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Pham T, Pereira L, Roth S, Galletta L, Link E, Akhurst T, Solomon B, Michael M, Darcy P, Sampurno S, Heriot A, Ramsay R, Desai J. First-in-human phase I clinical trial of a combined immune modulatory approach using TetMYB vaccine and Anti-PD-1 antibody in patients with advanced solid cancer including colorectal or adenoid cystic carcinoma: The MYPHISMO study protocol (NCT03287427). Contemp Clin Trials Commun 2019; 16:100409. [PMID: 31650066 PMCID: PMC6804811 DOI: 10.1016/j.conctc.2019.100409] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background MYB is a transcription factor that is overexpressed in colorectal cancer (CRC) and also a driver mutation in adenoid cystic carcinoma (AdCC). Therefore, the MYB protein is an ideal target to vaccinate against to aid recruitment of tumour infiltrating lymphocytes (TILs) against these tumours. The Peter MacCallum Cancer Centre (Melbourne, Australia) has engineered a DNA vaccine, TetMYB, based on the pVAX1 plasmid vector carrying a fusion construct consisting of the universal tetanus toxin T-cell epitopes flanking an inactivated MYB gene. Methods This prospective first-in-human phase I single-arm multi-centre clinical trial involves patients with metastatic CRC or AdCC. Stage 1 will evaluate the safety profile of escalating doses of TetMYB vaccine, given sequentially and in combination with an anti-PD-1 inhibitory antibody, to determine the maximum tolerated dose (MTD). Stage 2 will assess the MTD in an expanded cohort. The calculated sample size is 32 patients: 12 in Stage 1 and 20 in Stage 2. The expected total duration of the trial is 3 years with 15 months of recruitment followed by a minimum of 18 months follow-up. Discussion MYB transcription factor is aberrantly overexpressed in a range of epithelial cancers, not limited to the above tumour types. Based on promising pre-clinical data of vaccine-induced tumour clearance and establishment of anti-tumour memory, we are embarking on this first-in-human trial. If successful, the results from this trial will allow progression to a Phase II trial and validation of this breakthrough immunotherapeutic approach, not only in CRC and AdCC, but other MYB over-expressing cancers. Trial registration ClinicalTrials.gov ID: NCT03287427. Registered: September 19, 2017.
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Affiliation(s)
- Toan Pham
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Lloyd Pereira
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sara Roth
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Laura Galletta
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emma Link
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tim Akhurst
- Division of Medical Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ben Solomon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Phillip Darcy
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shienny Sampurno
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Robert Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Jayesh Desai
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Weickhardt AJ, Foroudi F, Sengupta S, Galletta L, Herschtal A, Grimison PS, Patanjali N, Ng S, Tang C, Goodwin R, Hovey EJ, Jarvis T, Chen C, Sandhu SK, Tai KH, Lawrentschuk N, Davis ID. Pembrolizumab and chemoradiotherapy for muscle invasive bladder cancer: The ANZUP 1502 PCR-MIB trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.tps531] [Citation(s) in RCA: 3] [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
TPS531 Background: Pembrolizumab leads to responses in ~20% of metastatic bladder cancer patients. Irradiation of bladder cancer cells in-vitro and in-vivo leads to upregulation of PD-L1, and in immunocompetent mouse models blockade of PD-L1 leads to delayed tumour growth following irradiation. Randomised data from PACIFIC trial in NSCLC shows the addition of PD-L1 inhibition to chemoradiation significantly prolongs PFS. A trial of chemoradiotherapy with pembrolizumab will assess safety and synergy of the combination in localised bladder cancer. Methods: This pilot study enrols patients with maximally resected non-metastatic muscle invasive bladder cancer, who either wish for bladder preservation or are ineligible for cystectomy. This study will assess the safety and feasibility of combining pembrolizumab with chemoradiotherapy in ECOG 0-1 patients without contraindications to pembrolizumab. The study has enrolled 4 of a planned 30 patients. All patients treated with 64Gy of radiation therapy in 32 fractions over 6 weeks, 2 days. Cisplatin 35mg/m2 IV concurrently weekly for 6 doses with radiation. Pembrolizumab commences concurrently with radiation and is given 200mg IV q21 days for 7 doses. Surveillance cystoscopy is performed 12 & 24 weeks after the commencement of chemoradiotherapy to assess response to therapy. Patients will enter follow up with clinical assessment, cystoscopy and CT staging performed at intervals until close of study. The primary endpoint assessed will be safety, as defined by a satisfactorily low rate of unacceptable toxicity (G3-4 adverse events or failure of completion of planned chemotherapy and radiotherapy according to defined parameters). The secondary endpoint will be efficacy, as assessed by the proportion of patients achieving a best response of complete response based on the first two 12 and 24 week post chemoradiotherapy cystoscopic assessments. Exploratory analysis will include assessment of tumour histopathological, molecular, genetic and immunological parameters. It is expected that it will take two years to accrue the 30 patients across 5 Australian centres. NCT02662062. Clinical trial information: NCT02662062.
