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Takeshita T, Iwamoto T, Niikura N, Watanabe K, Kikawa Y, Kobayashi K, Iwakuma N, Okamura T, Tada H, Ozaki S, Okuno T, Toh U, Yamamoto Y, Tsuneizumi M, Ishiguro H, Masuda N, Saji S. Identifying prognostic biomarkers for palbociclib add-on therapy in fulvestrant-resistant breast cancer using cell-free DNA sequencing. ESMO Open 2024; 9:102385. [PMID: 38387111 DOI: 10.1016/j.esmoop.2024.102385] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The FUTURE trial (UMIN000029294) demonstrated the safety and efficacy of adding palbociclib after fulvestrant resistance in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced and metastatic breast cancer (ABC/MBC). In this planned sub-study, cancer panel sequencing of cell-free DNA (cfDNA) was utilized to explore prognostic and predictive biomarkers for further palbociclib treatment following fulvestrant resistance. MATERIALS AND METHODS Herein, 149 cfDNA samples from 65 patients with fulvestrant-resistant disease were analysed at the time of palbociclib addition after fulvestrant resistance (baseline), on day 15 of cycle 1, and at the end of treatment using the assay for identifying diverse mutations in 34 cancer-related genes. RESULTS During the course of treatment, mutations in ESR1, PIK3CA, FOXA1, RUNX1, TBX3, and TP53 were the most common genomic alterations observed. Analysis of genomic mutations revealed that before fulvestrant introduction, baseline PIK3CA mutations were marginally lower in metastatic aromatase inhibitor (AI)-treated patients compared to adjuvant AI-treated patients (P = 0.063). Baseline PIK3CA mutations were associated with poorer progression-free survival [hazard ratio: 1.62, P = 0.04]. Comparative analysis between baseline and early-changing gene mutations identified poor prognostic factors including early-changing MAP3K1 mutations (hazard ratio: 4.66, P = 0.04), baseline AR mutations (hazard ratio: 3.53, P = 0.04), and baseline PIK3CA mutations (hazard ratio: 3.41, P = 0.02). Notably, the relationship between ESR1 mutations and mutations in PIK3CA, MAP3K1, and TP53 weakened as treatment progressed. Instead, PIK3CA mutations became correlated with TP53 and FOXA1 mutations. CONCLUSIONS Cancer panel testing for cfDNA identified prognostic and predictive biomarkers for palbociclib add-on therapy after acquiring fulvestrant resistance in patients with HR+/HER2- ABC/MBC.
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Affiliation(s)
- T Takeshita
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, Kumamoto.
| | - T Iwamoto
- Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Kurashiki
| | - N Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Kanagawa
| | - K Watanabe
- Department of Breast Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido
| | - Y Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata, Osaka
| | - K Kobayashi
- Department of Medical Oncology, Saitama Red Cross Hospital, Chuo-ku, Saitama
| | - N Iwakuma
- Breast Center, Department of Breast Surgery, NHO Kyushu Medical Center, Fukuoka
| | - T Okamura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Kanagawa
| | - H Tada
- Division of Breast and Endocrine Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | - S Ozaki
- Department of Gastrointestinal and Breast Surgery, Hiroshima Prefectural Hospital, Hiroshima
| | - T Okuno
- Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo
| | - U Toh
- Department of Breast Surgery, Kurume University Hospital, Kurume, Fukuoka
| | - Y Yamamoto
- Department of Breast and Endocrine Surgery, Kumamoto University Hospital, Kumamoto
| | - M Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka
| | - H Ishiguro
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - N Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - S Saji
- Department of Medical Oncology, Fukushima Medical University, School of Medicine, Fukushima, Japan
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Iwamoto T, Niikura N, Watanabe K, Takeshita T, Kikawa Y, Kobayashi K, Iwakuma N, Okamura T, Tada H, Ozaki S, Okuno T, Toh U, Yamamoto Y, Tsuneizumi M, Ishiguro H, Masuda N, Saji S. Changes in cell-free DNA after short-term palbociclib and fulvestrant treatment for advanced or metastatic hormone receptor-positive and human epidermal growth factor 2-negative breast cancer. Breast Cancer Res Treat 2024; 203:225-234. [PMID: 37875670 DOI: 10.1007/s10549-023-07144-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Here, we investigated the potential predictive and elucidating efficacy of cell-free DNA (cfDNA) changes on clinical outcomes and biological effects, respectively, after short-term palbociclib and fulvestrant treatment for patients with hormone receptor (HR)-positive and human epidermal growth factor 2 (HER2)-negative advanced or metastatic breast cancer (ABC). METHODS In this secondary analysis of the Japan Breast Cancer Research Group-M07 (FUTURE) trial, blood cfDNA was obtained before palbociclib treatment and on day 15 of cycle one (28-day cycle). Target enrichment was performed using next-generation sequencing; progression-free survival (PFS) was compared based on cfDNA changes between baseline and day 15 of cycle one after combination therapy. RESULTS Fifty-six patients (112 paired blood samples) were examined. The median follow-up time was 8.9 months. PIK3CA (30.4%, 17/56), FOXA1 (30.4%, 17/56), and ESR1 (28.6%, 16/56) were most frequently mutated at baseline. The number of mutated genes was significantly decreased on day 15 compared with that at baseline (paired t test: P value = 0.025). No significant difference was observed in PFS (decrease group, 7.9 m vs the others, 9.3 m; log-rank P value = 0.75; hazard ratio, 1.13; 95% confidence interval, 0.53-2.41). Among patients without previous aromatase inhibitor treatment (n = 15), three (20%) had ESR1 mutations after progression to fulvestrant. CONCLUSION No significant association was observed between changes in mutated genes after short-term palbociclib and fulvestrant treatment and disease progression; a significant reduction in cfDNA mutation level was observed on day 15 of cycle one. Clinical meanings of cfDNA should be investigated in the future trials.
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Affiliation(s)
- Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.
- Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kenichi Watanabe
- Breast Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Takashi Takeshita
- Breast and Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Kumamoto, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Kokoro Kobayashi
- Department of Medical Oncology, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Nobutaka Iwakuma
- Breast Center, Department of Breast Surgery, Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Takuho Okamura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroshi Tada
- Department of Surgery, Division of Breast and Endocrine Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinji Ozaki
- Department of Gastrointestinal and Breast Surgery, Hiroshima Prefectural Hospital, Hiroshima, Hiroshima, Japan
| | - Toshitaka Okuno
- Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | - Uhi Toh
- Department of Breast Surgery, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Hiroshi Ishiguro
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
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Watanabe K, Niikura N, Kikawa Y, Oba M, Kobayashi K, Tada H, Ozaki S, Toh U, Yamamoto Y, Tsuneizumi M, Okuno T, Iwakuma N, Takeshita T, Iwamoto T, Ishiguro H, Masuda N, Saji S. Fulvestrant plus palbociclib in advanced or metastatic hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer after fulvestrant monotherapy: Japan Breast Cancer Research Group-M07 (FUTURE trial). Breast Cancer Res Treat 2023; 199:253-263. [PMID: 37000345 PMCID: PMC10175424 DOI: 10.1007/s10549-023-06911-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE The combination of cyclin-dependent kinase 4/6 inhibitors and endocrine therapy is a standard treatment for hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC); however, their toxicities and financial burden are major issues, especially for prolonged treatment. We investigated fulvestrant plus palbociclib in patients with HR-positive MBC resistant to fulvestrant monotherapy. METHODS Patients who initially received fulvestrant as their first- or second-line endocrine therapy were assigned to group A. Patients with disease progression during fulvestrant monotherapy who subsequently received fulvestrant plus palbociclib were assigned to group B. The primary endpoint was progression-free survival (PFS1) in group B. We set the threshold median PFS of 5 months (null hypothesis). RESULTS Between January 2018 and February 2020 we enrolled 167 patients in group A (January 2018-February 2020) from 55 institutions, of whom 72 subsequently received fulvestrant plus palbociclib and were enrolled in group B. The median follow-up was 23.8 and 8.9 months in groups A and B, respectively. The median PFS in group B (combination therapy) was 9.4 (90% confidence interval [CI]: 6.9-11.2) months (p < 0.001). This was 25.7 (90% CI: 21.2-30.3) months in group A (fulvestrant monotherapy). The TTF in group B was 7.2 (90% CI: 5.5-10.4) months. In the post-hoc analysis, the median PFS1 in group B among patients with longer-duration fulvestrant monotherapy (> 1 year) was longer than that of patients with shorter-duration monotherapy (≤ 1 year) (11.3 vs. 7.6 months). No new toxicities were observed. CONCLUSION Our findings suggest that palbociclib plus fulvestrant after disease progression despite fulvestrant monotherapy is potentially safe and effective in patients with HR-positive/HER2-negative advanced MBC.
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Affiliation(s)
- Kenichi Watanabe
- Department of Breast Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mari Oba
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kokoro Kobayashi
- Department of Breast Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Hiroshi Tada
- Department of Breast and Endocrine Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shinji Ozaki
- Department of Gastrointestinal and Breast Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Uhi Toh
- Department of Breast Surgery, Kurume University Hospital, Kurume, Japan
| | - Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Toshitaka Okuno
- Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobutaka Iwakuma
- Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takashi Takeshita
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Ishiguro
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Watanabe K, Niikura N, Kikawa Y, Oba M, Kobayashi K, Tada H, Ozaki S, Toh U, Yamamoto Y, Tsuneizumi M, Okuno T, Iwakuma N, Takeshita T, Iwamoto T, Ishiguro H, Masuda N, Saji S. 228P Fulvestrant with additional palbociclib in advanced or metastatic hormone receptor-positive HER2-negative breast cancer after progression to fulvestrant monotherapy: JBCRG- M07 (FUTURE trial). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Toh U, Sakurai S, Saku S, Takao Y, Okabe M, Iwakuma N, Shichijo S, Yamada A, Itoh K, Akagi Y. Early phase II study of mixed 19-peptide vaccine monotherapy for refractory triple-negative breast cancer. Cancer Sci 2020; 111:2760-2769. [PMID: 32495455 PMCID: PMC7419019 DOI: 10.1111/cas.14510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
We undertook an early phase II study of mixed 19‐peptide cancer vaccine monotherapy for 14 advanced metastatic triple‐negative breast cancer (mTNBC) patients refractory to systemic chemotherapy to develop a new type of cancer vaccine. The treatment protocol consisted of a weekly vaccination for 6 weeks, and there were no severe adverse events related to the vaccination throughout the trial. Increase of peptide‐specific IgG against the vaccinated human leukocyte antigen‐matched peptides, but not against the nonmatched peptides, was positively correlated with overall survival (OS) (P < .01). The median OS was 11.5 or 24.4 months in all 14 patients or the 10 patients who completed the vaccination. The patients with lower C‐reactive protein levels or 3 or fewer systemic chemotherapies were favorable candidates for this treatment. Advancement of this therapy to the next stage of study could be warranted based on the safety and immune boosting determined herein (clinical trial registration number: UMIN000014616).
