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Manjunath Y, Nagaraj SK, Nussbaum YI, Gadelkarim M, Staveley-O’Carroll KF, Kimchi ET, Li G, Warren W, Shyu CR, Ciorba M, Mitchem JB, Kaifi JT. Abstract 205: Patient-derived organoids from surgically treated, localized non-small cell lung cancer as high-throughput drug testing platforms for conventional and repurposed drugs. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Non-metastatic NSCLC treated with curative surgery has a five-year survival of ~50%, mostly due to development of recurrences. Despite being considered as potential drug screening platforms, patient-derived xenograft (PDX) models are inefficient due to low tumor engraftment rates and complex animal care. Patient-derived organoid (PDO) models overcome these limitations as potential clinically applicable drug testing platforms. Our objective was to develop PDO models from non-metastatic NSCLC patients to study epithelial cell type heterogeneity and drug sensitivities for precision medicine.
Hypothesis: PDO models reliably capitulate the patient primary tumor and serve as versatile platforms for high-throughput screening of standard-of-care and repurposed drugs.
Methods: Single cell suspensions prepared from resected lung tumor tissues from ten NSCLC patients (both adenocarcinoma and squamous cell carcinoma) were mixed with Matrigel (growth factor-reduced) and cultured in organoid growth medium. Organoids and matched primary tumors were compared by histopathology [H&E staining and immunohistochemistry for cytokeratin (CK) 5/6, CK7, Napsin A, Thyroid transcription factor-1 (TTF-1) and p40] and by bulk RNA sequencing. Upon passaging, PDOs were seeded in triplicates, treated with carboplatin/paclitaxel doublet chemotherapy, and drug responses were determined using bright-field 3D imaging (z-stack method). Tumor growth (%) was determined on day 3 and 6 of treatments. RNA sequencing analyses identified a potential drug targets and repurposed drug (aldoketoreductase inhibitor Epalrestat) was tested to overcome chemoresistance in PDOs.
Results: NSCLC PDO growth was established from 11/12 (91.7%) primary tumors with a median time of 11 days (range 4-18 days) to reach volume of 100 μm3. PDOs retained histopathological features and biomarker expression of the matched tumors. As determined by growth differences (p<0.05), 5/9 (55.6%) PDOs were chemosensitive and 4/9 (44.4%) PDOs were chemoresistant against carboplatin/paclitaxel. Whole transcriptome analysis confirmed conservation of the epithelial cell composition in all PDOs in comparison to the matched primary tumors. Potentially druggable genes associated with chemotherapy resistance were identified and the aldoketoreductase inhibitor Epalrestat was repurposed and shown to be effective in overcoming chemoresistance towards carboplatin/paclitaxel.
Conclusions: PDOs can be established from resectable NSCLC patients with high success rates, while preserving histopathological, cellular, and molecular characteristics of the matched primary tumors. Considering the time frames of growth and drug testing, PDOs can serve as clinically applicable drug response testing platforms to traditional and repurposed drugs.
Citation Format: Yariswamy Manjunath, Suvilesh Kanve Nagaraj, Yulia I. Nussbaum, Mohamed Gadelkarim, Kevin F. Staveley-O’Carroll, Eric T. Kimchi, Guangfu Li, Wesley Warren, Chi-Ren Shyu, Matthew Ciorba, Jonathan B. Mitchem, Jussuf T. Kaifi. Patient-derived organoids from surgically treated, localized non-small cell lung cancer as high-throughput drug testing platforms for conventional and repurposed drugs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 205.