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Affiliation(s)
| | - Farshad Foroudi
- Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia
| | - Shomik Sengupta
- Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia
| | - Laura Galletta
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Siobhan Ng
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - Tom Jarvis
- Prince of Wales Hospital, Sydney, Australia
| | - Colin Chen
- Prince of Wales Hospital, Sydney, Australia
| | - Shahneen Kaur Sandhu
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Keen Hun Tai
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Ian D. Davis
- Monash University Eastern Health Clinical School, Victoria, Australia
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Weickhardt A, Foroudi F, Sengupta S, Grimison P, Patanjali N, Leslie S, Ng S, Tang C, Goodwin R, Hovey E, Jarvis T, Chen C, Herschtal A, Galletta L, Sandhu S, Tai KH, Lawrentschuk N, Davis I. Pembrolizumab with ChemoRadiotherapy for Muscle Invasive Bladder Cancer: the ANZUP PCR-MIB trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Leong HS, Galletta L, Etemadmoghadam D, George J, Köbel M, Ramus SJ, Bowtell D. Efficient molecular subtype classification of high-grade serous ovarian cancer. J Pathol 2015; 236:272-7. [PMID: 25810134 DOI: 10.1002/path.4536] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 12/21/2022]
Abstract
High-grade serous carcinomas (HGSCs) account for approximately 70% of all epithelial ovarian cancers diagnosed. Using microarray gene expression profiling, we previously identified four molecular subtypes of HGSC: C1 (mesenchymal), C2 (immunoreactive), C4 (differentiated), and C5 (proliferative), which correlate with patient survival and have distinct biological features. Here, we describe molecular classification of HGSC based on a limited number of genes to allow cost-effective and high-throughput subtype analysis. We determined a minimal signature for accurate classification, including 39 differentially expressed and nine control genes from microarray experiments. Taqman-based (low-density arrays and Fluidigm), fluorescent oligonucleotides (Nanostring), and targeted RNA sequencing (Illumina) assays were then compared for their ability to correctly classify fresh and formalin-fixed, paraffin-embedded samples. All platforms achieved > 90% classification accuracy with RNA from fresh frozen samples. The Illumina and Nanostring assays were superior with fixed material. We found that the C1, C2, and C4 molecular subtypes were largely consistent across multiple surgical deposits from individual chemo-naive patients. In contrast, we observed substantial subtype heterogeneity in patients whose primary ovarian sample was classified as C5. The development of an efficient molecular classifier of HGSC should enable further biological characterization of molecular subtypes and the development of targeted clinical trials.
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Affiliation(s)
- Huei San Leong
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Laura Galletta
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Dariush Etemadmoghadam
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshy George
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | | | - Martin Köbel
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Susan J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - David Bowtell
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,The Department of Biochemistry, University of Melbourne, Parkville, Victoria, Australia.,Hammersmith Hospital, Imperial College, London, UK
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5
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Leong HS, Galletta L, Etemadmoghadam D, George J, Köbel M, Ramus SJ, Bowtell D. Efficient molecular subtype classification of high-grade serous ovarian cancer. J Pathol 2015. [PMID: 25810134 DOI: 10.1002/path.4536] [] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-grade serous carcinomas (HGSCs) account for approximately 70% of all epithelial ovarian cancers diagnosed. Using microarray gene expression profiling, we previously identified four molecular subtypes of HGSC: C1 (mesenchymal), C2 (immunoreactive), C4 (differentiated), and C5 (proliferative), which correlate with patient survival and have distinct biological features. Here, we describe molecular classification of HGSC based on a limited number of genes to allow cost-effective and high-throughput subtype analysis. We determined a minimal signature for accurate classification, including 39 differentially expressed and nine control genes from microarray experiments. Taqman-based (low-density arrays and Fluidigm), fluorescent oligonucleotides (Nanostring), and targeted RNA sequencing (Illumina) assays were then compared for their ability to correctly classify fresh and formalin-fixed, paraffin-embedded samples. All platforms achieved > 90% classification accuracy with RNA from fresh frozen samples. The Illumina and Nanostring assays were superior with fixed material. We found that the C1, C2, and C4 molecular subtypes were largely consistent across multiple surgical deposits from individual chemo-naive patients. In contrast, we observed substantial subtype heterogeneity in patients whose primary ovarian sample was classified as C5. The development of an efficient molecular classifier of HGSC should enable further biological characterization of molecular subtypes and the development of targeted clinical trials.
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Affiliation(s)
- Huei San Leong
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Laura Galletta
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Dariush Etemadmoghadam
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshy George
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | | | - Martin Köbel
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Susan J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - David Bowtell
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,The Department of Biochemistry, University of Melbourne, Parkville, Victoria, Australia.,Hammersmith Hospital, Imperial College, London, UK
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6
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Köbel M, Madore J, Ramus SJ, Clarke BA, Pharoah PDP, Deen S, Bowtell DD, Odunsi K, Menon U, Morrison C, Lele S, Bshara W, Sucheston L, Beckmann MW, Hein A, Thiel FC, Hartmann A, Wachter DL, Anglesio MS, Høgdall E, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Fogarty ZC, Vierkant RA, Liu S, Cho S, Nelson G, Ghatage P, Gentry-Maharaj A, Gayther SA, Benjamin E, Widschwendter M, Intermaggio MP, Rosen B, Bernardini MQ, Mackay H, Oza A, Shaw P, Jimenez-Linan M, Driver KE, Alsop J, Mack M, Koziak JM, Steed H, Ewanowich C, DeFazio A, Chenevix-Trench G, Fereday S, Gao B, Johnatty SE, George J, Galletta L, Goode EL, Kjær SK, Huntsman DG, Fasching PA, Moysich KB, Brenton JD, Kelemen LE. Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma: implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study. Br J Cancer 2014; 111:2297-307. [PMID: 25349970 PMCID: PMC4264456 DOI: 10.1038/bjc.2014.567] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2014] [Accepted: 10/02/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa. METHODS Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival. RESULTS FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94). CONCLUSIONS FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.