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Affiliation(s)
- Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Sayaka Sakurai
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shuko Saku
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yuko Takao
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Mina Okabe
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Nobutaka Iwakuma
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shigeki Shichijo
- Cancer Vaccine Center, Kurume University School of Medicine, Kurume, Japan
| | - Akira Yamada
- Division of Cancer Vaccine, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Cancer Vaccine Center, Kurume University School of Medicine, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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Toh U, Okabe M, Takao Y, Tanaka Y, Shigaki T, Takenaka M, Iwakuma N, Sudo T, Yamada A, Shichijo S, Itoh K, Akagi Y. Abstract P4-06-06: Comparison of the immunological and clinical effect of personalized peptide vaccination for patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-06-06] [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: Selected therapeutic personalized peptide vaccines (PPV) were effective for boosting anticancer immune response that was associated with the clinical outcome as a prognostic factor for metastatic recurrent breast cancer (mrBC) 1-2. In this study, we investigated the immunological and clinical effect of PPV as the prophylactic cancer vaccine for non-recurrent but high-risk BC (nrhrBC) patients (pts), and we compared it's features to those of the mrBC pts who had active cancers or became resistant to the standard therapies(TR-mrBC). Methods: Material and Patient eligibility criteria: The peptides were selected from the 31 PPVs according to the results of HLA typing and peptide-specific IgG titers. Pts with a histological diagnosis of BC and their HLA-A molecules should be each of -A2, A3, A11, A24, A26, A31 or A33. The clinical protocols were approved by the institutional review board. (UMIN000003081and 00000184400000). Treatment schedule: A maximum of 4 peptides was administrated as weekly for initial four vaccinations and as biweekly for further inoculations. The concomitant standard endocrine therapy and the chemo-endocrine therapy were available for nrhrBC pts after finishing the standard adjuvant chemotherapy, and for mrBC pts concurrently. Immune and clinical response assessment: Specific T-cell responses, IgG titers and cytokines were evaluated using by interferon (IFN)-γ ELISPOT, Luminex assay and ELISA system in every 6-8 vaccinations. Toxicity, clinical response and correlation with the immune responses were investigated. Results: 16 pts with nrhrBC, 41 pts with mrBC and 79 pts with TR-mrBC received median 18, 16 and 14 vaccines, respectively. After PPV therapies, peptide-specific IgG and CTLs increased significantly in a total of 47 (77%) and 37(60%) in nrhrBC pts, 102 (63%) and 98 (61%) in mrBC pts, and 150(53%) and 100 (42%) in TR-mrBC pts. Pts experienced Grade 1-3 skin reaction at injection site, no other grade 3 or 4 SAEs were associated with PPV but with the disease progression or combination therapy. The median time to progression (TTP) and overall survival (OS) were not reached in nrhrBC pts, 7.8 and 29 months in mrBC pts, and were 7.5 and 15.9 months in TR-mrBC pts, respectively. The peptide specific CTL response was correlated significantly with OS in nrhrBC pts and the IgG levels were associated with the better OS in either non TR-mrBC pts or TR-mrBC pts. High levels of IL-6, GM-CSF, IFN-g, IL-2 receptor, BAFF were associated with worse prognosis for pts with TR-mrBC. And high levels of GM-CSF and BAFF were associated with worse prognosis for pts with nrhrBC and mrBC, respectively. In contrast, High levels of IL-2 were associated with the better prognosis for pts with mrBC. Conclusion: This study indicated that immunological features of these three groups were different from each other with most potent PPV-induced immune boosting for nrhrBC pts. Pts with mrBC who had lower immune-suppressive cytokine levels had the better prognosis. These results suggested the PPV therapy could be effective for postoperative prophylactic vaccination in patients with nrhrBC. References: 1. Takahashi R, Toh U, et al. Breast Cancer Res. 2014; 2. Toh U, Okabe M, et al. THE BREAST 2015.
Citation Format: Toh U, Okabe M, Takao Y, Tanaka Y, Shigaki T, Takenaka M, Iwakuma N, Sudo T, Yamada A, Shichijo S, Itoh K, Akagi Y. Comparison of the immunological and clinical effect of personalized peptide vaccination for patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-06.
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Affiliation(s)
- U Toh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - M Okabe
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - Y Takao
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - Y Tanaka
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - T Shigaki
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - M Takenaka
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - N Iwakuma
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - T Sudo
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - A Yamada
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - S Shichijo
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - K Itoh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
| | - Y Akagi
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, Japan
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Matsubayashi RN, Iwasaki H, Iwakuma N, Momosaki S. Methotrexate (MTX)-associated malignant lymphoma of the bilateral breast: imaging features in comparison to other nipple-areolar tumors. Clin Imaging 2019; 53:120-125. [DOI: 10.1016/j.clinimag.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/06/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
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Toh U, Saku S, Iwakuma N, Takao Y, Okabe M, Akashi M, Yamada A, Shichijo S, Itoh K, Akagi Y. Abstract P3-05-09: Prognostic factors for therapeutic personalized peptide vaccines in patients with metastatic recurrent breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-05-09] [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: We have previously reported the prognostic role of humoral antigen spreading response against prostate-related antigen (PRA) for metastatic recurrent breast cancer (mrBC) patients who received personalized peptide vaccine (PPV) therapy (Toh U, SABCS 2015). The prognostic effect was additionally evaluated by the clinical relevant factors including intrinsic subtype, the regimens of combined chemo-hormonal therapies in present study.
Methods:We analyzed serum IgG responses to all of the peptide candidates included PRAs (PSA, PAP and PMSA) after PPV therapy by the Luminex systemusing peripheral blood samples from 77 vaccinated mrBC patients. The clinical factors and relevant events were statistically evaluated.
Results: After 6 and 12cycles of PPV therapy, the serum IgG of anti-PSA, anti-PAP, and/or anti-PMSA increased significantly in 31 patients (PRA response group), and the median progression free survival (PFS) and median overall survival (OS) were 8.1 and 14.3 months, but were 5.1 and 10.8 months, respectively, in the remaining 46 patients with no anti-PRA IgG response (PRA non-response Group). The anti-PRA IgG level was marginally correlated withPFS (p=0.059) and OS (p=0.082) between these two groups, which was a significant prognostic factor for PFS (Log-rank: 0.009) in estrogen-positive cancer patients (ER+). The statistical analyses showed that the clinical outcome was in favor of > 60 year-old patients, those with longer PPV therapies (>3 months), and those who received combined standard hormonal therapies or bisphosphonate/anti-RANKL therapy.
Conclusions: This study indicated a clinical significance between the pre-and post- PPV therapy measurement of serum anti-PRA IgG in patients with mrBC, which may be a useful prognostic marker for monitoring peptide vaccine treatment outcomes, particularly for patients > 60 years with ER+ breast cancer. These results also suggest that the immunotherapeutic peptide vaccine could be efficiently combined with hormonal therapy, anti-HER2 therapy, and bisphosphonate/anti-RANKL therapy in mrBC patients.
Citation Format: Toh U, Saku S, Iwakuma N, Takao Y, Okabe M, Akashi M, Yamada A, Shichijo S, Itoh K, Akagi Y. Prognostic factors for therapeutic personalized peptide vaccines in patients with metastatic recurrent breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-09.
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Affiliation(s)
- U Toh
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - S Saku
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - N Iwakuma
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - Y Takao
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Okabe
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Akashi
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - A Yamada
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - S Shichijo
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - K Itoh
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - Y Akagi
- Kurume University School of Medicine, Kurume, Japan; Kurume University Research Center for Innovative Cancer Therapy, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
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9
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Toh U, Okabe M, Iwakuma N, Saku S, Akashi M, Ogo E, Itoh K, Akagi Y. Association of PD-L1/CD8+TIL and expression of PD-L1, PTEN as predictive biomarkers for long-term follow-up in early breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12072] [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: 11/20/2022] Open
Abstract
e12072 Background: The aim of this study was to investigate the correlation of immunologic factors including the expression of PD-1/PD-L1, PTEN, and the density of TILs, macrophages in the tumor area of breast cancer, using immunohistological staining and to evaluate the association between the immunologic factors and the clinical outcome for early breast cancer (EBC). Methods: A total of 97 EBC patients (pts) who underwent surgery from February 1995 to November 2005 were investigated.The postoperative adjuvant chemotherapies were routinely performed, adjuvant Tmab were not available in Japan within this period.The immunohistological staining was performed with the monoclonal antibodies for PD-1/PD-L1, PTEN, CD3, CD8, and CD163. Pathological analysis was performed to measure the expression area of each antibody, using images scanned by a CCD digital camera (Nikon), and the digitized data of the expression area (μm2) were analyzed by ‘Win ROOF’ (version 5.7) software. The association between the immunologic factors and clinical outcome was statistically analyzed for over 10-years follow-up. Results: The density of CD3+TILs, CD8+TILs, CD163+ macrophages and non-expression of PTEN was significantly higher in triple negative breast cancer (TNBC). CD8+TIL density and PD-L1+/CD8+ expression were predictive factors for DFS and OS. Her2+ pts with PTEN expression and luminal/Her2- patients without PD-L1 expression had longer OS, compared to patients without PTEN expression (p=0.049) and with PD-L1 expression (p=0.036), respectively. Furthermore, the pts with PD-L1+/CD8+ expression had worse median PFS (p = 0.022) and median OS (p = 0.037), compared with pts without PD-L1+/CD8+ expression. Conclusions: Our results demonstrated that CD3+ TILs, CD8+ TILs, and CD163+ macrophages were shown to infiltrate the tumor area of EBC. In particular, TNBC had a higher rate of TIL infiltration within the tumor environment. PTEN expression and lack of PD-L1 expression were associated with favorable survival in Her2-positive and luminal/Her2-negative EBC patients, respectively. The PD-L1 expression combined with CD8+ density was significantly associated with an aggressive clinical outcome.
