1
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Karsa M, Xiao L, Ronca E, Bongers A, Spurling D, Karsa A, Cantilena S, Mariana A, Failes TW, Arndt GM, Cheung LC, Kotecha RS, Sutton R, Lock RB, Williams O, de Boer J, Haber M, Norris MD, Henderson MJ, Somers K. FDA-approved disulfiram as a novel treatment for aggressive leukemia. J Mol Med (Berl) 2024; 102:507-519. [PMID: 38349407 DOI: 10.1007/s00109-023-02414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 03/26/2024]
Abstract
Acute leukemia continues to be a major cause of death from disease worldwide and current chemotherapeutic agents are associated with significant morbidity in survivors. While better and safer treatments for acute leukemia are urgently needed, standard drug development pipelines are lengthy and drug repurposing therefore provides a promising approach. Our previous evaluation of FDA-approved drugs for their antileukemic activity identified disulfiram, used for the treatment of alcoholism, as a candidate hit compound. This study assessed the biological effects of disulfiram on leukemia cells and evaluated its potential as a treatment strategy. We found that disulfiram inhibits the viability of a diverse panel of acute lymphoblastic and myeloid leukemia cell lines (n = 16) and patient-derived xenograft cells from patients with poor outcome and treatment-resistant disease (n = 15). The drug induced oxidative stress and apoptosis in leukemia cells within hours of treatment and was able to potentiate the effects of daunorubicin, etoposide, topotecan, cytarabine, and mitoxantrone chemotherapy. Upon combining disulfiram with auranofin, a drug approved for the treatment of rheumatoid arthritis that was previously shown to exert antileukemic effects, strong and consistent synergy was observed across a diverse panel of acute leukemia cell lines, the mechanism of which was based on enhanced ROS induction. Acute leukemia cells were more sensitive to the cytotoxic activity of disulfiram than solid cancer cell lines and non-malignant cells. While disulfiram is currently under investigation in clinical trials for solid cancers, this study provides evidence for the potential of disulfiram for acute leukemia treatment. KEY MESSAGES: Disulfiram induces rapid apoptosis in leukemia cells by boosting oxidative stress. Disulfiram inhibits leukemia cell growth more potently than solid cancer cell growth. Disulfiram can enhance the antileukemic efficacy of chemotherapies. Disulfiram strongly synergises with auranofin in killing acute leukemia cells by ROS induction. We propose testing of disulfiram in clinical trial for patients with acute leukemia.
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Affiliation(s)
- Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Lin Xiao
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Emma Ronca
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Dayna Spurling
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Ayu Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sandra Cantilena
- Cancer Section, Development Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Anna Mariana
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Tim W Failes
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Greg M Arndt
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Laurence C Cheung
- Leukemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Rishi S Kotecha
- Leukemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Rosemary Sutton
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- UNSW Centre for Childhood Cancer Research, UNSW Sydney, Sydney, Australia
| | - Owen Williams
- Cancer Section, Development Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Jasper de Boer
- Cancer Section, Development Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- UNSW Centre for Childhood Cancer Research, UNSW Sydney, Sydney, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia.
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia.
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2
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Xiao L, Karsa M, Ronca E, Bongers A, Kosciolek A, El-Ayoubi A, Revalde JL, Seneviratne JA, Cheung BB, Cheung LC, Kotecha RS, Newbold A, Bjelosevic S, Arndt GM, Lock RB, Johnstone RW, Gudkov AV, Gurova KV, Haber M, Norris MD, Henderson MJ, Somers K. The Combination of Curaxin CBL0137 and Histone Deacetylase Inhibitor Panobinostat Delays KMT2A-Rearranged Leukemia Progression. Front Oncol 2022; 12:863329. [PMID: 35677155 PMCID: PMC9168530 DOI: 10.3389/fonc.2022.863329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Rearrangements of the Mixed Lineage Leukemia (MLL/KMT2A) gene are present in approximately 10% of acute leukemias and characteristically define disease with poor outcome. Driven by the unmet need to develop better therapies for KMT2A-rearranged leukemia, we previously discovered that the novel anti-cancer agent, curaxin CBL0137, induces decondensation of chromatin in cancer cells, delays leukemia progression and potentiates standard of care chemotherapies in preclinical KMT2A-rearranged leukemia models. Based on the promising potential of histone deacetylase (HDAC) inhibitors as targeted anti-cancer agents for KMT2A-rearranged leukemia and the fact that HDAC inhibitors also decondense chromatin via an alternate mechanism, we investigated whether CBL0137 could potentiate the efficacy of the HDAC inhibitor panobinostat in KMT2A-rearranged leukemia models. The combination of CBL0137 and panobinostat rapidly killed KMT2A-rearranged leukemia cells by apoptosis and significantly delayed leukemia progression and extended survival in an aggressive model of MLL-AF9 (KMT2A:MLLT3) driven murine acute myeloid leukemia. The drug combination also exerted a strong anti-leukemia response in a rapidly progressing xenograft model derived from an infant with KMT2A-rearranged acute lymphoblastic leukemia, significantly extending survival compared to either monotherapy. The therapeutic enhancement between CBL0137 and panobinostat in KMT2A-r leukemia cells does not appear to be mediated through cooperative effects of the drugs on KMT2A rearrangement-associated histone modifications. Our data has identified the CBL0137/panobinostat combination as a potential novel targeted therapeutic approach to improve outcome for KMT2A-rearranged leukemia.
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Affiliation(s)
- Lin Xiao
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Emma Ronca
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Angelika Kosciolek
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Ali El-Ayoubi
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Jezrael L Revalde
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Janith A Seneviratne
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Belamy B Cheung
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Laurence C Cheung
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia.,Curtin Medical School, Curtin University, Perth, WA, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Rishi S Kotecha
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia.,Curtin Medical School, Curtin University, Perth, WA, Australia.,Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Andrea Newbold
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Stefan Bjelosevic
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg M Arndt
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Ricky W Johnstone
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrei V Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, United States
| | - Katerina V Gurova
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, United States
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, Sydney, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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3
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Gao J, Jung M, Williams RT, Hui D, Russell AJ, Naim AJ, Kamili A, Clifton M, Bongers A, Mayoh C, Ho G, Scott CL, Jessup W, Haber M, Norris MD, Henderson MJ. Suppression of the ABCA1 Cholesterol Transporter Impairs the Growth and Migration of Epithelial Ovarian Cancer. Cancers (Basel) 2022; 14:cancers14081878. [PMID: 35454786 PMCID: PMC9029800 DOI: 10.3390/cancers14081878] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer. Over 80% of cases have already spread at diagnosis, and these patients face a five-year survival rate of 35%. EOC cells often spread to the greater omentum, an abdominal fat pad. Here, EOC cells take-up cholesterols. Excessive amounts of cholesterol are lethal; thus, we proposed that the ABCA1 cholesterol transporter exports cholesterol from serous EOC cells to maintain cholesterol balance. Indeed, we found that reducing the level of ABCA1 could suppress serous EOC growth in two-dimensional as well as three-dimensional cell culture and also hindered their migration, a key process required for cancer spread. We also identified drugs that impair EOC cell growth by inhibiting cholesterol export. Our data demonstrate that disrupting the cholesterol balance by targeting ABCA1 may be an effective treatment strategy for EOC patients. Abstract Background: Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy with over 80% of cases already disseminated at diagnosis and facing a dismal five-year survival rate of 35%. EOC cells often spread to the greater omentum where they take-up cholesterol. Excessive amounts of cholesterol can be cytocidal, suggesting that cholesterol efflux through transporters may be important to maintain homeostasis, and this may explain the observation that high expression of the ATP-binding cassette A1 (ABCA1) cholesterol transporter has been associated with poor outcome in EOC patients. Methods: ABCA1 expression was silenced in EOC cells to investigate the effect of inhibiting cholesterol efflux on EOC biology through growth and migration assays, three-dimensional spheroid culture and cholesterol quantification. Results: ABCA1 suppression significantly reduced the growth, motility and colony formation of EOC cell lines as well as the size of EOC spheroids, whilst stimulating expression of ABCA1 reversed these effects. In serous EOC cells, ABCA1 suppression induced accumulation of cholesterol. Lowering cholesterol levels using methyl-B-cyclodextrin rescued the effect of ABCA1 suppression, restoring EOC growth. Furthermore, we identified FDA-approved agents that induced cholesterol accumulation and elicited cytocidal effects in EOC cells. Conclusions: Our data demonstrate the importance of ABCA1 in maintaining cholesterol balance and malignant properties in EOC cells, highlighting its potential as a therapeutic target for this disease.
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Affiliation(s)
- Jixuan Gao
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- Telomere Length Regulation Unit, Children’s Medical Research Institute, Westmead, NSW 2145, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Correspondence:
| | - MoonSun Jung
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Rebekka T. Williams
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
| | - Danica Hui
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
| | - Amanda J. Russell
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
| | - Andrea J. Naim
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
| | - Alvin Kamili
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Molly Clifton
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
| | - Angelika Bongers
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
| | - Chelsea Mayoh
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Gwo Ho
- Australia Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (G.H.); (C.L.S.)
| | - Clare L. Scott
- Australia Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (G.H.); (C.L.S.)
| | - Wendy Jessup
- ANZAC Research Institute, Concord, Sydney, NSW 2139, Australia;
| | - Michelle Haber
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Murray D. Norris
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- UNSW Centre for Childhood Cancer Research, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Michelle J. Henderson
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.); (R.T.W.); (D.H.); (A.J.R.); (A.J.N.); (A.K.); (M.C.); (A.B.); (C.M.); (M.H.); (M.D.N.); (M.J.H.)
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW 2052, Australia
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4
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Karsa M, Ronca E, Bongers A, Mariana A, Moles E, Failes TW, Arndt GM, Cheung LC, Kotecha RS, Kavallaris M, Haber M, Norris MD, Henderson MJ, Xiao L, Somers K. Systematic In Vitro Evaluation of a Library of Approved and Pharmacologically Active Compounds for the Identification of Novel Candidate Drugs for KMT2A-Rearranged Leukemia. Front Oncol 2022; 11:779859. [PMID: 35127484 PMCID: PMC8811472 DOI: 10.3389/fonc.2021.779859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/13/2021] [Indexed: 01/06/2023] Open
Abstract
Patients whose leukemias harbor a rearrangement of the Mixed Lineage Leukemia (MLL/KMT2A) gene have a poor prognosis, especially when the disease strikes in infants. The poor clinical outcome linked to this aggressive disease and the detrimental treatment side-effects, particularly in children, warrant the urgent development of more effective and cancer-selective therapeutics. The aim of this study was to identify novel candidate compounds that selectively target KMT2A-rearranged (KMT2A-r) leukemia cells. A library containing 3707 approved drugs and pharmacologically active compounds was screened for differential activity against KMT2A-r leukemia cell lines versus KMT2A-wild type (KMT2A-wt) leukemia cell lines, solid tumor cells and non-malignant cells by cell-based viability assays. The screen yielded SID7969543, an inhibitor of transcription factor Nuclear Receptor Subfamily 5 Group A Member 1 (NR5A1), that limited the viability of 7 out of 11 KMT2A-r leukemia cell lines including 5 out of 7 lines derived from infants, without affecting KMT2A-wt leukemia cells, solid cancer lines, non-malignant cell lines, or peripheral blood mononuclear cells from healthy controls. The compound also significantly inhibited growth of leukemia cell lines with a CALM-AF10 translocation, which defines a highly aggressive leukemia subtype that shares common underlying leukemogenic mechanisms with KMT2A-r leukemia. SID7969543 decreased KMT2A-r leukemia cell viability by inducing caspase-dependent apoptosis within hours of treatment and demonstrated synergy with established chemotherapeutics used in the treatment of high-risk leukemia. Thus, SID7969543 represents a novel candidate agent with selective activity against CALM-AF10 translocated and KMT2A-r leukemias that warrants further investigation.
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Affiliation(s)
- Mawar Karsa
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Emma Ronca
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Angelika Bongers
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Anna Mariana
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Ernest Moles
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Australian Research Council (ARC) Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for Nanomedicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Timothy W. Failes
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Greg M. Arndt
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Laurence C. Cheung
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Rishi S. Kotecha
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children’s Hospital, Perth, WA, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Maria Kavallaris
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Australian Research Council (ARC) Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for Nanomedicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Michelle Haber
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Murray D. Norris
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- University of New South Wales (UNSW) Centre for Childhood Cancer Research, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Michelle J. Henderson
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Lin Xiao
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Klaartje Somers
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- *Correspondence: Klaartje Somers,
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5
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Chen D, Sutton R, Giles J, Venn NC, Huang L, Law T, Subhash VV, Trahair TN, Henderson MJ. Analytical Quality Controls for ddPCR Detection of Minimal Residual Disease in Acute Lymphoblastic Leukemia. Clin Chem 2021. [DOI: 10.1093/clinchem/hvab117] [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: 11/13/2022]
Abstract
Abstract
Background
Droplet digital PCR (ddPCR) is a promising technique for absolute quantification of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL), but there is no comprehensive quality assurance program to enable its application in clinical laboratories. Current guidelines for real-time quantitative PCR (qPCR) assays targeting immunoglobulin/T-cell receptor (Ig/TCR) gene rearrangements needed adaptation for ddPCR to cover droplet generation, intraassay variation, and interassay variation in the absence of standard curves.
Methods
Six qPCR MRD assays for Ig/TCR gene rearrangements and a standard albumin control gene assay were migrated to a ddPCR platform and used to test 82 remission samples from 6 patients with ALL. Three analytical quality controls (QC) were developed and evaluated for ddPCR MRD detection.
Results
Analytical QC for droplet number generation (DN-QC), for albumin ddPCR assay performance (Alb-QC) and for patient-specific marker assay performance (PS-QC) were established with pass/fail limits and corresponding QC rules. Compared to established qPCRs, the ddPCR assays had comparable sensitivity and quantitative range. Overall, there was close agreement (91%) of MRD results between qPCR and ddPCR (κ = 0.86, P < 0.0001) and stronger concordance in 32 quantifiable samples (R2 = 0.97, P < 0.0001).
Conclusions
The use of this newly developed quality control system for ddPCR MRD testing avoids the need to repeat standard curves and provides reliable results comparable to standardized qPCR methods for MRD detection in ALL.
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Affiliation(s)
- Dan Chen
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Rosemary Sutton
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
- School of Women’s and Children’s Health, UNSW Medicine, Randwick, Australia
| | - Jodie Giles
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Nicola C Venn
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Libby Huang
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Tamara Law
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Vinod Vijay Subhash
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Toby N Trahair
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
- School of Women’s and Children’s Health, UNSW Medicine, Randwick, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Michelle J Henderson
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
- School of Women’s and Children’s Health, UNSW Medicine, Randwick, Australia
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6
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Xiao L, Somers K, Murray J, Pandher R, Karsa M, Ronca E, Bongers A, Terry R, Ehteda A, Gamble LD, Issaeva N, Leonova KI, O'Connor A, Mayoh C, Venkat P, Quek H, Brand J, Kusuma FK, Pettitt JA, Mosmann E, Kearns A, Eden G, Alfred S, Allan S, Zhai L, Kamili A, Gifford AJ, Carter DR, Henderson MJ, Fletcher JI, Marshall G, Johnstone RW, Cesare AJ, Ziegler DS, Gudkov AV, Gurova KV, Norris MD, Haber M. Dual Targeting of Chromatin Stability By The Curaxin CBL0137 and Histone Deacetylase Inhibitor Panobinostat Shows Significant Preclinical Efficacy in Neuroblastoma. Clin Cancer Res 2021; 27:4338-4352. [PMID: 33994371 DOI: 10.1158/1078-0432.ccr-20-2357] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/25/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated whether targeting chromatin stability through a combination of the curaxin CBL0137 with the histone deacetylase (HDAC) inhibitor, panobinostat, constitutes an effective multimodal treatment for high-risk neuroblastoma. EXPERIMENTAL DESIGN The effects of the drug combination on cancer growth were examined in vitro and in animal models of MYCN-amplified neuroblastoma. The molecular mechanisms of action were analyzed by multiple techniques including whole transcriptome profiling, immune deconvolution analysis, immunofluorescence, flow cytometry, pulsed-field gel electrophoresis, assays to assess cell growth and apoptosis, and a range of cell-based reporter systems to examine histone eviction, heterochromatin transcription, and chromatin compaction. RESULTS The combination of CBL0137 and panobinostat enhanced nucleosome destabilization, induced an IFN response, inhibited DNA damage repair, and synergistically suppressed cancer cell growth. Similar synergistic effects were observed when combining CBL0137 with other HDAC inhibitors. The CBL0137/panobinostat combination significantly delayed cancer progression in xenograft models of poor outcome high-risk neuroblastoma. Complete tumor regression was achieved in the transgenic Th-MYCN neuroblastoma model which was accompanied by induction of a type I IFN and immune response. Tumor transplantation experiments further confirmed that the presence of a competent adaptive immune system component allowed the exploitation of the full potential of the drug combination. CONCLUSIONS The combination of CBL0137 and panobinostat is effective and well-tolerated in preclinical models of aggressive high-risk neuroblastoma, warranting further preclinical and clinical investigation in other pediatric cancers. On the basis of its potential to boost IFN and immune responses in cancer models, the drug combination holds promising potential for addition to immunotherapies.
