Proteomic profiles of peritoneal-derived small extracellular vesicles correlate with outcome in ovarian cancer patients

Cancer-derived small extracellular vesicles (sEVs) are capable of modifying tumor microenvironment and promoting tumor progression. Ovarian cancer (OvCa) is a lethal malignancy that preferentially spreads through the abdominal cavity. Thus, the secretion of such vesicles into the peritoneal fluid could be a determinant factor in the dissemination and behavior of this disease. We designed a prospective observational study to assess the impact of peritoneal fluid-derived sEVs (PFD-sEVs) in OvCa clinical outcome. For this purpose, two patient cohorts were enrolled, including OvCa cases who underwent a diagnostic or cytoreductive surgery, and non-oncological patients as controls, who underwent abdominal surgery for benign gynecological conditions. PFD-sEVs systematic extraction from surgical samples enabled us to observe significant quantitative and qualitative differences associated with cancer diagnosis, disease stage and platinum chemosensitivity. Proteomic profiling of PFD-sEVs led to the identification of molecular pathways and proteins of interest and to the biological validation of S100A4 and STX5. In addition, unsupervised analysis of PFD-sEVs proteomic profiles in high-grade serous ovarian carcinomas (HGSOC) revealed two clusters with different outcomes in terms of overall survival. In conclusion, comprehensive characterization of the PFD-sEVs content provided a prognostic value with potential implications in HGSOC clinical management.

Randomized phase II clinical trial of ruxolitinib plus simvastatin in COVID19 clinical outcome and cytokine evolution

Background

Managing the inflammatory response to SARS-Cov-2 could prevent respiratory insufficiency. Cytokine profiles could identify cases at risk of severe disease.

Methods

We designed a randomized phase II clinical trial to determine whether the combination of ruxolitinib (5 mg twice a day for 7 days followed by 10 mg BID for 7 days) plus simvastatin (40 mg once a day for 14 days), could reduce the incidence of respiratory insufficiency in COVID-19. 48 cytokines were correlated with clinical outcome.

Participants

Patients admitted due to COVID-19 infection with mild disease.

Results

Up to 92 were included. Mean age was 64 ± 17, and 28 (30%) were female. 11 (22%) patients in the control arm and 6 (12%) in the experimental arm reached an OSCI grade of 5 or higher (p = 0.29). Unsupervised analysis of cytokines detected two clusters (CL-1 and CL-2). CL-1 presented a higher risk of clinical deterioration vs CL-2 (13 [33%] vs 2 [6%] cases, p = 0.009) and death (5 [11%] vs 0 cases, p = 0.059). Supervised Machine Learning (ML) analysis led to a model that predicted patient deterioration 48h before occurrence with a 85% accuracy.

Conclusions

Ruxolitinib plus simvastatin did not impact the outcome of COVID-19. Cytokine profiling identified patients at risk of severe COVID-19 and predicted clinical deterioration.

Trial registration

https://clinicaltrials.gov/, identifier NCT04348695.

Abstract 3223: Prospective study for the assessment of exosomes in ascitic fluid as prognostic markers in patients with advanced ovarian cancer

Background: Exosomes have been involved in tumor progression and the development of therapeutic resistances in several malignancies. These extracellular vesicles (EVs) promote angiogenesis, premetastatic niches formation and the communication between the tumor and its environment. Ovarian cancer (OC) is a highly lethal tumor that typically spreads within the abdominal cavity rather than through the blood vessels. Based on this behavior, we aimed to study the presence of exosomes in ascitic fluid of OC patients and explore their potential as predictors of tumor volume and chemoresistance.

Methods: We designed an observational prospective study in advanced OC patients who underwent a diagnostic laparoscopy or cytoreductive surgery at our institution. Abdominal washings of a cohort of non-cancer patients were collected as controls. All cases provided written consent. Clinical data and tumor genomic alterations (NGS, FoundationOne CDx) were recorded. EVs pellets were collected by ultracentrifugation and profiled by NTA and western blot (WB) (EVs markers: CD9, TSG101 and ALIX; non EVs related markers: ALB and APOB). PAX8, a protein characteristically expressed in OC cells, was used as a marker of tumor EVs. EVs proteins were quantified by BCA assay; mass spectrometry profiling is ongoing.