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Affiliation(s)
- Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Mina Okabe
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Shuko Saku
- Kurume University School of Medicine, Kurume, Japan
| | | | - Etsuyo Ogo
- Kurume University Faculty of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Kurume University Cancer Vaccine Center, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University, Kurume, Japan
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Toh U, Saku S, Iwakuma N, Okabe M, Shichijo S, Yamada A, Itoh K, Akagi Y. Feasibility study of multiple HLA-class IA restricted peptide vaccines (KRM-19) for metastatic triple negative breast cancer (TNBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.164] [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: 11/20/2022] Open
Abstract
164 Background: Our previous phase II clinical trial has indicated that the therapeutic selected personalized peptide vaccines (PPV) were effective for boosting anticancer immunity and the immune response after PPV was associated with the clinical outcome as a prognostic factor for metastatic breast cancer (mBC). Based on the data from the PPV studies, we have conducted an early phase II study to evaluate the safety and the efficacy of a new regimen using multiple peptide vaccines (KRM-19) for pts with metastatic TNBC. Methods: KRM-19 consisted of 19 mixed peptides which were chosen from the previously reported 31 PPVs according to their anti-tumor immunologic effect and safety profile for mBC pts. All patients had histologically confirmed measurable ER-PgR-Her2- mBC and their human leukocyte antigen (HLA)-A molecules should be each of -A2, A3, A11, A24, A26, A31, or A33. KRM-19 (19mg/ml) was administrated subcutaneously in order with schedule of every week for a total of 6 doses. The concurrent conventional chemo- and/or endocrine therapy was not permitted for the combination, but was available for post-study treatment. Measurement of peptide-specific cytotoxic T lymphocyte (CTL) and IgG responses were conducted before and after vaccination. Levels of IgG reactive to each of the 19 peptides in the pre- and post-vaccination plasma were measured using the LUMINEX system at every 6 vaccinations. Peptide-specific CTL responses were examined by INF-ɤ ELISPOT. Clinical response was evaluated by RECIST criteria. Results: 10 patients with refractory metastatic TNBC received all 6 vaccines and 10/10 patients experienced Grade 1-2 skin reaction at injection site, 5/10 pts had Grade 2-3 liver function disorder, 3/10 and 1/10 pts had Grade 2 bone marrow suppression and nausea, respectively. The clinical responses were assessed in 8 pts included 1 PR case, 4 SD cases, and 3 PD cases. The evaluation of other clinical and immunologic data is underway. Conclusions: Subcutaneous KRM-19 vaccine administration was safe and resulted in a 12.5% objective response and 62.5% clinical benefit rate in TNBC pts, warranting further larger scale study. Clinical trial information: UMIN000014616.
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Affiliation(s)
- Uhi Toh
- Department of Surgery, Kurume Univ School of Medcn, Kurume-Shi, Japan
| | - Shuko Saku
- Kurume University School of Medicine, Kurume, Japan
| | | | - Mina Okabe
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Akira Yamada
- Cancer Vaccine of the Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Kurume University Cancer Vaccine Center, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University, Kurume, Japan
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11
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Saku S, Toh U, Okabe M, Iwakuma N, Shichijo S, Yamada A, Itoh K, Akagi Y. IgG response against prostate-related antigen as potential biomarker for personalized peptide vaccination in metastatic recurrent breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.167] [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: 11/20/2022] Open
Abstract
167 Background: The aim of this study is to identify the prognostic role of serum value of IgG antibody against prostate related-antigen (PRA), including prostate-specific antigen (PSA), prostate specific membrane antigen (PSMA), and prostate acid phosphatase (PAP) in mrBC patients. Methods: Peripheral blood samples of 77 patients with mrBC were analyzed for serum anti-PRA IgG levels before and after 6th and 12th PPV therapy prospectively. Most of the peptides used for PPV are derived from cancer associated antigens expressing in various types of advanced cancers, but the peptides derived from PRAs were not used in this study. Results: After PPV therapy, total serum levels of anti-PRA IgG were significantly increased in 31 mrBC patients (Group 1) compared with remaining 46 rmBC patients (Group 2). Either serum anti-PSA, anti-PAP, and/or anti-PMSA IgGs showed a significant increase in patients of Group 1 after 6th (p=0.045) and 12th PPV treatment (p < 0.001), irrespective of their intrinsic subtypes. The median PFS and median OS of Group 1 patients were 8.1 and 14.3 months, while those of Group 2 patients were 5.1 and 10.8 months, respectively. Anti-PRA IgG levels were significantly associated with PFS (p=0.0073; HR: 0.37) and OS (p=0.025; HR: 0.43) between these two groups, whereas no significant relation was found with age, clinical response rate, and recurrent metastatic status. Conclusions: The Group 1 patients with elevated anti-PRA IgG may have better prognosis compared to Group 2 patients who showed no IgG elevation after PPV treatment for rmBC. These results indicated a clinical significance between pre-and post- treatment measurement of serum anti-PRA IgGs in mrBC patients receiving PPV therapy, and may be a useful prognostic marker for monitoring the outcome to PPV treatment of breast cancer.
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Affiliation(s)
- Shuko Saku
- Kurume University School of Medicine, Kurume, Japan
| | - Uhi Toh
- Department of Surgery, Kurume Univ School of Medcn, Kurume-Shi, Japan
| | - Mina Okabe
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | | | - Akira Yamada
- Cancer Vaccine of the Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Kurume University Cancer Vaccine Center, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University, Kurume, Japan
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12
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Okabe M, Toh U, Iwakuma N, Saku S, Akashi M, Kimitsuki Y, Seki N, Kawahara A, Ogo E, Itoh K, Akagi Y. Predictive factors of the tumor immunological microenvironment for long-term follow-up in early stage breast cancer. Cancer Sci 2017; 108:81-90. [PMID: 27801993 PMCID: PMC5276839 DOI: 10.1111/cas.13114] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of this research was to investigate the correlation of immunologic factors in the tumor environment of breast cancer, using immunohistological staining to evaluate the expression of programmed death 1/programmed death ligand 1 (PD‐1/PD‐L1), phosphatase and tensin homolog (PTEN), tumor infiltrating lymphocytes (TILs), and macrophages, and to analyze the association between the immunologic factors and clinical outcome for patients with early stage breast cancer (EBC). A total of 97 EBC patients who underwent standard surgery were investigated. Expression of PD‐1/PD‐L1 and PTEN and the density of CD3+TILs, CD8+TILs, and CD163+ macrophages were evaluated by immunohistochemical analysis. The association between the immunologic factors and clinical outcome was statistically analyzed. The density of CD3+TILs, CD8+TILs, and CD163+ macrophages and non‐expression of PTEN was significantly higher in cases of triple negative breast cancer. CD8+TIL density and CD8+/PD‐L1+ expression were predictive factors for disease‐free survival and overall survival (OS). Human epidermal growth factor 2 (HER2)‐positive patients with PTEN expression and luminal/HER2‐negative patients without PD‐L1 expression had significantly longer OS compared to patients without PTEN expression (P = 0.049) and with PD‐L1 expression (P = 0.036), respectively. Furthermore, patients with PD‐L1+/CD8+ expression had worse median progression‐free survival (P = 0.022) and median OS (P = 0.037) compared with patients without PD‐L1+/CD8+ expression. The CD3+TILs, CD8+TILs, and CD163+ macrophages were shown to infiltrate the tumor area of EBC. In particular, triple negative breast cancer had a higher rate of TIL infiltration within the tumor environment. Expression of PTEN and lack of PD‐L1 expression were associated with favorable survival in HER2‐positive and luminal/HER2‐negative EBC patients, respectively. The PD‐L1 expression combined with CD8+ density was significantly associated with an aggressive clinical outcome.
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Affiliation(s)
- Mina Okabe
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Nobutaka Iwakuma
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shuko Saku
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Momoko Akashi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yuko Kimitsuki
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Naoko Seki
- Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Akihiko Kawahara
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Cancer Vaccine Center, Kurume University School of Medicine, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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13
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Toh U, Saku S, Okabe M, Iwakuma N, Kimitsuki Y, Akashi M, Ogo E, Yamada A, Shichijo S, Itoh K, Akagi Y. [Development of Peptide Vaccines for Triple-Negative Breast Cancer Treatment]. Gan To Kagaku Ryoho 2016; 43:1249-1251. [PMID: 27760950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Our previous phase II clinical trial showed that therapeutically selected personalized peptide vaccines(PPVs)were effective at boosting anticancer immunity; the immune response after PPV was associated with a clinical outcome as a prognostic factor for metastatic breast cancer(mBC). We conducted an early phase II study to evaluate the safety and efficacy of a new regimen using multiple peptide vaccines(KRM-19)for patients with metastatictriple -negative breast cancer. KRM-19 consisted of 19 mixed peptides chosen from the previously reported 31 PPVs according to their anti-tumor immunologiceffec ts and safety profiles for patients with mBC. All patients had histologically confirmed measurable ER-PgR-HER2- mBC and their human leukocyte antigen(HLA) / -A molecules were A2, A3, A11, A24, A26, A31, or A33. KRM-19(19mg/mL)was administrated subcutaneously every week for a total of 6 doses. Concurrent conventional chemo- and/or endocrine therapy were not permitted during treatment. This was an open-label, early phase II study. The primary endpoint was safety and anti-tumor immunologic effect, while the secondary endpoints were clinical responses and progression-free survival(PFS). The estimated enrollment was 10-15 and 8 patients were enrolled(Clinical trial registry number: UMIN000014616). Measurement of peptide-specific cytotoxic T lymphocyte and IgG responses were conducted before and after vaccination. The correlation between PFS and the increased IgG response and/or CTL levels were investigated.
