studies of anthracycline-free platinum-containing NCT are warranted in LABC patients with HER2+ and TNBC.
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Affiliation(s)
- Arvind M Shinde
- Department of Medical Oncology and Therapeutic Research, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Jing Zhai
- Department of Pathology, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Kim Wai Yu
- Department of Clinical Pharmacy, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Paul Frankel
- Department of Information Sciences, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - John H Yim
- Department of General Oncologic Surgery, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Thehang Luu
- Department of Medical Oncology and Therapeutic Research, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Laura Kruper
- Department of General Oncologic Surgery, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Courtney Vito
- Department of General Oncologic Surgery, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - Sally Shaw
- Department of Diagnostic Radiology, City of Hope, 1500 East Duarte Rd., Duarte, CA, 91010 USA
| | - Nayana L Vora
- Department of Diagnostic Radiology, City of Hope, 1500 East Duarte Rd., Duarte, CA, 91010 USA
| | - Michele Kirschenbaum
- Office of Clinical Trials, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA
| | - George Somlo
- Department of Medical Oncology and Therapeutic Research, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA.
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Wang Y, Han E, Xing Q, Yan J, Arrington A, Wang C, Tully D, Kowolik CM, Lu DM, Frankel PH, Zhai J, Wen W, Horne D, Yip MLR, Yim JH. Baicalein upregulates DDIT4 expression which mediates mTOR inhibition and growth inhibition in cancer cells. Cancer Lett 2014; 358:170-179. [PMID: 25543165 DOI: 10.1016/j.canlet.2014.12.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 09/09/2014] [Revised: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 11/28/2022]
Abstract
Baicalein is a natural flavone that exhibits anticancer properties. Using microarrays we found that DDIT4 was the highest transcript induced by baicalein in cancer cells. We confirmed in multiple cancer cell lines large, dose-related expression of DDIT4 by quantitative RT-PCR and immunoblot, which correlates with growth inhibition. Time course experiments demonstrate that DDIT4 is rapidly inducible, with high expression maintained for several days in vitro. Induction of DDIT4 expression is p53 independent based on evaluation of p53 knockout cells. Since DDIT4 is known to inhibit mTORC1 activity we confirmed that baicalein suppresses phosphorylation of mTORC1 targets. Using RNA interference we demonstrate that mTORC1 activity and growth inhibition by baicalein is attenuated by knockdown of DDIT4. We furthermore demonstrate suppression of established tumors by baicalein in a mouse model of breast cancer with increased DDIT4 expression in the tumors. Finally, we demonstrate that baicalein upregulates DDIT4 and causes mTORC1 and growth inhibition in platinum resistant cancer cells in marked contrast to platinum chemotherapy treatment. These studies demonstrate that baicalein inhibits mTORC1 through DDIT4 expression, and may be useful in cancer chemotherapy and chemoprevention.
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Affiliation(s)
- Yujun Wang
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Ernest Han
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Quanhua Xing
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Jin Yan
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Amanda Arrington
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Charles Wang
- Molecular & Cellular Biology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Dylan Tully
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Claudia M Kowolik
- Molecular & Cellular Biology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA; Medical Oncology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - David M Lu
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Paul H Frankel
- Biostatistics, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Jing Zhai
- Pathology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Wei Wen
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - David Horne
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - M L Richard Yip
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - John H Yim
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA.
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28
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Wen W, Liang W, Wu J, Kowolik CM, Buettner R, Scuto A, Hsieh MY, Hong H, Brown CE, Forman SJ, Horne D, Morgan R, Wakabayashi M, Dellinger TH, Han ES, Yim JH, Jove R. Targeting JAK1/STAT3 signaling suppresses tumor progression and metastasis in a peritoneal model of human ovarian cancer. Mol Cancer Ther 2014; 13:3037-48. [PMID: 25319391 DOI: 10.1158/1535-7163.mct-14-0077] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
JAK/STAT3 is one of the major signaling pathways that is aberrantly activated in ovarian cancer and associated with tumor progression and poor prognosis in patients with ovarian cancer. In this study, we evaluated the therapeutic potential of targeting JAK/STAT3 signaling in ovarian cancer using a peritoneal dissemination mouse model. We developed this mouse model by injecting a metastatic human ovarian cancer cell line, SKOV3-M-Luc, into the peritoneal cavity of immunodeficient mice. This model displayed a phenotype similar to late-stage ovarian cancer, including extensive peritoneal metastasis and ascites production. The constitutive activation of STAT3 in human ovarian cancer cells appeared to be mediated by an autocrine cytokine loop involving the IL6 family of cytokines and JAK1 kinase. shRNA-mediated knockdown of JAK1 or STAT3 in ovarian cancer cells led to reduced tumor growth, decreased peritoneal dissemination, and diminished ascites production, suggesting a critical role of STAT3 in ovarian cancer progression. Similar results were obtained when a small-molecule inhibitor (JAKi) of the JAK1 kinase was used to treat ovarian cancer in this model. In addition, we found that the expression level of IL6 was correlated with activation of STAT3 in ovarian cancer cells both in vitro and in vivo, suggesting a potential application of IL6 as a biomarker. Altogether, our results demonstrate that targeting JAK1/STAT3, using shRNA knockdown or a small-molecule inhibitor, effectively suppressed ovarian tumor progression and, therefore, could be a potential novel therapeutic approach for treating advanced ovarian cancer.
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Affiliation(s)
- Wei Wen
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California. Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Wei Liang
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jun Wu
- Department of Comparative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Claudia M Kowolik
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ralf Buettner
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Anna Scuto
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Meng-Yin Hsieh
- Department of Comparative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Hao Hong
- Department of Hematology/Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California. Department of Cancer Immunotherapeutics and Tumor Immunology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Christine E Brown
- Department of Hematology/Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California. Department of Cancer Immunotherapeutics and Tumor Immunology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - David Horne
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Robert Morgan
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mark Wakabayashi
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Thanh H Dellinger
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ernest S Han
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - John H Yim
- Department of Surgery, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Richard Jove
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California.
