Assessing Therapeutic Efficacy of MEK Inhibition in a KRASG12C-Driven Mouse Model of Lung Cancer

Purpose: Despite the challenge to directly target mutant KRAS due to its high GTP affinity, some agents are under development against downstream signaling pathways, such as MEK inhibitors. However, it remains controversial whether MEK inhibitors can boost current chemotherapy in KRAS-mutant lung tumors in clinic. Considering the genomic heterogeneity among patients with lung cancer, it is valuable to test potential therapeutics in KRAS mutation-driven mouse models.Experimental Design: We first compared the pERK1/2 level in lung cancer samples with different KRAS substitutions and generated a new genetically engineered mouse model whose tumor was driven by KRAS G12C, the most common KRAS mutation in lung cancer. Next, we evaluated the efficacy of selumetinib or its combination with chemotherapy, in KRASG12C tumors compared with KRASG12D tumors. Moreover, we generated KRASG12C/p53R270H model to explore the role of a dominant negative p53 mutation detected in patients in responsiveness to MEK inhibition.Results: We determined higher pERK1/2 in KRASG12C lung tumors compared with KRASG12D Using mouse models, we further identified that KRASG12C tumors are significantly more sensitive to selumetinib compared with KrasG12D tumors. MEK inhibition significantly increased chemotherapeutic efficacy and progression-free survival of KRASG12C mice. Interestingly, p53 co-mutation rendered KRASG12C lung tumors less sensitive to combination treatment with selumetinib and chemotherapy.Conclusions: Our data demonstrate that unique KRAS mutations and concurrent mutations in tumor-suppressor genes are important factors for lung tumor responses to MEK inhibitor. Our preclinical study supports further clinical evaluation of combined MEK inhibition and chemotherapy for lung cancer patients harboring KRAS G12C and wild-type p53 status. Clin Cancer Res; 24(19); 4854-64. ©2018 AACR.

BET Bromodomain Inhibition Cooperates with PD-1 Blockade to Facilitate Antitumor Response in Kras-Mutant Non-Small Cell Lung Cancer

KRAS mutation is present in approximately 30% of human lung adenocarcinomas. Although recent advances in targeted therapy have shown great promise, effective targeting of KRAS remains elusive, and concurrent alterations in tumor suppressors render KRAS-mutant tumors even more resistant to existing therapies. Contributing to the refractoriness of KRAS-mutant tumors are immunosuppressive mechanisms, such as increased presence of suppressive regulatory T cells (Treg) in tumors and elevated expression of the inhibitory receptor PD-1 on tumor-infiltrating T cells. Treatment with BET bromodomain inhibitors is beneficial for hematologic malignancies, and they have Treg-disruptive effects in a non-small cell lung cancer (NSCLC) model. Targeting PD-1-inhibitory signals through PD-1 antibody blockade also has substantial therapeutic impact in lung cancer, although these outcomes are limited to a minority of patients. We hypothesized that the BET bromodomain inhibitor JQ1 would synergize with PD-1 blockade to promote a robust antitumor response in lung cancer. In the present study, using Kras^+/LSL-G12D ; Trp53^L/L (KP) mouse models of NSCLC, we identified cooperative effects between JQ1 and PD-1 antibody. The numbers of tumor-infiltrating Tregs were reduced and activation of tumor-infiltrating T cells, which had a T-helper type 1 (Th1) cytokine profile, was enhanced, underlying their improved effector function. Furthermore, lung tumor-bearing mice treated with this combination showed robust and long-lasting antitumor responses compared with either agent alone, culminating in substantial improvement in the overall survival of treated mice. Thus, combining BET bromodomain inhibition with immune checkpoint blockade offers a promising therapeutic approach for solid malignancies such as lung adenocarcinoma. Cancer Immunol Res; 6(10); 1234-45. ©2018 AACR.