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Affiliation(s)
- Uhi Toh
- Dept. of Surgery Kurume University School of Medicine
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14
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Okabe M, Toh U, Iwakuma N, Mishima M, Kawahara A, Kage M, Itoh K, Akagi Y. Abstract P5-08-16: Local immunologic environment related with tumor infiltrating lymphocytes (TIL) and PD-1/PD-L1 expression in early stage breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-08-16] [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
Purpose:
Recent studies have shown that local immune environment revealed with programmed death 1(PD-1)/programmed death ligand 1(PD-L1) and tumor infiltrating lymphocytes(TIL) affects the tumor-growth and prognosis. In this study, we evaluated the tumor local immune environments using immunohistological staining for analysis of PD-1/PD-L1 expression and TIL of tumor local in operable early-stage breast cancer.
Method:
A total of 100 surgical specimens of stageI-III invasive breast carcinoma paraffinembedded between 1995 and 2005 were analyzed. Immunohistological staining for PD-1, PD-L1, PTEN, CD3, CD8, and CD163 were performed by the conventional PAP method. In addition, intratumoral and intrastromal TILs and macrophages were simultaneously stained by anti-CD3, CD8, CD163 antibodies and measured by 'Win ROOF' computer software (version 5.7, Mitani Corporation, Japan).
Results:
Intratumoral PD-1 expressed significantly higher in triple negative breast cancer (TNBC) compared to other subtype BC (p=0.0094), intratumoral and intrastromal CD3+ lymphocytes and CD163+ macrophages were also significantly higher in TNBC, respectively (CD3: p=0.0002; 0.0139 and CD163: p=0.0043; 0.0270). PTEN loss was also more frequently observed in TNBC (p=0.0475). In addition, after a median 5-year follow-up, patients of luminal A subtype with lower PD-L1 and PTEN expression showed better disease free survival (DFS) with a significant difference (p=0.0148, p=0.0475).
Conclusion:
Local expression of PD-1/PD-L1 antigens on tumor cells, CD3+ lymphocytes, CD163+ macrophages infiltration singnificantly increased in early-stage TNBC. PTEN expression on tumor local might be associated with DFS in patients with early-stage BC.
Citation Format: Okabe M, Toh U, Iwakuma N, Mishima M, Kawahara A, Kage M, Itoh K, Akagi Y. Local immunologic environment related with tumor infiltrating lymphocytes (TIL) and PD-1/PD-L1 expression in early stage breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-16.
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Affiliation(s)
- M Okabe
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - U Toh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - N Iwakuma
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Mishima
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - A Kawahara
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Kage
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - K Itoh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - Y Akagi
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
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15
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Toh U, Okabe M, Iwakuma N, Mishima M, Shichijo S, Yamada A, Noguchi M, Itoh K, Akagi Y. Abstract P2-11-04: Serum IgG response against prostate-related antigen revealed by personalized peptide vaccination in patients with metastatic recurrent breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-11-04] [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
Purpose: We have indicated that IgG and CTL boosting response could be a potential prognostic factor for overall survival (OS) and progression free survival (PFS) in metastatic recurrent breast cancer (mrBC) patients, who had received personalized selected peptide vaccine (PPV) therapy in our previously reported clinical phase II study. The aim of this study is to identify the prognostic role of serum value of IgG antibody against prostate related-antigen (PRA), including prostate-specific antigen (PSA), prostate specific membrane antigen (PSMA) and prostate acid phosphatase (PAP) in mrBC patients
Methods: Peripheral blood samples of 77 patients with mrBC were analyzed for serum anti-PRA IgG levels before and after 6th and 12th PPV therapy prospectively. Most of the peptides using for PPV are derived from cancer associated antigens expressing in various types of advanced cancers, but the peptides derived from PRAs were not used in this study.
Results: After PPV therapy, total serum levels of anti-PRA IgG were significantly increased in 31 mrBC patients (Group 1) whereas in remaining 46 rmBC patients (Group 2). Either serum anti-PSA, anti-PAP and/or anti-PMSA IgGs showed a significant increase in patients of Group 1 after 6th (p=0.045) and 12th PPV treatment (p < 0.001), irrespective of their intrinsic subtypes. The median PFS and median OS of Group 1 patients were 8.1 and 14.3 months, while those of Group 2 patients were 5.1 and 10.8 months, respectively. Anti-PRA IgG levels were significantly associated with PFS (p=0.0073; HR: 0.37) and OS (p=0.025; HR: 0.43) between these two groups, whereas no significant relation was found with age, clinical response rate and recurrent metastatic status.
Conclusions: The Group 1 patients with elevated anti-PRA IgG may have better prognosis compared to Group 2 patients who showed no IgG elevation after PPV treatment for rmBC. These results indicated a clinical significance between pre-and post- treatment measurement of serum anti-PRA IgGs in mrBC patients receiving PPV therapy, and may be a useful prognostic marker for monitoring the outcome to PPV treatment of breast cancer.
Citation Format: Toh U, Okabe M, Iwakuma N, Mishima M, Shichijo S, Yamada A, Noguchi M, Itoh K, Akagi Y. Serum IgG response against prostate-related antigen revealed by personalized peptide vaccination in patients with metastatic recurrent breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-11-04.
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Affiliation(s)
- U Toh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Okabe
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - N Iwakuma
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Mishima
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - S Shichijo
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - A Yamada
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - M Noguchi
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - K Itoh
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
| | - Y Akagi
- Kurume University School of Medicine, Kurume, Fukuoka, Japan; Kurume University Cancer Vaccine Center, Kurume, Fukuoka, Japan
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Okabe M, Toh U, Iwakuma N, Mishima M, Matsueda S, Shichijo S, Itoh K, Akagi Y. [Pretreatment and Posttreatment Evaluations of Circulating Tumor Cells(CTC)in Patients with Metastatic Breast Cancer]. Gan To Kagaku Ryoho 2015; 42:1237-1239. [PMID: 26489558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Recently, circulating tumor cells (CTCs) of cancer patients have been analyzed as a biomarker of disease progression and as a new prognostic tool.We conducted a pilot study to determine whether CTCs present before and after chemotherapy or peptide vaccination predicted outcome in patients with metastatic breast cancer (MBC). CTCs were isolated from the peripheral blood of MBC patients and evaluated using the CellSearch®System (Janssen Diagnostics). The expression of the HLA classⅠ molecule in the CTCs was analyzed simultaneously by using a flow cytometric system. A CTC-positive test result was defined as five or more CTCs/7.5 mL blood. Nine patients (median [range] age, 64.2 years [44-80 years]) were included. Four (57.1%) of 7 MBC patients with Luminal A subtype tested positive for CTC.Of 6 MBC patients, 5 (83.3%) had a decreased mean number of CTCs, from 35.8/7.5 to 0.4/7.5 mL, after 3 courses of systemic chemotherapy. Furthermore, CTC-HLA class Ⅰexpression level was decreased in 2 (66.7%) of 3 patients after cytotoxic chemotherapy but increased in 4 (80.0%) of 5 patients after 6 vaccinations with tumor-specific peptide vaccines. The number of CTCs and CTC-HLA class Ⅰ expression level in the patients with MBC changed after the treatment with systemic chemotherapy or peptide-vaccine therapy.
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Affiliation(s)
- Mina Okabe
- Dept. of Surgery, Kurume University School of Medicine
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Toh U, Iwakuma N, Mishima M, Furukawa M, Fujii T, Ogo E, Nakagawa S, Tanaka M, Akagi Y. P008 S-1 in combination with CPT-11 plus trastuzumab for pretreated HER2+ metastatic breast cancer. Breast 2015. [DOI: 10.1016/s0960-9776(15)70059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Toh U, Iwakuma N, Mishima M, Furukawa M, Akagi Y. P223 Image-guided sentinel lymph node detection using near-infrared fluorescence in breast cancer. Breast 2015. [DOI: 10.1016/s0960-9776(15)70255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fujii T, Miwa K, Ushijima T, Matsunaga M, Fukahori M, Yuge K, Toh U, Iwakuma N, Takahashi R, Takahashi H, Takenaka M, Mishima M, Akagi Y, Kage M, Nakagawa S. HER2-targeted Therapeutic Strategies for HER2-positive Metastatic Breast Cancers. CCTR 2015. [DOI: 10.2174/157339471003150212111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mishima M, Toh U, Iwakuma N, Takenaka M, Furukawa M, Akagi Y. Evaluation of contrast Sonazoid-enhanced ultrasonography for the detection of hepatic metastases in breast cancer. Breast Cancer 2014; 23:231-41. [PMID: 25143060 PMCID: PMC4773471 DOI: 10.1007/s12282-014-0560-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 02/28/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022]
Abstract
Background The present study was aimed to evaluate the usefulness of contrast Sonazoid-enhanced ultrasonography (US) for the detection of hepatic metastases in breast cancer patients and compare the clinical efficacy and sensitivity of this technique with conventional contrast unenhanced B-mode US in follow-up examinations of breast cancer patients with liver metastasis. Methods We assessed a total of 84 hepatic tumors from 24 patients diagnosed with or suspected of having metastatic cancer. These hepatic nodules were diagnosed through imaging, including dynamic magnetic resonance imaging (MRI), contrast-enhanced computed tomography (CECT) scan, B-mode US or contrast Sonazoid-enhanced US (SEUS). Differences in the sensitivity between US and SEUS were compared using MR imaging, CECT, and follow-up imaging. Results A total of 79 nodules were diagnosed as metastatic tumors. The remaining nodules were diagnosed as benign tumors (hepatic hemangioma: n = 3; local fatty change: n = 2). SEUS precisely detected the presence or absence of hepatic tumors in the 24 patients examined, showing a sensitivity of 98.8 % (83 of 84 lesions) for total imaged solid liver lesions, with an accuracy of 98.7 % (78 of 79 lesions) for total metastatic breast cancer lesions. In contrast, conventional B-mode US imaging revealed hepatic tumor lesions at a sensitivity of 66.7 % (56 of 84 lesions) and an accuracy of 64.6 % (51 of 79 lesions), respectively. Furthermore, the false positive and false negative rates were, respectively, 6.33 and 29.1 % for B-mode US and 0 and 1.3 % for SEUS. Moreover, twenty-seven metastatic tumors and five benign lesions (3 hemangiomas and 2 focal fatty changes/sparings) were imaged using SEUS but not conventional B-mode US. Significant differences in diagnostic accuracy rates between contrast Sonazoid-enhanced US and conventional B-mode US were observed (Wilcoxon signed rank test: p = 0.0009). No severe adverse events occurred during SEUS after the administration of Sonazoid, except for a grade 1 skin reaction and nausea in one patient. Conclusion These results suggested that Sonazoid could be safely administrated to breast cancer patients with liver metastatic disease. Thus, contrast Sonazoid-enhanced US is a feasible and more effective method than B-mode US for the detection of hepatic metastasis, particularly for small metastatic breast cancer lesions less than 14 mm in diameter, showing significant high sensitivity and accuracy.