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Affiliation(s)
| | | | | | | | | | | | - Guangfu Li
- 1University of Missouri - Columbia, Columbia, MO
| | | | - Chi-Ren Shyu
- 1University of Missouri - Columbia, Columbia, MO
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Butt O, Huang J, Luo J, Tao Y, Strowd R, Hissim D, Kizilbash S, Abraham C, Anstass G, Johanns T, Kim A, Ciorba M, Chheda MG, Campian J. CTIM-10. A PHASE II STUDY OF RETIFANLIMAB (PD-1 INHIBITOR) IN COMBINATION WITH BEVACIZUMAB AND HYPOFRACTIONATED RADIOTHERAPY FOR RECURRENT GLIOBLASTOMA: NCT03532295. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.242] [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] Open
Abstract
Abstract
INTRODUCTION
Immunotherapies targeting PD-1 in recurrent glioblastoma (rGBM) have shown limited activity. We hypothesize combining therapies targeting immunosuppressive pathways with cytotoxic and antiangiogenic therapies will improve survival. This nonrandomized, noncomparative Phase II study examines safety and efficacy of an anti-PD-1 monoclonal antibody (retifanlimab), hypofractionated radiotherapy (HFRT), and bevacizumab, with or without an IDO1 inhibitor (epacadostat), in patients with rGBM.
METHODS
This is an open-label Phase II study of two regimens. Regimen A examines retifanlimab (500mg IV Q4W) + bevacizumab (10mg/kg IV Q2W) + HFRT (3.5Gy/day x 10) in patients with IDH1/2-WT rGBM. Regimen B adds epacadostat. Key inclusions include dexamethasone ≤ 4 mg/day and reirradiation candidacy. The primary endpoint is overall survival (OS) probability at 9 months (OS-9). An increase of OS-9 from 38% (bevacizumab alone) to 60% was considered clinically relevant and required 24 efficacy evaluable patients.
RESULTS
Regimen A accrual is complete; interim results are as follows: 26 rGBM enrolled, with 24 evaluable [median age 64.2 years (42.1-81.8); 29% female; 29% MGMT promotor methylated; 33.3% with multi-focal disease; median KPS 90 (70-100); median baseline dexamethasone 0 mg (0-4) and ALC 1,000 cells/µl (300-3,700)]. Patients received a median of 6 cycles as of May 2022 (2-24). Median follow-up is 16.0 months. Interim median PFS is 7.0 months (95%CI: 4.5~11.1) and median OS is 12.2 months (95%CI 7.1~18.0). Regimen A met primary endpoint with OS-9 of 67% (95%CI: 44~82%). Overall response rate is currently 58% (95%CI: 36.94~77.2%). There were five possible immune-related grade 3+ toxicities to date (n = 1 each colitis, vomiting, and seizure; n = 2 diarrhea). Regimen B is enrolling.
CONCLUSIONS
Interim analysis suggests combination retifanlimab, HFRT, and bevacizumab in rGBM is generally well-tolerated, with encouraging OS and PFS at the time of submission. Correlative analysis is ongoing and will be presented at the meeting.
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Affiliation(s)
- Omar Butt
- Washington University in St. Louis School of Medicine, St. Louis, MO , USA
| | | | - Jingqin Luo
- Washington School of Medicine in Saint Louis , Saint Louis , USA
| | - Yu Tao
- Washington University in St. Louis School of Medicine, St. Louis, MO , USA
| | - Roy Strowd
- Wake Forest Baptist Health, Department of Neuro-Oncology, Winston-Salem, NC , USA
| | - Deanna Hissim
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine , Winston Salem, NC , USA
| | - Sani Kizilbash
- Department of Medical Oncology, Mayo Clinic , Rochester, MN , USA
| | | | | | - Tanner Johanns
- Washington University in St. Louis School of Medicine, Division of Medical Oncology, Department of Medicine, St. Louis, MO , USA
| | - Albert Kim
- Washington University in St. Louis School of Medicine, St. Louis, MO , USA
| | - Matthew Ciorba
- Washington University in St. Louis School of Medicine, St. Louis, MO , USA
| | | | - Jian Campian
- Mayo Clinic, Department of Oncology , Rochester, MN , USA
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Raffals LE, Saha S, Bewtra M, Norris C, Dobes A, Heller C, O’Charoen S, Fehlmann T, Sweeney S, Weaver A, Bishu S, Cross R, Dassopoulos T, Fischer M, Yarur A, Hudesman D, Parakkal D, Duerr R, Caldera F, Korzenik J, Pekow J, Wells K, Bohm M, Perera L, Kaur M, Ciorba M, Snapper S, Scoville EA, Dalal S, Wong U, Lewis JD. The Development and Initial Findings of A Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD). Inflamm Bowel Dis 2021; 28:192-199. [PMID: 34436563 PMCID: PMC9013198 DOI: 10.1093/ibd/izab071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clinical and molecular subcategories of inflammatory bowel disease (IBD) are needed to discover mechanisms of disease and predictors of response and disease relapse. We aimed to develop a study of a prospective adult research cohort with IBD (SPARC IBD) including longitudinal clinical and patient-reported data and biosamples. METHODS We established a cohort of adults with IBD from a geographically diverse sample of patients across the United States with standardized data and biosample collection methods and sample processing techniques. At enrollment and at time of lower endoscopy, patient-reported outcomes (PRO), clinical data, and endoscopy scoring indices are captured. Patient-reported outcomes are collected