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Dery KJ, Kujawski M, Grunert D, Wu X, Ngyuen T, Cheung C, Yim JH, Shively JE. IRF-1 regulates alternative mRNA splicing of carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) in breast epithelial cells generating an immunoreceptor tyrosine-based inhibition motif (ITIM) containing isoform. Mol Cancer 2014; 13:64. [PMID: 24650050 PMCID: PMC4113144 DOI: 10.1186/1476-4598-13-64] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/07/2014] [Indexed: 11/17/2022] Open
Abstract
Background Interferon regulatory factor-1 (IRF-1) is a master regulator of IFN-γ induced gene transcription. Previously we have shown that IRF-1 transcriptionally induces CEACAM1 via an ISRE (Interferon-Stimulated Response Element) in its promoter. CEACAM1 pre-mRNA undergoes extensive alternative splicing (AS) generating isoforms to produce either a short (S) cytoplasmic domain expressed primarily in epithelial cells or as an ITIM-containing long (L) isoform in immune cells. Methods The transcriptional and molecular mechanism of CEACAM1 minigenes AS containing promoter ISREs mutations in the breast epithelial, MDA-MB-468, cell line was detected using flow cytometry. In addition, transcriptome sequencing was utilized to determine whether IRF-1 could direct the AS of other genes as well. Tumor xenografts were used to evaluate CEACAM1 isoform expression on the leading edge of breast tumor cells. Results In the present study, we provide evidence that CEACAM1’s promoter and variable exon 7 cross-talk allowing IRF-1 to direct AS events. Transcriptome sequencing shows that IRF-1 can also induce the global AS of genes involved in regulation of growth and differentiation as well as genes of the cytokine family. Furthermore, MDA-MB-468 cells grown as tumor xenografts exhibit an AS switch to the L-isoform of CEACAM1, demonstrating that an in vivo inflammatory milieu is also capable of generating the AS switch, similar to that found in human breast cancers Mol Cancer 7:46, 2008. Conclusions The novel AS regulatory activities attributed to IRF-1 indicate that the IFN-γ response involves a global change in both gene transcription and AS in breast epithelial cells.
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Affiliation(s)
| | | | | | | | | | | | | | - John E Shively
- Departments of Immunology, Beckman Research Institute, City of Hope, Duarte, California, USA.
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Behrendt CE, Tumyan L, Gonser L, Shaw SL, Vora L, Paz IB, Ellenhorn JDI, Yim JH. Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer. Breast 2014; 23:341-5. [PMID: 24530008 DOI: 10.1016/j.breast.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/11/2013] [Accepted: 01/09/2014] [Indexed: 01/15/2023] Open
Abstract
Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.
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MESH Headings
- Adult
- Aged
- Breast/pathology
- Breast/surgery
- Breast Density
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/surgery
- Cohort Studies
- Female
- Genetic Predisposition to Disease
- Humans
- Magnetic Resonance Imaging/methods
- Mammary Glands, Human/abnormalities
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/surgery
- Patient Selection
- Practice Guidelines as Topic/standards
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Assessment
- Young Adult
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Affiliation(s)
- Carolyn E Behrendt
- Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Lusine Tumyan
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Laura Gonser
- General Surgery, University of California San Francisco, Fresno Campus/Community Regional Medical Center, 2823 Fresno St., Fresno, CA 93721, USA
| | - Sara L Shaw
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Lalit Vora
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - I Benjamin Paz
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Joshua D I Ellenhorn
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - John H Yim
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
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Luyimbazi D, Luu T, Xing Q, Yan J, Tully D, Han E, Yip RML, Yim JH. Abstract P3-03-08: A comparison of PI3K inhibition by eribulin, other microtubule targeting agents and a DNA-damaging chemotherapeutic in triple negative and HER2 expressing breast cancer cell lines. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-03-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Eribulin is a microtubule-targeting agent with significant benefits in treating refractory metastatic breast cancer. Tumors from patients with Triple negative breast cancer (TNBC) have high levels of Akt expression and consistently show activation of the PI3K-mTOR pathway. Our objective was to compare Eribulin's ability to inhibit PI3K pathway activity and cell growth with two other microtubule targeting agents, Paclitaxel and Vinblastine, as well as a conventional DNA damaging chemotherapeutic Cisplatin.
Methods. MDA468 and BT549 TNBC cell lines and SKBR3 HER2 overexpressing breast cancer cell lines were used for this study. Western blot analysis was used to evaluate the expression of phosphorylated Akt-Ser473 (pAkt) and S6K1 (pS6K1) at different time points from 2 to 24 hours of treatment with Eribulin, Paclitaxel, Vinblastine, or Cisplatin. MTT assays were used to assess growth inhibition after 72 hours of treatment.
Results. Western blot analysis for MDA468 cells treated with Eribulin in varying concentrations confirm partial inhibition of pAkt expression as early as 4 hours at 100 pM concentration. Complete inhibition is reached at 50 nM. Partial inhibition of pS6K1 can be seen as early as 4 hours at 500 nM. Western analysis for MDA468 cells treated with Vinblastine in varying concentrations confirms inhibition of pAkt and pS6K1 beginning at 50 nM at 24 hours. Western analysis for MDA468 cells treated with Paclitaxel in varying concentrations showed increases in pAkt expression in a dose responsive fashion with significant increase in pAkt beginning at 5 nM concentration as well as increase in pS6K1 at 24 hours. Cisplatin markedly increases pAkt at 24 hours in a dose responsive fashion and decreases pS6K1 at 500 nM to 1000 nM concentration range in BT549. The IC50's for Eribulin ranged from 0.06 nM to 0.3 nM at 72 hours by MTT assay. The IC50's for Vinblastine ranged from 0.5 nM to 0.9 nM. Paclitaxel has reported IC50's in the 2 nM to 75 nM range in these cell lines, and Cisplatin has IC50's ranging from to ∼500 nM to ∼2000 nM at 72 hours in these cell lines.