NK Cells Mediate Synergistic Antitumor Effects of Combined Inhibition of HDAC6 and BET in a SCLC Preclinical Model

Small-cell lung cancer (SCLC) has the highest malignancy among all lung cancers, exhibiting aggressive growth and early metastasis to distant sites. For 30 years, treatment options for SCLC have been limited to chemotherapy, warranting the need for more effective treatments. Frequent inactivation of TP53 and RB1 as well as histone dysmodifications in SCLC suggest that transcriptional and epigenetic regulations play a major role in SCLC disease evolution. Here we performed a synthetic lethal screen using the BET inhibitor JQ1 and an shRNA library targeting 550 epigenetic genes in treatment-refractory SCLC xenograft models and identified HDAC6 as a synthetic lethal target in combination with JQ1. Combined treatment of human and mouse SCLC cell line-derived xenograft tumors with the HDAC6 inhibitor ricolinostat (ACY-1215) and JQ1 demonstrated significant inhibition of tumor growth; this effect was abolished upon depletion of NK cells, suggesting that these innate immune lymphoid cells play a role in SCLC tumor treatment response. Collectively, these findings suggest a potential new treatment for recurrent SCLC.Significance: These findings identify a novel therapeutic strategy for SCLC using a combination of HDAC6 and BET inhibitors. Cancer Res; 78(13); 3709-17. ©2018 AACR.

Targeting HER2 Aberrations in Non-Small Cell Lung Cancer with Osimertinib

Purpose:HER2 (or ERBB2) aberrations, including both amplification and mutations, have been classified as oncogenic drivers that contribute to 2% to 6% of lung adenocarcinomas. HER2 amplification is also an important mechanism for acquired resistance to EGFR tyrosine kinase inhibitors (TKI). However, due to limited preclinical studies and clinical trials, currently there is still no available standard of care for lung cancer patients with HER2 aberrations. To fulfill the clinical need for targeting HER2 in patients with non-small cell lung cancer (NSCLC), we performed a comprehensive preclinical study to evaluate the efficacy of a third-generation TKI, osimertinib (AZD9291).Experimental Design: Three genetically modified mouse models (GEMM) mimicking individual HER2 alterations in NSCLC were generated, and osimertinib was tested for its efficacy against these HER2 aberrations in vivoResults: Osimertinib treatment showed robust efficacy in HER2^wt overexpression and EGFR del19/HER2 models, but not in HER2 exon 20 insertion tumors. Interestingly, we further identified that combined treatment with osimertinib and the BET inhibitor JQ1 significantly increased the response rate in HER2-mutant NSCLC, whereas JQ1 single treatment did not show efficacy.Conclusions: Overall, our data indicated robust antitumor efficacy of osimertinib against multiple HER2 aberrations in lung cancer, either as a single agent or in combination with JQ1. Our study provides a strong rationale for future clinical trials using osimertinib either alone or in combination with epigenetic drugs to target aberrant HER2 in patients with NSCLC. Clin Cancer Res; 24(11); 2594-604. ©2018 AACRSee related commentary by Cappuzzo and Landi, p. 2470.

CDK4/6 Inhibition Augments Antitumor Immunity by Enhancing T-cell Activation

Immune checkpoint blockade, exemplified by antibodies targeting the PD-1 receptor, can induce durable tumor regressions in some patients. To enhance the efficacy of existing immunotherapies, we screened for small molecules capable of increasing the activity of T cells suppressed by PD-1. Here, we show that short-term exposure to small-molecule inhibitors of cyclin-dependent kinases 4 and 6 (CDK4/6) significantly enhances T-cell activation, contributing to antitumor effects in vivo, due in part to the derepression of NFAT family proteins and their target genes, critical regulators of T-cell function. Although CDK4/6 inhibitors decrease T-cell proliferation, they increase tumor infiltration and activation of effector T cells. Moreover, CDK4/6 inhibition augments the response to PD-1 blockade in a novel ex vivo organotypic tumor spheroid culture system and in multiple in vivo murine syngeneic models, thereby providing a rationale for combining CDK4/6 inhibitors and immunotherapies.Significance: Our results define previously unrecognized immunomodulatory functions of CDK4/6 and suggest that combining CDK4/6 inhibitors with immune checkpoint blockade may increase treatment efficacy in patients. Furthermore, our study highlights the critical importance of identifying complementary strategies to improve the efficacy of immunotherapy for patients with cancer. Cancer Discov; 8(2); 216-33. ©2017 AACR.See related commentary by Balko and Sosman, p. 143See related article by Jenkins et al., p. 196This article is highlighted in the In This Issue feature, p. 127.