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Affiliation(s)
- Lin Xiao
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Jayne Murray
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Ruby Pandher
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Emma Ronca
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Rachael Terry
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Anahid Ehteda
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Laura D Gamble
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Natalia Issaeva
- Department of Otolaryngology/Head and Neck Surgery, Department of Pathology and Lab Medicine, Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Katerina I Leonova
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York
| | - Aisling O'Connor
- Children's Medical Research Institute, University of Sydney, Westmead, New South Wales, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Pooja Venkat
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Hazel Quek
- Mental Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jennifer Brand
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Frances K Kusuma
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Jessica A Pettitt
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Erin Mosmann
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Adam Kearns
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Georgina Eden
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Stephanie Alfred
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Sophie Allan
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Lei Zhai
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia
| | - Alvin Kamili
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Andrew J Gifford
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Daniel R Carter
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia.,School of Biomedical Engineering, University of Technology Sydney, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
| | - Glenn Marshall
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ricky W Johnstone
- Immune Defence Laboratory, Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anthony J Cesare
- Children's Medical Research Institute, University of Sydney, Westmead, New South Wales, Australia
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Andrei V Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York
| | - Katerina V Gurova
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia. .,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia.,University of New South Wales Centre for Childhood Cancer Research, Sydney, Australia
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales Sydney, New South Wales, Australia. .,School of Women's and Children's Health, University of New South Wales Sydney, Randwick, New South Wales, Australia
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7
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Sutton R, Pozza LD, Khaw SL, Fraser C, Revesz T, Chamberlain J, Mitchell R, Trahair TN, Bateman CM, Venn NC, Law T, Ong E, Heatley SL, McClure BJ, Meyer C, Marschalek R, Henderson MJ, Cross S, White DL, Kotecha RS. Outcomes for Australian children with relapsed/refractory acute lymphoblastic leukaemia treated with blinatumomab. Pediatr Blood Cancer 2021; 68:e28922. [PMID: 33638292 DOI: 10.1002/pbc.28922] [Citation(s) in RCA: 12] [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: 11/18/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023]
Abstract
We report on the Australian experience of blinatumomab for treatment of 24 children with relapsed/refractory precursor B-cell acute lymphoblastic leukaemia (B-ALL) and high-risk genetics, resulting in a minimal residual disease (MRD) response rate of 58%, 2-year progression-free survival (PFS) of 39% and 2-year overall survival of 63%. In total, 83% (n = 20/24) proceeded to haematopoietic stem cell transplant, directly after blinatumomab (n = 12) or following additional salvage therapy (n = 8). Four patients successfully received CD19-directed chimeric antigen receptor T-cell therapy despite prior blinatumomab exposure. Inferior 2-year PFS was associated with MRD positivity (20%, n = 15) and in KMT2A-rearranged infants (15%, n = 9). Our findings highlight that not all children with relapsed/refractory B-ALL respond to blinatumomab and factors such as blast genotype may affect prognosis.
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Affiliation(s)
- Rosemary Sutton
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Luciano Dalla Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Seong Lin Khaw
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Chris Fraser
- Blood and Bone Marrow Transplant Program, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Tom Revesz
- Department of Clinical Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Janis Chamberlain
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Richard Mitchell
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Toby N Trahair
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Caroline M Bateman
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nicola C Venn
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia
| | - Tamara Law
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia
| | - Erika Ong
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia
| | - Susan L Heatley
- University of Adelaide, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Barbara J McClure
- University of Adelaide, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Claus Meyer
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia, Goethe University, Frankfurt, Germany
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia, Goethe University, Frankfurt, Germany
| | - Michelle J Henderson
- Molecular Diagnostics, Children's Cancer Institute, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Siobhan Cross
- Children's Haematology/Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Deborah L White
- University of Adelaide, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Australian Genomics Health Alliance, Parkville, Melbourne, Victoria, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
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8
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Gamble LD, Purgato S, Henderson MJ, Di Giacomo S, Russell AJ, Pigini P, Murray J, Valli E, Milazzo G, Giorgi FM, Cowley M, Ashton LJ, Bhalshankar J, Schleiermacher G, Rihani A, Van Maerken T, Vandesompele J, Speleman F, Versteeg R, Koster J, Eggert A, Noguera R, Stallings RL, Tonini GP, Fong K, Vaksman Z, Diskin SJ, Maris JM, London WB, Marshall GM, Ziegler DS, Hogarty MD, Perini G, Norris MD, Haber M. A G316A Polymorphism in the Ornithine Decarboxylase Gene Promoter Modulates MYCN-Driven Childhood Neuroblastoma. Cancers (Basel) 2021; 13:cancers13081807. [PMID: 33918978 PMCID: PMC8069650 DOI: 10.3390/cancers13081807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Neuroblastoma is a devasting childhood cancer in which multiple copies (amplification) of the cancer-causing gene MYCN strongly predict poor outcome. Neuroblastomas are reliant on high levels of cellular components called polyamines for their growth and malignant behavior, and the gene regulating polyamine synthesis is called ODC1. ODC1 is often coamplified with MYCN, and in fact is regulated by MYCN, and like MYCN is prognostic of poor outcome. Here we studied a naturally occurring genetic variant or polymorphism that occurs in the ODC1 gene, and used gene editing to demonstrate the functional importance of this variant in terms of ODC1 levels and growth of neuroblastoma cells. We showed that this variant impacts the ability of MYCN to regulate ODC1, and that it also influences outcome in neuroblastoma, with the rarer variant associated with a better survival. This study addresses the important topic of genetic polymorphisms in cancer. Abstract Ornithine decarboxylase (ODC1), a critical regulatory enzyme in polyamine biosynthesis, is a direct transcriptional target of MYCN, amplification of which is a powerful marker of aggressive neuroblastoma. A single nucleotide polymorphism (SNP), G316A, within the first intron of ODC1, results in genotypes wildtype GG, and variants AG/AA. CRISPR-cas9 technology was used to investigate the effects of AG clones from wildtype MYCN-amplified SK-N-BE(2)-C cells and the effect of the SNP on MYCN binding, and promoter activity was investigated using EMSA and luciferase assays. AG clones exhibited decreased ODC1 expression, growth rates, and histone acetylation and increased sensitivity to ODC1 inhibition. MYCN was a stronger transcriptional regulator of the ODC1 promoter containing the G allele, and preferentially bound the G allele over the A. Two neuroblastoma cohorts were used to investigate the clinical impact of the SNP. In the study cohort, the minor AA genotype was associated with improved survival, while poor prognosis was associated with the GG genotype and AG/GG genotypes in MYCN-amplified and non-amplified patients, respectively. These effects were lost in the GWAS cohort. We have demonstrated that the ODC1 G316A polymorphism has functional significance in neuroblastoma and is subject to allele-specific regulation by the MYCN oncoprotein.
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Affiliation(s)
- Laura D. Gamble
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
| | - Stefania Purgato
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Michelle J. Henderson
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
| | - Simone Di Giacomo
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Amanda J. Russell
- Cancer Research Program, The Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia;
| | - Paolo Pigini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Jayne Murray
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
| | - Emanuele Valli
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
| | - Giorgio Milazzo
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Federico M. Giorgi
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Mark Cowley
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
| | - Lesley J. Ashton
- Research Portfolio, University of Sydney, Sydney, NSW 2008, Australia;
| | - Jaydutt Bhalshankar
- SIREDO, Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (J.B.); (G.S.)
| | - Gudrun Schleiermacher
- SIREDO, Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (J.B.); (G.S.)
| | - Ali Rihani
- Center for Medical Genetics, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (A.R.); (T.V.M.); (J.V.); (F.S.)
| | - Tom Van Maerken
- Center for Medical Genetics, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (A.R.); (T.V.M.); (J.V.); (F.S.)
| | - Jo Vandesompele
- Center for Medical Genetics, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (A.R.); (T.V.M.); (J.V.); (F.S.)
| | - Frank Speleman
- Center for Medical Genetics, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (A.R.); (T.V.M.); (J.V.); (F.S.)
| | - Rogier Versteeg
- Department of Oncogenomics, Academic Medical Center, University of Amsterdam, 1100 Amsterdam, The Netherlands; (R.V.); (J.K.)
| | - Jan Koster
- Department of Oncogenomics, Academic Medical Center, University of Amsterdam, 1100 Amsterdam, The Netherlands; (R.V.); (J.K.)
| | - Angelika Eggert
- Department of Pediatric Hematology, Oncology and SCT, Charité-University Hospital Berlin, Campus Virchow-Klinikum, 10117 Berlin, Germany;
| | - Rosa Noguera
- Department of Pathology, Medical School, University of Valencia, 46010 Valencia, Spain;
- CIBERONC-INCLIVA, Biomedical Health Research Institute, 46010 Valencia, Spain
| | - Raymond L. Stallings
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, D02 YN77 Dublin 2, Ireland;
| | - Gian Paolo Tonini
- Neuroblastoma Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, 35127 Padova, Italy;
| | - Kwun Fong
- Thoracic Research Centre, University of Queensland, The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
| | - Zalman Vaksman
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (Z.V.); (S.J.D.); (J.M.M.); (M.D.H.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sharon J. Diskin
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (Z.V.); (S.J.D.); (J.M.M.); (M.D.H.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John M. Maris
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (Z.V.); (S.J.D.); (J.M.M.); (M.D.H.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wendy B. London
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Glenn M. Marshall
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
- Kids Cancer Centre, Sydney Children’s Hospital, High St, Randwick, NSW 2031, Australia
| | - David S. Ziegler
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
- Kids Cancer Centre, Sydney Children’s Hospital, High St, Randwick, NSW 2031, Australia
| | - Michael D. Hogarty
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (Z.V.); (S.J.D.); (J.M.M.); (M.D.H.)
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Giovanni Perini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.P.); (S.D.G.); (P.P.); (G.M.); (F.M.G.); (G.P.)
| | - Murray D. Norris
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
- Centre for Childhood Cancer Research, University of New South Wales, Sydney, NSW 2052, Australia
| | - Michelle Haber
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, PO Box 81, Randwick, NSW 2031, Australia; (L.D.G.); (M.J.H.); (J.M.); (E.V.); (M.C.); (G.M.M.); (D.S.Z.); (M.D.N.)
- Correspondence: ; Tel.: +61-(02)-9385-2170
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9
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Jessop S, Ruhayel S, Sutton R, Youlden DR, Pearson G, Lu C, Milne S, Henderson MJ, Aitken JF, Kotecha RS, Revesz T. Are outcomes for childhood leukaemia in Australia influenced by geographical remoteness and Indigenous race? Pediatr Blood Cancer 2021; 68:e28945. [PMID: 33565233 DOI: 10.1002/pbc.28945] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Presenting features, biology and outcome for childhood leukaemia are known to vary by ethnic origin, geographic location and socioeconomic group. This study aimed to compare presentation patterns, follow-up and clinical outcomes in Indigenous and non-Indigenous children with acute leukaemia in Australia, and to assess the impact of remoteness and area-based socioeconomic disadvantage on outcome. METHODS A retrospective review of children aged between 1 day and 18 years who were diagnosed with acute leukaemia in South Australia (SA), Northern Territory (NT) and Western Australia (WA) between 2009 and 2018 was performed. Data were collected from children treated at the Women's and Children's Hospital, Adelaide and Perth Children's Hospital. RESULTS Analysis of 455 children treated for acute leukaemia showed that children from remote/very remote localities had inferior overall survival (p = .004). Five-year overall survival was 91.7% (95% CI: 87.9-94.3%) for children with acute lymphoblastic leukaemia (ALL) and 69.8% (56.7-79.5%) for acute myeloid leukaemia (AML). A larger proportion of Indigenous children from SA/NT were diagnosed with AML compared to non-Indigenous children (60.0% vs. 14.4%, p = .001). Indigenous children were less likely to be enrolled on clinical trials (34.5% vs. 53.1%, p = .03) and more likely to be lost to follow-up (26.1% vs. 9.2%, p = .009). CONCLUSION Geographic remoteness of residence is associated with inferior overall survival for Australian children with leukaemia. Indigenous children with acute leukaemia suffer from disparities in outcomes. These findings provide evidence to guide national policy in supporting appropriate resource allocation to overcome the challenges faced by children within these groups.
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Affiliation(s)
- Sophie Jessop
- Department of Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sandra Ruhayel
- Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Rosemary Sutton
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Research Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Glenn Pearson
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Cynthia Lu
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Suzanne Milne
- Department of Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Research Institute, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Tom Revesz
- Department of Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,MRD Team, University of Adelaide, Adelaide, South Australia, Australia
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10
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Putra V, Hulme AJ, Tee AE, Sun JQ, Atmadibrata B, Ho N, Chen J, Gao J, Norris MD, Haber M, Kavallaris M, Henderson MJ, McCarroll J, Trahair T, Liu T, Liu PY. The RNA-helicase DDX21 upregulates CEP55 expression and promotes neuroblastoma. Mol Oncol 2021; 15:1162-1179. [PMID: 33497018 PMCID: PMC8024731 DOI: 10.1002/1878-0261.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
Approximately 25% of human neuroblastoma is caused by amplification of the MYCN oncogene, which leads to overexpression of N-Myc oncoprotein. The survival rate for this patient subtype is <50%. Here, we show that N-Myc protein bound to the DEAD-box RNA helicase DDX21 gene promoter and upregulated DDX21 mRNA and protein expression. Genome-wide differential gene expression studies identified centrosomal protein CEP55 as one of the genes most dramatically downregulated after DDX21 knockdown in MYCN-amplified neuroblastoma cells. Knocking down DDX21 or CEP55 reduced neuroblastoma cell cytoskeleton stability and cell proliferation and all but abolished clonogenic capacity. Importantly, DDX21 knockdown initially induced tumor regression in neuroblastoma-bearing mice and suppressed tumor progression. In human neuroblastoma tissues, a high level of DDX21 expression correlated with a high level of N-Myc expression and with CEP55 expression, and independently predicted poor patient prognosis. Taken together, our data show that DDX21 induces CEP55 expression, MYCN-amplified neuroblastoma cell proliferation, and tumorigenesis, and that DDX21 and CEP55 are valid therapeutic targets for the treatment of MYCN-amplified neuroblastoma.
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Affiliation(s)
- Vina Putra
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Amy J. Hulme
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Andrew E. Tee
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Jane Q.J. Sun
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Bernard Atmadibrata
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Nicholas Ho
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Jingwei Chen
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Jixuan Gao
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Murray D. Norris
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
- University of New South Wales Centre for Childhood Cancer ResearchSydneyNSWAustralia
| | - Michelle Haber
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Maria Kavallaris
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
- ARC Centre of Excellence in Convergent Bio‐Nano Science and TechnologyAustralian Centre for NanomedicineUNSW SydneyKensingtonNSWAustralia
- School of Women’s and Children’s HealthFaculty of MedicineUNSW SydneyKensingtonNSWAustralia
| | - Michelle J. Henderson
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Joshua McCarroll
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Toby Trahair
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Tao Liu
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
| | - Pei Y. Liu
- Children’s Cancer InstituteLowy Cancer Research CentreUNSW SydneyKensingtonNSWAustralia
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11
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Talhouk A, George J, Wang C, Budden T, Tan TZ, Chiu DS, Kommoss S, Leong HS, Chen S, Intermaggio MP, Gilks B, Nazeran TM, Volchek M, Elatre W, Bentley RC, Senz J, Lum A, Chow V, Sudderuddin H, Mackenzie R, Leong SCY, Liu G, Johnson D, Chen B, Group A, Alsop J, Banerjee SN, Behrens S, Bodelon C, Brand AH, Brinton L, Carney ME, Chiew YE, Cushing-Haugen KL, Cybulski C, Ennis D, Fereday S, Fortner RT, García-Donas J, Gentry-Maharaj A, Glasspool R, Goranova T, Greene CS, Haluska P, Harris HR, Hendley J, Hernandez BY, Herpel E, Jimenez-Linan M, Karpinskyj C, Kaufmann SH, Keeney GL, Kennedy CJ, Köbel M, Koziak JM, Larson MC, Lester J, Lewsley LA, Lissowska J, Lubiński J, Luk H, Macintyre G, Mahner S, McNeish IA, Menkiszak J, Nevins N, Osorio A, Oszurek O, Palacios J, Hinsley S, Pearce CL, Pike MC, Piskorz AM, Ray-Coquard I, Rhenius V, Rodriguez-Antona C, Sharma R, Sherman ME, De Silva D, Singh N, Sinn P, Slamon D, Song H, Steed H, Stronach EA, Thompson PJ, Tołoczko A, Trabert B, Traficante N, Tseng CC, Widschwendter M, Wilkens LR, Winham SJ, Winterhoff B, Beeghly-Fadiel A, Benitez J, Berchuck A, Brenton JD, Brown R, Chang-Claude J, Chenevix-Trench G, deFazio A, Fasching PA, García MJ, Gayther SA, Goodman MT, Gronwald J, Henderson MJ, Karlan BY, Kelemen LE, Menon U, Orsulic S, Pharoah PDP, Wentzensen N, Wu AH, Schildkraut JM, Rossing MA, Konecny GE, Huntsman DG, Huang RYJ, Goode EL, Ramus SJ, Doherty JA, Bowtell DD, Anglesio MS. Development and Validation of the Gene Expression Predictor of High-grade Serous Ovarian Carcinoma Molecular SubTYPE (PrOTYPE). Clin Cancer Res 2020; 26:5411-5423. [PMID: 32554541 PMCID: PMC7572656 DOI: 10.1158/1078-0432.ccr-20-0103] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Received: 01/11/2020] [Revised: 03/31/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Gene expression-based molecular subtypes of high-grade serous tubo-ovarian cancer (HGSOC), demonstrated across multiple studies, may provide improved stratification for molecularly targeted trials. However, evaluation of clinical utility has been hindered by nonstandardized methods, which are not applicable in a clinical setting. We sought to generate a clinical grade minimal gene set assay for classification of individual tumor specimens into HGSOC subtypes and confirm previously reported subtype-associated features. EXPERIMENTAL DESIGN Adopting two independent approaches, we derived and internally validated algorithms for subtype prediction using published gene expression data from 1,650 tumors. We applied resulting models to NanoString data on 3,829 HGSOCs from the Ovarian Tumor Tissue Analysis consortium. We further developed, confirmed, and validated a reduced, minimal gene set predictor, with methods suitable for a single-patient setting. RESULTS Gene expression data were used to derive the predictor of high-grade serous ovarian carcinoma molecular subtype (PrOTYPE) assay. We established a de facto standard as a consensus of two parallel approaches. PrOTYPE subtypes are significantly associated with age, stage, residual disease, tumor-infiltrating lymphocytes, and outcome. The locked-down clinical grade PrOTYPE test includes a model with 55 genes that predicted gene expression subtype with >95% accuracy that was maintained in all analytic and biological validations. CONCLUSIONS We validated the PrOTYPE assay following the Institute of Medicine guidelines for the development of omics-based tests. This fully defined and locked-down clinical grade assay will enable trial design with molecular subtype stratification and allow for objective assessment of the predictive value of HGSOC molecular subtypes in precision medicine applications.See related commentary by McMullen et al., p. 5271.