Conclusion. Our study shows that for microtubule targeting agents such as Eribulin and Vinblastine that block polymerization of tubulin into microtubules, both pAkt and pS6K1 expression is suppressed. Growth inhibition is also confirmed, and is seen at doses when pAkt and pS6K1 are not suppressed. Eribulin inhibits pAkt and pS6K1 at lower concentrations than Vinblastine. With Paclitaxel, a microtubule-targeting agent that enhances polymerization of tubulin to microtubules, and Cisplatin, a conventional DNA damaging chemotherapeutic we observe an increase in pAkt expression, with variable effects on pS6K1. Enhancement of Akt activity is a likely survival response by cancer cells to chemotherapy, yet in the case of microtubule polymerization blockade as seen with Eribulin and Vinblastine, Akt activity is suppressed, along with downstream mTOR activity. The potential role of microtubule polymerization blockade in inhibition of the PI3K pathway needs further study. It may be a factor in the novel finding of pAkt and pS6K1 inhibition by Eribulin.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-03-08.
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Affiliation(s)
- D Luyimbazi
- City of Hope National Medical Center, Duarte, CA
| | - T Luu
- City of Hope National Medical Center, Duarte, CA
| | - Q Xing
- City of Hope National Medical Center, Duarte, CA
| | - J Yan
- City of Hope National Medical Center, Duarte, CA
| | - D Tully
- City of Hope National Medical Center, Duarte, CA
| | - E Han
- City of Hope National Medical Center, Duarte, CA
| | - RML Yip
- City of Hope National Medical Center, Duarte, CA
| | - JH Yim
- City of Hope National Medical Center, Duarte, CA
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Luyimbazi D, Luu T, Xing Q, Yan J, Tully D, Han E, Yip RML, Yim JH. Abstract P3-03-07: Combination of eribulin and PI3K inhibitors in triple negative and HER2 expressing breast cancer cell lines results in synergistic growth inhibition and enhanced inhibition of the PI3K pathway. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-03-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 with triple negative breast cancer (TNBC) have high levels of pAkt expression and activation of the PI3K-mTOR pathway. Eribulin is a microtubule-targeting agent with benefits in treating taxane and anthracycline refractory breast cancer. Our objective was to evaluate its efficacy in inhibiting PI3K pathway activity and cell growth both alone and in combination with PI3K/MTOR inhibitors BEZ 235 and BKM 120.
Methods. TNBC cell lines MDA468, BT549, HS587T, MDA231, and HER2 expressing breast cancer cell line SKBR3 were used for this study. Both MDA468 and BT549 have PI3K- related mutations. The tetrazolium salt, 3-4,5 dimethylthiazol-2,5 diphenyl tetrazolium bromide (MTT) assays were used to assess growth inhibition after 72 hour treatment with eribulin, BEZ 235 and BKM 120 both alone and in combination. Combination indices (CI) generated by Chou-Talalay plots were used to quantify synergy. Western blots were used to evaluate the expression of phosphorylated Akt (pAkt), S6K1 (pS6K1) and S6 (pS6) from 30 min to 24 hours of treatment at different doses.
Results. Eribulin has IC50 ranging from 60 pM to 300 pM, BEZ 235 has IC50 ranging from 50 nM to 80 nM, and BKM has IC50 ranging from 500 nM or higher. Standard dilutions of eribulin in combination with BEZ 235 resulted in synergistic growth inhibition (CI<1) in both MDA468 and BT549 cells at all doses tested, but required higher concentrations (500 to 2000 nM) for BKM 120. Western blot analysis for all cell lines treated with eribulin showed pAkt inhibition by eribulin alone with doses as low as 1 nM and as early as 4 hours. PI3K inhibitor alone confirmed inhibition of pAkt, pS6K1 and pS6 at early time points with feedback increase in pAkt at 24h. While both BEZ 235 and BKM 120 treatment increased pAkt in a dose dependent fashion at 24 hours, combination treatment with eribulin showed a dose dependent decrease in pAkt.
Conclusion. Our study shows significant synergistic growth inhibition with the combination of eribulin and PI3K inhibitors. This may be related to inhibition by eribulin of the feedback increase in pAkt seen with PI3K inhibitors alone at later time points. These findings point to a potential role for combination therapy of both eribulin and PI3K inhibitors in treating refractory metastatic disease.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-03-07.