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Affiliation(s)
- Mai Mishima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan.
| | - Nobutaka Iwakuma
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Miki Takenaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Mina Furukawa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
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Toh U, Iwakuma N, Mishima M, Takenaka M, Takahashi R, Furukawa M, Fujii T, Ogo E, Nakagawa S, Tanaka M, Sasada T, Itoh K, Akagi Y. Safety and immunologic efficacy of personalized multiple HLA class I-restricted peptide vaccines for breast cancer patients in the adjuvant setting. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Uhi Toh
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Mai Mishima
- Kurume University Faculty of Medicine, Kurume, Japan
| | - Miki Takenaka
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | - Ryuji Takahashi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Mina Furukawa
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Etsuyo Ogo
- Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Maki Tanaka
- Kurume Social Insurance Daiichi Hospital, Kurume, Japan
| | - Tetsuro Sasada
- Department of Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Kurume University School of Medicine, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
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22
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Momosaki K, Ishibashi N, Yoshida S, Muraoka T, Tanaka K, Iwakuma N, Oka Y, Kaibara A, Akagi Y, Shirouzu K. Effect of preoperative administration of methylpredonisolone and ulinastatin on tumor cell metastasis after surgical stress. Kurume Med J 2014; 60:79-88. [PMID: 24531184 DOI: 10.2739/kurumemedj.ms63004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Using a rat laparotomy stress model, we conducted a comparative analysis of postoperative organ metastasis after administration of ulinastatin (UTI) or methylprednisolone (MP), which have an inhibitory effect on cytokine production. The subjects were classified into 4 groups: 1) minimal laparotomy group (C group), 2) major laparotomy group (L group), 3) preoperative MP intravenous administration + major laparotomy group (MP group), and 4) preoperative UTI intravenous administration + major laparotomy group (UTI group). Either MP or UTI was administered intravenously before surgery, and RI-labeled cells were injected into the portal vein immediately after laparotomy to collect tissue specimens in order to measure radiation dosage. Then, the concentrations of serum IL-2 and IL-6, liver interleukin 1 beta (IL-1β) and interleukin 10 (IL-10), and liver E-selectin were measured. In addition natural killer cell, (NK cell) activation and neoplastic nodules on the liver surface at 3 weeks after surgery were also measured. The adhesion rate of malignant cells to the liver was higher in the L group than in the C group, higher in the MP group than the L group, and lower overall in the UTI group. The concentration of IL-1β and IL-6 were decreased in the MP and UTI groups compared to the L group. IL-2 was decreased significantly in the MP group compared with the C and L groups. E-selectin expression level decreased in the UTI group compared with the L group. NK cell activation decreased in the MP group compared with the C group and L group, but no differences were observed between the UTI and L groups. The number of tumor nodules on the surface of the liver increased in the MP group compared with the L group, and decreased in the UTI group compared with the L group. Postoperative alleviation of invasive reaction was suggested in both the MP and UTI groups. However, preoperative administration of MP increased metastasis while that of UTI inhibited metastasis. MP was considered to have decreased anti-tumor immunocompetence and promoted metastasis, while UTI was considered to have inhibited the expression of adhesive molecules and decreased metastasis.
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Muraoka T, Shirouzu K, Ozasa H, Oka Y, Momosaki K, Iwakuma N, Tanaka K, Ishibashi N. The effect of starvation on blood stream cancer cell metastasis to the liver in rat after laparotomy. Kurume Med J 2014; 60:59-66. [PMID: 24492784 DOI: 10.2739/kurumemedj.ms63005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preoperative malnutrition worsens the prognosis of cancer patients. However, it is not certain how preoperative malnutrition affects postoperative hematogenous metastasis. We examined the influence of preoperative starvation on liver metastasis in rats using intra-vascular injection of AH109A hepatoma cells. METHODS Male donryu rats were divided into Fasting and Control groups. Rats received laparotomy and (125)I-iodo-deoxyuridine labeled AH109A hepatoma cells were inoculated via superior mesenteric vein. Radioactivity in the organs, macroscopic liver metastasis, white blood cell count, leukocyte count, NK cell activity, endogenous serum corticosterone and ACTH concentration and mRNA expression of cytokine in the liver and brain were evaluated at certain time points. RESULTS 48hours preoperative starvation reduced body weight and induced a state of malnutrition. Accumulation of radioactivity in the liver was more than 4 times higher, and the number of liver metastases was 3.5 times higher in the Fasting than in the Control group. Preoperative starvation caused an almost 2 fold increase in plasma endogenous corticosterone levels and a 66% reduction in white blood cell and lymphocyte counts. Postoperative hypothalamus pituitary adrenal axis response was preserved. In addition, inflammatory cytokine expression in the liver was suppressed in the starved animals, suggesting that preoperative starvation led to a state of cellular immunosuppression, which would be an important factor for liver metastasis. CONCLUSION Preoperative malnutrition by 48 hours starvation reduced inflammatory cytokine response and cellular immunity, resulting in an increase in hematogenous liver metastasis.
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Toh U, Iwakuma N, Mishima M, Takenaka M, Takahashi R, Koura K, Fujii T, Nakagawa S, Ogo E, Tanaka M, Sasada T, Itoh K, Shirouzu K. Abstract P5-01-05: Personalized peptide vaccines in combination with conventional chemo- or endocrine therapy for metastatic breast cancer: A single-arm phase II study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-01-05] [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: Immunotherapy using multiple personalized peptide vaccines (PPV) has been reported to be effective for boosting anticancer immunity in patients (pts) with advanced prostate cancer and glioblastoma. The PPVs binding HLA-A2, A24, A3 family and A26 molecules were selected from 31 candidate peptides derived from various tumor associated antigens. Currently, we performed a phase II trial to evaluate the benefit of the PPVs in combination with conventional chemo-or endocrine therapy for pretreated metastatic breast cancer (MBC). Methods: Seventy-one pretreated pts had histologically confirmed measurable MBC and their HLA A molecules matched each of HLA-A2, A24, A26 and A3 family. Pre-vaccination plasma was measured for their IgG levels reactive to each of 31 peptides followed by administration subcutaneously of the four peptides at maximum showing higher levels of IgG in order with schedule of every 1-2 week. The concurrent conventional chemotherapy or endocrine therapy was available for the combination of PPVs. The primary endpoint was anti-tumor immunologic effect and safety, and the secondary endpoints were clinical responses and survival. Levels of IgG reactive to each of the 31 peptides in the pre- and post-treatment plasma at every 6 times of vaccination were measured using LUMNEX system. The CTL responses were simultaneously evaluated using ELISPOT method. Clinical response was evaluated by RECIST criteria. Results: Between May 2009 and December 2012, a total of 71 pts (Luminal-Her2- cases: 39; Her2+cases: 18; Triple negative(TN) cases:14) were enrolled in this study. The median duration of follow-up was 20.7 months. Concurrent chemotherapies (capecitabine, gemcitabine, eribulin, vinorelbine etc.) and endocrine therapies (aromatase inhibitor, toremifen or fulvestrant) were administered to 36 and 24 pts, respectively. Trastuzumab, Laptinib or Bevacizumab was simultaneously used for 13 pts. After 6th vaccination, the IgG reaction and CTL response were identified in 53 of 71 (74.6%) pts and 33 of 63 (52.3%) pts. There were no significant differences between TN cases and the other cases of MBC with regard to immunological humoral and/or cellular responses. No vaccine-related severe adverse events were observed. Clinical response rate of assessable 61 pts was 14.8% (CR 3, PR 6, SD 24, PD 28). The median PFS and OS were 7.6 m and 20.7 m, respectively. In contrast, the PFS and OS of luminal type, Her2 type or TN type were 12, 4.6 or 8.3 m and 24, 15 or 12 m. Conclusions: The phase II PPVs study for MBC demonstrated the promising response and safety, and further studies are essential to identify the clinical benefits of this novel therapy. Clinical trial information: UMIN000001482.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-01-05.