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Affiliation(s)
- Aline Talhouk
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, Canada
| | - Joshy George
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Chen Wang
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Department of Health Science Research, Rochester, Minnesota
| | - Timothy Budden
- University of NSW Sydney, School of Women's and Children's Health, Faculty of Medicine, Sydney, New South Wales, Australia
- The University of Manchester, CRUK Manchester Institute, Manchester, United Kingdom
| | - Tuan Zea Tan
- National University of Singapore, Cancer Science Institute of Singapore, Center for Translational Medicine, Singapore, Singapore
| | - Derek S Chiu
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stefan Kommoss
- Tuebingen University Hospital, Department of Women's Health, Tuebingen, Germany
| | - Huei San Leong
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
| | - Stephanie Chen
- Cedars-Sinai Medical Center, Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Maria P Intermaggio
- University of NSW Sydney, School of Women's and Children's Health, Faculty of Medicine, Sydney, New South Wales, Australia
| | - Blake Gilks
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tayyebeh M Nazeran
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mila Volchek
- Royal Women's Hospital, Anatomical Pathology, Parkville, Victoria, Australia
| | - Wafaa Elatre
- Department of Pathology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rex C Bentley
- Department of Pathology, Duke University Hospital, Durham, North Carolina
| | - Janine Senz
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy Lum
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Veronica Chow
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hanwei Sudderuddin
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Robertson Mackenzie
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Samuel C Y Leong
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Geyi Liu
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Dustin Johnson
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Billy Chen
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aocs Group
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, Queensland, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Alsop
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Susana N Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Gynaecology Unit, London, United Kingdom
| | - Sabine Behrens
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Clara Bodelon
- NCI, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland
| | - Alison H Brand
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Louise Brinton
- NCI, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland
| | - Michael E Carney
- Department of Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Yoke-Eng Chiew
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kara L Cushing-Haugen
- Fred Hutchinson Cancer Research Center, Program in Epidemiology, Division of Public Health Sciences, Seattle, Washington
| | - Cezary Cybulski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Darren Ennis
- Imperial College London, Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, London, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sian Fereday
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Renée T Fortner
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Jesús García-Donas
- HM Hospitales Centro Integral Oncológico Clara Campal (HM CIOCC), Madrid, Spain
| | - Aleksandra Gentry-Maharaj
- University College London, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, United Kingdom
| | - Rosalind Glasspool
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, United Kingdom
| | - Teodora Goranova
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Casey S Greene
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul Haluska
- Mayo Clinic, Department of Oncology, Rochester, Minnesota
| | - Holly R Harris
- Fred Hutchinson Cancer Research Center, Program in Epidemiology, Division of Public Health Sciences, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joy Hendley
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Brenda Y Hernandez
- University of Hawaii Cancer Center, Cancer Epidemiology Program, Honolulu, Hawaii
| | - Esther Herpel
- Institute of Pathology and NCT Tissue Bank, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Chloe Karpinskyj
- University College London, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, United Kingdom
| | - Scott H Kaufmann
- Mayo Clinic, Department of Oncology, Rochester, Minnesota
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Gary L Keeney
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Catherine J Kennedy
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | | | - Melissa C Larson
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Department of Health Science Research, Rochester, Minnesota
| | - Jenny Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California
- Cedars-Sinai Medical Center, Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jolanta Lissowska
- M Sklodowska Curie National Research Institute of Oncology, Department of Cancer Epidemiology and Prevention, Warsaw, Poland
| | - Jan Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Hugh Luk
- University of Hawaii Cancer Center, Cancer Epidemiology Program, Honolulu, Hawaii
| | - Geoff Macintyre
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Iain A McNeish
- Imperial College London, Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, London, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Nikilyn Nevins
- Department of Gynaecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Ana Osorio
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, Spain
| | - Oleg Oszurek
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - José Palacios
- Hospital Universitario Ramón y Cajal, Pathology Department. IRYCIS. CIBERONC. Universidad de Alcalá, Madrid, Spain
| | - Samantha Hinsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Celeste L Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Malcolm C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anna M Piskorz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | | | - Valerie Rhenius
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Cristina Rodriguez-Antona
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Raghwa Sharma
- Pathology West ICPMR Westmead, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
- University of Western Sydney at Westmead Hospital, Sydney, New South Wales, Australia
| | - Mark E Sherman
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Dilrini De Silva
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, London, United Kingdom
| | - Peter Sinn
- Department of Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dennis Slamon
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Honglin Song
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Helen Steed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Euan A Stronach
- Imperial College London, Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, London, United Kingdom
| | - Pamela J Thompson
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Los Angeles, California
| | - Aleksandra Tołoczko
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Britton Trabert
- NCI, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland
| | - Nadia Traficante
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Lynne R Wilkens
- University of Hawaii Cancer Center, Cancer Epidemiology Program, Honolulu, Hawaii
| | - Stacey J Winham
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Department of Health Science Research, Rochester, Minnesota
| | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Javier Benitez
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, Spain
| | - Andrew Berchuck
- Department of Gynecologic Oncology, Duke University Hospital, Durham, North Carolina
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Robert Brown
- Division of Cancer and Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jenny Chang-Claude
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
- University Medical Center Hamburg-Eppendorf, Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Georgia Chenevix-Trench
- QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, Queensland, Australia
| | - Anna deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Peter A Fasching
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - María J García
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Simon A Gayther
- Cedars-Sinai Medical Center, Center for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics Core, Los Angeles, California
| | - Marc T Goodman
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Los Angeles, California
| | - Jacek Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, New South Wales, Australia
| | - Beth Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California
- Cedars-Sinai Medical Center, Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Linda E Kelemen
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Usha Menon
- University College London, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, United Kingdom
| | - Sandra Orsulic
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California
- Cedars-Sinai Medical Center, Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Anne Rossing
- Fred Hutchinson Cancer Research Center, Program in Epidemiology, Division of Public Health Sciences, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Gottfried E Konecny
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - David G Huntsman
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Ruby Yun-Ju Huang
- National University of Singapore, Cancer Science Institute of Singapore, Center for Translational Medicine, Singapore, Singapore
- National Taiwan University, School of Medicine, College of Medicine, Taipei City, Taiwan
| | - Ellen L Goode
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, Minnesota.
| | - Susan J Ramus
- University of NSW Sydney, School of Women's and Children's Health, Faculty of Medicine, Sydney, New South Wales, Australia.
- Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, New South Wales, Australia
| | - Jennifer A Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
| | - David D Bowtell
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael S Anglesio
- British Columbia's Gynecological Cancer Research Program (OVCARE), BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, British Columbia, Canada.
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Millstein J, Budden T, Goode EL, Anglesio MS, Talhouk A, Intermaggio MP, Leong HS, Chen S, Elatre W, Gilks B, Nazeran T, Volchek M, Bentley RC, Wang C, Chiu DS, Kommoss S, Leung SCY, Senz J, Lum A, Chow V, Sudderuddin H, Mackenzie R, George J, Fereday S, Hendley J, Traficante N, Steed H, Koziak JM, Köbel M, McNeish IA, Goranova T, Ennis D, Macintyre G, Silva De Silva D, Ramón Y Cajal T, García-Donas J, Hernando Polo S, Rodriguez GC, Cushing-Haugen KL, Harris HR, Greene CS, Zelaya RA, Behrens S, Fortner RT, Sinn P, Herpel E, Lester J, Lubiński J, Oszurek O, Tołoczko A, Cybulski C, Menkiszak J, Pearce CL, Pike MC, Tseng C, Alsop J, Rhenius V, Song H, Jimenez-Linan M, Piskorz AM, Gentry-Maharaj A, Karpinskyj C, Widschwendter M, Singh N, Kennedy CJ, Sharma R, Harnett PR, Gao B, Johnatty SE, Sayer R, Boros J, Winham SJ, Keeney GL, Kaufmann SH, Larson MC, Luk H, Hernandez BY, Thompson PJ, Wilkens LR, Carney ME, Trabert B, Lissowska J, Brinton L, Sherman ME, Bodelon C, Hinsley S, Lewsley LA, Glasspool R, Banerjee SN, Stronach EA, Haluska P, Ray-Coquard I, Mahner S, Winterhoff B, Slamon D, Levine DA, Kelemen LE, Benitez J, Chang-Claude J, Gronwald J, Wu AH, Menon U, Goodman MT, Schildkraut JM, Wentzensen N, Brown R, Berchuck A, Chenevix-Trench G, deFazio A, Gayther SA, García MJ, Henderson MJ, Rossing MA, Beeghly-Fadiel A, Fasching PA, Orsulic S, Karlan BY, Konecny GE, Huntsman DG, Bowtell DD, Brenton JD, Doherty JA, Pharoah PDP, Ramus SJ. Prognostic gene expression signature for high-grade serous ovarian cancer. Ann Oncol 2020; 31:1240-1250. [PMID: 32473302 PMCID: PMC7484370 DOI: 10.1016/j.annonc.2020.05.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Median overall survival (OS) for women with high-grade serous ovarian cancer (HGSOC) is ∼4 years, yet survival varies widely between patients. There are no well-established, gene expression signatures associated with prognosis. The aim of this study was to develop a robust prognostic signature for OS in patients with HGSOC. PATIENTS AND METHODS Expression of 513 genes, selected from a meta-analysis of 1455 tumours and other candidates, was measured using NanoString technology from formalin-fixed paraffin-embedded tumour tissue collected from 3769 women with HGSOC from multiple studies. Elastic net regularization for survival analysis was applied to develop a prognostic model for 5-year OS, trained on 2702 tumours from 15 studies and evaluated on an independent set of 1067 tumours from six studies. RESULTS Expression levels of 276 genes were associated with OS (false discovery rate < 0.05) in covariate-adjusted single-gene analyses. The top five genes were TAP1, ZFHX4, CXCL9, FBN1 and PTGER3 (P < 0.001). The best performing prognostic signature included 101 genes enriched in pathways with treatment implications. Each gain of one standard deviation in the gene expression score conferred a greater than twofold increase in risk of death [hazard ratio (HR) 2.35, 95% confidence interval (CI) 2.02-2.71; P < 0.001]. Median survival [HR (95% CI)] by gene expression score quintile was 9.5 (8.3 to -), 5.4 (4.6-7.0), 3.8 (3.3-4.6), 3.2 (2.9-3.7) and 2.3 (2.1-2.6) years. CONCLUSION The OTTA-SPOT (Ovarian Tumor Tissue Analysis consortium - Stratified Prognosis of Ovarian Tumours) gene expression signature may improve risk stratification in clinical trials by identifying patients who are least likely to achieve 5-year survival. The identified novel genes associated with the outcome may also yield opportunities for the development of targeted therapeutic approaches.
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Affiliation(s)
- J Millstein
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - T Budden
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia; CRUK Manchester Institute, The University of Manchester, Manchester, UK
| | - E L Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, USA
| | - M S Anglesio
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - A Talhouk
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - M P Intermaggio
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - H S Leong
- Peter MacCallum Cancer Center, Melbourne, Australia
| | - S Chen
- Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - W Elatre
- Department of Pathology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, USA
| | - B Gilks
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - T Nazeran
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - M Volchek
- Anatomical Pathology, Royal Women's Hospital, Parkville, Australia
| | - R C Bentley
- Department of Pathology, Duke University Hospital, Durham, USA
| | - C Wang
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - D S Chiu
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - S C Y Leung
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - J Senz
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - A Lum
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - V Chow
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - H Sudderuddin
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - R Mackenzie
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - J George
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - S Fereday
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - J Hendley
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - N Traficante
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, Edmonton, Canada
| | - J M Koziak
- Alberta Health Services-Cancer Care, Calgary, Canada
| | - M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, Calgary, Canada
| | - I A McNeish
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - T Goranova
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - D Ennis
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - G Macintyre
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - D Silva De Silva
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - T Ramón Y Cajal
- Medical Oncology Service, Hospital Sant Pau, Barcelona, Spain
| | - J García-Donas
- HM Hospitales D Centro Integral Oncológico HM Clara Campal, Madrid, Spain
| | - S Hernando Polo
- Medical Oncology Service, Hospital Universitario Funcacion Alcorcon, Alcorcón, Spain
| | - G C Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, University of Chicago, Evanston, USA
| | - K L Cushing-Haugen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - H R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Epidemiology, University of Washington, Seattle, USA
| | - C S Greene
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - R A Zelaya
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - S Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Sinn
- Department of Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - E Herpel
- Department of Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - J Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - O Oszurek
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - A Tołoczko
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - C Cybulski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - J Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - C L Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA; Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - M C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - C Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - J Alsop
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - V Rhenius
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - H Song
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - M Jimenez-Linan
- Department of Pathology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - A M Piskorz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - A Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - C Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - M Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - N Singh
- Department of Pathology, Barts Health National Health Service Trust, London, UK
| | - C J Kennedy
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - R Sharma
- Pathology West ICPMR Westmead, Westmead Hospital, The University of Sydney, Sydney, Australia; University of Western Sydney at Westmead Hospital, Sydney, Australia
| | - P R Harnett
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Crown Princess Mary Cancer Centre Westmead, Sydney-West Cancer Network, Westmead Hospital, Sydney, Australia
| | - B Gao
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Crown Princess Mary Cancer Centre Westmead, Sydney-West Cancer Network, Westmead Hospital, Sydney, Australia
| | - S E Johnatty
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - R Sayer
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - J Boros
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - S J Winham
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, USA
| | - S H Kaufmann
- Department of Oncology, Mayo Clinic, Rochester, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - M C Larson
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - H Luk
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - B Y Hernandez
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - P J Thompson
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, USA
| | - L R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - M E Carney
- John A. Burns School of Medicine, Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, USA
| | - B Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - J Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - M E Sherman
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, USA
| | - C Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - S Hinsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L A Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - R Glasspool
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, UK
| | - S N Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - E A Stronach
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK
| | - P Haluska
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - I Ray-Coquard
- Centre Leon Berard and University Claude Bernard Lyon 1, Lyon, France
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - B Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, USA
| | - D Slamon
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA
| | - D A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Gynecologic Oncology, Laura and Isaac Pearlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - L E Kelemen
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - J Benitez
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - A H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - U Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - M T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - N Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - R Brown
- Division of Cancer and Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Berchuck
- Department of Gynecologic Oncology, Duke University Hospital, Durham, USA
| | - G Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - A deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - S A Gayther
- Center for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics Core, Cedars-Sinai Medical Center, Los Angeles, USA
| | - M J García
- Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - M J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, Australia
| | - M A Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Epidemiology, University of Washington, Seattle, USA
| | - A Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - P A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA; Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Orsulic
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - B Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - G E Konecny
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA
| | - D G Huntsman
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, Canada
| | - D D Bowtell
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - J D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - J A Doherty
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - P D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S J Ramus
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia; Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, Australia.
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Gao J, Jung M, Mayoh C, Venkat P, Hannan KM, Fletcher JI, Kamili A, Gifford AJ, Kusnadi EP, Pearson RB, Hannan RD, Haber M, Norris MD, Somers K, Henderson MJ. Suppression of ABCE1-Mediated mRNA Translation Limits N-MYC-Driven Cancer Progression. Cancer Res 2020; 80:3706-3718. [PMID: 32651259 DOI: 10.1158/0008-5472.can-19-3914] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
The ability of the N-MYC transcription factor to drive cancer progression is well demonstrated in neuroblastoma, the most common extracranial pediatric solid tumor, where MYCN amplification heralds a poor prognosis, with only 11% of high-risk patients surviving past 5 years. However, decades of attempts of direct inhibition of N-MYC or its paralogues has led to the conclusion that this protein is "undruggable." Therefore, targeting pathways upregulated by N-MYC signaling presents an alternative therapeutic approach. Here, we show that MYCN-amplified neuroblastomas are characterized by elevated rates of protein synthesis and that high expression of ABCE1, a translation factor directly upregulated by N-MYC, is itself a strong predictor of poor clinical outcome. Despite the potent ability of N-MYC in heightening protein synthesis and malignant characteristics in cancer cells, suppression of ABCE1 alone selectively negated this effect, returning the rate of translation to baseline levels and significantly reducing the growth, motility, and invasiveness of MYCN-amplified neuroblastoma cells and patient-derived xenograft tumors in vivo. The growth of nonmalignant cells or MYCN-nonamplified neuroblastoma cells remained unaffected by reduced ABCE1, supporting a therapeutic window associated with targeting ABCE1. Neuroblastoma cells with c-MYC overexpression also required ABCE1 to maintain cell proliferation and translation. Taken together, ABCE1-mediated translation constitutes a critical process in the progression of N-MYC-driven and c-MYC-driven cancers that warrants investigations into methods of its therapeutic inhibition. SIGNIFICANCE: These findings demonstrate that N-MYC-driven cancers are reliant on elevated rates of protein synthesis driven by heightened expression of ABCE1, a vulnerability that can be exploited through suppression of ABCE1.