Gemcitabine and Chk1 Inhibitor AZD7762 Synergistically Suppress the Growth of Lkb1-Deficient Lung Adenocarcinoma

Cells lacking the tumor suppressor gene LKB1/STK11 alter their metabolism to match the demands of accelerated growth, leaving them highly vulnerable to stress. However, targeted therapy for LKB1-deficient cancers has yet to be reported. In both Kras/p53/Lkb1 cell lines and a genetically engineered mouse model of Kras/p53/Lkb1-induced lung cancer, much higher rates of DNA damage occur, resulting in increased dependence on Chk1 checkpoint function. Here we demonstrate that short-term treatment with the Chk1 inhibitor AZD7762 reduces metabolism in pembrolizumab tumors, synergizing with the DNA-damaging drug gemcitabine to reduce tumor size in these models. Our results offer preclinical proof of concept for use of a Chk1 inhibitor to safely enhance the efficacy of gemcitabine, particularly in aggressive KRAS-driven LKB1-deficient lung adenocarcinomas. Cancer Res; 77(18); 5068-76. ©2017 AACR.

Determinants of dynamic hyperinflation during metronome-paced tachypnea in COPD and normal subjects

In COPD, dynamic hyperinflation (DH) occurs during exercise and during metronome-paced tachypnea (MPT). We investigated the relationship of DH with breathing pattern and ventilation (V˙E) in COPD and normal subjects (NS). In 35 subjects with moderate COPD and 17 younger healthy volunteers we measured inspiratory capacity (IC), breathing frequency (fR), expiratory time (TE), ventilation (V˙E) and end-tidal carbon dioxide tension (PETCO2) at baseline and after 30s of MPT at 40breaths/min with metronome-defined I:E ratios of 1:1 and 1:2. A reduction in IC (ΔIC) was taken to indicate DH. In COPD subjects, DH correlated with TE but not with V˙E or PETCO2, and was best predicted by total lung capacity. NS also showed DH (although less than in COPD), which correlated with PETCO2 but not with fR, TE or V˙E. We conclude that MPT evokes DH in both NS and patients with COPD. TE is the most important determinant of DH during MPT in patients with COPD.

A case control study of lung cancer and exposure to chrysotile and amphibole at a slovenian asbestos-cement plant

A lung cancer case-control study was conducted in a Slovenian asbestos-cement factory for which unusually good records of asbestos exposures were available. The cohort consisted of all 6714 workers employed at the Salonit Anhovo factory after 31 December 1946 who worked there for at least one day between 1964 and 1994. Fifty-eight histologically confirmed cases of primary lung cancer and 290 controls were selected from the cohort. Working life exposure histories to amphibole and chrysotile forms of asbestos were estimated separately. Airborne asbestos concentrations were low. For example, the arithmetic mean exposure to all forms of asbestos in the highest exposure period (1947-1971) was 1.2 f/cm(3). Chrysotile asbestos made up about 90% of this exposure (mean 1.1 f/cm(3)), whereas amphibole accounted for 10% (0.1 f/cm(3)). Comparing those above and below the 90 percentile of cumulative exposure, the odds ratios for all asbestos, chrysotile and amphibole were 1.5, 1.6 and 2.0, respectively, but confidence intervals were wide. There are only a few asbestos-lung cancer studies with high-quality exposure data and exposures in this low range. Though imprecise, the findings are important to the ongoing debate about asbestos risks.

Historical cohort study of US man-made vitreous fiber production workers: VII. Overview of the exposure assessment

Data and procedures used to reconstruct the history of exposures at each of the 15 plants (19 distinct sites) are presented. The assessment consisted of five steps: (1) develop a Technical History of operations, stable periods, and time points of changes relevant for exposures, and identify the presence of potentially confounding co-exposures; (2) develop a set of unique department-job names with descriptions and a Job Dictionary for all verbatim names in work histories; (3) collect all company and other exposure data (> 1600 observed), and develop quantitative fiber, formaldehyde, and silica exposure estimates; (4) integrate estimates with the Technical History to make Exposure Extrapolation Tables; and (5) use the the Tables with job data to develop an Exposure Matrix for each plant. Nineteen Exposure Matrices were made, with 82 to 621 lines, covering up to 54 years of operations.