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Affiliation(s)
- M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - J Madore
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
- Melanoma Institute Australia, University of Sydney, Royal Prince Alfred Hospital, Gloucester House–level 3, Missenden Road, Camperdown, NSW 2050, Australia
| | - S J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B A Clarke
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, University of Toronto, 610 Univeristy Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P D P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - S Deen
- Department of Histopathology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - D D Bowtell
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
| | - K Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - C Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - S Lele
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - W Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - L Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - F C Thiel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - M S Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
| | - E Høgdall
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2370 Herlev, Denmark
| | - A Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
| | - C Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - K R Kalli
- Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - B L Fridley
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Stabile 13, Rochester, MN 55905, USA
| | - Z C Fogarty
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - R A Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - S Liu
- Anatomic Pathology Research Laboratory, Calgary Laboratory Services, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - S Cho
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - G Nelson
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - P Ghatage
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S A Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - E Benjamin
- Department of Pathology, Cancer Institute, University College London, Maple House, 149 Tottenham Court Road, London WC1E 6JJ, UK
| | - M Widschwendter
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK
| | - M P Intermaggio
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Q Bernardini
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - H Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - A Oza
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P Shaw
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Jimenez-Linan
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - K E Driver
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J Alsop
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - M Mack
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J M Koziak
- Department of Population Health Research, Alberta Health Services-Cancer Care, 2210 2nd Street SW, Calgary, AB, T2S 3C3, Canada
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - C Ewanowich
- Department of Laboratory Medicine and Pathology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - A DeFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - G Chenevix-Trench
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - S Fereday
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - B Gao
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - S E Johnatty
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - J George
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - L Galletta
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - AOCS Study Group
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - E L Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW Charlton 6, Rochester, MN 55905, USA
| | - S K Kjær
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - D G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - K B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - J D Brenton
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 0XZ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
- Cambridge Experimental Cancer Medicine Centre, Cambridge CB2 0RE, UK
| | - L E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina and Hollings Cancer Center, 135 Cannon Street, Charleston, SC 29425, USA
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Köbel M, Madore J, Ramus SJ, Clarke BA, Pharoah PDP, Deen S, Bowtell DD, Odunsi K, Menon U, Morrison C, Lele S, Bshara W, Sucheston L, Beckmann MW, Hein A, Thiel FC, Hartmann A, Wachter DL, Anglesio MS, Høgdall E, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Fogarty ZC, Vierkant RA, Liu S, Cho S, Nelson G, Ghatage P, Gentry-Maharaj A, Gayther SA, Benjamin E, Widschwendter M, Intermaggio MP, Rosen B, Bernardini MQ, Mackay H, Oza A, Shaw P, Jimenez-Linan M, Driver KE, Alsop J, Mack M, Koziak JM, Steed H, Ewanowich C, DeFazio A, Chenevix-Trench G, Fereday S, Gao B, Johnatty SE, George J, Galletta L, Goode EL, Kjær SK, Huntsman DG, Fasching PA, Moysich KB, Brenton JD, Kelemen LE. Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma: implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study. Br J Cancer 2014. [PMID: 25349970 DOI: 10.1038/bjc.2014.567] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa. METHODS Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival. RESULTS FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94). CONCLUSIONS FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.
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Affiliation(s)
- M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - J Madore
- 1] Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada [2] Melanoma Institute Australia, University of Sydney, Royal Prince Alfred Hospital, Gloucester House-level 3, Missenden Road, Camperdown, NSW 2050, Australia
| | - S J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B A Clarke
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, University of Toronto, 610 Univeristy Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P D P Pharoah
- 1] Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK [2] Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - S Deen
- Department of Histopathology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - D D Bowtell
- 1] Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia [2] Department of Biochemistry and Molecular Biology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia [3] Sir Peter MacCallum Department of Oncology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
| | - K Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - C Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - S Lele
- 1] Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA [2] Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - W Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - L Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - F C Thiel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - M S Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
| | - E Høgdall
- 1] Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark [2] Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2370 Herlev, Denmark
| | - A Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
| | - C Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - K R Kalli
- Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - B L Fridley
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Stabile 13, Rochester, MN 55905, USA
| | - Z C Fogarty
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - R A Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - S Liu
- Anatomic Pathology Research Laboratory, Calgary Laboratory Services, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - S Cho
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - G Nelson
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - P Ghatage
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S A Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - E Benjamin
- Department of Pathology, Cancer Institute, University College London, Maple House, 149 Tottenham Court Road, London WC1E 6JJ, UK
| | - M Widschwendter
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK
| | - M P Intermaggio
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Q Bernardini
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - H Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - A Oza
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P Shaw
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Jimenez-Linan
- 1] Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK [2] National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - K E Driver
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J Alsop
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - M Mack
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J M Koziak
- Department of Population Health Research, Alberta Health Services-Cancer Care, 2210 2nd Street SW, Calgary, AB, T2S 3C3, Canada
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - C Ewanowich
- Department of Laboratory Medicine and Pathology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - A DeFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - G Chenevix-Trench
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - S Fereday
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - B Gao
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - S E Johnatty
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - J George
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - L Galletta
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | | | - E L Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW Charlton 6, Rochester, MN 55905, USA
| | - S K Kjær
- 1] Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark [2] The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - D G Huntsman
- 1] Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada [2] Centre For Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - P A Fasching
- 1] Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany [2] Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - K B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - J D Brenton
- 1] National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK [2] Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 0XZ, UK [3] Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK [4] Cambridge Experimental Cancer Medicine Centre, Cambridge CB2 0RE, UK
| | - L E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina and Hollings Cancer Center, 135 Cannon Street, Charleston, SC 29425, USA
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8
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Topp MD, Hartley L, Cook M, Heong V, Boehm E, McShane L, Pyman J, McNally O, Ananda S, Harell MI, Etemadmoghadam D, Galletta L, Alsop K, Mitchell G, Fox SB, Kerr JB, Hutt KJ, Kaufmann SH, Swisher EM, Bowtell DD, Wakefield MM, Scott CL. Abstract 38: Using molecularly characterized patient-derived models to delineate underlying drivers and vulnerabilities of epithelial ovarian cancer. Cancer Res 2014. [DOI: 10.1158/1538-7445.cansusc14-38] [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
Background: Treatment options for women with ovarian cancer remain very limited and acquired resistance to current therapies is very common. Altered DNA repair capability in epithelial ovarian cancer (EOC) may underlie response to both standard therapy and novel treatments, such as PARP inhibitors. Molecular sub-classification of high-grade serous ovarian cancer (HG-SOC) may uncover potential drug targets and possible mechanisms of drug resistance. Understanding the contribution of DNA repair and other driver mutations to drug response and resistance requires the development of molecularly annotated preclinical models reflective of the clinic.