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Affiliation(s)
- U Toh
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - N Iwakuma
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - M Mishima
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - M Takenaka
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - R Takahashi
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - K Koura
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - T Fujii
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - S Nakagawa
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - E Ogo
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - M Tanaka
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - T Sasada
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - K Itoh
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
| | - K Shirouzu
- Kurume University School of Medicine, Kurume, Japan; Social Insurance Kurume Daiichi Hospital, Kurume, Japan
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Takahashi R, Toh U, Iwakuma N, Mishima M, Fujii T, Takenaka M, Koura K, Seki N, Kawahara A, Kage M, Ogo E, Shirouzu K. Treatment outcome in patients with stage III breast cancer treated with neoadjuvant chemotherapy. Exp Ther Med 2013; 6:1089-1095. [PMID: 24223627 PMCID: PMC3820806 DOI: 10.3892/etm.2013.1289] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/22/2013] [Indexed: 11/05/2022] Open
Abstract
Despite the good responses of patients (pts) with stage III breast cancer to neoadjuvant chemotherapy (NAC), most eventually relapse and have a poor prognosis. We investigated the prognostic indicators in pts with stage III breast cancer treated with NAC, using epirubicin and/or docetaxel. A total of 22 women with stage III breast cancer underwent NAC between January 2005 and May 2011. The regimens of NAC comprised ED (epirubicin 60 mg/m2 and docetaxel 60 mg/m2) in 10 cases, FEC (fluorouracil 500 mg/m2, epirubicin 75-100 mg/m2 and cyclophosphamide 500 mg/m2) in 10 cases and EC (epirubicin 60 mg/m2 and cyclophosphamide 600 mg/m2) in two cases. Following four cycles of each regimen, a further four cycles of D (docetaxel 70 mg/m2) were undertaken in nine cases. Subsequent to the completion of NAC and surgery, we assessed the clinicopathological results and performed prognostic analyses. Statistical analyses concerning disease-free survival (DFS) or overall survival (OS) were conducted by a Cox proportional hazard model. The median survival time was 66 months and there were 12 distant metastases and two local recurrences. Multivariate analyses showed the number of metastatic axillary lymph nodes (ALNs) [hazard ratio (HR), 1.079; P=0.023] was correlated with DFS, while the Ki-67 labeling index (HR, 1.109; P=0.042) and the number of meta-static ALNs (HR, 1.087; P=0.023) were correlated with OS. In conclusion, even if pts with stage III breast cancer show good responses to NAC using epirubicin and/or docetaxel, the majority eventually relapse and have a poor prognosis. The Ki-67 labeling index and the number of involved ALNs are suggested as prognostic indicators in stage III breast cancer.
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Affiliation(s)
- Ryuji Takahashi
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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26
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Takahashi H, Fujii T, Nakagawa S, Inoue Y, Akashi M, Toh U, Iwakuma N, Takahashi R, Takenaka M, Fukuma E, Shirouzu K. Usefulness of endoscopic breast-conserving surgery for breast cancer. Surg Today 2013; 44:2037-44. [PMID: 24150099 DOI: 10.1007/s00595-013-0767-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared the safety, invasiveness and cosmetic outcomes between endoscopic breast-conserving surgery (endoscopic group) and surgery under direct vision (direct vision group) for treating breast cancer. METHODS We compared 100 cases of endoscopic surgery with 150 cases of direct vision surgery. The safety was evaluated in terms of the blood loss, length of the operation and presence or absence of complications, whereas the degree of invasiveness was assessed using preoperative and postoperative leukocyte counts, neutrophil counts, interleukin (IL-6) levels and fever. The cosmetic outcome was assessed on the basis of a breast evaluation by the medical staff and the patient's subjective satisfaction. RESULTS In both groups, serious postoperative complications were absent. No significant differences were observed in the leukocyte counts, neutrophil counts, IL-6 level or fever between the groups. An evaluation of the cosmetic outcomes by the staff showed a more favorable breast size, breast shape and scar condition in the endoscopic group. A significantly higher level of patient satisfaction was also observed in the endoscopic group. Postoperative local recurrence was absent. CONCLUSIONS The endoscopic approach showed comparable safety and invasiveness, and provided better postoperative cosmetic outcomes than direct vision surgery. Our results suggest that endoscopic breast-conserving surgery is a potentially useful surgical method for the treatment of breast cancer.
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Affiliation(s)
- Hiroki Takahashi
- Breast Care Center, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Oka Y, Akagi Y, Kinugasa T, Ishibashi N, Iwakuma N, Shiratsuchi I, Shirouzu K. Heat-shock pre-treatment reduces liver injury and aids liver recovery after partial hepatectomy in mice. Anticancer Res 2013; 33:2887-2894. [PMID: 23780975] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Heat-shock proteins (HSPs) are members of a chaperone protein family reported to modify stress responses. The aim of this study was to clarify the hypothesis of whether pre-treatment with heat shock reduces liver damage and influences liver regeneration after partial hepatectomy. MATERIALS AND METHODS Mice (N=6) were divided into two groups: the control group underwent partial hepatectomy without heat shock pre-treatment, the heat shock (HS) group underwent partial hepatectomy 12 hours after pre-treatment with heat shock. Mice were sacrificed at different time points after hepatectomy, remnant liver and blood were collected for further analyses in blood samples and liver tissues. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), interleukin-6 (IL6), and tumor necrosis factor-alpha (TNFα) were measured using enzyme-linked immunosorbent assay (ELISA). We used tissue samples for several experiments: staining by 5-bromo-2-deoxyuridine (BrdU), evaluation of cytokines, transcription factors and signal-transduction associated proteins. RESULTS HSP70 levels in the liver were clearly increased from 6 h to 72 h after heat shock treatment. Serum ALT and AST levels were significantly reduced in the HS group compared to the control group after partial hepatectomy. Liver regeneration rate and BrdU labeling index were significantly higher in the HS group than in the control group after partial hepatectomy. IL6 and TNFα in serum and liver tissues were significantly reduced in the HS group compared to the control group after hepatectomy. We did not detect phosphorylation of signal transducer and activator of transcription-3 (STAT3) protein by western blotting. Binding activities of transcription factors: nuclear factor-interleukin-6 (NF-IL6) and nuclear factor-kappa B (NF-kB) were significantly lower in the HS group than in the control group after hepatectomy. CONCLUSION Pre-treatment with heat shock appears to reduce liver injury and promote liver regeneration, as HSP70 can reduce the inflammatory response and up-regulate liver regeneration without IL6 STAT signaling pathway in the liver after partial hepatectomy.
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Affiliation(s)
- Yousuke Oka
- Department of Surgery, School of Medicine, Kurume University, Fukuoka, Japan
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28
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Takenaka M, Seki N, Toh U, Hattori S, Kawahara A, Yamaguchi T, Koura K, Takahashi R, Otsuka H, Takahashi H, Iwakuma N, Nakagawa S, Fujii T, Sasada T, Yamaguchi R, Yano H, Shirouzu K, Kage M. FOXP3 expression in tumor cells and tumor-infiltrating lymphocytes is associated with breast cancer prognosis. Mol Clin Oncol 2013; 1:625-632. [PMID: 24649219 PMCID: PMC3915667 DOI: 10.3892/mco.2013.107] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [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: 09/27/2012] [Accepted: 04/05/2013] [Indexed: 12/04/2022] Open
Abstract
The forkhead box protein 3 (FOXP3) transcription factor is highly expressed in tumor cells as well as in regulatory T cells (Tregs). It plays a tumor-enhancing role in Tregs and suppresses carcinogenesis as a potent repressor of several oncogenes. The clinical prognostic value of FOXP3 expression has not yet been elucidated. In this study, immunohistochemistry was used to investigate the prognostic significance of FOXP3 expression in tumor cells and tumor-infiltrating lymphocytes (TILs) in breast cancer patients. Of the 100 tumor specimens obtained from primary invasive breast carcinoma, 63 and 57% were evaluated as FOXP3+ tumor cells and as being highly infiltrated by FOXP3+ lymphocytes, respectively. Although FOXP3 expression in tumor cells was of no prognostic significance, FOXP3+ lymphocytes were significantly associated with poor overall survival (OS) (n=98, log-rank test P=0.008). FOXP3 exhibited a heterogeneous subcellular localization in tumor cells (cytoplasm, 31%; nucleus, 26%; both, 6%) and, although cytoplasmic FOXP3 was associated with poor OS (P= 0.058), nuclear FOXP3 demonstrated a significant association with improved OS (P=0.016). Furthermore, when patients were grouped according to their expression of tumor cytoplasmic FOXP3 and lymphocyte FOXP3, there were notable differences in the Kaplan-Meier curves for OS (P<0.001), with a high infiltration of FOXP3+ lymphocytes accompanied by a cytoplasmic FOXP3+ tumor being the most detrimental phenotype. These findings indicated that FOXP3 expression in lymphocytes as well as in tumor cells may be a prognostic marker for breast cancer. FOXP3 in tumor cells may have distinct biological activities and prognostic values according to its localization, which may help establish appropriate cancer treatments.
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Affiliation(s)
- Miki Takenaka
- Departments of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan ; ; Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Naoko Seki
- Research Center for Innovative Cancer Therapy, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Uhi Toh
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Satoshi Hattori
- Biostatistical Center, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - Tomohiko Yamaguchi
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - Keiko Koura
- Departments of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan ; ; Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Ryuji Takahashi
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Hiroko Otsuka
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Hiroki Takahashi
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Nobutaka Iwakuma
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Shino Nakagawa
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Teruhiko Fujii
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan ; ; Multidisciplinary Treatment Center, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - Tetsuro Sasada
- Department of Immunology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Rin Yamaguchi
- Departments of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Hirohisa Yano
- Departments of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Kazuo Shirouzu
- Surgery, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Masayoshi Kage
- Research Center for Innovative Cancer Therapy, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan ; ; Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
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Sharma P, Bengtsson NE, Walter GA, Sohn HB, Zhou G, Iwakuma N, Zeng H, Grobmyer SR, Scott EW, Moudgil BM. Gadolinium-doped silica nanoparticles encapsulating indocyanine green for near infrared and magnetic resonance imaging. Small 2012; 8:2856-2868. [PMID: 22744832 DOI: 10.1002/smll.201200258] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/30/2012] [Indexed: 06/01/2023]
Abstract
Clinical applications of the indocyanine green (ICG) dye, the only near infrared (NIR) imaging dye approved by the Food and Drug Administration (FDA) in the USA, are limited due to rapid protein binding, fast clearance, and instability in physiologically relevant conditions. Encapsulating ICG in silica particles can enhance its photostability, minimize photobleaching, increase the signal-to-noise (S/N) ratio and enable in vivo studies. Furthermore, a combined magnetic resonance (MR) and NIR imaging particulate can integrate the advantage of high-resolution 3D anatomical imaging with high-sensitivity deep-tissue in-vivo fluorescent imaging. In this report, a novel synthesis technique that can achieve these goals is presented. A reverse-microemulsion-based synthesis protocol is employed to produce 25 nm ICG-doped silica nanoparticles (NPs). The encapsulation of ICG is achieved by manipulating coulombic attractions with bivalent ions and aminated silanes and carrying out silica synthesis in salt-catalyzed, mildly basic pH conditions using dioctyl sulfosuccinate (AOT)/heptane/water microemulsion system. Furthermore, paramagnetic properties are imparted by chelating paramagnetic Gd to the ICG-doped silica NPs. Aqueous ICG-dye-doped silica NPs show increased photostability (over a week) and minimal photobleaching as compared to the dye alone. The MR and optical imaging capabilities of these particles are demonstrated through phantom, in vitro and in vivo experiments. The described particles have the potential to act as theranostic agents by combining photodynamic therapy through the absorption of NIR irradiated light.