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Affiliation(s)
- D Luyimbazi
- City of Hope National Medical Center, Duarte, CA
| | - T Luu
- City of Hope National Medical Center, Duarte, CA
| | - Q Xing
- City of Hope National Medical Center, Duarte, CA
| | - J Yan
- City of Hope National Medical Center, Duarte, CA
| | - D Tully
- City of Hope National Medical Center, Duarte, CA
| | - E Han
- City of Hope National Medical Center, Duarte, CA
| | - RML Yip
- City of Hope National Medical Center, Duarte, CA
| | - JH Yim
- City of Hope National Medical Center, Duarte, CA
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Luyimbazi D, Luu TH, Xing Q, Yan J, Tully D, Han ES, Yip R, Yim JH. Effect of eribulin on cell growth and PI3K pathway activity with and without RAD001 in triple-negative and HER2-expressing breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.173] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
Abstract
173 Background: Patients with triple-negative breast cancer have high levels of Akt expression and activation of the PI3K-mTOR pathway. Eribulin is a microtubule-targeting agent with benefits in treating refractory triple negative disease. Our objective was to evaluate its efficacy in inhibiting PI3K pathway activity and cell growth both alone and in combination with the mTOR inhibitor RAD001. Methods: MDA468, BT549 and SKBR3 breast cancer cell lines were used for this study. MTT assays were used to assess growth inhibition after 72 hour treatment with eribulin alone and in combination with RAD001. Combination indices (CI) generated by Chou-Talalay plots were used to quantify synergy. Western blots were used to evaluate the expression of phosphorylated Akt-Ser473 (pAkt) and S6K1 after 24 hours of treatment with both agents. Results: Both MDA468 and SKBR3 cells treated with eribulin in varying concentrations showed inhibition of pAkt expression. Standard dilutions of eribulin in combination with log dilutions of RAD001 resulted in marked synergistic growth inhibition (CI<<1) in both MDA468 and BT549 cells. Western blot analysis for MDA468 cells treated with the combination erubulin and RAD001 showed a dose related suppression of pAkt along with complete inhibition of pS6K1, while RAD001 alone increased pAkt. Conclusions: Our study shows dose related inhibition of Akt activation as well as inhibition of cell growth in triple negative breast cancer and HER2 cell lines treated with eribulin alone or combined with RAD001. We also show reversal of the pAkt feedback response seen with mTOR inactivation, and a significant synergistic growth inhibition with combination treatment. These findings point to a potential role for eribulin and RAD001 in the treatment of refractory triple-negative breast cancer. [Table: see text]
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Affiliation(s)
- David Luyimbazi
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - Thehang H. Luu
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - Quanhua Xing
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - Jin Yan
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - Dylan Tully
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | | | - Richard Yip
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - John H. Yim
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
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Uyeno L, Streja L, Yim JH, Chen SL, Kruper L. A comparison of rates and predictors of hospital readmission: Outpatient versus inpatient mastectomy for breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
116 Background: The odds of readmission have been reported to be slightly higher with outpatient (OP) compared to inpatient (IP) mastectomy, although overall rates are low. While OP mastectomy procedures have become more common, predictors of readmission and current rates are unknown. Methods: Observational study of women 18+ years who underwent mastectomy in California from 2005-2009 from the Healthcare Cost and Utilization Project (HCUP) linked state database. Associations of readmission and post-mastectomy complications with length of stay (LOS) were assessed using Jonkheere – Terpstra test for trend. Multivariate logistic regression was used to test the association of LOS with readmission to hospital within 30 days, adjusting for patient, clinical, and hospital factors. Results: Readmission rates for OP compared to IP mastectomy was 3.3 % vs. 5.6% (p<0.0001). OP mastectomy had the highest hematoma/seroma and chemotherapy related anemia/ neutropenia readmissions (19% p=0.0112; 2.9% p=0.0009). Readmits for cardiopulmonary events were higher for the longest LOS. Multivariate analysis showed increased readmission rates by LOS, race, payer, comorbidities (all p-values <0.0001). Odds of readmission were higher with increasing LOS vs. OP (1d OR 1.13 95% CI 0.99-1.3; 2d OR 1.6 95%CI 1.4-1.8; ≥3d OR 3.0 95%CI 2.6-3.4). Increased odds of readmission was associated with African-Americans (OR 1.5 95%CI 1.2-1.9) and Whites (OR 1.4 95%CI 1.2-1.7) vs. Asians. Revisit rates were higher with Medicare (OR 1.7 95%CI 1.4-1.9) and Medicaid (OR 1.6 95%CI 1.3-1.8) compared to private insurance. The highest readmission rates were ≥ 3 comorbidities (OR 2.7 95%CI 2.2-3.2). Conclusions: In California, readmission rates increase with increasing LOS. Risks of readmission following IP mastectomy are higher compared to OP. Low readmission rates suggest appropriate selection of patients for OP mastectomy. However, subsets of patients are at higher risk of readmission. Additional studies of patients with extended LOS; racial disparities in access to services; and evaluation of payer policies are needed to improve care and decrease hospital readmissions.
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Affiliation(s)
| | | | - John H. Yim
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
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Kruper L, Bhatt M, London K, Henderson K, Vito C, Yim JH, Chen SL. Prophylactic mastectomy: The role of risk aversion. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.39] [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
39 Background: The rate of women undergoing contralateral prophylactic mastectomy (CPM) has increased significantly over the past decade. Large population studies have examined factors associated with the use of CPM. We studied the factors associated with CPM within our institution. Methods: A 30-question validated survey was mailed to all patients who underwent mastectomy from 1972 to 2011 and are currently receiving treatment or surveillance at our institution. Responses were analyzed to determine the factors predictive of CPM. Multivariate logistic regression methods were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for possible associations between exposures (including age at surgery, marital status, education, race, family history of breast cancer, and BRCA genetic mutation (BRCA mutation) and likelihood of CPM. Results: 368 of 691 surveys were returned. Younger age was statistically significantly associated with increased likelihood of CPM (p-trend < 0.001). Caucasian patients were 4 times as likely to undergo CPM compared to non-Caucasian patients (OR 3.95, 95%CI=1.89-8.23). Patients with a family history of breast cancer were 3 times as likely to undergo CPM as compared with those with no family history (OR 3.38, 95%CI=1.4-8.16). Married patients were also 3 times as likely to undergo CPM compared with unmarried patients (OR 3.00, 95%CI=1.39-6.52). Reporting a BRCA mutation was highly correlated with younger age, positive family history, higher level of education and marital status. Conclusions: When faced with the decision of whether to undergo a CPM, patients must assess both objective future risks and subjective feelings about those risks. These results suggest that the decision to undergo CPM is associated with known risk factors for the development of contralateral cancer such as younger age and positive breast cancer family history. In addition, multiple demographic factors including Caucasian race and married status increased the likelihood of choosing CPM. This may relate to social support as well socioeconomic status. Further exploration into societal factors that impact CPM use is warranted.