Historical cohort study of US man-made vitreous fiber production workers: I. 1992 fiberglass cohort follow-up: initial findings

This 1986 to 1992 update and expansion of an earlier historical cohort study examined the 1946 to 1992 mortality experience of 32,110 workers employed for 1 year or more during 1945 to 1978 at any of 10 US fiberglass (FG) manufacturing plants. Included are (1) a new historical exposure reconstruction for respirable glass fibers and several co-exposures (arsenic, asbestos, asphalt, epoxy, formaldehyde, polycyclic aromatic hydrocarbons, phenolics, silica, styrene, and urea); and (2) a nested, matched case-control study of 631 respiratory system cancer (RSC) deaths in male workers during 1970 to 1992 with interview data on tobacco smoking history. Our findings to date from external comparisons based on standardized mortality ratios (SMRs) in the cohort study provide no evidence of excess mortality risk from all causes combined, all cancers combined, and non-malignant respiratory disease. Also, excluding RSC, we observed no evidence of excess mortality risk from any of the other cause-of-death categories considered. For RSC among the total cohort, we observed a 6% excess (P = 0.05) based on 874 deaths. Among long-term workers (5 or more years of employment) we observed a not statistically significant 3% excess based on 496 deaths. Among the total cohort, we observed increases in RSC SMRs with calendar time and time since first employment, but these were less pronounced among long-term workers. RSC SMRs were not related to duration of employment among the total cohort or long-term workers. In an externally controlled analysis of male workers at risk between 1970 and 1992, we observed no association between RSC SMRs and increasing exposure to respirable FG. Our findings to date from internal comparisons based on rate ratios in the case-control study of RSC were limited to analyses of categorized study variables with and without adjustment for smoking. On the basis of these analyses, the duration of exposure and cumulative exposure to respirable FG at the levels encountered at the study plants did not appear to be associated with an increased risk of RSC. RSC risk also did not seem to increase with time since first employment. There is some evidence of elevated RSC risk associated with non-baseline levels of average intensity of exposure to respirable glass, but when adjusted for smoking this was not statistically significant, and there was no apparent trend with increasing exposure. This same pattern of findings was observed for duration of exposure, cumulative exposure, and average intensity of exposure to formaldehyde. None of the other individual co-exposures encountered in the study plants appeared to be associated with an increased risk of RSC. The primary focus of ongoing analyses is to determine the extent to which our present findings are robust to alternative characterizations of exposure.

Historical cohort study of US man-made vitreous fiber production workers: VIII. Exposure-specific job analysis

All jobs held by a cohort of US man-made vitreous fiber production workers were analyzed for airborne fiber exposure. This exposure-specific job analysis was part of an exposure assessment for an epidemiologic study of mortality patterns, with particular focus on respiratory cancer, among 35,145 workers employed in 10 fiberglass and five rock or slag wool plants. The exposure assessment was conducted from the start-up date of each plant (1917 to 1946) to 1990. For the job analysis, 15,465 crude department names and 47,693 crude job titles were grouped into 1668 unique department and job pairs (UDJobs), which represented a job title linked to a specific department within each plant. Every UDJob was evaluated according to a set of job elements related to airborne fiber exposure. The distribution of the cohort person-years by UDJob and the job-exposure elements was then evaluated. The results show the main departments and jobs that employed the workers for each plant. The distribution of person-years varies across the job-exposure elements. The same job title was used in different departments within and across plants. When job titles not linked to departments were evaluated, the values of the job-exposure elements varied considerably across all plants and within plant.

IN CONCLUSION

(1) exposure misclassification could occur if job title alone were used for the exposure assessment; (2) the job-exposure elements analysis provides an efficient way to identify major job determinants of exposure without relying on the more detailed, resource-intensive task-based approach; and (3) the evaluation of the cohort person-years by UDJobs and job-exposure elements is an effective way to identify which plants, departments, and jobs have sufficient information for making precise risk estimates in the broader epidemiologic study.

Implications of different fiber measures for epidemiologic studies of man-made vitreous fibers

BACKGROUND

Several researchers have proposed fiber size ranges representing hypotheses about the biological activity of fibers. Each of these indices has a biologically plausible rationale, yet they propose different fiber dimensions.