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Affiliation(s)
- Jixuan Gao
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - MoonSun Jung
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Pooja Venkat
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine M Hannan
- The John Curtin School of Medical Research, The Australian National University, Canberra City.,Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Alvin Kamili
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Andrew J Gifford
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Eric P Kusnadi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard B Pearson
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ross D Hannan
- The John Curtin School of Medical Research, The Australian National University, Canberra City.,Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,UNSW Centre for Childhood Cancer Research, Sydney, New South Wales, Australia
| | - Klaartje Somers
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia. .,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
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14
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Jung M, Gao J, Cheung L, Bongers A, Somers K, Clifton M, Ramsay EE, Russell AJ, Valli E, Gifford AJ, George J, Kennedy CJ, Wakefield MJ, Topp M, Ho GY, Scott CL, Bowtell DD, deFazio A, Norris MD, Haber M, Henderson MJ. ABCC4/MRP4 contributes to the aggressiveness of Myc-associated epithelial ovarian cancer. Int J Cancer 2020; 147:2225-2238. [PMID: 32277480 DOI: 10.1002/ijc.33005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 12/24/2022]
Abstract
Epithelial ovarian cancer (EOC) is a complex disease comprising discrete histological and molecular subtypes, for which survival rates remain unacceptably low. Tailored approaches for this deadly heterogeneous disease are urgently needed. Efflux pumps belonging to the ATP-binding cassette (ABC) family of transporters are known for roles in both drug resistance and cancer biology and are also highly targetable. Here we have investigated the association of ABCC4/MRP4 expression to clinical outcome and its biological function in endometrioid and serous tumors, common histological subtypes of EOC. We found high expression of ABCC4/MRP4, previously shown to be directly regulated by c-Myc/N-Myc, was associated with poor prognosis in endometrioid EOC (P = .001) as well as in a subset of serous EOC with a "high-MYCN" profile (C5/proliferative; P = .019). Transient siRNA-mediated suppression of MRP4 in EOC cells led to reduced growth, migration and invasion, with the effects being most pronounced in endometrioid and C5-like serous cells compared to non-C5 serous EOC cells. Sustained knockdown of MRP4 also sensitized endometrioid cells to MRP4 substrate drugs. Furthermore, suppression of MRP4 decreased the growth of patient-derived EOC cells in vivo. Together, our findings provide the first evidence that MRP4 plays an important role in the biology of Myc-associated ovarian tumors and highlight this transporter as a potential therapeutic target for EOC.
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Affiliation(s)
- Moonsun Jung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,School of Women's and Children's Health, UNSW Australia, Kensington, New South Wales, Australia
| | - Jixuan Gao
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Leanna Cheung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Angelika Bongers
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Klaartje Somers
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,School of Women's and Children's Health, UNSW Australia, Kensington, New South Wales, Australia
| | - Molly Clifton
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Emma E Ramsay
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Amanda J Russell
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Emanuele Valli
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia
| | - Andrew J Gifford
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Joshy George
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine J Kennedy
- Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew J Wakefield
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Monique Topp
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Gwo-Yaw Ho
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
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- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Clare L Scott
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - David D Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna deFazio
- Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,School of Women's and Children's Health, UNSW Australia, Kensington, New South Wales, Australia.,University of New South Wales Centre for Childhood Cancer Research, UNSW Australia, Kensington, New South Wales, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,School of Women's and Children's Health, UNSW Australia, Kensington, New South Wales, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, New South Wales, Australia.,School of Women's and Children's Health, UNSW Australia, Kensington, New South Wales, Australia
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15
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Korotchkina L, Kazyulkin D, Komarov PG, Polinsky A, Andrianova EL, Joshi S, Gupta M, Vujcic S, Kononov E, Toshkov I, Tian Y, Krasnov P, Chernov MV, Veith J, Antoch MP, Middlemiss S, Somers K, Lock RB, Norris MD, Henderson MJ, Haber M, Chernova OB, Gudkov AV. OT-82, a novel anticancer drug candidate that targets the strong dependence of hematological malignancies on NAD biosynthesis. Leukemia 2020; 34:1828-1839. [PMID: 31896781 DOI: 10.1038/s41375-019-0692-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/23/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
Effective treatment of some types of cancer can be achieved by modulating cell lineage-specific rather than tumor-specific targets. We conducted a systematic search for novel agents selectively toxic to cells of hematopoietic origin. Chemical library screenings followed by hit-to-lead optimization identified OT-82, a small molecule with strong efficacy against hematopoietic malignancies including acute myeloblastic and lymphoblastic adult and pediatric leukemias, erythroleukemia, multiple myeloma, and Burkitt's lymphoma in vitro and in mouse xenograft models. OT-82 was also more toxic towards patients-derived leukemic cells versus healthy bone marrow-derived hematopoietic precursors. OT-82 was shown to induce cell death by inhibiting nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in the salvage pathway of NAD synthesis. In mice, optimization of OT-82 dosing and dietary niacin further expanded the compound's therapeutic index. In toxicological studies conducted in mice and nonhuman primates, OT-82 showed no cardiac, neurological or retinal toxicities observed with other NAMPT inhibitors and had no effect on mouse aging or longevity. Hematopoietic and lymphoid organs were identified as the primary targets for dose limiting toxicity of OT-82 in both species. These results reveal strong dependence of neoplastic cells of hematopoietic origin on NAMPT and introduce OT-82 as a promising candidate for the treatment of hematological malignancies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jean Veith
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | | | | | | | - Murray D Norris
- Children's Cancer Institute, Sydney, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, Sydney, NSW, Australia
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16
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Huynh T, Murray J, Flemming CL, Kamili A, Hofmann U, Cheung L, Roundhill EA, Yu DMT, Webber HT, Schwab M, Henderson MJ, Haber M, Norris MD, Fletcher JI. CCI52 sensitizes tumors to 6-mercaptopurine and inhibits MYCN-amplified tumor growth. Biochem Pharmacol 2019; 172:113770. [PMID: 31862449 DOI: 10.1016/j.bcp.2019.113770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
The antimetabolite 6-mercaptopurine (6-MP) is an important component in the treatment of specific cancer subtypes, however, the development of drug resistance and dose-limiting toxicities can limit its effectiveness. The therapeutic activity of 6-MP requires cellular uptake, enzymatic conversion to thio-GMP and incorporation of thio-GTP into RNA and DNA, as well as inhibition of de novo purine synthesis by methyl-thio-IMP. Mechanisms that prevent 6-MP entry into the cell, prevent 6-MP metabolism or deplete thiopurine intermediates, can all lead to 6-MP resistance. We previously conducted a high-throughput screen for inhibitors of the multidrug transporter MRP4 using 6-MP sensitivity as the readout. In addition to MRP4-specific inhibitors, we identified a compound, CCI52, that sensitized cell lines to 6-MP independent of this transporter. CCI52 and its more stable analogue CCI52-14 also function as effective chemosensitizers in vivo, substantially extending survival in a transgenic mouse cancer model treated with 6-MP. Chemosensitization was associated with an increase in thio-IMP, suggesting that CCI52 functions directly on 6-MP uptake or metabolism. In addition to its chemosensitizing effects, CCI52 and CCI52-14 inhibited the growth of MYCN-amplified high-risk neuroblastoma cell lines and delayed tumor progression in a MYCN-driven, transgenic mouse model of neuroblastoma. These multifunctional inhibitors may be useful for the further development of anticancer agents and as tools to better understand 6-MP metabolism.
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Affiliation(s)
- Tony Huynh
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Jayne Murray
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Claudia L Flemming
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Alvin Kamili
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Ute Hofmann
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tuebingen, Tuebingen, Germany
| | - Leanna Cheung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Elizabeth A Roundhill
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Denise M T Yu
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Hannah T Webber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tuebingen, Tuebingen, Germany; Departments of Clinical Pharmacology, and of Pharmacy and Biochemistry, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia; University of New South Wales Centre for Childhood Cancer Research, UNSW Sydney, Kensington, NSW, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Sydney, Kensington, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.
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17
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Liu PY, Tee AE, Milazzo G, Hannan KM, Maag J, Mondal S, Atmadibrata B, Bartonicek N, Peng H, Ho N, Mayoh C, Ciaccio R, Sun Y, Henderson MJ, Gao J, Everaert C, Hulme AJ, Wong M, Lan Q, Cheung BB, Shi L, Wang JY, Simon T, Fischer M, Zhang XD, Marshall GM, Norris MD, Haber M, Vandesompele J, Li J, Mestdagh P, Hannan RD, Dinger ME, Perini G, Liu T. The long noncoding RNA lncNB1 promotes tumorigenesis by interacting with ribosomal protein RPL35. Nat Commun 2019; 10:5026. [PMID: 31690716 PMCID: PMC6831662 DOI: 10.1038/s41467-019-12971-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 10/09/2019] [Indexed: 12/22/2022] Open
Abstract
The majority of patients with neuroblastoma due to MYCN oncogene amplification and consequent N-Myc oncoprotein over-expression die of the disease. Here our analyses of RNA sequencing data identify the long noncoding RNA lncNB1 as one of the transcripts most over-expressed in MYCN-amplified, compared with MYCN-non-amplified, human neuroblastoma cells and also the most over-expressed in neuroblastoma compared with all other cancers. lncNB1 binds to the ribosomal protein RPL35 to enhance E2F1 protein synthesis, leading to DEPDC1B gene transcription. The GTPase-activating protein DEPDC1B induces ERK protein phosphorylation and N-Myc protein stabilization. Importantly, lncNB1 knockdown abolishes neuroblastoma cell clonogenic capacity in vitro and leads to neuroblastoma tumor regression in mice, while high levels of lncNB1 and RPL35 in human neuroblastoma tissues predict poor patient prognosis. This study therefore identifies lncNB1 and its binding protein RPL35 as key factors for promoting E2F1 protein synthesis, N-Myc protein stability and N-Myc-driven oncogenesis, and as therapeutic targets. MYCN amplification is common in neuroblastomas. Here, the authors identify a long noncoding RNA, lncNB1 in these cancers and show that it promotes tumorigenesis by binding to ribosomal protein, RPL35 to enhance E2F1 and DEPDC1B protein synthesis, which phosphorylates ERK to stabilise N-Myc.
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Affiliation(s)
- Pei Y Liu
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Andrew E Tee
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Giorgio Milazzo
- Department of Pharmacy and Biotechnology, University of Bologna, 40126, Bologna, Italy
| | - Katherine M Hannan
- Australian Cancer Research Foundation Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jesper Maag
- Garvan Institute of Medical Research, Sydney, Darlinghurst, NSW, 2010, Australia.,Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sujanna Mondal
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Bernard Atmadibrata
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Nenad Bartonicek
- Garvan Institute of Medical Research, Sydney, Darlinghurst, NSW, 2010, Australia.,Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hui Peng
- Advanced Analytics Institute, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Nicholas Ho
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Roberto Ciaccio
- Department of Pharmacy and Biotechnology, University of Bologna, 40126, Bologna, Italy
| | - Yuting Sun
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Jixuan Gao
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Celine Everaert
- Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Amy J Hulme
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Matthew Wong
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Qing Lan
- Department of Neurosurgery, the Second Affiliated Hospital of Soochow University, 215004, Suzhou, Jiangsu, P.R. China
| | - Belamy B Cheung
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Leming Shi
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, 201203, Shanghai, China
| | - Jenny Y Wang
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, Cologne, Germany
| | - Matthias Fischer
- Department of Experimental Pediatric Oncology, University Hospital, University of Cologne, Cologne, Germany
| | - Xu D Zhang
- School of Medicine and Public Health, Priority Research Centre for Cancer Research, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Glenn M Marshall
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia
| | - Jo Vandesompele
- Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Jinyan Li
- Advanced Analytics Institute, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Pieter Mestdagh
- Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Ross D Hannan
- Australian Cancer Research Foundation Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, VIC, 3010, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia.,School of Biomedical Sciences, University of Queensland, St Lucia, QLD, 4067, Australia
| | - Marcel E Dinger
- Garvan Institute of Medical Research, Sydney, Darlinghurst, NSW, 2010, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Giovanni Perini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126, Bologna, Italy.
| | - Tao Liu
- Children's Cancer Institute Australia for Medical Research, Randwick, NSW, 2031, Australia.
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18
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Somers K, Kosciolek A, Bongers A, El-Ayoubi A, Karsa M, Mayoh C, Wadham C, Middlemiss S, Neznanov N, Kees UR, Lock RB, Gudkov A, Sutton R, Gurova K, Haber M, Norris MD, Henderson MJ. Potent antileukemic activity of curaxin CBL0137 against MLL-rearranged leukemia. Int J Cancer 2019; 146:1902-1916. [PMID: 31325323 DOI: 10.1002/ijc.32582] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Around 10% of acute leukemias harbor a rearrangement of the MLL/KMT2A gene, and the presence of this translocation results in a highly aggressive, therapy-resistant leukemia subtype with survival rates below 50%. There is a high unmet need to identify safer and more potent therapies for MLL-rearranged (MLL-r) leukemia that can be combined with established chemotherapeutics to decrease treatment-related toxicities. The curaxin, CBL0137, has demonstrated nongenotoxic anticancer and chemopotentiating effects in a number of preclinical cancer models and is currently in adult Phase I clinical trials for solid tumors and hematological malignancies. The aim of our study was to investigate whether CBL0137 has potential as a therapeutic and chemopotentiating compound in MLL-r leukemia through a comprehensive analysis of its efficacy in preclinical models of the disease. CBL0137 decreased the viability of a panel of MLL-r leukemia cell lines (n = 12) and xenograft cells derived from patients with MLL-r acute lymphoblastic leukemia (ALL, n = 3) in vitro with submicromolar IC50s. The small molecule drug was well-tolerated in vivo and significantly reduced leukemia burden in a subcutaneous MV4;11 MLL-r acute myeloid leukemia model and in patient-derived xenograft models of MLL-r ALL (n = 5). The in vivo efficacy of standard of care drugs used in remission induction for pediatric ALL was also potentiated by CBL0137. CBL0137 exerted its anticancer effect by trapping Facilitator of Chromatin Transcription (FACT) into chromatin, activating the p53 pathway and inducing an Interferon response. Our findings support further preclinical evaluation of CBL0137 as a new approach for the treatment of MLL-r leukemia.
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Affiliation(s)
- Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Angelika Kosciolek
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Ali El-Ayoubi
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Carol Wadham
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Shiloh Middlemiss
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Nickolay Neznanov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY
| | - Ursula R Kees
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia.,UNSW Centre for Childhood Cancer Research, Sydney, NSW, Australia
| | - Andrei Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY
| | - Rosemary Sutton
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Katerina Gurova
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia.,UNSW Centre for Childhood Cancer Research, Sydney, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
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19
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Somers K, Wen VW, Middlemiss SMC, Osborne B, Forgham H, Jung M, Karsa M, Clifton M, Bongers A, Gao J, Mayoh C, Raoufi-Rad N, Kusnadi EP, Hannan KM, Scott DA, Kwek A, Liu B, Flemming C, Chudakova DA, Pandher R, Failes TW, Lim J, Angeli A, Osterman AL, Imamura T, Kees UR, Supuran CT, Pearson RB, Hannan RD, Davis TP, McCarroll J, Kavallaris M, Turner N, Gudkov AV, Haber M, Norris MD, Henderson MJ. A novel small molecule that kills a subset of MLL-rearranged leukemia cells by inducing mitochondrial dysfunction. Oncogene 2019; 38:3824-3842. [PMID: 30670779 PMCID: PMC6756102 DOI: 10.1038/s41388-018-0666-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/21/2018] [Accepted: 12/11/2018] [Indexed: 12/27/2022]
Abstract
Survival rates for pediatric patients suffering from mixed lineage leukemia (MLL)-rearranged leukemia remain below 50% and more targeted, less toxic therapies are urgently needed. A screening method optimized to discover cytotoxic compounds selective for MLL-rearranged leukemia identified CCI-006 as a novel inhibitor of MLL-rearranged and CALM-AF10 translocated leukemias that share common leukemogenic pathways. CCI-006 inhibited mitochondrial respiration and induced mitochondrial membrane depolarization and apoptosis in a subset (7/11, 64%) of MLL-rearranged leukemia cell lines within a few hours of treatment. The unresponsive MLL-rearranged leukemia cells did not undergo mitochondrial membrane depolarization or apoptosis despite a similar attenuation of mitochondrial respiration by the compound. In comparison to the sensitive cells, the unresponsive MLL-rearranged leukemia cells were characterized by a more glycolytic metabolic phenotype, exemplified by a more pronounced sensitivity to glycolysis inhibitors and elevated HIF1α expression. Silencing of HIF1α expression sensitized an intrinsically unresponsive MLL-rearranged leukemia cell to CCI-006, indicating that this pathway plays a role in determining sensitivity to the compound. In addition, unresponsive MLL-rearranged leukemia cells expressed increased levels of MEIS1, an important leukemogenic MLL target gene that plays a role in regulating metabolic phenotype through HIF1α. MEIS1 expression was also variable in a pediatric MLL-rearranged ALL patient dataset, highlighting the existence of a previously undescribed metabolic variability in MLL-rearranged leukemia that may contribute to the heterogeneity of the disease. This study thus identified a novel small molecule that rapidly kills MLL-rearranged leukemia cells by targeting a metabolic vulnerability in a subset of low HIF1α/low MEIS1-expressing MLL-rearranged leukemia cells.
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Affiliation(s)
- Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Victoria W Wen
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Shiloh M C Middlemiss
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Brenna Osborne
- Mitochondrial Bioenergetics Laboratory, School of Medical Sciences, UNSW, Randwick, NSW, Australia
| | - Helen Forgham
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, UNSW Australia, Sydney, NSW, Australia
| | - MoonSun Jung
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Molly Clifton
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Jixuan Gao
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Newsha Raoufi-Rad
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Eric P Kusnadi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Kate M Hannan
- The John Curtin School of Medical Research, The Australian National University, Canberra City, ACT, Australia
| | - David A Scott
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
| | - Alan Kwek
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Bing Liu
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Claudia Flemming
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Daria A Chudakova
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Ruby Pandher
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Tim W Failes
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.,ACRF Drug Discovery Centre, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
| | - James Lim
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Andrea Angeli
- Neurofarba Department, University of Florence, Florence, Italy
| | - Andrei L Osterman
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ursula R Kees
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | | | - Ross D Hannan
- The John Curtin School of Medical Research, The Australian National University, Canberra City, ACT, Australia
| | - Thomas P Davis
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia.,Department of Chemistry, University of Warrick, Coventry, UK
| | - Joshua McCarroll
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, UNSW Australia, Sydney, NSW, Australia
| | - Maria Kavallaris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, UNSW Australia, Sydney, NSW, Australia
| | - Nigel Turner
- Mitochondrial Bioenergetics Laboratory, School of Medical Sciences, UNSW, Randwick, NSW, Australia
| | - Andrei V Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Oncotartis, Inc., Buffalo, NY, USA
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.,UNSW Centre for Childhood Cancer Research, Sydney, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia.