Methods: A patient derived xenograft (PDX) cohort has been generated from consecutive, chemotherapy-naïve human HG-SOC and stratified according to in vivo response to standard chemotherapy, DNA repair capability and molecular characteristics, including next generation sequencing by Foundation Medicine. Resistance to therapy is driven by re-treating relapsed PDX in vivo providing invaluable “paired samples” (pre and post drug treatment), which are difficult to obtain from patients, to allow clonal evolution analysis of mechanisms of drug response and resistance.
Results: The xenograft success rate was 83%. Of ten HG-SOC PDX, all exhibited mutations in TP53, five in BRCA1/2 (two of which were germline) and two were methylated for BRCA1. In vivo cisplatin response, determined as platinum sensitive (progression-free interval (PFI) ≥100 d, n=4), platinum resistant (PFI <100 d, n=3) or platinum refractory (n=3), was largely consistent with patient outcome. Three of four platinum sensitive HG-SOC PDX contained DNA repair gene mutations, and the fourth was methylated for BRCA1. In contrast, all three platinum refractory PDX overexpressed dominant oncogenes (CCNE1, LIN28B and/or BCL2). Molecular analysis of this cohort has revealed actionable targets for novel therapeutic strategies. In vivo studies, including with PARP inhibitors, are underway.
Conclusion: PDX with histologic, molecular and therapeutic annotation, as well as clinical outcome data allow interrogation of molecular aberrations and drug resistance in vivo. This will inform targeting of novel therapies and the design of clinical trials for women.
Citation Format: Monique D. Topp, Lynne Hartley, Michele Cook, Valerie Heong, Emma Boehm, Lauren McShane, Jan Pyman, Orla McNally, Sumi Ananda, Maria I. Harell, Dariush Etemadmoghadam, Laura Galletta, Kathryn Alsop, Gillian Mitchell, Stephen B. Fox, Jeff B. Kerr, Karla J. Hutt, Scott H. Kaufmann, Australian Ovarian Cancer Study (AOCS), Elizabeth M. Swisher, David D. Bowtell, Matthew M. Wakefield, Clare L. Scott. Using molecularly characterized patient-derived models to delineate underlying drivers and vulnerabilities of epithelial ovarian cancer. [abstract]. In: Proceedings of the AACR Special Conference: Cancer Susceptibility and Cancer Susceptibility Syndromes; Jan 29-Feb 1, 2014; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(23 Suppl):Abstract nr 38. doi:10.1158/1538-7445.CANSUSC14-38
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Affiliation(s)
- Monique D. Topp
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
- 5Monash University, Melbourne, Australia,
| | - Lynne Hartley
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
| | - Michele Cook
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
| | - Valerie Heong
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
- 2The Royal Women's Hospital, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
| | - Emma Boehm
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
| | - Lauren McShane
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
| | - Jan Pyman
- 2The Royal Women's Hospital, Melbourne, Australia,
| | - Orla McNally
- 2The Royal Women's Hospital, Melbourne, Australia,
| | - Sumi Ananda
- 2The Royal Women's Hospital, Melbourne, Australia,
| | | | - Dariush Etemadmoghadam
- 4Peter MacCallum Cancer Centre, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
| | | | - Kathryn Alsop
- 4Peter MacCallum Cancer Centre, Melbourne, Australia,
| | | | - Stephen B. Fox
- 4Peter MacCallum Cancer Centre, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
| | | | - Karla J. Hutt
- 5Monash University, Melbourne, Australia,
- 6Prince Henry's Institute of Medical Research, Melbourne, Australia,
| | | | | | - David D. Bowtell
- 4Peter MacCallum Cancer Centre, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
| | - Matthew M. Wakefield
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
| | - Clare L. Scott
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,
- 2The Royal Women's Hospital, Melbourne, Australia,
- 9University of Melbourne, Melbourne, Australia,
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9
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Emmanuel C, Chiew YE, George J, Etemadmoghadam D, Anglesio MS, Sharma R, Russell P, Kennedy C, Fereday S, Hung J, Galletta L, Hogg R, Wain GV, Brand A, Balleine R, MacConaill L, Palescandolo E, Hunter SM, Campbell I, Dobrovic A, Wong SQ, Do H, Clarke CL, Harnett PR, Bowtell DDL, deFazio A. Genomic classification of serous ovarian cancer with adjacent borderline differentiates RAS pathway and TP53-mutant tumors and identifies NRAS as an oncogenic driver. Clin Cancer Res 2014; 20:6618-30. [PMID: 25316818 DOI: 10.1158/1078-0432.ccr-14-1292] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Low-grade serous ovarian carcinomas (LGSC) are Ras pathway-mutated, TP53 wild-type, and frequently associated with borderline tumors. Patients with LGSCs respond poorly to platinum-based chemotherapy and may benefit from pathway-targeted agents. High-grade serous carcinomas (HGSC) are TP53-mutated and are thought to be rarely associated with borderline tumors. We sought to determine whether borderline histology associated with grade 2 or 3 carcinoma was an indicator of Ras mutation, and we explored the molecular relationship between coexisting invasive and borderline histologies. EXPERIMENTAL DESIGN We reviewed >1,200 patients and identified 102 serous carcinomas with adjacent borderline regions for analyses, including candidate mutation screening, copy number, and