quarterly. The quality of clinical data entry after the first year of the study was assessed. RESULTS Through January 2020, 3029 patients were enrolled in SPARC, of whom 66.1% have Crohn's disease (CD), 32.2% have ulcerative colitis (UC), and 1.7% have IBD-unclassified. Among patients enrolled, 990 underwent colonoscopy. Remission rates were 63.9% in the CD group and 80.6% in the UC group. In the quality study of the cohort, there was 96% agreement on year of diagnosis and 97% agreement on IBD subtype. There was 91% overall agreement describing UC extent as left-sided vs extensive or pancolitis. The overall agreement for CD behavior was 83%. CONCLUSION The SPARC IBD is an ongoing large prospective cohort with longitudinal standardized collection of clinical data, biosamples, and PROs representing a unique resource aimed to drive discovery of clinical and molecular markers that will meet the needs of precision medicine in IBD.
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Affiliation(s)
- Laura E Raffals
- Address correspondence to: Laura E. Raffals, MD, MS, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. E-mail:
| | - Sumona Saha
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meenakshi Bewtra
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cecile Norris
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Angela Dobes
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Caren Heller
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | - Tara Fehlmann
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Sara Sweeney
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | | | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Andres Yarur
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David Hudesman
- New York University Langone Health, New York, New York, USA
| | - Deepak Parakkal
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Richard Duerr
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Freddy Caldera
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Joel Pekow
- University of Chicago, Chicago, Illinois, USA
| | - Katerina Wells
- Baylor Scott and White Health and Baylor University Medical Center at Dallas, TX, USA
| | | | - Lilani Perera
- Advocate Aurora Healthcare, Milwaukee, Wisconsin, USA
| | | | - Matthew Ciorba
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Scott Snapper
- Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Uni Wong
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James D Lewis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cushing KC, Adar T, Ciorba M, Ananthakrishnan AN. Corrigendum to: Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions. Crohn's & Colitis 360 2021; 3:otab037. [PMID: 34374695 PMCID: PMC8318042 DOI: 10.1093/crocol/otab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelly C Cushing
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, University of Michigan, Ann Arbor, Massachusetts, USA
| | - Tomer Adar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Ciorba
- §Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
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Osterman MT, VanDussen KL, Gordon IO, Davis EM, Li K, Simpson K, Ciorba M, Glover SC, Abraham B, Guo X, Yee EU, Allard FD, Perrigoue JG, Claggett B, Shen B, Stappenbeck TS, Liu JJ. Epithelial Cell Biomarkers Are Predictive of Response to Biologic Agents in Crohn's Disease. Inflamm Bowel Dis 2020; 27:677-685. [PMID: 32964238 PMCID: PMC8047859 DOI: 10.1093/ibd/izaa251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapeutic efficacy of biologics has remained at about 50% for 2 decades. In Crohn's disease (CD) patients, we examined the predictive value of an epithelial cell biomarker, ileal microvillar length (MVL), for clinical response to ustekinumab (UST) and vedolizumab (VDZ) and its relationship to another biomarker, intestinal epithelial cell (IEC) pyroptosis, with respect to response to VDZ. METHOD Ileal biopsies from the UNITI-2 randomized controlled trial were analyzed for MVL as a predictor of clinical response to UST. In a 5-center academic retrospective cohort of CD patients, ileal MVL was analyzed to determine its predictive value for response to VDZ. Correlation between ileal MVL and IEC pyroptosis was determined, and the discriminant ability of the combination of 2 biomarkers to VDZ was examined. RESULTS Clinical response in UST was significantly higher than placebo (65% vs 39%; P = 0.03), with patients with normal MVL (>1.7 µm) having the greatest therapeutic effect: 85% vs 20% (P = 0.02). For VDZ, clinical response with MVL of 1.35 to 1.55 µm was 82% vs 44% (<1.35 µm) and 40% (>1.55 µm; P = 0.038). There was no correlation between ileal MVL and IEC pyroptosis. The combination criteria of ileal pyroptosis <14 positive cells/1000 IECs or MVL of 1.35 to 1.55 µm could identify 84% of responders and 67% of nonresponders (P = 0.001). CONCLUSION Ileal MVL was predictive of response to UST and VDZ in prospective and retrospective CD cohorts. It was independent of ileal IEC pyroptosis, and combination of the 2 biomarkers enhanced the discriminate ability of responders from nonresponders to VDZ.