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Affiliation(s)
- Parvesh Sharma
- Materials Science and Engineering & Particle Engineering Research Center, University of Florida, Gainesville, FL, 32611, USA.
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Iwakuma N, Toh U, Grobmyer SR, Koura K, Takenaka M, Otsuka H, Takahashi R, Shirouzu K. Active targeting nanoparticle for breast cancer diagnosis and treatment. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.163] [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: 11/20/2022] Open
Abstract
163 Background: Breast cancer remains a major ongoing public health problem among women. Nanotechnology is the exciting field focused on man-made materials in the size range of 1-100 nanometers (nm). Nanoparticles (NPs) are on the scale of many cellular-level processes and hence are attractive for targeting breast cancer. Emerging nanotechnologies promise new approaches to early detection and treatment of breast cancer. Our group has reported Gold Speckled Silica NPs (GSS) as multimodal contrast agents for fluorescence, magnetic resonance and photoacoustic tomographic (PAT) imaging. The near infrared (NIR) optical absorption property of these particles makes them potentially useful for therapeutic applications such as thermal ablation of tumors. Fulfilling the promise of nanotechnologies for patients with metastatic breast cancer, necessitates delivery of nanomaterials to sites of breast cancer. Now we have focused on the cancer metabolism, we have recently developed active targeting NPs with surface functionalizing agent such as glucose conjugated NPs. We hypothesize that active targeting NPs is more incorporated into cancer cells compared to normal NPs. Methods: Human breast cancer cells, BT474, were incubated with active targeting NPs or normal NPs (as control). The tumor cell uptake was assessed using flow cytometry and fluorescence microscopy experiments. Results: Uptake of active targeting NPs was significantly higher than uptake of normal NPs. Conclusions: Active targeting NPs can be used as suitable targeting NPs for development of imaging agents for early diagnosis of breast cancer. Evolving bio-nanotechnologies such as active targeting NPs promise to enhance the early detection and non-invasive treatment of breast cancer.
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Affiliation(s)
| | - Uhi Toh
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Keiko Koura
- Kurume University School of Medicine, Fukuoka, Japan
| | - Miki Takenaka
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Ryuji Takahashi
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | - Kazuo Shirouzu
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
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Grobmyer SR, Zhou G, Gutwein LG, Iwakuma N, Sharma P, Hochwald SN. Nanoparticle delivery for metastatic breast cancer. Nanomedicine 2012; 8 Suppl 1:S21-30. [PMID: 22640908 DOI: 10.1016/j.nano.2012.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Breast cancer represents a major ongoing public health problem as the most common non-cutaneous malignancy among U.S. women. While significant progress has been made in improving loco-regional treatments for breast cancer, relatively little progress has been made in diagnosing and treating patients with metastatic breast cancer. At present there are limited curative options for patients with breast cancer metastatic beyond regional nodes. Emerging nanotechnologies promise new approaches to early detection and treatment of metastatic breast cancer. Fulfilling the promise of nanotechnologies for patients with metastatic breast cancer will require delivery of nanomaterials to sites of metastatic disease. Future translational approaches will rely on an ever increasing understanding of the biology of breast cancer subtypes and their metastases. These important concepts will be highlighted and elucidated in this manuscript.
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Affiliation(s)
- Stephen R Grobmyer
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida 32610, USA.
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Takahashi R, Toh U, Iwakuma N, Otsuka H, Shirouzu K, Matsueda S, Shichijo S, Sasada T, Itoh K. Immunological evaluation of personalized peptide vaccination for metastatic breast cancer patients with triple-negative types. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13046] [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: 11/20/2022] Open
Abstract
e13046 Background: To develop cancer vaccine, we investigated immune responses of the patients (pts) with metastatic breast cancer (MBC) with triple negative (TN) types to personalized peptide vaccine (PPV). Methods: Thirty-four pts including 8 TN-MBC were enrolled a phase II study of PPV. A maximum of four HLA-class IA (A2, A3s, A24, A26)-matched peptides showing higher antigen-specific IgG responses were administered. Levels of IgG reactive to each of the 31 peptides in the pre- and post-treatment plasma at every 6 times of vaccination were measured using LUMNEX system. Peptide-specific CTL responses were examined by INF-g ELISPOT. Results: All 34 pts had significant pre-existing humoral immunity, whereas only 13 of 31 patients, including 3 of 6 TN cases, showed pre-existing cellular immunity. Thirty-one of 34 pts, including 6 TN cases, achieved more than one cycle (6 times) of vaccination. The augmentation of the IgG responses specific to at least one of the vaccinated peptides was observed in 18 of 31 pts, including 3 of 6 TN cases. CTL responses were augmented in 16 of 31 pts, including 5 of 6 TN cases. IgG responses were boosted to greater levels with 12th vaccination in all 31 pts tested including 6 TN cases. Best clinical responses of 6 TN cases were 1 CR, 0 PR, 5 SD, and 0 PD, while those of the other 25 cases were 1 CR, 1 PR, 17 SD, and 6 PD, respectively. Conclusions: There were no significant differences between TN cases and the other cases of MBC with regard to immunological humoral and/or cellular responses to PPV.
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Affiliation(s)
- Ryuji Takahashi
- Department of Surgery, Kurume University Faculty of Medicine,, Kurume, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Hiroko Otsuka
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | - Kazuo Shirouzu
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | - Satoko Matsueda
- Department of Immunology and Immunotherapy, Kurume University, School of Medicine, Kurume, Japan
| | - Shigeki Shichijo
- Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan
| | - Tetsuro Sasada
- Department of Immunology and Immunotherapy, Kurume University, School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan
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Toh U, Iwakuma N, Takahashi R, Otsuka H, Matsueda S, Shichijo S, Sasada T, Itoh K, Shirouzu K. Phase II study of personalized peptide vaccine for refractory breast cancer patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13050] [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: 11/20/2022] Open
Abstract
e13050 Background: To develop therapeutic cancer vaccine, we conducted a phase II study of personalized peptide vaccine (PPV) for refractory breast cancer patients. Methods: Thirty-four refractory breast cancer patients, including 8 triple negative (TN) cases, were enrolled to this study. A maximum of four HLA-class IA (A2, A3s, A24, A26)-matched peptides showing higher antigen-specific IgG responses were administered. Inflammatory markers, cytokines, and peptide-specific CTL and IgG responses were examined before and after vaccination to identify prognostic factors for overall survival (OS). Results: No vaccine-related severe adverse events were observed. Median numbers of preceding chemo- and/or hormone therapy regimens and median treatment duration from the recurrence to the vaccination were 2 regimens and 37 months, respectively. Three patients did not complete the 6th vaccination because of rapid disease progression. CTL or IgG boosting by PPV was observed in 16 or 18 of 31 patients at the time of 6th vaccination. IgG boosting was observed in all 24 patients tested at 12th vaccination. Median survival time of 31 patients receiving > 6th vaccination after the vaccination was 474 days with 2 complete responses and 1 partial response. There were no significant differences between 8 TN cases and the other cases from points of immunological and clinical responses. Lymphocyte frequency (Hazard ratio of 0.906, p=0.019) well associated with OS by multivariate Cox proportional hazard regression analysis for pre-vaccination samples. Conclusions: Next steps of PPV for the refractory breast cancer patients were warranted because of the lower toxicity and favorite immune responses along with possible clinical benefits.
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Affiliation(s)
- Uhi Toh
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | | | - Ryuji Takahashi
- Department of Surgery, Kurume University Faculty of Medicine,, Kurume, Japan
| | - Hiroko Otsuka
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
| | - Satoko Matsueda
- Department of Immunology and Immunotherapy, Kurume University, School of Medicine, Kurume, Japan
| | - Shigeki Shichijo
- Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan
| | - Tetsuro Sasada
- Department of Immunology and Immunotherapy, Kurume University, School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan
| | - Kazuo Shirouzu
- Department of Surgery, Kurume University Faculty of Medicine, Kurume, Japan
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Takenaka M, Toh U, Otsuka H, Takahashi H, Iwakuma N, Nakagawa S, Fujii T, Yamaguchi R, Yano H, Shirouzu K, Kage M. Giant malignant phyllodes tumor: a case report. Kurume Med J 2012; 58:67-72. [PMID: 22251824 DOI: 10.2739/kurumemedj.58.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We present a case of a 57-year-old woman with a giant malignant phyllodes tumor (PT) in her right breast, with maximum diameter of 20 cm. The core-needle and excisional biopsy specimens were diagnosed as suspicious for low-grade myofibroblastic sarcoma (LGMS). The subsequent total mastectomy with partial resection of the pectoral muscles showed predominance of stromal hypercellularity without an epithelial component. However, we diagnosed this as a malignant PT because focal areas showed a leaf-like pattern. In the case of large malignant PTs that exhibit stromal predominance, it can be difficult to distinguish between a pure sarcoma and malignant PT. It is important to thoroughly examine multiple sections from the view point of residual epithelial structure in morphological diagnosis.
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Affiliation(s)
- Miki Takenaka
- Department of Pathology, Kurume University School of Medicine, Kurume University Hospital, Kurume University, Kurume 830-0011, Japan.