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Arrington AK, Kruper L, Vito C, Yim JH, Chen SL. Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.71] [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
71 Background: Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. We examined SLNB utilization in urban versus rural settings as this procedure was adopted. We hypothesized that SLNB rates in urban centers quickly increased prior to 2000, while the technology shift and acceptance of SLNB was slower in rural centers. Methods: The SEER registry was used to identify patients with invasive ductal or lobular breast cancer from 1998-2008. Exclusion criteria included evidence of distant metastatic disease, T4 tumors, no curative-intent operation performed, or incomplete staging data. Residential setting was divided into three groups based on population density: rural, intermediate population, and urban. Results: The overall rate of SLNB increased with time (9.5% in 1998 to 72.7% in 2008). The adoption of SLNB was slower in rural settings than in urban populations (p<0.001). By 2003, only urban areas were utilizing SLNB in over 50% of cases. When stratified by population density, there was a significant difference in SLNB rates according to type of surgery performed (lumpectomy vs mastectomy) as well as by T-stage, with lower T-stage positively correlating with the likelihood of SLNB usage in all categories. Overall, there was a two-year lag in the adoption of between the increases in SLNB utilization rates in these groups. Conclusions: Since 1998, the use of SLNB for breast cancer has slowly increased throughout the United States. Though widely accepted as the preferred staging method, the overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1-T2 had increased to over 50% in all population categories. There was an overall 2-year lag in adoption of SLNB in less populated areas. While this may represent a more conservative approach as noted by the higher utilization in small tumors, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions. The provision of continued training in emerging technologies for rural surgeons, such as SLNB, should remain a priority in continuing surgical education.
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Shinde AM, Yim JH, Kruper L, Vito C, Chen SL, Paz IB, Luu TH, Tagawa T, Yu KW, Wilczynski S, Shaw S, Vora L, Park JM, Somlo G. Pathologic complete response rates observed in women with locally advanced and inflammatory breast cancer receiving neoadjuvant carboplatin and paclitaxel. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
1035 Background: Pathologic complete response (pCR) following neoadjuvant chemotherapy (NCT) is predictive of outcome in patients with locally advanced breast cancer (LABC). A non-anthracycline containing NCT regimen (Sikov et al. JCO 10/09) may reduce the risk of associated secondary hematologic malignancies and cardiac toxicity while yielding comparable pCR rates. Methods: A retrospective review of all LABC and inflammatory breast cancer (IBC) cases treated from 4/09 to 12/11 with a NCT regimen of carboplatin (AUC of 6, administered on day 1) and paclitaxel 80 mg/m2 (given weekly on a 21-28 day cycle) was conducted at the City of Hope Cancer Center (COHCC). Pts with HER2+ (HER+) tumors received trastuzumab during the NCT treatment. All pCRs (pCR of primary only – "pCR1°"; pCR of primary and lymph nodes – "pCR-All") were determined by a COHCC pathologist based on final surgical specimens. Results: 38 pts were identified, with 39 breast primaries; 18% had IBC, 62% of LABCs/IBCs were hormone receptor positive (HR+), 46% of tumors were HER2+, and 26% were triple negative. Median age was 51 [27-63]. All pts completed the planned number of cycles. Four pts required carboplatin dose reductions, 4 pts required dose reductions in paclitaxel, 3 pts had paclitaxel changed to nab-paclitaxel, and 17 pts required G-CSF to complete their planned treatment. One pt receiving trastuzumab experienced asymptomatic LVEF decline below normal limits. Conclusions: A non-anthracycline-containing NCT regimen of carboplatin/paclitaxel was well tolerated and resulted in high pCRs when given to triple negative (HER2-/HR-) pts, and HER2+ pts, especially with HER2+HR- subtypes. The findings warrant further studies of this regimen in a prospective randomized setting. [Table: see text]
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Arrington AK, London K, Chen SL, Vito C, Yim JH, Nelson RA, Kruper L. Patient factors and satisfaction in the choice of contralateral prophylactic mastectomy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1117] [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
1117 Background: The percentage of women undergoing contralateral prophylactic mastectomy (CPM) has more than doubled in recent years. The underlying reasons patients choose CPM have not been fully evaluated. Our objective was to survey patients who have undergone a unilateral mastectomy with or without CPM to identify reasons surrounding their decisions. Methods: After obtaining IRB approval, a 30-question cross-sectional validated survey was mailed to 691 patients who underwent mastectomy from 1972 to 2011 and are receiving treatment or surveillance at City of Hope. The questionnaire queried the factors behind the choice of surgery for each patient. Demographic questions were included and patient charts were also reviewed. Results: The overall response rate was 53% (N=368). Patients were classified into those who underwent mastectomy with CPM (N=139, 38%) and those who underwent mastectomy without CPM (no-CPM) (N=229, 62%). Of returned surveys, the median age was 50; 24% of patients reported a family history of breast cancer (42% CPM vs. 13% no-CPM, p<0.0001) and 80% of patients had education beyond the high school level (87% CPM vs. 77% no-CPM, p=0.013). PM patients reported being “very concerned” about breast cancer more often than no-CPM patients (46% vs. 34%, p=0.033).The primary reasons for CPM were: concern of recurrence (55%), cosmetic symmetry (27%), physician recommendation (17%), and unclear pre-operative imaging (9%). When questioned about regrets, the top response was decreased sensation (26%). Although 81% of CPM patients were “very satisfied” with their decision, 32% of no-CPM patients reported the same level of satisfaction with their decision (p<0.0001). For no-CPM patients, the primary reasons for the choice of no-CPM was physician advice and “monitoring is sufficient”; with 18% of the responders still considering a CPM. Conclusions: Patients’ perceived risk of contralateral breast cancer is the primary reason for CPM. CPM patients tend to be more satisfied with their decision compared to no-CPM patients. This may be related to the active decision-making thought processes and education necessary to choose CPM. Further patient education is warranted to minimize the risk of regret in making this decision.