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Affiliation(s)
- Mark T Osterman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kelli L VanDussen
- Divisions of Gastroenterology, Hepatology, and Nutrition and of Developmental Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ilyssa O Gordon
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elisabeth M Davis
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Katherine Li
- Janssen Research and Development, Spring House, PA, USA
| | - Kate Simpson
- Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Ciorba
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah C Glover
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Bincy Abraham
- Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, TX, USA
| | - Xueyan Guo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric U Yee
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Felicia D Allard
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Brian Claggett
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bo Shen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thaddeus S Stappenbeck
- Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julia J Liu
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Address correspondence to: Julia J. Liu, MD, MSc, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #567, Little Rock, AR 72205, USA. E-mail:
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Osterman MT, Gordon IO, Davis EM, Ciorba M, Glover SC, Abraham B, Khan F, Guo X, Yee EU, Allard FD, Claggett B, Shen B, Liu JJ. Mucosal Biomarker of Innate Immune Activation Predicts Response to Vedolizumab in Crohn's Disease. Inflamm Bowel Dis 2020; 26:1554-1561. [PMID: 31553433 DOI: 10.1093/ibd/izz222] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mucosal barrier dysfunction plays a crucial role in intestinal inflammation in Crohn's disease (CD). Intestinal epithelial cell (IEC) death resulting from innate immune activation, termed pyroptosis, was recently found to be a cause of this barrier defect. The aim of this study was to determine the predictive value of pretreatment ileal biopsy pyroptosis as a biomarker for clinical response to vedolizumab in CD. DESIGN Crohn's disease patients ranging 18 to 80 years old from 5 IBD centers with pre-vedolizumab ileal biopsies during colonoscopy were enrolled. Biopsies were stained for activated caspases, and levels of ileal IEC pyroptosis levels were quantified. The primary outcome was clinical response 6 months after therapy, defined as a reduction of Harvey-Bradshaw Index (HBI) of ≥5 points from baseline. Secondary outcomes included clinical remission, defined as HBI <5, and endoscopic improvement, as measured by the Simple Endoscopic Score for Crohn's Disease (SES-CD). RESULTS One hundred CD patients (45 male, 55 female), median age 47 (19, 78) years, were included; clinical response rate was 60%, and clinical remission was 36%. The response rate in patients with ileal pyroptosis <14 positive cells per 1000 IECs was significantly higher than those above the threshold: 89% (25 of 28) vs 49% (35 of 72), odds ratio (OR) 8.8 (95% CI, 2.3-48.6; P < 0.001). Corresponding remission rates were 54% (15 of 28) vs 29% (21 of 72; OR 2.8 [1.03-7.59; P = 0.036]). For endoscopic improvement, ileal pyroptosis of 22 positive cells per 1000 IECs was the optimal threshold that determines the magnitude SES-CD change. CONCLUSIONS Ileal biopsy IEC pyroptosis was predictive of clinical response and endoscopic improvement to vedolizmab in CD patients.