METHODS

Four biologically based and one standard fiber analytic method index, the NIOSH 7400 method with B rules, were evaluated in air monitoring data collected in a variety of fiber glass (FG) manufacturing settings to determine their impact on an assessment of fiber exposure for an epidemiologic study of the risk of respiratory cancer among FG production workers.

RESULTS

All indices varied considerably within and among the range of fiber size distributions sampled in the FG factories.

CONCLUSIONS

The asymptotic relative efficiencies (R(2)) calculated among the five indices indicate a potentially important loss of power from the use of the standard method index, if one of the biologically based indices is more closely related to the disease outcome in an epidemiologic study.

Sustainable production: a proposed strategy for the work environment

BACKGROUND

In the future, competitive industries will need to design for environment, health and safety as well as for productivity. Although the new areas of pollution prevention and clean production have evolved to address the design of production processes with concerns for the ambient environment, current pollution prevention models do not include explicit concerns for health, safety, and the work environment. The field of occupational health and safety has much to contribute to improve current pollution prevention approaches and solutions.

METHODS

The application of work environment disciplines will need to be expanded from the conventional focus on "end-of-pipe" assessment and solutions, which take the production processes and resulting hazards as a given, to include a new focus on materials selection and process redesign. To make this shift, a new framework called "sustainable production" is proposed. The basic unit of sustainable production is the production process. The framework integrates a focus on the ambient and work environment along with a focus on productivity and the economic viability of the business enterprise in setting production process design parameters.

RESULTS

By shifting the focus of occupational and environmental health and safety from exposure control to process design, sustainable production reduces the likelihood that concerns for health, safety, and the environment will be seen as antagonistic to productivity and economic development. To move a firm toward sustainable production, occupational health and safety professionals will need to participate in interdisciplinary workplace teams that design and build new production processes and that continuously evaluate and redesign existing processes.

CONCLUSIONS

This new strategy requires an expansion of the role of the occupational health and safety professional to include evaluation and redesign of processes that produce goods and services as well as the conventional evaluation of chemical, physical, and biological agents, work practices, and ergonomics. This expansion of occupational and environmental health and safety requires new research to develop the scientific and public policy basis of sustainable production.

Is your healthcare information system physician friendly?

An organization's healthcare information system (HIS) can be used as a tool to improve relationships with its physicians by facilitating physician work processes and research. An effective HIS should provide census reports tailored to individual physician needs, allow physicians access to information via dedicated personal computers (PCs) or terminals, and should have features, such as screen design and graphical interfaces that are easy to understand and use. In addition, the HIS should provide comprehensive reports, have online ordering capability, and respond quickly to the needs of busy physicians. A good HIS also supports physician-related activities occurring outside the hospital. For example, physician office managers should be able to access billing information, such as patient demographics and procedure codes, contained in the HIS. And, physicians should be able to retrieve archived information from their offices or homes. Critical to physicians' successful use of an organization's HIS is administration's attitude and support. An organization that places a priority on physician issues and needs can make even a basic HIS an effective tool for its physicians, while a sophisticated HIS that does not address physician needs will not maximize return on the investment.

Statistical power to detect occupationally related respiratory cancer risk in a cohort of female employees in the US man-made vitreous fiber industry

The current update of the US man-made vitreous fiber production worker cohort includes women for the first time. Preliminary comparisons of 3,820 female and 27,767 male workers from 11 participating fibrous glass plants show different hiring patterns during World War II. The gender-specific person-year distributions are similar with respect to duration of employment and time since first employment. The current follow-up of 118,559 person-years for women provides an estimated 80% power to detect a threefold relative risk of respiratory cancer for women who worked more than 14 years in these plants, based on a Poisson regression analysis of the cohort rates. When women comprise a small fraction of the cohort, the statistical power may be inadequate to detect risks of the magnitude typically of interest in studies of men.