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Kim WG, Choi HJ, Kim WB, Kim EY, Yim JH, Kim TY, Gong G, Kim SY, Chung N, Shong YK. Basal STAT3 activities are negatively correlated with tumor size in papillary thyroid carcinomas. J Endocrinol Invest 2012; 35:413-8. [PMID: 21897114 DOI: 10.3275/7907] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUNDS Signal transducer and activators of transcription-3 (STAT3) plays a critical role in promoting survival and cell growth as well as facilitating angiogenesis and metastasis in several cancers. AIM This investigation focused on evaluation of STAT3 activities in human papillary thyroid cancers (PTC). METHODS STAT3 activities of nuclear extracts of tumor tissue were measured from 35 PTC patients using enzyme- linked immunosorbent assay-based kits. RESULTS STAT3 activities of PTC tissues were significantly lower than those of surrounding normal thyroid tissues [0.36 (interquartile range 0.24-0.72) vs 0.50 (0.29-1.11) arbitrary units, p<0.01]. We further analyzed the association between STAT3 activity and clinicopathologic factors in PTC tissue. Tumors with size ≥2 cm displayed significantly lower STAT3 activities than those <2 cm [0.25 (0.21-0.37) vs 0.53 (0.37-0.61) arbitrary units, p<0.01]. Notably, tumor size was inversely correlated with STAT3 activities in T1799A BRAF mutation-positive cases (Rs=-0.58, p<0.05), but not mutation-negative cases. CONCLUSIONS STAT3 activities of PTC measured via DNA binding are suppressed in contrast to other human cancers. Tumor size larger than 2 cm is the only clinicopathologic parameter associated with low STAT3 activity. Moreover, tumor size appears inversely correlated with STAT3 activity, specifically in T1799A BRAF mutation-positive cases.
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Affiliation(s)
- W G Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wiatrek RL, Lee W, Wray CJ, Singh G, Yim JH, Chen SL, Garcia-Aguilar J, Kim J. The influence of surgical oncology fellowship programs in training hepatopancreatobiliary surgeons. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.358] [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
358 Background: It is unclear how the physician shortage in the US will affect cancer care for our aging population and specifically how it will affect the care of hepatopancreatobiliary (HPB) malignancies. Our objective was to assess the clinical practices of recent surgical oncology fellowship graduates to determine their contribution in caring for this patient population. Methods: Practice data was gathered for surgeons who completed Society of Surgical Oncology (SSO)-approved surgical oncology fellowship programs between 2003-2008. Types of practice were defined as: (1) University Hospital or NCI-designated Cancer Center (NCICC); (2) University-affiliated hospital with resident training; (3) Private/community hospital with residency training program; (4) Private practice; (5) Military; and (6) International. Results: Of 253 surgeons who matched into SSO approved programs during our study period, 10 did not complete training, 11 entered military positions, and 17 are practicing internationally. Of the remaining 215 surgeons, 75% (n=161) obtained teaching positions and 25% (n=54) entered private practice. Of those in teaching positions, the majority were at University Hospitals/NCICC (n=133); followed by University-affiliated hospitals (n=16) and private/community hospitals with resident training (n=12). Overall, the practice focus was most commonly general surgical oncology (60%, n=130) followed by primary HPB (20%, n=43), breast/endocrine or melanoma/sarcoma (17%, n=36), and breast alone (3%, n=6). Conclusions: Our investigation shows that the majority of trainees from surgical oncology fellowship training programs obtain teaching positions with at least a portion of their practice covering HPB malignancies. Thus, recent surgical oncology fellowship graduates are positively contributing to the workforce treating HPB malignancies.
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Affiliation(s)
- Rebecca Lynn Wiatrek
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Wendy Lee
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Curtis Jackson Wray
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Gagandeep Singh
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - John H Yim
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Steven L. Chen
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Julio Garcia-Aguilar
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
| | - Joseph Kim
- City of Hope National Medical Center, Duarte, CA; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Texas Houston Medical School, Houston, TX
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Armstrong MJ, Stang MT, Liu Y, Gao J, Ren B, Zuckerbraun BS, Mahidhara RS, Xing Q, Pizzoferrato E, Yim JH. Interferon Regulatory Factor 1 (IRF-1) induces p21(WAF1/CIP1) dependent cell cycle arrest and p21(WAF1/CIP1) independent modulation of survivin in cancer cells. Cancer Lett 2011; 319:56-65. [PMID: 22200613 DOI: 10.1016/j.canlet.2011.12.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/16/2011] [Indexed: 01/21/2023]
Abstract
We have shown that the ectopic expression of Interferon Regulatory Factor 1 (IRF-1) results in human cancer cell death accompanied by the down-regulation of the Inhibitor of Apoptosis Protein (IAP) survivin and the induction of the cyclin-dependent kinase inhibitor p21(WAF1/CIP1). In this report, we investigated the direct role of p21 in the suppression of survivin. We show that IRF-1 down-regulates cyclin B1, cdc-2, cyclin E, E2F1, Cdk2, Cdk4, and results in p21-mediated G1 cell cycle arrest. Interestingly, while p21 directly mediates G1 cell cycle arrest, IRF-1 or other IRF-1 signaling pathways may directly regulate survivin in human cancer cells.