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Affiliation(s)
- Mark T Osterman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ilyssa O Gordon
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elisabeth M Davis
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Matthew Ciorba
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah C Glover
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Bincy Abraham
- Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, TX, USA
| | - Freeha Khan
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xueyan Guo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric U Yee
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Felicia D Allard
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brian Claggett
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bo Shen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julia J Liu
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Park H, Otegbeye E, Kim H, Mutch M, Pedersen K, Amin M, Tan B, Trikalinos N, Lim KH, Aranha O, Suresh R, Badiyan S, Silviera M, Henke L, Wise P, Hunt S, Mitchem J, Lu E, Wang-Gillam A, Ciorba M. Abstract CT234: Phase I study of epacadostat added to preoperative chemoradiation in patients with locally advanced rectal cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct234] [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: Epacadostat is an orally active, potent and selective inhibitor of indoleamine 2, 3-dioxygenase 1 (IDO1). IDO1 inhibition enhances cytotoxic T cell activation by dendritic cells, and significantly decreases regulatory T cell proliferation. We developed preclinical data supporting combination of epacadostat with radiation therapy in rectal cancer. In rectal cancer samples obtained from patients who received hypofractionated radiation, IDO1 was overexpressed in tumor tissue as compensatory response after radiation in both microsatellite stable and unstable cell lines. IDO1 inhibition with epacadostat selectively reduced survival of cancer cells and enhanced radiosensitivity without impacting normal epithelial cells. Epacadostat in addition to radiation showed both increased tumor cytotoxicity and enhanced immune activation in tumor microenvironment in a syngeneic mouse model of colorectal cancer. Literature also supports the choice of high dose, hypofractionated radiation to induce a more favorable anti-tumor immune response. Therefore, we hypothesized that IDO1 expression is a mechanism of radioresistance in rectal cancer and IDO1 inhibition is a safe and well-tolerated combination therapy to enhance tumor radiosensitivity. Methods: Patients with locally advanced rectal cancer who are candidates for neoadjuvant therapy using short-course radiation and chemotherapy are included in this study. Primary objective of the study is to determine the recommended phase II dose (RP2D) of epacadostat for combination with short course radiation and chemotherapy in preoperative treatment of locally advanced rectal cancer. This study includes dose-escalation part of patients receiving epacadostat with radiation and chemotherapy (n=6-18) followed by dose-expansion (n=up to 27 including those treated at RP2D during escalation). Two dose levels of epacadostat (300mg and 600mg orally twice daily) will be explored. Epacadostat will be combined with short-course radiation (5Gy x 5 fractions) followed by 6 cycles of CAPOX chemotherapy, until the day of surgery for a total of approximately 24 weeks of therapy. Research biopsies of tumor and adjacent non-tumor tissue along with blood sample collection will be performed before and after the radiation, and at the time of surgery. Tryptophan pathway metabolites, immune checkpoint biomarkers, markers of cell death, proliferation and potentially prognostic molecular biomarkers will be measured in tumor tissues before and after radiation therapy. In addition, patient-derived organoid and xenograft models from rectal biopsy samples will be used to determine the success rate of organoid generation, to evaluate treatment response and to characterize molecular changes to identify potential predictors of response and mechanisms of resistance. Enrollment began in November 2019. NCT03516708
Citation Format: Haeseong Park, Ebunoluwa Otegbeye, Hyun Kim, Matthew Mutch, Katrina Pedersen, Manik Amin, Benjamin Tan, Nikolaos Trikalinos, Kian-Huat Lim, Olivia Aranha, Rama Suresh, Shahed Badiyan, Matthew Silviera, Lauren Henke, Paul Wise, Steven Hunt, Jonathan Mitchem, Esther Lu, Andrea Wang-Gillam, Matthew Ciorba. Phase I study of epacadostat added to preoperative chemoradiation in patients with locally advanced rectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT234.