gene expression profiling. RESULTS We found a similar frequency of low, moderate, and high-grade carcinomas with coexisting borderline histology. BRAF/KRAS alterations were common in LGSC; however, we also found recurrent NRAS mutations. Whereas borderline tumors harbored BRAF/KRAS mutations, NRAS mutations were restricted to carcinomas, representing the first example of a Ras oncogene with an obligatory association with invasive serous cancer. Coexisting borderline and invasive components showed nearly identical genomic profiles. Grade 2 cases with coexisting borderline included tumors with molecular features of LGSC, whereas others were typical of HGSC. However, all grade 3 carcinomas with coexisting borderline histology were molecularly indistinguishable from typical HGSC. CONCLUSION Our findings suggest that NRAS is an oncogenic driver in serous ovarian tumors. We demonstrate that borderline histology is an unreliable predictor of Ras pathway aberration and underscore an important role for molecular classification in identifying patients that may benefit from targeted agents.
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Affiliation(s)
- Catherine Emmanuel
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Yoke-Eng Chiew
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Joshy George
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Dariush Etemadmoghadam
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Sir Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Michael S Anglesio
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Raghwa Sharma
- University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Pathology West ICPMR Westmead, Sydney, New South Wales, Australia. University of Western Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Peter Russell
- Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Camperdown New South Wales, Australia. Douglass Hanly Moir Pathology, Macquarie Park, New South Wales, Australia
| | - Catherine Kennedy
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sian Fereday
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Jillian Hung
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Laura Galletta
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Russell Hogg
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gerard V Wain
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rosemary Balleine
- University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia. Pathology West ICPMR Westmead, Sydney, New South Wales, Australia
| | | | | | - Sally M Hunter
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Ian Campbell
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Alexander Dobrovic
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia. School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Stephen Q Wong
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia. School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Hongdo Do
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Christine L Clarke
- University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul R Harnett
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - David D L Bowtell
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Sir Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia. Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia. Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Anna deFazio
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia. University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead Hospital, Sydney, New South Wales, Australia.
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10
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Topp MD, Hartley L, Cook M, Heong V, Boehm E, McShane L, Pyman J, McNally O, Ananda S, Harrell M, Etemadmoghadam D, Galletta L, Alsop K, Mitchell G, Fox SB, Kerr JB, Hutt KJ, Kaufmann SH, Swisher EM, Bowtell DD, Wakefield MJ, Scott CL. Molecular correlates of platinum response in human high-grade serous ovarian cancer patient-derived xenografts. Mol Oncol 2014; 8:656-68. [PMID: 24560445 DOI: 10.1016/j.molonc.2014.01.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 01/14/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Improvement in the ability to target underlying drivers and vulnerabilities of high-grade serous ovarian cancer (HG-SOC) requires the development of molecularly annotated pre-clinical models reflective of clinical responses. METHODS We generated patient-derived xenografts (PDXs) from consecutive, chemotherapy-naïve, human HG-SOC by transplanting fresh human HG-SOC fragments into subcutaneous and intra-ovarian bursal sites of NOD/SCID IL2Rγ(null) recipient mice, completed molecular annotation and assessed platinum sensitivity. RESULTS The success rate of xenografting was 83%. Of ten HG-SOC PDXs, all contained mutations in TP53, two were mutated for BRCA1, three for BRCA2, and in two, BRCA1 was methylated. In vivo cisplatin response, determined as platinum sensitive (progression-free interval ≥ 100 d, n = 4), resistant (progression-free interval <100 d, n = 3) or refractory (n = 3), was largely consistent with patient outcome. Three of four platinum sensitive HG-SOC PDXs contained DNA repair gene mutations, and the fourth was methylated for BRCA1. In contrast, all three platinum refractory PDXs overexpressed dominant oncogenes (CCNE1, LIN28B and/or BCL2). CONCLUSIONS Because PDX platinum response reflected clinical outcome, these annotated PDXs will provide a unique model system for preclinical testing of novel therapies for HG-SOC.