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20
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Jung M, Russell AJ, Kennedy C, Gifford AJ, Mallitt KA, Sivarajasingam S, Bowtell DD, DeFazio A, Haber M, Norris MD, Henderson MJ. Clinical Importance of Myc Family Oncogene Aberrations in Epithelial Ovarian Cancer. JNCI Cancer Spectr 2018; 2:pky047. [PMID: 31360864 PMCID: PMC6649713 DOI: 10.1093/jncics/pky047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022] Open
Abstract
Background The Myc oncogene family has been implicated in many human malignancies and is often associated with particularly aggressive disease, suggesting Myc as an attractive prognostic marker and therapeutic target. However, for epithelial ovarian cancer (EOC), there is little consensus on the incidence and clinical relevance of Myc aberrations. Here we comprehensively investigated alterations in gene copy number, expression, and activity for Myc and evaluated their clinical significance in EOC. Methods To address inconsistencies in the literature regarding the definition of copy number variations, we developed a novel approach using quantitative polymerase chain reaction (qPCR) coupled with a statistical algorithm to estimate objective thresholds for detecting Myc gain/amplification in large cohorts of serous (n = 150) and endometrioid (n = 80) EOC. MYC, MYCN, and MYCL1 mRNA expression and Myc activity score for each case were examined by qPCR. Kaplan–Meier and Cox-regression analyses were conducted to assess clinical significance of Myc aberrations. Results Using a large panel of cancer cell lines (n = 34), we validated the statistical algorithm for determining clear thresholds for Myc gain/amplification. MYC was the most predominantly amplified of the Myc oncogene family members, and high MYC mRNA expression levels were associated with amplification in EOC. However, there was no association between prognosis and increased copy number or gene expression of MYC/MYCN/MYCL1 or with a pan-Myc transcriptional activity score, in EOC, although MYC amplification was associated with late stage and high grade in endometrioid EOC. Conclusion A systematic and comprehensive analysis of Myc genes, transcripts, and activity levels using qPCR revealed that although such aberrations commonly occur in EOC, overall they have limited impact on outcome, suggesting that the biological relevance of Myc oncogene family members is limited to certain subsets of this disease.
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Affiliation(s)
- MoonSun Jung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia
| | - Amanda J Russell
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Catherine Kennedy
- Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J Gifford
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia.,Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | | | - Kylie-Ann Mallitt
- Centre for Big Data Research in Health/School of Women's and Children's Health, UNSW Australia, Kensington, NSW, Australia
| | - Siva Sivarajasingam
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia
| | - David D Bowtell
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia.,Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, NSW, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (Australian Ovarian Cancer Study Group).,Centre for Big Data Research in Health/School of Women's and Children's Health, UNSW Australia, Kensington, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, UNSW Australia, Kensington, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Anna DeFazio
- Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, UNSW Australia, Kensington, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, Kensington, NSW, Australia
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21
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Murray J, Valli E, Yu DMT, Truong AM, Gifford AJ, Eden GL, Gamble LD, Hanssen KM, Flemming CL, Tan A, Tivnan A, Allan S, Saletta F, Cheung L, Ruhle M, Schuetz JD, Henderson MJ, Byrne JA, Norris MD, Haber M, Fletcher JI. Suppression of the ATP-binding cassette transporter ABCC4 impairs neuroblastoma tumour growth and sensitises to irinotecan in vivo. Eur J Cancer 2017; 83:132-141. [PMID: 28735070 DOI: 10.1016/j.ejca.2017.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023]
Abstract
The ATP-binding cassette transporter ABCC4 (multidrug resistance protein 4, MRP4) mRNA level is a strong predictor of poor clinical outcome in neuroblastoma which may relate to its export of endogenous signalling molecules and chemotherapeutic agents. We sought to determine whether ABCC4 contributes to development, growth and drug response in neuroblastoma in vivo. In neuroblastoma patients, high ABCC4 protein levels were associated with reduced overall survival. Inducible knockdown of ABCC4 strongly inhibited the growth of human neuroblastoma cells in vitro and impaired the growth of neuroblastoma xenografts. Loss of Abcc4 in the Th-MYCN transgenic neuroblastoma mouse model did not impact tumour formation; however, Abcc4-null neuroblastomas were strongly sensitised to the ABCC4 substrate drug irinotecan. Our findings demonstrate a role for ABCC4 in neuroblastoma cell proliferation and chemoresistance and provide rationale for a strategy where inhibition of ABCC4 should both attenuate the growth of neuroblastoma and sensitise tumours to ABCC4 chemotherapeutic substrates.
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Affiliation(s)
- Jayne Murray
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Emanuele Valli
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Women's and Children's Health, UNSW Australia, NSW 2052, Australia
| | - Denise M T Yu
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Women's and Children's Health, UNSW Australia, NSW 2052, Australia
| | - Alan M Truong
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Medical Sciences, UNSW Australia, NSW 2052, Australia
| | - Andrew J Gifford
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Women's and Children's Health, UNSW Australia, NSW 2052, Australia; Department of Anatomical Pathology (SEALS), Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Georgina L Eden
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Laura D Gamble
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Kimberley M Hanssen
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Medical Sciences, UNSW Australia, NSW 2052, Australia
| | - Claudia L Flemming
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Alvin Tan
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Amanda Tivnan
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Sophie Allan
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Federica Saletta
- Children's Cancer Research Unit, Kids Research Institute, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Leanna Cheung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Michelle Ruhle
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - John D Schuetz
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Women's and Children's Health, UNSW Australia, NSW 2052, Australia
| | - Jennifer A Byrne
- Children's Cancer Research Unit, Kids Research Institute, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; University of Sydney Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; University of New South Wales Centre for Childhood Cancer Research, UNSW Australia, NSW 2052, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW Australia, NSW 2052, Australia; School of Women's and Children's Health, UNSW Australia, NSW 2052, Australia.
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22
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Gao J, Somers K, Hannan KM, Fletcher JI, Liu B, Hannan RD, Pearson RB, Haber M, Norris MD, Henderson MJ. Abstract 1956: ABCE1 regulates the translational profile of neuroblastoma to drive tumor progression. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1956] [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
Neuroblastoma is the most common extracranial solid tumor in children. A key driver of high-risk neuroblastoma is the MYCN transcription factor which fuels neuroblastoma progression by enhancing metabolic processes including protein translation (1). ABCE1, a member of the ATP-binding cassette (ABC) superfamily of transporters, is a translation factor directly up-regulated by MYCN (2). It is thought to dissociate the 80S ribosome into free 40S and 60S subunits so they can re-initiate translation and provide the protein building blocks required for rapid cell growth and migration (3). High ABCE1 expression is associated with poor clinical outcome in neuroblastoma patients (2). Therefore, we hypothesized that ABCE1 suppression may inhibit the aggressiveness of neuroblastoma by disabling protein synthesis. To test this, we suppressed ABCE1 using siRNAs in MYCN-amplified neuroblastoma cell lines, SK-N-BE(2) and CHP-134, which resulted in severely impaired cell migration (P<0.001) and proliferation (P<0.005). In mice xenografted with SK-N-BE(2) cells, ABCE1 suppression delayed tumor growth (P=0.001) and metastasis (P<0.001). Mechanistically, when polyribosome analysis was used to monitor the impact of ABCE1 expression on protein translation in SK-N-BE(2) cells, loss of ABCE1 reduced the proportion of actively translating ribosomes (P<0.001), leading to lower global protein synthesis (P=0.018). This is the first report of ABCE1 acting as pro-tumorigenic factor in neuroblastoma. Our data imply that targeting the translational machinery through ABCE1 may be an effective therapeutic approach for the treatment of MYC-driven cancers.
1.
Boon, K., Caron, H. N., van Asperen, R., Valentijn, L., Hermus, M. C., van Sluis, P., Roobeek, I., Weis, I., Voûte, P.A., Schwab, M. & Versteeg, R. (2001) EMBO J. 20, 1383-1393.
2.
Porro, A., Haber, M., Diolaiti, D., Iraci, N., Henderson, M., Gherardi, S., Valli, E., Munoz, M.A., Xue, C., Flemming, C., Schwab, M., Wong, J.H., Marshall, G.M., Della Valle, G., Norris, M.D. & Perini, G. (2010) J. Biol. Chem. 285, 19532-19543.
3.
Pisarev, A.V., Skabkin, M.A., Pisareva, V.P., Skabkina, O.V., Rakotondrafara, A.M., Hentze, M.W., Hellen C.U. & Pestova, T.V. (2010). Mol. Cell, 37, 196-210.
Citation Format: Jixuan Gao, Klaartje Somers, Katherine M. Hannan, Jamie I. Fletcher, Bing Liu, Ross D. Hannan, Richard B. Pearson, Michelle Haber, Murray D. Norris, Michelle J. Henderson. ABCE1 regulates the translational profile of neuroblastoma to drive tumor progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1956. doi:10.1158/1538-7445.AM2017-1956
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Affiliation(s)
- Jixuan Gao
- 1Children's Cancer Institute, Randwick, Australia
| | | | | | | | - Bing Liu
- 1Children's Cancer Institute, Randwick, Australia
| | - Ross D. Hannan
- 2The Australian National University, Canberra City, Australia
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23
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Somers K, Middlemiss S, Biktasova A, Karsa M, Cheung L, Kosciolek A, Evans K, Mayoh C, Kees UR, Korotchkina L, Chernova OB, Lock RB, Gudkov AV, Haber M, Norris MD, Henderson MJ. Abstract 1175: Inhibition of NAMPT as a novel therapeutic strategy for infant leukemia. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1175] [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
Novel targeted therapies are urgently needed for infant leukemia as this disease is highly aggressive and refractory to treatment resulting in poor survival rates. The NAD (Nicotinamide Adenine Dinucleotide) producing enzyme NAMPT (Nicotinamide Phosphoribosyltransferase) has been considered an attractive selective target for anti-cancer therapy due to the high dependency of tumor cells on NAD for energy metabolism and activity of NAD-dependent enzymes such as poly-ADP-ribose polymerases (PARPs) and sirtuins that play key roles in cancer cell survival. A newly developed NAMPT inhibitor, OT-82, was initially isolated for its high selective toxicity against a panel of adult leukemia cell lines. Here we investigated NAMPT inhibition as a therapeutic strategy for infant leukemias characterized by rearrangement of the MLL gene (MLL-r), by testing the potency of OT-82 in a panel of preclinical in vitro and in vivo models of MLL-r leukemia that are based on the use of patient-derived xenograft (PDX) cells.
OT-82, as a single agent, dramatically reduced the viability of all tested MLL-r leukemia cell lines (n=9) and MLL-r leukemia PDX (n=6) with IC50s ranging from 0.15 to 3.82nM. While the IC50 for OT-82 correlated significantly with the IC50 of other NAMPT inhibitors STF-118804 and FK866, OT-82 was the most potent compound. When combining OT-82 with chemotherapeutic agents currently used to treat infants with leukemia, we observed significant synergy between OT-82 and cytarabine indicating the potential of OT-82 for chemosensitization. Consistent with NAMPT inhibition, OT-82 reduced cytosolic NAD+ levels in MLL-r leukemia cells and inhibited the activity of the NAD-requiring enzymes PARP-1 and SIRT-1, as exemplified by a decrease in PARylated PARP-1 levels and a p53-mediated increase in p21 levels, leading to apoptosis induction. Interestingly, despite the remarkable potency of OT-82 in killing MLL-r leukemia cells, a 25-fold difference in IC50 levels was noted across the cell line panel, with those lines harboring the MLL translocations most prevalent in infants, namely t(4;11) and t(11;19) translocations, being the most sensitive to the compound. A positive correlation was noted between baseline NAMPT mRNA levels and OT-82 IC50 (r=0.7712, P=0.015).
Further in vivo testing of OT-82 showed impressive efficacy of the compound in MLL-r leukemia PDX-based animal models (n=6). OT-82 (p.o. 3x week, 40-50 mg/kg, for 3 or 6 weeks) was well tolerated and significantly delayed leukemia progression in 6/6 MLL-r leukemia xenografts with 5/6 achieving objective responses. OT-82 given as monotherapy was as effective as the routinely used triple combination treatment of vincristine, L-asparaginase and dexamethasone.
Overall, these results demonstrate that NAMPT inhibition using OT-82 is highly effective against MLL-r leukemia and when combined with current chemotherapies may offer a more selective and potent therapeutic option for infants suffering from this disease.
Citation Format: Klaartje Somers, Shiloh Middlemiss, Asel Biktasova, Mawar Karsa, Leanna Cheung, Angelika Kosciolek, Kathryn Evans, Chelsea Mayoh, Ursula R. Kees, Lioubov Korotchkina, Olga B. Chernova, Richard B. Lock, Andrei V. Gudkov, Michelle Haber, Murray D. Norris, Michelle J. Henderson. Inhibition of NAMPT as a novel therapeutic strategy for infant leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1175. doi:10.1158/1538-7445.AM2017-1175
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Affiliation(s)
- Klaartje Somers
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Shiloh Middlemiss
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Asel Biktasova
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Mawar Karsa
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Leanna Cheung
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Angelika Kosciolek
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Kathryn Evans
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Chelsea Mayoh
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Ursula R. Kees
- 2Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | | | - Richard B. Lock
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | | | - Michelle Haber
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
| | - Murray D. Norris
- 1Children's Cancer Institute, University of New South Wales, Randwick, Australia
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24
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Evans K, Pritchard T, Henderson MJ, Somers K, Karsa M, Cheung L, Yung R, Erickson SW, Korotchkina L, Chernova O, Gudkov A, Smith MA, Lock RB. Abstract 1942: The nicotinamide phosphoribosyltransferase (NAMPT) inhibitor, OT-82, exhibits in vitro and in vivo efficacy against patient-derived xenograft models of high-risk acute lymphoblastic leukemia. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1942] [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
Cancer cells are highly dependent on nicotinamide phosphoribosyltransferase (NAMPT) for the biosynthesis of nicotinamide adenine dinucleotide (NAD). Besides its role in energy metabolism, NAMPT influences the activity of NAD-dependent enzymes, including poly (ADP-ribose) polymerase-1 (PARP-1) and sirtuins, and thereby regulates cellular survival and stress response. Disruption of NAD synthesis through NAMPT inhibition represents a potential therapeutic strategy for treating cancer. The aim of this study was to evaluate the efficacy of the novel NAMPT inhibitor OT-82, initially isolated for its selective toxicity against a panel of adult leukemia cell lines, in a diverse panel of leukemia cell lines in vitro and pediatric acute lymphoblastic leukemia (ALL) patient-derived xenografts (PDXs) in vivo, and to identify potential biomarkers predictive of OT-82 response. OT-82 demonstrated low nanomolar IC50 values (0.9 – 3.4 nM) in 3 ALL and 3 acute myeloid leukemia cell lines as determined by resazurin reduction assays. In vivo efficacy of OT-82 (40 mg/kg x 3 days x 3 weeks, p.o.) was evaluated as a single agent against pediatric ALL PDXs, including B-cell precursor ALL (n = 3), Philadelphia chromosome (Ph) positive ALL (n = 2), Ph-like ALL (n = 2), T-cell ALL (n = 3), and early T-cell precursor ALL (n = 3) in immune deficient (NSG) mice. Response to treatment was assessed by time to event or stringent objective response criteria modeled after the clinical setting. OT-82 was well tolerated, significantly increased event-free survival (EFS) relative to control mice in 11/13 ALL PDXs, and elicited objective responses in 11/13 (85%) PDXs [3 Partial Responses, 4 Complete Responses (CRs) and 4 Maintained CRs (MCRs)]. Analysis of basal protein expression revealed elevated levels of poly (ADP-ribosyl)ated (PARylated) PARP-1 in 4/5 responders versus 0/2 non-responders. In vitro studies examining various chemotherapeutic agents used for childhood leukemia showed synergy between cytarabine (AraC) and OT-82 in an ALL cell line. In an OT-82 sensitive Mixed Lineage Leukemia (MLL) PDX, treatment with AraC (25 mg/kg x 5 days x 2 weeks, i.p.) and OT-82 (40 mg/kg x 3 days x 2 weeks, p.o.) significantly increased EFS compared to OT-82 (P<0.0001) or AraC (P<0.0001) alone. Moreover, the OT-82/AraC combination elicited an MCR compared to OT-82 (CR) and AraC (Progressive Disease) alone. The results herein demonstrate significant activity of OT-82 against leukemia cell lines and a range of pediatric ALL subtypes in vivo, and the potential for PARylated PARP-1 expression as a biomarker for predicting OT-82 response. Moreover, the enhanced activity of OT-82 in combination with AraC over single agent therapy further suggests NAMPT inhibition as an attractive strategy for treating high-risk pediatric ALL. Supported by U01CA199000 from the NCI.