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Affiliation(s)
- Haeseong Park
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Hyun Kim
- 1Washington University in St. Louis, Saint Louis, MO
| | - Matthew Mutch
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Manik Amin
- 1Washington University in St. Louis, Saint Louis, MO
| | - Benjamin Tan
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Kian-Huat Lim
- 1Washington University in St. Louis, Saint Louis, MO
| | - Olivia Aranha
- 1Washington University in St. Louis, Saint Louis, MO
| | - Rama Suresh
- 1Washington University in St. Louis, Saint Louis, MO
| | | | | | - Lauren Henke
- 1Washington University in St. Louis, Saint Louis, MO
| | - Paul Wise
- 1Washington University in St. Louis, Saint Louis, MO
| | - Steven Hunt
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Esther Lu
- 1Washington University in St. Louis, Saint Louis, MO
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Cushing KC, Adar T, Ciorba M, Ananthakrishnan AN. Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions. Crohns Colitis 360 2020; 2:otaa019. [PMID: 34825180 PMCID: PMC8607547 DOI: 10.1093/crocol/otaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
Background Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD. Methods We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher's exact tests. Results A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy (P = 0.003), complicated IBD (P = 0.057), and peri-operative IBD (P = 0.057). No significant advantage was detected in academic productivity. Common barriers to participation in IBD fellowships included feeling it was unnecessary (45%) and desire to begin a faculty position (42%). Conclusions This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed.
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Affiliation(s)
- Kelly C Cushing
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tomer Adar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Ciorba
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor Boston, MA 02114 ()
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Tsai R, Mintz A, Lin M, Mhlanga J, Chiplunker A, Salter A, Ciorba M, Deepak P, Fowler K. Magnetic resonance enterography features of small bowel Crohn's disease activity: an inter-rater reliability study of small bowel active inflammation in clinical practice setting. Br J Radiol 2019; 92:20180930. [PMID: 31141389 PMCID: PMC6636275 DOI: 10.1259/bjr.20180930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/13/2019] [Accepted: 04/24/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the interrater agreement in a clinical practice environment for the most commonly used magnetic resonance enterography (MRE) features of Crohn's disease (CD). METHODS CD patients with MRE's before and after treatment were retrospectively identified using search queries over a 7-year period (May 2017-September 2017). MRE features of CD comprising components of multiple CD scoring indices were scored by radiologists in the same segment of bowel. Agreement for nominal categorical and continuous variables was assessed using a κ and interclass correlation coefficients, respectively. RESULTS 80 scans comprised the study population. Moderate interrater agreement was seen in both the pre- and post-treatment MRE's for presence of diffusion restriction (к = 0.43, 0.48; pre- and post-treatment), stricturing disease (к = 0.51, 0.52), overall degree of severity (к = 0.49, 0.59). Substantial agreement was seen in pre- and post-treatment scans for length of involvement (interclass correlation coefficient = 0.67, 0.61). The presence of mucosal ulceration had no agreement (к = -0.07, -0.042). CONCLUSION Many MRE features of active CD comprising the major CD scoring indices are reproducible when interpreted by non-CD focused abdominal radiologists. However, the presence of mucosal ulcerations had no agreement and may need more investigation before including this feature as a driver in therapeutic decision making. ADVANCES IN KNOWLEDGE Demonstrates the unreliability of mucosal ulceration by non-CD focused abdominal radiologists, targeting a potential area for future education. Key Points The majority of MRE findings incorporated in to many CD scoring indices have fair to moderate inter-rater agreement even when read by non-MRE expert radiologists. Substantial agreement was seen in the length of involved bowel, but this feature is only incorporated in to one of the CD scoring indices. Presence of mucosal ulcerations had no interrater agreement in our study-a feature which is heavily weighted by several CD scoring indices. Research should be focused bridging those features which have poor interrater agreement.