Uterotropic action in rats of amsonic acid and three of its synthetic precursors

Prompted by reports of sexual impotence among chemical factory workers exposed to amsonic acid (4,4'-diaminostilbene-2,2'-disulfonic acid; CAS 81-11-8) and its synthetic precursors 4,4'-dinitrostilbene-2,2'-disulfonic acid (DNSDSA; CAS 128-42-7), 2-methyl-5-nitrobenzenesulfonic acid (MNBSA; CAS 121-03-09), and 4-nitrotoluene (CAS 99-99-0), the uterine-weight-increasing actions of single intraperitoneal doses of these chemicals were determined at 24 h after treatment in weanling female rats and compared to the results of similar experiments with diethylstilbestrol (DES; CAS 56-53-01), a synthetic estrogen chemically related to amsonic acid and DNSDSA. Doses of 100 mg/kg or less of amsonic acid were either without effects or produced equivocal effects, while uterine weights were increased after doses of 300 and 1000 mg/kg; doses of 3000 mg/kg were clearly toxic. Neither DNSDSA nor MNBSA increased uterine weight after doses that were not overtly toxic. Doses of 10 mg/kg or less of 4-nitrotoluene were without effect, but doses of 30 and 100 mg/kg increased uterine weights without producing overt toxicity; doses of 1000 mg/kg were clearly toxic. While both amsonic acid and 4-nitrotoluene exhibited uterotropic effects, they were both much weaker than DES in this respect. Other experiments indicated that the time course of the effects of approximately equiactive doses of amsonic acid and DES were very similar, and that the responses to oral doses of amsonic acid were not appreciably different from the responses to the same doses given intraperitoneally. Finally, a sample of amsonic acid taken from the workplace of the complaining workers was also found to have uterotropic activity. These experiments suggest that amsonic acid and 4-nitrotoluene have estrogenic activity, and thus provide a possible mechanistic explanation for the complaints of impotency in factory workers exposed to these substances.

Investigation of reports of sexual dysfunction among male chemical workers manufacturing stilbene derivatives

A Health Hazard Evaluation was conducted by the National Institute for Occupational Safety and Health in an area of a large chemical plant that manufactured the stilbene derivative 4,4'-diaminostilbene-2,2'-disulfonic acid, an intermediate used for the production of optical brightening agents. Men employed in the area reported problems with impotence. The study population consisted of 44 men aged 20-57 years (mean age 37) employed in the area at the time of the evaluation. An industrial hygiene investigation, health and work history questionnaire survey, physical examinations, and blood chemistry and serum hormone evaluation were conducted. Fourteen percent of the men reported symptoms of impotence over the preceding 6 or more months, 7% had potency problems of shorter duration, and 7% were not currently impotent but had experienced impotence for 6 or more months in the past; 36% experienced decreased libido, all since beginning work in the production area. Low levels of serum testosterone (less than 350 ng/dl) were observed in 37% of the men. The low serum testosterone concentrations were not accounted for fully by diurnal variation or an effect of rotating shift work. It is suggested that exposures to chemicals possessing estrogenic activity may be related to the observed health effects in these workers.

Modernization and trends in occupational health and safety in the People's Republic of China 1981-1986

Exchanges between U.S. and Chinese professionals have provided opportunities for observation of recent developments in occupational health in China. For the past decade, China has been committed to an unprecedented drive for economic modernization, including new policies on ownership, business management, employment, health care, and disability as well as increased activity in heavy, light, and service industries. Chinese occupational health professionals and labor organizations have set a goal of modernizing worker health along with the rest of society. Examples of advances in occupational health occurring since 1981 are the coordination of industrial hygiene and health research and services, an emphasis on epidemiology, interdisciplinary approaches to problem-solving, the pretesting of toxic substances, regulation and standard setting, and on-site workplace hazard prevention.

An asbestos hazard in the reprocessed textile industry

Epidemiologic studies have identified an excess risk of lung cancer and mesothelioma among workers in the reprocessed textile industry in Prato, Italy. These studies suggested that there may have been asbestos hazard in this industry although exposure was not known to exist. An industrial hygiene investigation was conducted to determine whether there was previous or current asbestos exposure in the industry. Walk-through surveys, environmental sampling, process documentation, and management and worker interviews were conducted in 13 textile reprocessing establishments. Polypropylene bags that once contained asbestos were found in 2 of the 13. Asbestos bags were cut open and used to cover bales of rags which were then distributed throughout the world. Workers were exposed to asbestos while handling the bags which were contaminated with chrysotile, amosite, and crocidolite. Additional sources of asbestos exposure that may have existed in the past in the industry are also discussed.