Citation Format: Kathryn Evans, Tara Pritchard, Michelle J. Henderson, Klaartje Somers, Mawar Karsa, Leanna Cheung, Raymond Yung, Stephen W. Erickson, Lioubov Korotchkina, Olga Chernova, Andrei Gudkov, Malcolm A. Smith, Richard B. Lock. The nicotinamide phosphoribosyltransferase (NAMPT) inhibitor, OT-82, exhibits in vitro and in vivo efficacy against patient-derived xenograft models of high-risk acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1942. doi:10.1158/1538-7445.AM2017-1942
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Affiliation(s)
| | | | | | | | - Mawar Karsa
- 1Children's Cancer Institute, Sydney, Australia
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25
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Jung M, Russell AJ, Liu B, George J, Liu PY, Liu T, DeFazio A, Bowtell DDL, Oberthuer A, London WB, Fletcher JI, Haber M, Norris MD, Henderson MJ. A Myc Activity Signature Predicts Poor Clinical Outcomes in Myc-Associated Cancers. Cancer Res 2016; 77:971-981. [PMID: 27923830 DOI: 10.1158/0008-5472.can-15-2906] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/14/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
Myc transcriptional activity is frequently deregulated in human cancers, but a Myc-driven gene signature with prognostic ability across multiple tumor types remains lacking. Here, we selected 18 Myc-regulated genes from published studies of Myc family targets in epithelial ovarian cancer (EOC) and neuroblastoma. A Myc family activity score derived from the 18 genes was correlated to MYC/MYCN/MYCL1 expression in a panel of 35 cancer cell lines. The prognostic ability of this signature was evaluated in neuroblastoma, medulloblastoma, diffuse large B-cell lymphoma (DLBCL), and EOC microarray gene expression datasets using Kaplan-Meier and multivariate Cox regression analyses and was further validated in 42 primary neuroblastomas using qPCR. Cell lines with high MYC, MYCN, and/or MYCL1 gene expression exhibited elevated expression of the signature genes. Survival analysis showed that the signature was associated with poor outcome independently of well-defined prognostic factors in neuroblastoma, breast cancer, DLBCL, and medulloblastoma. In EOC, the 18-gene Myc activity signature was capable of identifying a group of patients with poor prognosis in a "high-MYCN" molecular subtype but not in the overall cohort. The predictive ability of this signature was reproduced using qPCR analysis of an independent cohort of neuroblastomas, including a subset of tumors without MYCN amplification. These data reveal an 18-gene Myc activity signature that is highly predictive of poor prognosis in diverse Myc-associated malignancies and suggest its potential clinical application in the identification of Myc-driven tumors that might respond to Myc-targeted therapies. Cancer Res; 77(4); 971-81. ©2016 AACR.
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Affiliation(s)
- MoonSun Jung
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Amanda J Russell
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Bing Liu
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Joshy George
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Pei Yan Liu
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Tao Liu
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Anna DeFazio
- Department of Gynecological Oncology, Westmead Hospital and Centre for Cancer Research, The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | | | - André Oberthuer
- Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne and Centre for Molecular Medicine Cologne, Cologne, Germany
| | - Wendy B London
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School Division of Hematology/Oncology and Children's Oncology Group Statistics and Data Center, Boston, Massachusetts
| | - Jamie I Fletcher
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia.,University of New South Wales Centre for Childhood Cancer Research, University of New South Wales Australia, Kensington, New South Wales, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales Australia, Kensington, New South Wales, Australia.
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Jones CM, Smith M, Henderson MJ. Reference data for cerebrospinal fluid and the utility of amino acid measurement for the diagnosis of inborn errors of metabolism. Ann Clin Biochem 2016; 43:63-6. [PMID: 16390611 DOI: 10.1258/000456306775141759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Cerebrospinal fluid (CSF) amino acid analysis is fundamental to the investigation of several inherited metabolic diseases, particularly those presenting with unexplained seizures. CSF glycine measurement is often crucial to the diagnosis of glycine encephalopathy (GE), low CSF serine concentrations are characteristic of 3-phosphoglycerate dehydrogenase deficiency (3-PGDD) and the presence of sulphocysteine is pathognomonic of sulphite oxidase deficiency (SOD), and a vital clue to molybdenum cofactor deficiency (MCD). Limited information is available in the literature on reference values of amino acids in CSF during infancy and CSF samples from healthy individuals are not easily obtained. Methods: In order to establish paediatric CSF amino acid reference ranges, we performed a retrospective analysis of all quantitative CSF amino acid data collected in our laboratory over a five-year period. Amino acid analysis was performed using ion-exchange chromatography on a Biochrom-20 amino acid analyser with ninhydrin detection. CSF samples were collected from infants undergoing investigation for unexplained seizures. Results: About 18 of the 95 samples received were excluded from the reference data-set; one was from a patient in whom a diagnosis of GE was confirmed by enzyme analysis, one was from a patient with CSF sulphocysteine of 19 μmol/L in whom a diagnosis of SOD was confirmed by enzyme analysis; the remaining 16 were clearly bloodstained ( n = 4) or xanthochromic ( n = 12). Frequency of distribution analysis revealed that concentration values for each amino acid demonstrated a right-skewed distribution which was not normalized by log transformation. Data were therefore analysed using non-parametric descriptive statistics and reference ranges were defined by the 2.5th and 97.5th centile limits. Conclusions: Our reference data were derived from 77 CSF samples taken from 77 infants. Median CSF glycine concentration was 9 μmol/L with a reference range of 3-19 μmol/L. For serine, the median CSF concentration was 52 μmol/L with a reference range of 25-105 μmol/L. Sulphocysteine was not normally present in detectable quantities (<1 μmol/L).
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Affiliation(s)
- C M Jones
- Department of Clinical Biochemistry, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Fletcher JI, Williams RT, Henderson MJ, Norris MD, Haber M. ABC transporters as mediators of drug resistance and contributors to cancer cell biology. Drug Resist Updat 2016; 26:1-9. [PMID: 27180306 DOI: 10.1016/j.drup.2016.03.001] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 03/04/2016] [Accepted: 03/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jamie I Fletcher
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Rebekka T Williams
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Michelle Haber
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia.
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French JD, Johnatty SE, Lu Y, Beesley J, Gao B, Kalimutho M, Henderson MJ, Russell AJ, Kar S, Chen X, Hillman KM, Kaufmann S, Sivakumaran H, O'Reilly M, Wang C, Korbie DJ, Lambrechts D, Despierre E, Van Nieuwenhuysen E, Lambrechts S, Vergote I, Karlan B, Lester J, Orsulic S, Walsh C, Fasching PA, Beckmann MW, Ekici AB, Hein A, Matsuo K, Hosono S, Pisterer J, Hillemanns P, Nakanishi T, Yatabe Y, Goodman MT, Lurie G, Matsuno RK, Thompson PJ, Pejovic T, Bean Y, Heitz F, Harter P, du Bois A, Schwaab I, Hogdall E, Kjaer SK, Jensen A, Hogdall C, Lundvall L, Engelholm SA, Brown B, Flanagan JM, Metcalf MD, Siddiqui N, Sellers T, Fridley B, Cunningham J, Schildkraut JM, Iversen E, Weber RP, Brennan D, Berchuck A, Pharoah P, Harnett P, Norris MD, Haber M, Goode EL, Lee JS, Khanna KK, Meyer KB, Chenevix-Trench G, deFazio A, Edwards SL, MacGregor S. Germline polymorphisms in an enhancer of PSIP1 are associated with progression-free survival in epithelial ovarian cancer. Oncotarget 2016; 7:6353-68. [PMID: 26840454 PMCID: PMC4872719 DOI: 10.18632/oncotarget.7047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 11/25/2022] Open
Abstract
Women with epithelial ovarian cancer (EOC) are usually treated with platinum/taxane therapy after cytoreductive surgery but there is considerable inter-individual variation in response. To identify germline single-nucleotide polymorphisms (SNPs) that contribute to variations in individual responses to chemotherapy, we carried out a multi-phase genome-wide association study (GWAS) in 1,244 women diagnosed with serous EOC who were treated with the same first-line chemotherapy, carboplatin and paclitaxel. We identified two SNPs (rs7874043 and rs72700653) in TTC39B (best P=7x10-5, HR=1.90, for rs7874043) associated with progression-free survival (PFS). Functional analyses show that both SNPs lie in a putative regulatory element (PRE) that physically interacts with the promoters of PSIP1, CCDC171 and an alternative promoter of TTC39B. The C allele of rs7874043 is associated with poor PFS and showed increased binding of the Sp1 transcription factor, which is critical for chromatin interactions with PSIP1. Silencing of PSIP1 significantly impaired DNA damage-induced Rad51 nuclear foci and reduced cell viability in ovarian cancer lines. PSIP1 (PC4 and SFRS1 Interacting Protein 1) is known to protect cells from stress-induced apoptosis, and high expression is associated with poor PFS in EOC patients. We therefore suggest that the minor allele of rs7874043 confers poor PFS by increasing PSIP1 expression.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Apoptosis
- Biomarkers, Tumor/genetics
- Cell Proliferation
- Chromatin Immunoprecipitation
- Cohort Studies
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/genetics
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Electrophoretic Mobility Shift Assay
- Enhancer Elements, Genetic/genetics
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/genetics
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Female
- Follow-Up Studies
- Germ-Line Mutation/genetics
- Humans
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/genetics
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Polymorphism, Single Nucleotide/genetics
- Prognosis
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Rate
- Transcription Factors/genetics
- Tumor Cells, Cultured
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Affiliation(s)
| | | | - Yi Lu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Bo Gao
- Department of Gynaecological Oncology and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead Hospital, Sydney, Australia
| | | | | | | | - Siddhartha Kar
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Xiaoqing Chen
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | | | | | - Martin O'Reilly
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK
| | - Chen Wang
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Darren J. Korbie
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Australia
| | - Australian Ovarian Cancer Study Group
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Department of Gynaecological Oncology and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead Hospital, Sydney, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, Belgium and Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
- Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Evelyn Despierre
- Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Sandrina Lambrechts
- Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ignace Vergote
- Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Beth Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jenny Lester
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sandra Orsulic
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christine Walsh
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen- Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen- Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen- Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Satoyo Hosono
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | | | - Peter Hillemanns
- Departments of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | - Toru Nakanishi
- Department of Gynecology, Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan
| | - Marc T. Goodman
- Cancer Prevention and Control Program, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Galina Lurie
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Hawaii, USA
| | - Rayna K. Matsuno
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Hawaii, USA
| | - Pamela J. Thompson
- Cancer Prevention and Control Program, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University and Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Yukie Bean
- Department of Obstetrics and Gynecology, Oregon Health and Science University and Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Ira Schwaab
- Institut für Humangenetik Wiesbaden, Germany
| | - Estrid Hogdall
- Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark
- Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K. Kjaer
- Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Allan Jensen
- Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark
| | - Claus Hogdall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lene Lundvall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Bob Brown
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James M. Flanagan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Nadeem Siddiqui
- North Glasgow University Hospitals NHS Trust, Stobhill Hospital, Glasgow, UK
| | - Thomas Sellers
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Brooke Fridley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie Cunningham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joellen M. Schildkraut
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Ed Iversen
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Rachel Palmieri Weber
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - Donal Brennan
- Queensland Centre for Gynaecological Cancer, Brisbane, Australia
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Paul Harnett
- Crown Princess Mary Cancer Centre and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead Hospital, Sydney, Australia
| | | | - Michelle Haber
- Children's Cancer Institute Australia, Randwick, Australia
| | - Ellen L. Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Jason S. Lee
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kum Kum Khanna
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kerstin B. Meyer
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK
| | | | - Anna deFazio
- Department of Gynaecological Oncology and Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead Hospital, Sydney, Australia
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Haber M, Murray J, Gamble L, Carnegie-Clark A, Webber H, Ruhle M, Henderson MJ, Middlemass S, Carter D, Tsoli M, Ehteda A, Simon S, Oberthuer A, Fischer M, Gurova K, Burkhart C, Purmal A, Lock RB, Ziegler D, Marshall GM, Gudkov AV, Norris MD. Abstract 1611: The FACT histone chaperone complex is highly expressed in aggressive drug refractory childhood cancers and the anti-FACT compound CBL0137 represents a highly promising therapeutic approach in this setting. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1611] [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: Despite the success of chemotherapy in improving the overall survival rate of childhood cancer, a number of types of children's cancers still have dismal outcomes. Included here are high risk neuroblastomas, Diffuse Intrinsic Pontine Gliomas (DIPG), and infant leukemias with MLL translocations. New treatments for these aggressive childhood cancers are urgently needed. Evidence is emerging of the importance of alterations in chromatin modifier genes in pediatric cancers. In this regard, CBL0137 is a carbazole-based anti-cancer agent with a unique mechanism of action. It is an indirect inhibitor of the chromatin remodeling complex FACT (Facilitates Chromatin Transcription). Inhibition of FACT by CBL0137 modulates the activity of several transcription factors involved in cancer: NF-kB and HSF1 are suppressed, while p53 is activated (Science Transl Med, 2011). We have examined FACT expression in neuroblastoma, DIPG and MLL leukemia, as well as the efficacy of CBL0137 in preclinical models of these diseases.
Methods: Expression of the FACT subunits, SSRP1 and SPT16, was examined in neuroblastoma, DIPG and MLL leukemia cells using RT-PCR and Western analysis. The clinical significance of SSRP1 and SPT16 was also analysed using expression array data on 650 primary untreated neuroblastomas. Colony-forming assays were used to study the effect of CBL0137, either alone or combined with chemotherapeutic drugs. Cohorts of neuroblastoma, DIPG and MLL leukemia xenografted mice, as well as neuroblastoma-prone TH-MYCN mice, were treated with CBL0137, alone or combined with chemotherapeutic drugs.
Results: High levels of SSRP1 and SPT16 expression were observed in all three types of child cancer. In addition, in neuroblastoma, the two FACT subunits were associated with MYCN amplification, and were strongly predictive of poor outcome (p<0.0001). As a single agent, CBL0137 administered iv had remarkable in vivo anti-tumor activity against neuroblastoma, DIPG and MLL leukemia xenografted mice. CBL0137 also synergized strongly with a variety of chemotherapeutic agents, including cyclophosphamide. Most dramatic results were observed when CBL0137 was combined with cyclophosphamide/topotecan, a highly active therapy for relapsed neuroblastoma that is currently in clinical trial. Cylophosphamide/topotecan plus CBL0137 resulted in cure of 90% of tumor-bearing MYCN-transgenic mice.
Conclusions: Targeting FACT offers a highly promising novel therapeutic approach for aggressive childhood cancers. The results for CBL0137 are as good or better than any chemotherapy regimens we have tested in our preclinical models, and a Phase I COG trial of this nongenotoxic agent in refractory pediatric cancer patients is currently being planned.
Citation Format: Michelle Haber, Jayne Murray, Laura Gamble, Ashleigh Carnegie-Clark, Hannah Webber, Michelle Ruhle, Michelle J. Henderson, Shiloh Middlemass, Daniel Carter, Maria Tsoli, Anahid Ehteda, Sandy Simon, Andre Oberthuer, Matthias Fischer, Katerina Gurova, Catherine Burkhart, Andrei Purmal, Richard B. Lock, David Ziegler, Glenn M. Marshall, Andrei V. Gudkov, Murray D. Norris. The FACT histone chaperone complex is highly expressed in aggressive drug refractory childhood cancers and the anti-FACT compound CBL0137 represents a highly promising therapeutic approach in this setting. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1611. doi:10.1158/1538-7445.AM2015-1611
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Affiliation(s)
- Michelle Haber
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Jayne Murray
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Laura Gamble
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | - Hannah Webber
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Michelle Ruhle
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | | | - Daniel Carter
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Maria Tsoli
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Anahid Ehteda
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Sandy Simon
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Andre Oberthuer
- 2University of Cologne, Children's Hospital Cologne, Cologne, Germany
| | - Matthias Fischer
- 3Children's Hospital Cologne and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | | | | | | | | | - David Ziegler
- 7Children's Cancer Institute Australia and Sydney Children's Hospital, Sydney, Australia
| | - Glenn M. Marshall
- 7Children's Cancer Institute Australia and Sydney Children's Hospital, Sydney, Australia
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Henderson MJ, Choi S, Beesley AH, Sutton R, Venn NC, Marshall GM, Kee UR, Haber M, Norris MD. Mechanism of relapse in pediatric acute lymphoblastic leukemia. Cell Cycle 2014; 7:1315-20. [DOI: 10.4161/cc.7.10.5885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cheung L, Flemming CL, Watt F, Masada N, Yu DMT, Huynh T, Conseil G, Tivnan A, Polinsky A, Gudkov AV, Munoz MA, Vishvanath A, Cooper DMF, Henderson MJ, Cole SPC, Fletcher JI, Haber M, Norris MD. High-throughput screening identifies Ceefourin 1 and Ceefourin 2 as highly selective inhibitors of multidrug resistance protein 4 (MRP4). Biochem Pharmacol 2014; 91:97-108. [PMID: 24973542 DOI: 10.1016/j.bcp.2014.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 04/04/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 12/27/2022]
Abstract
Multidrug resistance protein 4 (MRP4/ABCC4), a member of the ATP-binding cassette (ABC) transporter superfamily, is an organic anion transporter capable of effluxing a wide range of physiologically important signalling molecules and drugs. MRP4 has been proposed to contribute to numerous functions in both health and disease; however, in most cases these links remain to be unequivocally established. A major limitation to understanding the physiological and pharmacological roles of MRP4 has been the absence of specific small molecule inhibitors, with the majority of established inhibitors also targeting other ABC transporter family members, or inhibiting the production, function or degradation of important MRP4 substrates. We therefore set out to identify more selective and well tolerated inhibitors of MRP4 that might be used to study the many proposed functions of this transporter. Using high-throughput screening, we identified two chemically distinct small molecules, Ceefourin 1 and Ceefourin 2, that inhibit transport of a broad range of MRP4 substrates, yet are highly selective for MRP4 over other ABC transporters, including P-glycoprotein (P-gp), ABCG2 (Breast Cancer Resistance Protein; BCRP) and MRP1 (multidrug resistance protein 1; ABCC1). Both compounds are more potent MRP4 inhibitors in cellular assays than the most widely used inhibitor, MK-571, requiring lower concentrations to effect a comparable level of inhibition. Furthermore, Ceefourin 1 and Ceefourin 2 have low cellular toxicity, and high microsomal and acid stability. These newly identified inhibitors should be of great value for efforts to better understand the biological roles of MRP4, and may represent classes of compounds with therapeutic application.
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Affiliation(s)
- Leanna Cheung
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Claudia L Flemming
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Fujiko Watt
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Nanako Masada
- Department of Pharmacology, University of Cambridge, Cambridge, UK.
| | - Denise M T Yu
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Tony Huynh
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Gwenaëlle Conseil
- Division of Cancer Biology & Genetics, Queen's University Cancer Research Institute, Kingston, ON, Canada.
| | - Amanda Tivnan
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | | | - Andrei V Gudkov
- Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Marcia A Munoz
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Anasuya Vishvanath
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | | | - Michelle J Henderson
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Susan P C Cole
- Division of Cancer Biology & Genetics, Queen's University Cancer Research Institute, Kingston, ON, Canada.
| | - Jamie I Fletcher
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Michelle Haber
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
| | - Murray D Norris
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, PO Box 81, Randwick 2031, NSW, Australia.