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Affiliation(s)
- Michaele J Armstrong
- Department of Surgery, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213, USA
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Gao J, Wang Y, Xing Q, Yan J, Senthil M, Akmal Y, Kowolik CM, Kang J, Lu DM, Zhao M, Lin Z, Cheng CHK, Yip MLR, Yim JH. Identification of a natural compound by cell-based screening that enhances interferon regulatory factor-1 activity and causes tumor suppression. Mol Cancer Ther 2011; 10:1774-83. [PMID: 21817116 DOI: 10.1158/1535-7163.mct-11-0304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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
The transcription factor interferon regulatory factor-1 (IRF-1) is induced by many tumor-suppressive stimuli and can mediate antiproliferative and proapoptotic effects in cancer cells. Thus, identifying agents that enhance IRF-1 activity may be an effective approach to cancer therapy. A cell-based screening assay was developed to identify extracts and compounds that could enhance IRF-1 activity, using an IRF-1-dependent luciferase reporter cell line. Through this approach, we identified a natural product extract and a known active component of this extract, baicalein, which causes a marked increase in IRF-1-dependent reporter gene expression and IRF-1 protein, with modulation of known IRF-1 targets PUMA and cyclin D1. Baicalein causes suppression of growth in vitro in multiple cancer cell lines in the low micromolar range. IRF-1 plays a role in this growth suppression as shown by significant resistance to growth suppression in a breast cancer cell line stably transfected with short hairpin RNA against IRF-1. Finally, intraperitoneal administration of baicalein by repeated injection causes inhibition of growth in both xenogeneic and syngeneic mouse models of cancer without toxicity to the animals. These findings indicate that identifying enhancers of IRF-1 activity may have utility in anticancer therapies and that cell-based screening for activation of transcription factors can be a useful approach for drug discovery.
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Affiliation(s)
- Jinbo Gao
- Department of Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Abstract
BACKGROUND Most cases of sporadic primary hyperparathyroidism (PHP) are due to a single parathyroid adenoma and can be treated with minimally invasive parathyroid exploration guided by sestamibi SPECT imaging and intraoperative parathyroid hormone monitoring. Successful surgery depends on identification of the 10-15% of patients with multiglandular disease. Failed initial parathyroid exploration is both costly and morbid. We examined whether a sestamibi SPECT scoring system could predict anatomic findings in patients with PHP. METHODS Prospective data from 1,061 consecutive patients undergoing initial parathyroid exploration for PHP from March 6, 2000 to September 28, 2007 were reviewed. One nuclear medicine physician performed independent blinded review of 577 available dual time-point sestamibi SPECT scans, and scored the results into 1 of 5 categories: 0-negative, 1-possible, 2-probable, 3-definite adenoma, or 4-multiglandular disease. Intraoperative findings and outcomes at >5 months follow-up were examined. Chi-square and nonparametric analyses were used to evaluate variables for correlation. RESULTS Among patients with sestamibi SPECT scan results classified as either 0--negative or 1--possible adenoma, only 211/262 (81%) had a single adenoma, compared to 263/288 (91%) patients with scan results classified as 2--probable or 3--definite adenoma (p < 0.001). Positive predictive values increased in stepwise correlation with sestamibi SPECT image intensity: 1--possible 78.5%, 2--probable 94.3%, and 3--definite adenoma 98.8%. Multiglandular disease was present in 31/144 (22%) patients with a 0--negative scan versus 13/166 (8%) patients with a 3--definite adenoma scan (p = 0.0005). Only 7/27 (26%) patients with scans classified as 4-multiglandular had actual multiglandular disease. Negative scan results were associated with a greater risk of operative failure (p < 0.001). CONCLUSIONS A simple scoring system based on sestamibi SPECT intensity can predict the likelihood of single adenoma in PHP. Even the best localizing study cannot exclude multiglandular disease preoperatively. Negative sestamibi SPECT scans are associated with a higher rate of operative failure. Because sestamibi SPECT scans of any category do not reliably identify multiglandular disease, expert surgeons must use validated adjuncts to avoid operative failure.
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Affiliation(s)
- Linwah Yip
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Kaufmann Building, Suite 101, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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Yip L, Tublin ME, Falcone JA, Nordman CR, Stang MT, Ogilvie JB, Carty SE, Yim JH. The adrenal mass: correlation of histopathology with imaging. Ann Surg Oncol 2009; 17:846-52. [PMID: 19960266 DOI: 10.1245/s10434-009-0829-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance (MR) imaging can help diagnose benign adrenal adenomas, but prior studies rely on nonoperative follow-up as proof of a lesion's benign nature. We examined adrenalectomy tissues to determine if imaging characteristics correlate with histopathologic findings. METHODS We retrieved data for 196 consecutive adrenalectomies in 192 patients from 2000 to 2008. Imaging results were considered to signify benign adrenal adenoma if one or more of the following was present: Hounsfield units <10 on unenhanced CT, contrast-enhanced CT quantifying absolute contrast washout of >60% or relative contrast washout of >40%, or MR with chemical-shift imaging demonstrating loss of signal intensity on out-of-phase images. RESULTS The sensitivity and specificity of preoperative imaging in predicting benign adrenal adenoma were 57 and 94%, respectively. Histopathology confirmed that all 66 adrenal masses with imaging characteristics suggesting benign adenoma were indeed benign lesions and included 61 benign adrenal adenomas and 5 benign nonadenomatous lesions (3 myelolipomas, 1 composite myelolipoma/adenoma, and 1 ganglioliponeuroma). The specificity of imaging in predicting benignity was 100%. Malignant adrenal lesions were diagnosed in 17/130 (13%) masses: 8 metastases, 7 adrenal cortical carcinomas, 1 epithelioid angiosarcoma, and 1 ganglioneuroblastoma. The sensitivity of imaging in identifying malignancy was 100%. No malignancies were diagnosed during postoperative follow-up (mean 6 months, range 0.2-67 months). CONCLUSION CT or MR characteristics predicted the presence of benign lesions with 100% specificity. Every adrenal malignancy had CT or MR results that were inconsistent with benign adenoma (100% sensitivity). To exclude malignancy, adrenal masses with non-benign imaging characteristics should be resected.