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Affiliation(s)
- Monique D Topp
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia; Department of Medicine and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Lynne Hartley
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Michele Cook
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Valerie Heong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia; Royal Women's Hospital, Parkville, Victoria 3052, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Emma Boehm
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Lauren McShane
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Jan Pyman
- Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Orla McNally
- Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Sumitra Ananda
- Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | | | - Dariush Etemadmoghadam
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria 3010, Australia; Department of Pathology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Laura Galletta
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia
| | - Kathryn Alsop
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia
| | - Gillian Mitchell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia
| | - Stephen B Fox
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia; Department of Pathology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Jeffrey B Kerr
- Department of Medicine and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Karla J Hutt
- Department of Medicine and Health Sciences, Monash University, Clayton, Victoria 3168, Australia; Prince Henry's Institute of Medical Research, Clayton, Victoria 3168, Australia
| | | | | | - David D Bowtell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria 8006, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria 3010, Australia; Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria 8006, Australia
| | - Matthew J Wakefield
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia; Department of Genetics, University of Melbourne, Melbourne, Victoria 8006, Australia
| | - Clare L Scott
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia; Royal Women's Hospital, Parkville, Victoria 3052, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria 3052, Australia.
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11
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Sieh W, Köbel M, Longacre TA, Bowtell DD, deFazio A, Goodman MT, Høgdall E, Deen S, Wentzensen N, Moysich KB, Brenton JD, Clarke B, Menon U, Gilks CB, Kim A, Madore J, Fereday S, George J, Galletta L, Lurie G, Wilkens LR, Carney ME, Thompson PJ, Matsuno RK, Kjær SK, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Vierkant RA, Cunningham JM, Brinton LA, Yang HP, Sherman ME, Garcia-Closas M, Lissowska J, Odunsi K, Morrison C, Lele S, Bshara W, Sucheston L, Jimenez-Linan M, Blows FM, Alsop J, Mack M, McGuire V, Rothstein JH, Rosen BP, Bernardini MQ, Mackay H, Oza A, Wozniak EL, Benjamin E, Gentry-Maharaj A, Gayther SA, Tinker AV, Prentice LM, Chow C, Anglesio MS, Johnatty SE, Chenevix-Trench G, Whittemore AS, Pharoah PDP, Goode EL, Huntsman DG, Ramus SJ. Hormone-receptor expression and ovarian cancer survival: an Ovarian Tumor Tissue Analysis consortium study. Lancet Oncol 2013; 14:853-62. [PMID: 23845225 PMCID: PMC4006367 DOI: 10.1016/s1470-2045(13)70253-5] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few biomarkers of ovarian cancer prognosis have been established, partly because subtype-specific associations might be obscured in studies combining all histopathological subtypes. We examined whether tumour expression of the progesterone receptor (PR) and oestrogen receptor (ER) was associated with subtype-specific survival. METHODS 12 studies participating in the Ovarian Tumor Tissue Analysis consortium contributed tissue microarray sections and clinical data to our study. Participants included in our analysis had been diagnosed with invasive serous, mucinous, endometrioid, or clear-cell carcinomas of the ovary. For a patient to be eligible, tissue microarrays, clinical follow-up data, age at diagnosis, and tumour grade and stage had to be available. Clinical data were obtained from medical records, cancer registries, death certificates, pathology reports, and review of histological slides. PR and ER statuses were assessed by central immunohistochemistry analysis done by masked pathologists. PR and ER staining was defined as negative (<1% tumour cell nuclei), weak (1 to <50%), or strong (≥50%). Associations with disease-specific survival were assessed. FINDINGS 2933 women with invasive epithelial ovarian cancer were included: 1742 with high-grade serous carcinoma, 110 with low-grade serous carcinoma, 207 with mucinous carcinoma, 484 with endometrioid carcinoma, and 390 with clear-cell carcinoma. PR expression was associated with improved disease-specific survival in endometrioid carcinoma (log-rank p<0·0001) and high-grade serous carcinoma (log-rank p=0·0006), and ER expression was associated with improved disease-specific survival in endometrioid carcinoma (log-rank p<0·0001). We recorded no significant associations for mucinous, clear-cell, or low-grade serous carcinoma. Positive hormone-receptor expression (weak or strong staining for PR or ER, or both) was associated with significantly improved disease-specific survival in endometrioid carcinoma compared with negative hormone-receptor expression, independent of study site, age, stage, and grade (hazard ratio 0·33, 95% CI 0·21-0·51; p<0·0001). Strong PR expression was independently associated with improved disease-specific survival in high-grade serous carcinoma (0·71, 0·55-0·91; p=0·0080), but weak PR expression was not (1·02, 0·89-1·18; p=0·74). INTERPRETATION PR and ER are prognostic biomarkers for endometrioid and high-grade serous ovarian cancers. Clinical trials, stratified by subtype and biomarker status, are needed to establish whether hormone-receptor status predicts response to endocrine treatment, and whether it could guide personalised treatment for ovarian cancer. FUNDING Carraresi Foundation and others.