Results: 45 peritoneal fluids from 40 OC patients (median age [range] 62 [44-79] years) and 29 peritoneal washings from controls have been collected. Our cohort comprise various histological subtypes (high-grade serous, n=32 [80%]; low-grade serous, n=2 [5%]; endometrioid, n=3 [8%)]; clear cells, n=2 [5%] and mucinous, n=1 [2%]) and tumor stages (TI-II, n=5 [12%]; TIII; n=24 [60%]; TIV, n=11 [28%]). Samples were collected either from primary, n=18 (40%); interval, n=15 (33%); or relapse surgery, n=12 (27%). Pathogenic BRCA events were detected in 25% of patients. Mean concentration of exosomes (MCE) was 6.5x106 vs. 3.2x106 particles/ml (p/ml) in cases vs. controls (p<0.0005). No differences in MCE were observed regarding stages I-II vs. stages III-IV (7.1x106 vs. 6.5x106 p/ml; p=0.84), BRCA status (mutant=6.9x106 vs. wild type=6.8x106 p/ml, p=0.46) or platinum response (resistant=7.7x106 vs. sensitive=9.5x106 p/ml, p=0.14). WB analysis showed an enrichment in EVs markers from cancer patients vs. controls (>3-fold). Protein mean concentration in EVs of cancer patients vs. controls was 0.85µg/µl and 0.51µg/µl respectively (p=0.04). Proteomic characterization through mass spectrometry is ongoing and will be presented at the time of the meeting.

Conclusions: Our data, although preliminary, show a higher concentration of EVs and EVs proteins in OC cases vs controls with no difference between stages or genomic backgrounds. These results lead to the notion that exosomes could be involved in OC evolution and spread regardless of tumor volume or the molecular subtype.

Citation Format: Miguel Quiralte, Arantzazu Barquin, Elena Sevillano, Paloma Navarro, Monica Yagüe, Maria Barba, Juan F. Rodriguez-Moreno, Alejandra Balarezo, Héctor Peinado, Elena Izquierdo, Jesús García-Donas, Sergio Ruiz-Llorente. Prospective study for the assessment of exosomes in ascitic fluid as prognostic markers in patients with advanced ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3223.

Prognostic impact of fibroblast growth factor receptor (FGFR) genomic alterations and outcomes in patients with metastatic urothelial

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Background: FGFR mutations/translocations are druggable targets in metastatic urothelial cancer (mUC). However, the prognostic effect of these genomic alterations (GA) and their role in the response to conventional therapy remain poorly characterized. Methods: We undertook an observational retrospective study in four Academic Hospitals in Madrid, Spain. Clinical and molecular information of patients diagnosed of Urothelial Cancer (UC) between January 2010 and December 2020 was systematically reviewed. The objective of this work was to compare the outcome of mUC patients with GA in the FGFR 2-3 genes versus wild type tumors. Analyses for detection of FGFR translocations and mutations using DNA isolated from formalin-fixed and paraffinized tumor tissue samples consisted of either next-generation sequencing (Foundation One test; n = 68) or qualitative real-time polymerase chain reaction–based assays (n = 9) with TFGFR or QIAGEN therascreen® tests that evaluated somatic mutations within the FGFR2-3 gene: R248C, S249C, G370C and Y373C and fusions: FGFR3-TACC3v3, FGFR3-TACC3v1 and FGFR3-BAIAP2L1, FGFR2-BICC1 and FGFR2-CASP7. Overall response rate (ORR), Progression Free Survival (PFS) and Overall Survival (OS) were determined and Cox-regression analysis were performed to assess the prognostic impact of these alterations. Results: We identified 201 patients diagnosed with UC. Genomic profiling was available in 77 mUC with 28 patients harboring any FGFR GA. Regarding ORR to first line a trend towards a better outcome was identified in FGFR GA (mutation/translocation/fusion) vs wild type cases (57,7% vs 45,5%, p=0,46). However, median OS was significantly worse among FGFR GA (mutation/translocation) vs FGFR wt tumours (13.8 vs 26.2 months, p=0,021). Prognostic factors associated with an unfavorable outcome in multivariable analysis were visceral metastases (HR 7,29 95% CI 1.6-32,3), ECOG >1 (HR 7,03 95% CI 2,59-19,1), first line treatment with checkpoint inhibitors (HR 2,67; 95% CI 1,06-6,74) and the presence of FGFR GAs (HR 2,98, 95% CI 1.37-6.5). Conclusions: Despite a better response to first line treatment, overall FGFR GA showed to be an independent risk factor in mUC. Thus, this determination should be included in new prognostic models.[Table: see text]