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Affiliation(s)
- Linwah Yip
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Tublin ME, Pryma DA, Yim JH, Ogilvie JB, Mountz JM, Bencherif B, Carty SE. Localization of parathyroid adenomas by sonography and technetium tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 2009; 28:183-190. [PMID: 19168768 DOI: 10.7863/jum.2009.28.2.183] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the utility of radiologist-performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. METHODS Both sonography and technetium Tc 99m sestamibi single-photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E.T.), and results were immediately reported. Findings of a subsequent Tc 99m sestamibi study were recorded blinded to the sonographic results. The sensitivity and specificity of sonography and Tc 99m sestamibi SPECT were assessed with the use of surgery and pathology reports as a reference standard. The 2007 global Medicare reimbursement rates were used to assess the costs of preoperative localization. RESULTS Parathyroidectomy was performed in 144 of 172 patients evaluated by both modalities. The sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74%, 96%, and 90%, respectively. Sonography correctly localized a single adenoma or suggested multiglandular disease in 112 of 144 patients (78%). The sensitivity, specificity, and positive predictive value of SPECT were 58%, 96%, and 89%. Technetium 99m sestamibi SPECT correctly predicted an adenoma or multiglandular disease in 88 of 144 patients (61%). Five patients with negative sonographic findings were shown to have uniglandular disease on Tc 99m sestamibi SPECT. Selective use of Tc 99m sestamibi SPECT (ie, when sonographic findings were negative or equivocal) would have decreased the cost of imaging by 53%. CONCLUSIONS Radiologist-performed sonography may potentially be used as a principal imaging modality for patients with HPTH. Selective use of Tc 99m sestamibi in cases with negative or equivocal sonographic findings can decrease the cost of imaging before parathyroid resection considerably.
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Affiliation(s)
- Mitchell E Tublin
- Department of Radiology, Division of Abdominal Imaging-Ultrasound, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Yu J, Nikiforova MN, Hodak SP, Yim JH, Cai G, Walls A, Nikiforov YE, Seethala RR. Tumor-to-tumor metastases to follicular variant of papillary thyroid carcinoma: histologic, immunohistochemical, and molecular studies of two unusual cases. Endocr Pathol 2009; 20:235-42. [PMID: 19707890 DOI: 10.1007/s12022-009-9087-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tumor-to-tumor metastasis in thyroid neoplasms is exceedingly uncommon. Two unusual cases of breast carcinoma and renal cell carcinoma metastatic to follicular variant papillary carcinoma are reported. On histologic sections, the donor tumor cells infiltrated the substance of the recipient tumor and the angiolymphatic channels, but the bulk of metastatic tumor was confined within the thyroid carcinoma. Immunohistochemical stains as well as molecular studies confirmed the origin of both donor tumors, as well as the diagnosis of follicular variant of papillary carcinoma in the recipient tumors. Distinguishing between two such tumor populations may be difficult when the donor tumor cells morphologically resemble primary neoplasms of the recipient organ. A history of previous malignancy and ancillary studies can be helpful in making this distinction and rendering the correct diagnosis. A brief review of literature and discussion of tumor-to-tumor metastasis in thyroid neoplasms is also presented.
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Affiliation(s)
- Jing Yu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Yip L, Seethala RR, Nikiforova MN, Nikiforov YE, Ogilvie JB, Carty SE, Yim JH. Loss of heterozygosity of selected tumor suppressor genes in parathyroid carcinoma. Surgery 2008; 144:949-55; discussion 954-5. [DOI: 10.1016/j.surg.2008.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/07/2008] [Indexed: 11/27/2022]
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Yip L, Ogilvie JB, Challinor SM, Salata RA, Thull DL, Yim JH, Carty SE. Identification of multiple endocrine neoplasia type 1 in patients with apparent sporadic primary hyperparathyroidism. Surgery 2008; 144:1002-6; discussion 1006-7. [DOI: 10.1016/j.surg.2008.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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Yip L, Pryma DA, Yim JH, Virji MA, Carty SE, Ogilvie JB. Can a lightbulb sestamibi SPECT accurately predict single-gland disease in sporadic primary hyperparathyroidism? World J Surg 2008; 32:784-92; discussion 793-4. [PMID: 18324345 DOI: 10.1007/s00268-008-9532-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
BACKGROUND Technetium-99m sestamibi scintigraphy with single photon emission computed tomography (SPECT) is widely used to guide minimally invasive exploration in patients with sporadic primary hyperparathyroidism (SPH), although its sensitivity in multiglandular disease is limited. We examined the incidence of missed multiglandular disease and associated anatomic findings when sestamibi SPECT was positive for a single intense focus of delayed tracer uptake, termed a lightbulb scan (LBS). METHODS Prospectively entered data from 764 patients with SPH treated with initial parathyroid exploration from March 5, 2000, to December 31, 2006, were reviewed. A single radiologist performed blinded interpretation of 585 available sestamibi SPECT images, classifying 167 (28.5%) patients with a LBS. Clinical findings were compared among LBS patients with a single adenoma (true positive) and LBS patients with multiglandular disease (false negative). RESULTS One hundred fifty of 167 (89.8%) LBS patients had a single adenoma and 3 (1.8%) had carcinoma. Multiglandular disease was anatomically present in 14 of 167 (8.4%) LBS patients compared with 60 of 418 (15.6%) non-LBS patients (p=0.05). Parathyroid hyperplasia occurred less frequently in LBS patients [5/167 (3%)] compared with non-LBS patients [36/418 (8.6%)], (p=0.02), while double adenomas occurred equally often in LBS patients [9/167 (5.4%)] compared with non-LBS patients [24/418 (5.7%)], (p=0.87). Double adenomas in LBS patients were more likely ipsilateral (7/9, p=0.005) and left-sided (7/7, p=0.008). LBS patients with multiglandular disease were more likely to have a history of neck irradiation, prior neck exploration, and concomitant thyroid pathology. CONCLUSIONS In patients with SPH, sestamibi SPECT studies show a single bright focus of uptake in only 29% of patients. LBS findings do not exclude multiglandular disease. To avoid unacceptable rates of failure at initial parathyroid exploration, the expert surgeon should use validated adjuncts such as intraoperative PTH monitoring or four-gland exploration.
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Affiliation(s)
- Linwah Yip
- Department of Surgery, University of Pittsburgh School of Medicine, 497 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA
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