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MESH Headings
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Biomarkers, Tumor/metabolism
- Carcinoma, Endometrioid/metabolism
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Case-Control Studies
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Female
- Follow-Up Studies
- Humans
- Immunoenzyme Techniques
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Staging
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovary/metabolism
- Ovary/pathology
- Prognosis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Survival Rate
- Tissue Array Analysis
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Affiliation(s)
- Weiva Sieh
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | | | - David D. Bowtell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna deFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marc T. Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Estrid Høgdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Suha Deen
- Department of Histopathology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Kirsten B. Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - James D. Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Usha Menon
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, London, UK
| | - C. Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Genetic Pathology Evaluation Centre, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Andre Kim
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason Madore
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Sian Fereday
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Joshy George
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Laura Galletta
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Galina Lurie
- Cancer Center, University of Hawaii, Honolulu, HI, USA
| | | | | | - Pamela J. Thompson
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Susanne Krüger Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claus Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
| | | | - Brooke L. Fridley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary L. Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Robert A. Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Julie M. Cunningham
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Hannah P. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Jolanta Lissowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Kunle Odunsi
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Carl Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shashikant Lele
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wiam Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Lara Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mercedes Jimenez-Linan
- Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Pathology, University of Cambridg, Cambridge, UK
| | - Fiona M. Blows
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Jennifer Alsop
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Marie Mack
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Joseph H. Rothstein
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Barry P. Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | | | - Helen Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Ontario, Canada
| | - Amit Oza
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Eva L. Wozniak
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, London, UK
| | - Elizabeth Benjamin
- Department of Pathology, Cancer Institute, University College London, London, UK
| | | | - Simon A. Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anna V. Tinker
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Leah M. Prentice
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Christine Chow
- Genetic Pathology Evaluation Centre, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Michael S. Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Sharon E. Johnatty
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Australia
| | | | - Alice S. Whittemore
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Paul D. P. Pharoah
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ellen L. Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - David G. Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Susan J. Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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12
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Anglesio MS, Kommoss S, Tolcher MC, Clarke B, Galletta L, Porter H, Damaraju S, Fereday S, Winterhoff BJ, Kalloger SE, Senz J, Yang W, Steed H, Allo G, Ferguson S, Shaw P, Teoman A, Garcia JJ, Schoolmeester JK, Bakkum-Gamez J, Tinker AV, Bowtell DD, Huntsman DG, Gilks CB, McAlpine JN. Molecular characterization of mucinous ovarian tumours supports a stratified treatment approach with HER2 targeting in 19% of carcinomas. J Pathol 2013; 229:111-20. [PMID: 22899400 DOI: 10.1002/path.4088] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/31/2012] [Accepted: 08/04/2012] [Indexed: 12/11/2022]
Abstract
Mucinous ovarian carcinomas (MCs) typically do not respond to current conventional therapy. We have previously demonstrated amplification of HER2 in 6 of 33 (18.2%) mucinous ovarian carcinomas (MCs) and presented anecdotal evidence of response with HER2-targeted treatment in a small series of women with recurrent HER2-amplified (HER2+) MC. Here, we explore HER2 amplification and KRAS mutation status in an independent cohort of 189 MCs and 199 mucinous borderline ovarian tumours (MBOTs) and their association to clinicopathological features. HER2 status was assessed by immunohistochemistry (IHC), FISH, and CISH, and interpreted per ASCO/CAP guidelines, with intratumoural heterogeneity assessment on full sections, where available. KRAS mutation testing was performed with Sanger sequencing. Stage and grade were associated with recurrence on both univariate and multivariate analysis (p < 0.001). Assessment of HER2 status revealed overexpression/amplification of HER2 in 29/154 (18.8%) MCs and 11/176 (6.2%) MBOTs. There was excellent agreement between IHC, FISH, and CISH assessment of HER2 status (perfect concordance of HER2 0 or 1+ IHC with non-amplified status, and 3+ IHC with amplified status). KRAS mutations were seen in 31/71 (43.6%) MCs and 26/33 (78.8%) MBOTs, and were near mutually exclusive of HER2 amplification. In the 189 MC cases, a total of 54 recurrences and 59 deaths (53 of progressive disease) were observed. Within MCs, either HER2 amplification/overexpression or KRAS mutation was associated with decreased likelihood of disease recurrence (p = 0.019) or death (p = 0.0041) when compared to cases with neither feature. Intratumoural heterogeneity was noted in 26% of HER2-overexpressing cases. These data support the stratification of MCs for the testing of new treatments, with HER2-targeted therapy as a viable option for HER2+ advanced or recurrent disease. Further research is required to delineate the molecular and clinical features of the ∼34% of MC cases with neither HER2 amplification nor KRAS mutations.
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Affiliation(s)
- Michael S Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Cowin PA, George J, Fereday S, Loehrer E, Van Loo P, Cullinane C, Etemadmoghadam D, Ftouni S, Galletta L, Anglesio MS, Hendley J, Bowes L, Sheppard KE, Christie EL, Pearson RB, Harnett PR, Heinzelmann-Schwarz V, Friedlander M, McNally O, Quinn M, Campbell P, deFazio A, Bowtell DDL. LRP1B deletion in high-grade serous ovarian cancers is associated with acquired chemotherapy resistance to liposomal doxorubicin. Cancer Res 2012; 72:4060-73. [PMID: 22896685 DOI: 10.1158/0008-5472.can-12-0203] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High-grade serous cancer (HGSC), the most common subtype of ovarian cancer, often becomes resistant to chemotherapy, leading to poor patient outcomes. Intratumoral heterogeneity occurs in nearly all solid cancers, including ovarian cancer, contributing to the development of resistance mechanisms. In this study, we examined the spatial and temporal genomic variation in HGSC using high-resolution single-nucleotide polymorphism arrays. Multiple metastatic lesions from individual patients were analyzed along with 22 paired pretreatment and posttreatment samples. We documented regions of differential DNA copy number between multiple tumor biopsies that correlated with altered expression of genes involved in cell polarity and adhesion. In the paired primary and relapse cohort, we observed a greater degree of genomic change in tumors from patients that were initially sensitive to chemotherapy and had longer progression-free interval compared with tumors from patients that were resistant to primary chemotherapy. Notably, deletion or downregulation of the lipid transporter LRP1B emerged as a significant correlate of acquired resistance in our analysis. Functional studies showed that reducing LRP1B expression was sufficient to reduce the sensitivity of HGSC cell lines to liposomal doxorubicin, but not to doxorubicin, whereas LRP1B overexpression was sufficient to increase sensitivity to liposomal doxorubicin. Together, our findings underscore the large degree of variation in DNA copy number in spatially and temporally separated tumors in HGSC patients, and they define LRP1B as a potential contributor to the emergence of chemotherapy resistance in these patients.