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Hedditch EL, Gao B, Russell AJ, Lu Y, Emmanuel C, Beesley J, Johnatty SE, Chen X, Harnett P, George J, Williams RT, Flemming C, Lambrechts D, Despierre E, Lambrechts S, Vergote I, Karlan B, Lester J, Orsulic S, Walsh C, Fasching P, Beckmann MW, Ekici AB, Hein A, Matsuo K, Hosono S, Nakanishi T, Yatabe Y, Pejovic T, Bean Y, Heitz F, Harter P, du Bois A, Schwaab I, Hogdall E, Kjaer SK, Jensen A, Hogdall C, Lundvall L, Engelholm SA, Brown B, Flanagan J, Metcalf MD, Siddiqui N, Sellers T, Fridley B, Cunningham J, Schildkraut J, Iversen E, Weber RP, Berchuck A, Goode E, Bowtell DD, Chenevix-Trench G, deFazio A, Norris MD, MacGregor S, Haber M, Henderson MJ. ABCA transporter gene expression and poor outcome in epithelial ovarian cancer. J Natl Cancer Inst 2014; 106:dju149. [PMID: 24957074 DOI: 10.1093/jnci/dju149] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND ATP-binding cassette (ABC) transporters play various roles in cancer biology and drug resistance, but their association with outcomes in serous epithelial ovarian cancer (EOC) is unknown. METHODS The relationship between clinical outcomes and ABC transporter gene expression in two independent cohorts of high-grade serous EOC tumors was assessed with real-time quantitative polymerase chain reaction, analysis of expression microarray data, and immunohistochemistry. Associations between clinical outcomes and ABCA transporter gene single nucleotide polymorphisms were tested in a genome-wide association study. Impact of short interfering RNA-mediated gene suppression was determined by colony forming and migration assays. Association with survival was assessed with Kaplan-Meier analysis and log-rank tests. All statistical tests were two-sided. RESULTS Associations with outcome were observed with ABC transporters of the "A" subfamily, but not with multidrug transporters. High-level expression of ABCA1, ABCA6, ABCA8, and ABCA9 in primary tumors was statistically significantly associated with reduced survival in serous ovarian cancer patients. Low levels of ABCA5 and the C-allele of rs536009 were associated with shorter overall survival (hazard ratio for death = 1.50; 95% confidence interval [CI] =1.26 to 1.79; P = 6.5e-6). The combined expression pattern of ABCA1, ABCA5, and either ABCA8 or ABCA9 was associated with particularly poor outcome (mean overall survival in group with adverse ABCA1, ABCA5 and ABCA9 gene expression = 33.2 months, 95% CI = 26.4 to 40.1; vs 55.3 months in the group with favorable ABCA gene expression, 95% CI = 49.8 to 60.8; P = .001), independently of tumor stage or surgical debulking status. Suppression of cholesterol transporter ABCA1 inhibited ovarian cancer cell growth and migration in vitro, and statin treatment reduced ovarian cancer cell migration. CONCLUSIONS Expression of ABCA transporters was associated with poor outcome in serous ovarian cancer, implicating lipid trafficking as a potentially important process in EOC.
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Affiliation(s)
- Ellen L Hedditch
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Bo Gao
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Amanda J Russell
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Yi Lu
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Catherine Emmanuel
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Jonathan Beesley
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Sharon E Johnatty
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Xiaoqing Chen
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Paul Harnett
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Joshy George
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | | | - Rebekka T Williams
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Claudia Flemming
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Diether Lambrechts
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Evelyn Despierre
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Sandrina Lambrechts
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Ignace Vergote
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Beth Karlan
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Jenny Lester
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Sandra Orsulic
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Christine Walsh
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Peter Fasching
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Matthias W Beckmann
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Arif B Ekici
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Alexander Hein
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Keitaro Matsuo
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Satoyo Hosono
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Toru Nakanishi
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Yasushi Yatabe
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Tanja Pejovic
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Yukie Bean
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Florian Heitz
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Philipp Harter
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Andreas du Bois
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Ira Schwaab
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Estrid Hogdall
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Susan K Kjaer
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Allan Jensen
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Claus Hogdall
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Lene Lundvall
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Svend Aage Engelholm
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Bob Brown
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - James Flanagan
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Michelle D Metcalf
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Nadeem Siddiqui
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Thomas Sellers
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Brooke Fridley
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Julie Cunningham
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Joellen Schildkraut
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Ed Iversen
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Rachel P Weber
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Andrew Berchuck
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Ellen Goode
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - David D Bowtell
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Georgia Chenevix-Trench
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Anna deFazio
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Murray D Norris
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Stuart MacGregor
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Michelle Haber
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
| | - Michelle J Henderson
- Affiliations of authors: Children's Cancer Institute Australia, Randwick, Australia (ELH, AJR, RTW, CF, MDN, MH, MJH); Department of Gynaecological Oncology and Westmead Institute for Cancer Research (BG, CE, AOCSG, AdF), Crown Princess Mary Cancer Centre and Westmead Institute for Cancer Research (PH) University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia; Queensland Institute of Medical Research, Brisbane, Australia (YL, JB, SEJ, XC, AOCSG, GC-T, SM); Peter MacCallum Cancer Centre, Melbourne, Australia (JG, AOCSG, DDB); Vesalius Research Center, VIB, Leuven, Belgium (DL); Department of Oncology, University of Leuven and University Hospitals Leuven, Leuven, Belgium (ED, SL, IV); Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA (BK, JL, SO, CW); Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PF, MWB, AH); University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA (PF); Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan (ABE, KM, SH); Department of Gynecology (TN), and Department of Pathology and Molecular Diagnostics (YY), Aichi Cancer Center Central Hospital, Nagoya, Aichi, Japan; Department of Obstetrics and Gynecology (TP, YB), and Knight Cancer Institute (TP, YB), Oregon Health & Science University, Portland, OR; Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen Nuremberg, Erlangen, Germany (FH); Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/ Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany (FH); De
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Johnatty SE, Beesley J, Gao B, Chen X, Lu Y, Law MH, Henderson MJ, Russell AJ, Hedditch EL, Emmanuel C, Fereday S, Webb PM, Goode EL, Vierkant RA, Fridley BL, Cunningham JM, Fasching PA, Beckmann MW, Ekici AB, Hogdall E, Kjaer SK, Jensen A, Hogdall C, Brown R, Paul J, Lambrechts S, Despierre E, Vergote I, Lester J, Karlan BY, Heitz F, du Bois A, Harter P, Schwaab I, Bean Y, Pejovic T, Levine DA, Goodman MT, Camey ME, Thompson PJ, Lurie G, Shildkraut J, Berchuck A, Terry KL, Cramer DW, Norris MD, Haber M, MacGregor S, deFazio A, Chenevix-Trench G. ABCB1 (MDR1) polymorphisms and ovarian cancer progression and survival: a comprehensive analysis from the Ovarian Cancer Association Consortium and The Cancer Genome Atlas. Gynecol Oncol 2013; 131:8-14. [PMID: 23917080 PMCID: PMC3795832 DOI: 10.1016/j.ygyno.2013.07.107] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 06/16/2013] [Accepted: 07/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE ABCB1 encodes the multi-drug efflux pump P-glycoprotein (P-gp) and has been implicated in multi-drug resistance. We comprehensively evaluated this gene and flanking regions for an association with clinical outcome in epithelial ovarian cancer (EOC). METHODS The best candidates from fine-mapping analysis of 21 ABCB1 SNPs tagging C1236T (rs1128503), G2677T/A (rs2032582), and C3435T (rs1045642) were analysed in 4616 European invasive EOC patients from thirteen Ovarian Cancer Association Consortium (OCAC) studies and The Cancer Genome Atlas (TCGA). Additionally we analysed 1,562 imputed SNPs around ABCB1 in patients receiving cytoreductive surgery and either 'standard' first-line paclitaxel-carboplatin chemotherapy (n=1158) or any first-line chemotherapy regimen (n=2867). We also evaluated ABCB1 expression in primary tumours from 143 EOC patients. RESULT Fine-mapping revealed that rs1128503, rs2032582, and rs1045642 were the best candidates in optimally debulked patients. However, we observed no significant association between any SNP and either progression-free survival or overall survival in analysis of data from 14 studies. There was a marginal association between rs1128503 and overall survival in patients with nil residual disease (HR 0.88, 95% CI 0.77-1.01; p=0.07). In contrast, ABCB1 expression in the primary tumour may confer worse prognosis in patients with sub-optimally debulked tumours. CONCLUSION Our study represents the largest analysis of ABCB1 SNPs and EOC progression and survival to date, but has not identified additional signals, or validated reported associations with progression-free survival for rs1128503, rs2032582, and rs1045642. However, we cannot rule out the possibility of a subtle effect of rs1128503, or other SNPs linked to it, on overall survival.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carboplatin/administration & dosage
- Carcinoma, Ovarian Epithelial
- Disease Progression
- Disease-Free Survival
- Drug Resistance, Multiple/genetics
- Drug Resistance, Neoplasm/genetics
- Female
- Humans
- Kaplan-Meier Estimate
- Neoplasms, Glandular and Epithelial/drug therapy
- Neoplasms, Glandular and Epithelial/genetics
- Neoplasms, Glandular and Epithelial/surgery
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/surgery
- Paclitaxel/administration & dosage
- Pharmacogenetics
- Polymorphism, Single Nucleotide
- Proportional Hazards Models
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Affiliation(s)
| | | | - Bo Gao
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
| | - Xiaoqing Chen
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Yi Lu
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Matthew H. Law
- Queensland Institute of Medical Research, Brisbane, Australia
| | | | | | | | - Catherine Emmanuel
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
| | - Sian Fereday
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Australian Ovarian Cancer Study Group
- Queensland Institute of Medical Research, Brisbane, Australia
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ellen L. Goode
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Robert A. Vierkant
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Brooke L. Fridley
- Dept of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie M Cunningham
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A. Fasching
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center, Erlangen, Germany
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Matthias W. Beckmann
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center, Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Estrid Hogdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claus Hogdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Robert Brown
- Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Jim Paul
- Cancer Research UK Clinical Trials Unit, Glasgow University, Glasgow, UK
| | - Sandrina Lambrechts
- Gynecologic Oncology, University Hospitals Leuven, & Department of Oncology, KU Leuven, Belgium
| | - Evelyn Despierre
- Gynecologic Oncology, University Hospitals Leuven, & Department of Oncology, KU Leuven, Belgium
| | - Ignace Vergote
- Gynecologic Oncology, University Hospitals Leuven, & Department of Oncology, KU Leuven, Belgium
| | - Jenny Lester
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beth Y. Karlan
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Ira Schwaab
- Institut für Humangenetik Wiesbaden, Wiesbaden, Germany
| | - Yukie Bean
- Department of Obstetrics and Gynecology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Douglas A. Levine
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Marc T. Goodman
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael E. Camey
- Cancer Epidemiology Program, University of Hawaii Cancer Center, HI, USA
| | - Pamela J. Thompson
- Cancer Epidemiology Program, University of Hawaii Cancer Center, HI, USA
| | - Galina Lurie
- Cancer Epidemiology Program, University of Hawaii Cancer Center, HI, USA
| | - Joellen Shildkraut
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, North Carolina, USA
| | - Andrew Berchuck
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathryn L. Terry
- Obstetrics and Gynecology Epidemiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel W. Cramer
- Obstetrics and Gynecology Epidemiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Michelle Haber
- Children’s Cancer Institute Australia, Randwick, Australia
| | | | - Anna deFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
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Johnatty SE, Beesley J, Gao B, Chen X, Lu Y, Law MH, Henderson MJ, Russell AJ, Hedditch EL, Emmanuel C, Fereday S, Webb PM, Goode EL, Vierkant RA, Fridley BL, Cunningham JM, Fasching PA, Beckmann MW, Ekici AB, Hogdall E, Kjaer SK, Jensen A, Hogdall C, Brown R, Paul J, Lambrechts S, Despierre E, Vergote I, Lester J, Karlan BY, Heitz F, du Bois A, Harter P, Schwaab I, Bean Y, Pejovic T, Levine DA, Goodman MT, Camey ME, Thompson PJ, Lurie G, Shildkraut J, Berchuck A, Terry KL, Cramer DW, Norris MD, Haber M, MacGregor S, deFazio A, Chenevix-Trench G. ABCB1 (MDR1) polymorphisms and ovarian cancer progression and survival: a comprehensive analysis from the Ovarian Cancer Association Consortium and The Cancer Genome Atlas. Gynecol Oncol 2013. [PMID: 23917080 DOI: 10.1016/j.ygyno.2013.07.107] [] [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: 09/30/2022]
Abstract
OBJECTIVE ABCB1 encodes the multi-drug efflux pump P-glycoprotein (P-gp) and has been implicated in multi-drug resistance. We comprehensively evaluated this gene and flanking regions for an association with clinical outcome in epithelial ovarian cancer (EOC). METHODS The best candidates from fine-mapping analysis of 21 ABCB1 SNPs tagging C1236T (rs1128503), G2677T/A (rs2032582), and C3435T (rs1045642) were analysed in 4616 European invasive EOC patients from thirteen Ovarian Cancer Association Consortium (OCAC) studies and The Cancer Genome Atlas (TCGA). Additionally we analysed 1,562 imputed SNPs around ABCB1 in patients receiving cytoreductive surgery and either 'standard' first-line paclitaxel-carboplatin chemotherapy (n=1158) or any first-line chemotherapy regimen (n=2867). We also evaluated ABCB1 expression in primary tumours from 143 EOC patients. RESULT Fine-mapping revealed that rs1128503, rs2032582, and rs1045642 were the best candidates in optimally debulked patients. However, we observed no significant association between any SNP and either progression-free survival or overall survival in analysis of data from 14 studies. There was a marginal association between rs1128503 and overall survival in patients with nil residual disease (HR 0.88, 95% CI 0.77-1.01; p=0.07). In contrast, ABCB1 expression in the primary tumour may confer worse prognosis in patients with sub-optimally debulked tumours. CONCLUSION Our study represents the largest analysis of ABCB1 SNPs and EOC progression and survival to date, but has not identified additional signals, or validated reported associations with progression-free survival for rs1128503, rs2032582, and rs1045642. However, we cannot rule out the possibility of a subtle effect of rs1128503, or other SNPs linked to it, on overall survival.
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Huynh T, Norris MD, Haber M, Henderson MJ. ABCC4/MRP4: a MYCN-regulated transporter and potential therapeutic target in neuroblastoma. Front Oncol 2012; 2:178. [PMID: 23267433 PMCID: PMC3526013 DOI: 10.3389/fonc.2012.00178] [Citation(s) in RCA: 27] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/09/2012] [Indexed: 02/03/2023] Open
Abstract
Resistance to cytotoxic drugs is thought to be a major cause of treatment failure in childhood neuroblastoma, and members of the ATP-binding cassette (ABC) transporter superfamily may contribute to this phenomenon by active efflux of chemotherapeutic agents from cancer cells. As a member of the C subfamily of ABC transporters, multidrug resistance-associated protein MRP4/ABCC4 has the ability to export a variety of endogenous and exogenous substances across the plasma membrane. In light of its capacity for chemotherapeutic drug efflux, MRP4 has been studied in the context of drug resistance in a number of cancer cell types. However, MRP4 also influences cancer cell biology independently of chemotherapeutic drug exposure, which highlights the potential importance of endogenous MRP4 substrates in cancer biology. Furthermore, MRP4 is a direct transcriptional target of Myc family oncoproteins and expression of this transporter is a powerful independent predictor of clinical outcome in neuroblastoma. Together, these features suggest that inhibition of MRP4 may be an attractive therapeutic approach for neuroblastoma and other cancers that rely on MRP4. In this respect, existing options for MRP4 inhibition are relatively non-selective and thus development of more specific anti-MRP4 compounds should be a major focus of future work in this area.
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Affiliation(s)
- Tony Huynh
- Experimental Therapeutics Program, Lowy Cancer Research Centre, Children's Cancer Institute Australia for Medical Research, University of New South Wales and Sydney Children's Hospital Sydney, NSW, Australia
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Henderson MJ, Haber M, Porro A, Munoz MA, Iraci N, Xue C, Murray J, Flemming CL, Smith J, Fletcher JI, Gherardi S, Kwek CK, Russell AJ, Valli E, London WB, Buxton AB, Ashton LJ, Sartorelli AC, Cohn SL, Schwab M, Marshall GM, Perini G, Norris MD. ABCC multidrug transporters in childhood neuroblastoma: clinical and biological effects independent of cytotoxic drug efflux. J Natl Cancer Inst 2011; 103:1236-51. [PMID: 21799180 PMCID: PMC3156802 DOI: 10.1093/jnci/djr256] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Although the prognostic value of the ATP-binding cassette, subfamily C (ABCC) transporters in childhood neuroblastoma is usually attributed to their role in cytotoxic drug efflux, certain observations have suggested that these multidrug transporters might contribute to the malignant phenotype independent of cytotoxic drug efflux. Methods A v-myc myelocytomatosis viral related oncogene, neuroblastoma derived (MYCN)–driven transgenic mouse neuroblastoma model was crossed with an Abcc1-deficient mouse strain (658 hMYCN1/−, 205 hMYCN+/1 mice) or, alternatively, treated with the ABCC1 inhibitor, Reversan (n = 20). ABCC genes were suppressed using short interfering RNA or overexpressed by stable transfection in neuroblastoma cell lines BE(2)-C, SH-EP, and SH-SY5Y, which were then assessed for wound closure ability, clonogenic capacity, morphological differentiation, and cell growth. Real-time quantitative polymerase chain reaction was used to examine the clinical significance of ABCC family gene expression in a large prospectively accrued cohort of patients (n = 209) with primary neuroblastomas. Kaplan–Meier survival analysis and Cox regression were used to test for associations with event-free and overall survival. Except where noted, all statistical tests were two-sided. Results Inhibition of ABCC1 statistically significantly inhibited neuroblastoma development in hMYCN transgenic mice (mean age for palpable tumor: treated mice, 47.2 days; control mice, 41.9 days; hazard ratio [HR] = 9.3, 95% confidence interval [CI] = 2.65 to 32; P < .001). Suppression of ABCC1 in vitro inhibited wound closure (P < .001) and clonogenicity (P = .006); suppression of ABCC4 enhanced morphological differentiation (P < .001) and inhibited cell growth (P < .001). Analysis of 209 neuroblastoma patient tumors revealed that, in contrast with ABCC1 and ABCC4, low rather than high ABCC3 expression was associated with reduced event-free survival (HR of recurrence or death = 2.4, 95% CI = 1.4 to 4.2; P = .001), with 23 of 53 patients with low ABCC3 expression experiencing recurrence or death compared with 31 of 155 patients with high ABCC3. Moreover, overexpression of ABCC3 in vitro inhibited neuroblastoma cell migration (P < .001) and clonogenicity (P = .03). The combined expression of ABCC1, ABCC3, and ABCC4 was associated with patients having an adverse event, such that of the 12 patients with the “poor prognosis” expression pattern, 10 experienced recurrence or death (HR of recurrence or death = 12.3, 95% CI = 6 to 27; P < .001). Conclusion ABCC transporters can affect neuroblastoma biology independently of their role in chemotherapeutic drug efflux, enhancing their potential as targets for therapeutic intervention.