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Affiliation(s)
- Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron Mintz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Michael Lin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Joyce Mhlanga
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Adeeti Chiplunker
- Division of Gastroenterology. Washington University in St. Louis., St. Louis, MO, United States
| | - Amber Salter
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, United States
| | - Matthew Ciorba
- Washington University Inflammatory Bowel Diseases Center, St. Louis, MO, United States
| | - Parakkal Deepak
- Washington University Inflammatory Bowel Diseases Center, St. Louis, MO, United States
| | - Kathryn Fowler
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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Affiliation(s)
- Ted Walker
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Ciorba
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Erik R Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Affiliation(s)
- Kelly Cushing
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110. Support provided by the T32DK007130 grant
| | - Navya Kanuri
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110
| | - Matthew Ciorba
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110
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Riehl TE, Santhanam S, Foster L, Ciorba M, Stenson WF. CD44 and TLR4 mediate hyaluronic acid regulation of Lgr5+ stem cell proliferation, crypt fission, and intestinal growth in postnatal and adult mice. Am J Physiol Gastrointest Liver Physiol 2015; 309:G874-87. [PMID: 26505972 PMCID: PMC4669354 DOI: 10.1152/ajpgi.00123.2015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/13/2015] [Indexed: 01/31/2023]
Abstract
Hyaluronic acid, a glycosaminoglycan in the extracellular matrix, binds to CD44 and Toll-like receptor 4 (TLR4). We previously addressed the role of hyaluronic acid in small intestinal and colonic growth in mice. We addressed the role of exogenous hyaluronic acid by giving hyaluronic acid intraperitoneally and the role of endogenous hyaluronic acid by giving PEP-1, a peptide that blocks hyaluronic acid binding to its receptors. Exogenous hyaluronic acid increased epithelial proliferation but had no effect on intestinal length. PEP-1 resulted in a shortened small intestine and colon and diminished epithelial proliferation. In the current study, we sought to determine whether the effects of hyaluronic acid on growth were mediated by signaling through CD44 or TLR4 by giving exogenous hyaluronic acid or PEP-1 twice a week from 3-8 wk of age to wild-type, CD44(-/-), and TLR4(-/-) mice. These studies demonstrated that signaling through both CD44 and TLR4 were important in mediating the effects of hyaluronic acid on growth in the small intestine and colon. Extending our studies to early postnatal life, we assessed the effects of exogenous hyaluronic acid and PEP-1 on Lgr5(+) stem cell proliferation and crypt fission. Administration of PEP-1 to Lgr5(+) reporter mice from postnatal day 7 to day 14 decreased Lgr5(+) cell proliferation and decreased crypt fission. These studies indicate that endogenous hyaluronic acid increases Lgr5(+) stem cell proliferation, crypt fission, and intestinal lengthening and that these effects are dependent on signaling through CD44 and TLR4.
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Affiliation(s)
- Terrence E. Riehl
- Division of Gastroenterology at Washington University School of Medicine, St. Louis, Missouri
| | - Srikanth Santhanam
- Division of Gastroenterology at Washington University School of Medicine, St. Louis, Missouri
| | - Lynne Foster
- Division of Gastroenterology at Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Ciorba
- Division of Gastroenterology at Washington University School of Medicine, St. Louis, Missouri
| | - William F. Stenson
- Division of Gastroenterology at Washington University School of Medicine, St. Louis, Missouri
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Abstract
OBJECTIVE : Our objective is to assess the effect of genetic and environmental factors on Crohn's disease location. DESIGN : We identified 628 patients with Crohn's disease within the Washington University database (April 2005 through February 2010) that had complete information on 31 Crohn's disease-associated genotypes and clinical information on disease location (L1 to L4), smoking, sex, race, and age at diagnosis. For statistical reasons, the 3 major NOD2 alleles (rs2066844, rs2066845, and rs2066847) were grouped together. Logistic regression incorporating all of the genotypes and clinical covariates, including smoking, was performed with stepwise variable selection and by best subset selection. RESULTS : Stepwise variable selection selected 3 major covariates, composite NOD2 genotype, smoking, and TNFSF15 genotype, which are also the 3 covariates selected by the best subset method. Whereas the NOD2 genotype and smoking are positively associated with ileal (L1 + L3) disease, the TNFSF15 genotype is positively associated with isolated colonic (L2) disease. LIMITATIONS : The ability to detect disease site associations in this single-center study may be limited by the population size, low allelic frequency, and/or low odds ratio of certain Crohn's disease risk alleles. CONCLUSION : These results indicate that NOD2 genotype, smoking status, and TNFSF15 genotype should be included as covariates in assessing the effect of genetic and environmental factors on Crohn's disease site location.
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Affiliation(s)
- Hongyan Chen
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
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