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Affiliation(s)
- Prue A Cowin
- Cancer Genomics and Genetics Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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14
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Traficante N, Fereday S, Galletta L, Hung J, Giles D, Alsop K, Hendley J, Iuga A, Chenevix-Trench G, Green A, Webb P, DeFazio A, Bowtell D. The Australian Ovarian Cancer Study. Hered Cancer Clin Pract 2012. [PMCID: PMC3327148 DOI: 10.1186/1897-4287-10-s2-a94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Kulbe H, Chakravarty P, Leinster DA, Charles KA, Kwong J, Thompson RG, Coward JI, Schioppa T, Robinson SC, Gallagher WM, Galletta L, Salako MA, Smyth JF, Hagemann T, Brennan DJ, Bowtell DD, Balkwill FR. A dynamic inflammatory cytokine network in the human ovarian cancer microenvironment. Cancer Res 2011; 72:66-75. [PMID: 22065722 DOI: 10.1158/0008-5472.can-11-2178] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Constitutive production of inflammatory cytokines is a characteristic of many human malignant cell lines; however, the in vitro and in vivo interdependence of these cytokines, and their significance to the human cancer microenvironment, are both poorly understood. Here, we describe for the first time how three key cytokine/chemokine mediators of cancer-related inflammation, TNF, CXCL12, and interleukin 6, are involved in an autocrine cytokine network, the "TNF network," in human ovarian cancer. We show that this network has paracrine actions on angiogenesis, infiltration of myeloid cells, and NOTCH signaling in both murine xenografts and human ovarian tumor biopsies. Neutralizing antibodies or siRNA to individual members of this TNF network reduced angiogenesis, myeloid cell infiltration, and experimental peritoneal ovarian tumor growth. The dependency of network genes on TNF was shown by their downregulation in tumor cells from patients with advanced ovarian cancer following the infusion of anti-TNF antibodies. Together, the findings define a network of inflammatory cytokine interactions that are crucial to tumor growth and validate this network as a key therapeutic target in ovarian cancer.
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Affiliation(s)
- Hagen Kulbe
- Centre for Cancer and Inflammation, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, Cancer Research UK, Bioinformatics and Biostatistics Service, London, United Kingdom
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16
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Wiegand KC, Shah SP, Al-Agha OM, Zhao Y, Tse K, Zeng T, Senz J, McConechy MK, Anglesio MS, Kalloger SE, Yang W, Heravi-Moussavi A, Giuliany R, Chow C, Fee J, Zayed A, Prentice L, Melnyk N, Turashvili G, Delaney AD, Madore J, Yip S, McPherson AW, Ha G, Bell L, Fereday S, Tam A, Galletta L, Tonin PN, Provencher D, Miller D, Jones SJM, Moore RA, Morin GB, Oloumi A, Boyd N, Aparicio SA, Shih IM, Mes-Masson AM, Bowtell DD, Hirst M, Gilks B, Marra MA, Huntsman DG. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med 2010; 363:1532-43. [PMID: 20942669 PMCID: PMC2976679 DOI: 10.1056/nejmoa1008433] [Citation(s) in RCA: 1216] [Impact Index Per Article: 86.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ovarian clear-cell and endometrioid carcinomas may arise from endometriosis, but the molecular events involved in this transformation have not been described. METHODS We sequenced the whole transcriptomes of 18 ovarian clear-cell carcinomas and 1 ovarian clear-cell carcinoma cell line and found somatic mutations in ARID1A (the AT-rich interactive domain 1A [SWI-like] gene) in 6 of the samples. ARID1A encodes BAF250a, a key component of the SWI–SNF chromatin remodeling complex. We sequenced ARID1A in an additional 210 ovarian carcinomas and a second ovarian clear-cell carcinoma cell line and measured BAF250a expression by means of immunohistochemical analysis in an additional 455 ovarian carcinomas. RESULTS ARID1A mutations were seen in 55 of 119 ovarian clear-cell carcinomas (46%), 10 of 33 endometrioid carcinomas (30%), and none of the 76 high-grade serous ovarian carcinomas. Seventeen carcinomas had two somatic mutations each. Loss of the BAF250a protein correlated strongly with the ovarian clear-cell carcinoma and endometrioid carcinoma subtypes and the presence of ARID1A mutations. In two patients, ARID1A mutations and loss of BAF250a expression were evident in the tumor and contiguous atypical endometriosis but not in distant endometriotic lesions. CONCLUSIONS These data implicate ARID1A as a tumor-suppressor gene frequently disrupted in ovarian clear-cell and endometrioid carcinomas. Since ARID1A mutation and loss of BAF250a can be seen in the preneoplastic lesions, we speculate that this is an early event in the transformation of endometriosis into cancer. (Funded by the British Columbia Cancer Foundation and the Vancouver General Hospital–University of British Columbia Hospital Foundation.).
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