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Affiliation(s)
- Michelle J Henderson
- Experimental Therapeutics and Molecular Diagnostics Program, Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, University of New South Wales, P.O. Box 81, Randwick, NSW 2031, Australia
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Norris MD, Henderson MJ, Porro A, Munoz M, Iraci N, Xue C, Murray J, Flemming C, Fletcher J, Gherardi S, Kwek A, Russell A, London WB, Buxton AB, Ashton L, Sartorelli AC, Cohn SL, Schwab M, Marshall GM, Perini G, Haber M. Abstract 954: ABCC/MRP multidrug transporters contribute to neuroblastoma biology, pathogenesis and clinical outcome, independently of any role in cytotoxic drug efflux. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-954] [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
We have previously shown that high levels of the multidrug transporters ABCC1/MRP1 (1,2) and ABCC4/MRP4 (3) are strongly predictive of poor outcome in the childhood cancer, neuroblastoma. Although the prognostic significance of ABCC1 may be explained in terms of cytotoxic drug resistance, none of the drugs used to treat children in these studies were ABCC4 substrates. This suggests that multidrug transporters can contribute to the malignant phenotype, independent of cytotoxic drug efflux, as we have recently outlined (4). To address this hypothesis, a MYCN-driven transgenic mouse neuroblastoma model was crossed with an Abcc1-deficient mouse strain or alternatively, treated with an ABCC1 inhibitor. Pharmacological inhibition or genetic depletion of ABCC1 significantly inhibited neuroblastoma development in MYCN transgenic mice, while knockdown of ABCC1 using siRNA reduced cell motility and clonogenicity in cultured neuroblastoma cells, and induced morphological differentiation. Analysis of a large neuroblastoma cohort of 209 primary untreated tumors revealed that amongst the 12 members of the ABCC gene family, expression of only ABCC1, ABCC4 and also ABCC3 were predictive of neuroblastoma outcome. We confirmed a highly significant association between high levels of either ABCC1 or ABCC4 and poor outcome (p<0.0001), but in addition, found the surprising result of a highly significant association between low expression of ABCC3 and poor outcome (p<0.0001). Expression levels of ABCC1, ABCC3 and ABCC4 were all independently prognostic of outcome and their combined expression pattern defined a subgroup of patients with a survival rate of less than 20%. These results were confirmed by analysis of a large publicly available neuroblastoma gene expression database. siRNA knockdown of ABCC4, or over-expression of ABCC3, also influenced multiple biological characteristics of neuroblastoma cells, resulting in reduced proliferation and migration, and enhanced morphological differentiation. This study provides the first evidence that ABCC multidrug transporters can contribute to neuroblastoma biology and pathogenesis independently of any role in chemotherapeutic drug efflux, and suggests that ABCC1, ABCC3 and ABCC4 represent attractive targets for therapeutic intervention.
1) New Engl J Med 334:231-238, 1996
2) J Clin Oncol 24:1546-53, 2006
3) Mol Cancer Ther 4:547-53, 2005
4) Nat Rev Cancer, 10:147-156, 2010
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 954. doi:10.1158/1538-7445.AM2011-954
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Affiliation(s)
| | | | | | - Marcia Munoz
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | - Chengyuan Xue
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Jayne Murray
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | - Jamie Fletcher
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | - Alan Kwek
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Amanda Russell
- 1Children's Cancer Institute Australia, Sydney, Australia
| | - Wendy B. London
- 3University of Florida and Children's Oncology Group Statistics and Data Center, Gainesville, FL
| | - Allen B. Buxton
- 3University of Florida and Children's Oncology Group Statistics and Data Center, Gainesville, FL
| | - Lesley Ashton
- 1Children's Cancer Institute Australia, Sydney, Australia
| | | | | | | | | | | | - Michelle Haber
- 1Children's Cancer Institute Australia, Sydney, Australia
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Henderson MJ, Hedditch EL, Russell AJ, deFazio A, Emmanuel C, George J, Chenevix-Trench G, Bowtell D, Norris MD, Haber M. Abstract 1660: Cholesterol efflux transporter gene expression predicts clinical outcome in serous ovarian cancer. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-1660] [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
Ovarian cancer is a devastating disease. More than half the women diagnosed with advanced disease will die within five years. Tumours displaying serous histology are the most common, and although initially responsive to current chemotherapy regimens, the disease is characterised by a frequent rate of relapse, often with disease that is resistant to further treatment. Tumours displaying serous histology are the most common and often have the worst prognosis. The ATP-binding cassette (ABC) transporter superfamily consists of 48 functional transmembrane proteins which are further classified into seven subfamilies according to sequence similarity, designated A through G. Various members of the B, C and G branches are well-known for their abilities to convey drug resistance to cancer cells in vitro, but their precise roles in determining clinical outcome are still unclear. In addition, ABC transporters have important and diverse physiological roles through active transport of a variety of endogenous substrates, which could also contribute to tumour phenotype and treatment response. This is the first study to explore the entire ABC transporter gene family in relation to clinical outcome of ovarian cancer. Using a Taqman low density array format for real-time PCR, we examined expression of all ABC transporter genes in a cohort of 150 serous ovarian cancers. Kaplan-Meier survival analysis revealed that expression of multiple ABCA family transporters was significantly associated with progression-free or overall survival and multivariate modelling identified ABCA1, ABCA5, ABCA6, ABCA8 and ABCA9 as new prognostic markers for serous ovarian cancer that are independent of established clinical indicators. The prognostic significance of ABCA family transporter expression was validated in an independent microarray dataset consisting of 350 serous tumours available through The Cancer Genome Atlas. These ABCA family transporters are not known to transport drugs but instead function in cellular lipid trafficking and cholesterol homeostasis, suggesting that treatment failure may involve mechanisms other than simple efflux of chemotherapeutic drugs. In light of accumulating evidence for the importance of cholesterol and bioactive lipids in several cancers, this study highlights an important area for investigation into the biology and treatment of serous ovarian cancer.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1660. doi:10.1158/1538-7445.AM2011-1660
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Affiliation(s)
| | | | | | - Anna deFazio
- 2Westmead Institute for Cancer Research, WMI, Westmead, Sydney, Australia
| | - Catherine Emmanuel
- 2Westmead Institute for Cancer Research, WMI, Westmead, Sydney, Australia
| | - Joshy George
- 3Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | | | - David Bowtell
- 3Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Murray D. Norris
- 1Children's Cancer Institute Australia, Randwick, Sydney, Australia
| | - Michelle Haber
- 1Children's Cancer Institute Australia, Randwick, Sydney, Australia
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McDonald WJ, Sangster SM, Moffat LD, Henderson MJ, Too CK. α4 phosphoprotein interacts with EDD E3 ubiquitin ligase and poly(A)-binding protein. J Cell Biochem 2010; 110:1123-9. [DOI: 10.1002/jcb.22624] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Multidrug transporter proteins are best known for their contributions to chemoresistance through the efflux of anticancer drugs from cancer cells. However, a considerable body of evidence also points to their importance in cancer extending beyond drug transport to fundamental roles in tumour biology. Currently, much of the evidence for these additional roles is correlative and definitive studies are needed to confirm causality. We propose that delineating the precise roles of these transporters in tumorigenesis and treatment response will be important for the development of more effective targeted therapies.
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Affiliation(s)
- Jamie I Fletcher
- Children's Cancer Institute Australia for Medical Research, Lowry Cancer Research Centre, University of New South Wales, P.O. BOX 151, Randwick NSW 2031, Australia
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Henderson MJ. It's a great life if you don't weaken. Reflections on living and dying. Adv Nurse Pract 2009; 17:45-47. [PMID: 19999408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Zychowicz M, Craig A, Green R, Weill V, Kaplan C, Resnick B, Henderson MJ, Arnold KC, Halloran L, Ryan S. Your first NP position. Adv Nurse Pract 2009; 17:53-54. [PMID: 20014727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Walter JH, Patterson A, Till J, Besley GTN, Fleming G, Henderson MJ. Bloodspot acylcarnitine and amino acid analysis in cord blood samples: efficacy and reference data from a large cohort study. J Inherit Metab Dis 2009; 32:95-101. [PMID: 19191006 DOI: 10.1007/s10545-008-1047-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/07/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In order to test the feasibility of cord blood screening for inherited metabolic disease, a two-year cohort study of births in six obstetric units from five towns in the north of England was undertaken. These towns have a high prevalence of consanguineous marriages, largely among the immigrant Asian community. The purpose of the study was to determine whether early detection of metabolic disease was possible and whether early intervention would improve prognosis. METHODS Following parental consent, cord blood samples were collected at birth and analysed for acylcarnitine and amino acid profiles by tandem mass spectrometry in one of two laboratories. One laboratory used butylated derivatives, the other used underivatized samples. The same laboratories performed routine blood spot neonatal screening at 5-7 days of age on these babies. Patients with positive results were investigated and treated by a metabolic paediatrician as soon as possible. RESULTS 24,983 births were examined. 12,952 samples were analysed as butyl derivatives, 12,031 samples were analysed underivatized. The following disorders were detected: medium-chain acyl-CoA dehydrogenase (MCAD) deficiency (1 case), 3-methylcrotonyl-CoA carboxylase (MCC) deficiency (2 cases), maternal carnitine transporter defect (2 cases), maternal MCC (1 case). The following disorders were diagnosed subsequently but were not detected by the cord blood screening: phenylketonuria (PKU) (1 case), maple syrup urine disease (MSUD) (2 cases), argininosuccinic aciduria (1 case), methylmalonic acidaemia (MMA) (1 case), glutaric aciduria type 2 (1 case), MCAD deficiency (2 cases), 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (1 case). Comprehensive reference data for all analytes by both methods were obtained. CONCLUSIONS Cord blood testing is of limited value in detecting inherited metabolic disease. The metabolites associated with most disorders examined were not elevated in cord blood. Some maternal disorders, carnitine transporter defect and 3-methlycrotonyl-CoA carboxylase deficiency, are detected. These remain of uncertain clinical significance. Comprehensive reference data have been obtained that will facilitate future interpretation of studies in cord blood.
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Affiliation(s)
- J H Walter
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, Manchester, UK.
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O'Brien PM, Davies MJ, Scurry JP, Smith AN, Barton CA, Henderson MJ, Saunders DN, Gloss BS, Patterson KI, Clancy JL, Heinzelmann-Schwarz VA, Murali R, Scolyer RA, Zeng Y, Williams ED, Scurr L, DeFazio A, Quinn D, Watts CKW, Hacker NF, Henshall SM, Sutherland RL. Erratum: The E3 ubiquitin ligase EDD is an adverse prognostic factor for serous epithelial ovarian cancer and modulates cisplatin resistance in vitro. Br J Cancer 2008. [PMCID: PMC2410105 DOI: 10.1038/sj.bjc.6604419] [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: 11/09/2022] Open
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O'Brien PM, Davies MJ, Scurry JP, Smith AN, Barton CA, Henderson MJ, Saunders DN, Gloss BS, Patterson KI, Clancy JL, Heinzelmann-Schwarz VA, Murali R, Scolyer RA, Zeng Y, Williams ED, Scurr L, Defazio A, Quinn DI, Watts CKW, Hacker NF, Henshall SM, Sutherland RL. The E3 ubiquitin ligase EDD is an adverse prognostic factor for serous epithelial ovarian cancer and modulates cisplatin resistance in vitro. Br J Cancer 2008; 98:1085-93. [PMID: 18349819 PMCID: PMC2275489 DOI: 10.1038/sj.bjc.6604281] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite a high initial response rate to first-line platinum/paclitaxel chemotherapy, most women with epithelial ovarian cancer relapse with recurrent disease that becomes refractory to further cytotoxic treatment. We have previously shown that the E3 ubiquitin ligase, EDD, a regulator of DNA damage responses, is amplified and overexpressed in serous ovarian carcinoma. Given that DNA damage pathways are linked to platinum resistance, the aim of this study was to determine if EDD expression was associated with disease recurrence and platinum sensitivity in serous ovarian cancer. High nuclear EDD expression, as determined by immunohistochemistry in a cohort of 151 women with serous ovarian carcinoma, was associated with an approximately two-fold increased risk of disease recurrence and death in patients who initially responded to first-line chemotherapy, independently of disease stage and suboptimal debulking. Although EDD expression was not directly correlated with relative cisplatin sensitivity of ovarian cancer cell lines, sensitivity to cisplatin was partially restored in platinum-resistant A2780-cp70 ovarian cancer cells following siRNA-mediated knockdown of EDD expression. These results identify EDD as a new independent prognostic marker for outcome in serous ovarian cancer, and suggest that pathways involving EDD, including DNA damage responses, may represent new therapeutic targets for chemoresistant ovarian cancer.
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Affiliation(s)
- P M O'Brien
- Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales 2010, Australia .
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Henderson MJ, Choi S, Beesley AH, Baker DL, Wright D, Papa RA, Murch A, Campbell LJ, Lock RB, Norris MD, Haber M, Kees UR. A xenograft model of infant leukaemia reveals a complex MLL translocation. Br J Haematol 2008; 140:716-9. [PMID: 18218047 DOI: 10.1111/j.1365-2141.2007.06966.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Henderson MJ. Two weddings and a funeral. Everlasting love. Adv Nurse Pract 2008; 16:51-72. [PMID: 20014743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- M J Henderson
- American College of Nurse Practitioners, Political Action Committee, USA
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Munoz MA, Saunders DN, Henderson MJ, Clancy JL, Russell AJ, Lehrbach G, Musgrove EA, Watts CKW, Sutherland RL. The E3 ubiquitin ligase EDD regulates S-phase and G(2)/M DNA damage checkpoints. Cell Cycle 2007; 6:3070-7. [PMID: 18073532 DOI: 10.4161/cc.6.24.5021] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The cellular response to DNA damage is critical for maintenance of genomic integrity and inhibition of tumorigenesis. Mutations or aberrant expression of the E3 ubiquitin ligase EDD have been observed in a number of carcinomas and we recently reported that EDD modulates activity of the DNA damage checkpoint kinase, CHK2. Here, we demonstrate that EDD is necessary for G(1)/S and intra S phase DNA damage checkpoint activation and for the maintenance of G(2)/M arrest after double strand DNA breaks. Defective checkpoint activation in EDD-depleted cells led to radio-resistant DNA synthesis, premature entry into mitosis, accumulation of polyploid cells, and cell death via mitotic catastrophe. In addition to decreased CHK2 activation in EDD-depleted cells, the expression of several key cell cycle mediators including Cdc25A/C and E2F1 was altered, suggesting that these checkpoint defects may be both CHK2-dependent and -independent. These data support a role for EDD in the maintenance of genomic stability, emphasising the potential importance of dysregulated EDD expression and/or function in the evolution of cancer.
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Affiliation(s)
- Marcia A Munoz
- Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
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Henderson MJ. Anemia in the older adult. Engineering George's road to better health. Adv Nurse Pract 2007; 15:55-58. [PMID: 19999010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Choi S, Henderson MJ, Kwan E, Beesley AH, Sutton R, Bahar AY, Giles J, Venn NC, Pozza LD, Baker DL, Marshall GM, Kees UR, Haber M, Norris MD. Relapse in children with acute lymphoblastic leukemia involving selection of a preexisting drug-resistant subclone. Blood 2007; 110:632-9. [PMID: 17371950 DOI: 10.1182/blood-2007-01-067785] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Relapse following remission induction chemotherapy remains a barrier to survival in approximately 20% of children suffering from acute lymphoblastic leukemia (ALL). To investigate the mechanism of relapse, 27 matched diagnosis and relapse ALL samples were analyzed for clonal populations using polymerase chain reaction (PCR)-based detection of multiple antigen receptor gene rearrangements. These clonal markers revealed the emergence of apparently new populations at relapse in 13 patients. More sensitive clone-specific PCR revealed that, in 8 cases, these "relapse clones" were present at diagnosis and a significant relationship existed between presence of the relapse clone at diagnosis and time to first relapse (P < .007). Furthermore, in cases where the relapse clone could be quantified, time to first relapse was dependent on the amount of the relapse clone at diagnosis (r = -0.84; P = .018). This observation, together with demonstrated differential chemosensitivity between subclones at diagnosis, argues against therapy-induced acquired resistance as the mechanism of relapse in the informative patients. Instead these data indicate that relapse in ALL patients may commonly involve selection of a minor intrinsically resistant subclone that is undetectable by routine PCR-based methods. Relapse prediction may be improved with strategies to detect minor potentially resistant subclones early during treatment, hence allowing intensification of therapy.
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Affiliation(s)
- Seoyeon Choi
- Children's Cancer Institute Australia for Medical Research, Sydney, Australia
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