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35
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Grobmyer SR, Zhou G, Gutwein LG, Iwakuma N, Sharma P, Hochwald SN. Nanoparticle delivery for metastatic breast cancer. Maturitas 2012; 73:19-26. [PMID: 22402026 DOI: 10.1016/j.maturitas.2012.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
Abstract
Breast cancer represents a major ongoing public health problem as the most common non-cutaneous malignancy among U.S. women. While significant progress has been made in improving loco-regional treatments for breast cancer, relatively little progress has been made in diagnosing and treating patients with metastatic breast cancer. At present there are limited curative options for patients with breast cancer metastatic beyond regional nodes. Emerging nanotechnologies promise new approaches to early detection and treatment of metastatic breast cancer. Fulfilling the promise of nanotechnologies for patients with metastatic breast cancer will require delivery of nanomaterials to sites of metastatic disease. Future translational approaches will rely on an ever increasing understanding of the biology of breast cancer subtypes and their metastases. These important concepts will be highlighted and elucidated in this manuscript.
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Affiliation(s)
- Stephen R Grobmyer
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL 32610, USA.
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36
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Takenaka M, Toh U, Seki N, Kawahara A, Hattori S, Iwakuma N, Yamaguchi R, Yano H, Shirouzu K, Kage M. 335 FOXP3 Expression in Tumor Cells Associated with the Prognosis in Breast Cancer Patients. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Ogo E, Suzuki G, Abe T, Watanabe Y, Hattori C, Hayabuchi N, Otsuka H, Iwakuma N, Nakagawa S, Toh U. 478 Radiation-induced Pulmonary Injury After Radiotherapy for Early Breast Conserving Therapy. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Iwakuma N, Toh U, Grobmyer S, Koura K, Takenaka M, Otsuka H, Takahashi R, Shirouzu K. 75 The Potential of Targeting Nanoparticle for Breast Cancer Diagnosis. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Toh U, Iwakuma N, Otsuka H, Takenaka M, Ogo E, Fujii T, Tanaka M, Shirouzu K. A multicenter phase II study of S-1 combined with irinotecan (CPT-11) for patients with advanced/recurrent breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Toh U, Iwakuma N, Otsuka H, Ogo E, Fujii T, Tanaka M, Itoh K, Shirouzu K. P326 Immunologic and clinical effects of personalized selection of peptide vaccines in patients with refractory breast cancer. Breast 2011. [DOI: 10.1016/s0960-9776(11)70264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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41
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Krishna V, Singh A, Sharma P, Iwakuma N, Wang Q, Zhang Q, Knapik J, Jiang H, Grobmyer SR, Koopman B, Moudgil B. Polyhydroxy fullerenes for non-invasive cancer imaging and therapy. Small 2010; 6:2236-41. [PMID: 20818623 DOI: 10.1002/smll.201000847] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Vijay Krishna
- Particle Engineering Research Center, 205 Particle Science and Technology Building, PO Box 116135, University of Florida, Gainesville, Florida 32611, USA.
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42
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Takahashi H, Fujii T, Inoue Y, Katsura M, Yokoyama G, Matsubayashi Namoto R, Nakayama Y, Momosaki S, Ariyama H, Takenaka M, Otsuka H, Iwakuma N, Toh U, Shirouzu K. [A case of breast meningeal carcinomatosis caused by trastuzumab treatment as adjuvant chemotherapy]. Gan To Kagaku Ryoho 2010; 37:1607-1609. [PMID: 20716898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 52-year-old woman underwent modified radical mastectomy and axillary lymph node resection for right breast cancer (stage IIB). Afterwards FEC therapy (5-FU 500 mg/m/2, epirubicin 75 mg/m2, cyclophosphamide 500 mg/m2) x 4, docetaxel therapy (60 mg/m2) x 4 and radiation of the illness side collarbone, upper and lower lymph nodes were enforced for adjuvant therapy after the operation. Furthermore, administration of aromatase inhibitor (anastrozole) and trastuzumab was started due to the postoperative pathological diagnosis of hormone receptor-positive and HER2 (score 3+). This became an urgent hospital admission because of the sudden escape power from impaired consciousness due to the articulation disorders and limb weakness when trastuzumab was administered nine times. It was diagnosed by MRI examination and the cerebrospinal fluid cytology as meningeal carcinomatosis of breast cancer, and she died on the 31st recurrence of disease. A serious relapse may be caused in a case of fast-progressing breast cancer like this while being administered trastuzumab as an adjuvant treatment.
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Affiliation(s)
- Hiroki Takahashi
- Breast Care Center, National Hospital Organization Kyushu Medical Center
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43
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Toh U, Otsuka H, Iwakuma N, Shirouzu K, Ogo E, Yamana H, Itoh K, Tanaka M, Fujii T. A phase II study of personalized selection of peptide vaccines combined with conventional chemo- or endocrine therapy for refractory breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Toh U, Fukushima T, Fukunaga M, Iwakuma N, Takenaka M, Otsuka H, Shirouzu K, Ogo E. 494 Phase II study of S-1 in combination with irinotecan (CPT-11) for patients with advanced/recurrent breast cancer (KSCOG-BC01). EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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45
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Otsuka H, Toh U, Fukushima T, Fukunaga M, Iwakuma N, Shiruzu K. 635 The usefulness of screening FDG-PET for breast cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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46
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Iwakuma N, Tou U, Shirozu K, Sharma P, Zhang Q, Jiang H, Moudgil B, Grobmyer S. 97 Novel gold speckled silica nanoparticle (GSS) as madiators of tumour imaging and photothermal ablation (University of Florida and Kurume University, Cancer Nanotechnology Study Group). EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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47
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Sharma P, Brown SC, Singh A, Iwakuma N, Pyrgiotakis G, Krishna V, Knapik JA, Barr K, Moudgil BM, Grobmyer SR. Near-infrared absorbing and luminescent gold speckled silica nanoparticles for photothermal therapy. ACTA ACUST UNITED AC 2010. [DOI: 10.1039/c0jm00354a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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48
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Sharma P, Singh A, Brown SC, Bengtsson N, Walter GA, Grobmyer SR, Iwakuma N, Santra S, Scott EW, Moudgil BM. Multimodal nanoparticulate bioimaging contrast agents. Methods Mol Biol 2010; 624:67-81. [PMID: 20217589 DOI: 10.1007/978-1-60761-609-2_5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A wide variety of bioimaging techniques (e.g., ultrasound, computed X-ray tomography, magnetic resonance imaging (MRI), and positron emission tomography) are commonly employed for clinical diagnostics and scientific research. While all of these methods use a characteristic "energy-matter" interaction to provide specific details about biological processes, each modality differs from another in terms of spatial and temporal resolution, anatomical and molecular details, imaging depth, as well as the desirable material properties of contrast agents needed for augmented imaging. On many occasions, it is advantageous to apply multiple complimentary imaging modalities for faster and more accurate prognosis. Since most imaging modalities employ exogenous contrast agents to improve the signal-to-noise ratio, the development and use of multimodal contrast agents is considered to be highly advantageous for obtaining improved imagery from sought-after imaging modalities. Multimodal contrast agents offer improvements in patient care, and at the same time can reduce costs and enhance safety by limiting the number of contrast agent administrations required for imaging purposes. Herein, we describe the synthesis and characterization of nanoparticulate-based multimodal contrast agent for noninvasive bioimaging using MRI, optical, and photoacoustic tomography (PAT)-imaging modalities. The synthesis of these agents is described using microemulsions, which enable facile integration of the desired diversity of contrast agents and material components into a single entity.
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Affiliation(s)
- Parvesh Sharma
- Department of Materials Science and Engineering, Particle Engineering Research Center, University of Florida, Gainesville, FL, USA
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Zhang Q, Iwakuma N, Sharma P, Moudgil BM, Wu C, McNeill J, Jiang H, Grobmyer SR. Gold nanoparticles as a contrast agent for in vivo tumor imaging with photoacoustic tomography. Nanotechnology 2009; 20:395102. [PMID: 19726840 DOI: 10.1088/0957-4484/20/39/395102] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Photoacoustic tomography (PAT) is a rapidly emerging non-invasive imaging technology that integrates the merits of high optical contrast with high ultrasound resolution. The ability to quantitatively and non-invasively image nanoparticles has important implications for the development of nanoparticles as in vivo cancer diagnostic and therapeutic agents. In this study, the ability of systemically administered poly(ethylene glycol)-coated (PEGylated) gold nanoparticles as a contrast agent for in vivo tumor imaging with PAT has been evaluated. We demonstrate that gold nanoparticles (20 and 50 nm) have high photoacoustic contrast as compared to mouse tissue ex vivo. Gold nanoparticles can be visualized in mice in vivo following subcutaneous administration using PAT. Following intravenous administration of PEGylated gold nanoparticles to tumor-bearing mice, accumulation of gold nanoparticles in tumors can be effectively imaged with PAT. With gold nanoparticles as a contrast agent, PAT has important potential applications in the image guided therapy of superficial tumors such as breast cancer, melanoma and Merkel cell carcinoma.
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Affiliation(s)
- Q Zhang
- Department of Biomedical Engineering, College of Engineering, University of Florida, 130 BME building, Gainesville Florida 32611-3161, USA.
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50
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Ishikawa M, Takamatsu Y, Mitsuyama S, Iwakuma N, Anan K, Umeda S, Tamura K. Paclitaxel as a first-line chemotherapy for Japanese women with advanced or recurrent breast cancer: a multi-institutional practice-based study by the Kyushu Breast Cancer Study Group (KBC-SG). Breast Cancer 2009; 17:131-5. [PMID: 19472037 DOI: 10.1007/s12282-009-0118-8] [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] [Received: 07/30/2008] [Accepted: 04/06/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anthracycline-containing chemotherapy has represented the standard treatment for advanced breast cancer. However, it is sometimes difficult to continue it because of its cumulative cardiac toxicity, and the benefit of adding anthracyclines to the chemotherapy regimen is confined to HER2-overexpressed breast cancer. A non-anthracycline-based novel therapy is necessary to improve the survival and reduce the toxicity. METHODS We evaluated the tumor response and adverse events of a first-line paclitaxel therapy in advanced or recurrent breast cancer in a variety of practice settings. Patients were to receive paclitaxel tri-weekly (175 mg/m(2)), bi-weekly (120 mg/m(2)) or weekly (80 mg/m(2)) until disease progression or toxicity precluded further treatment. Tumor response and toxicities were evaluated. RESULTS Thirty-three patients received a total of 191 cycles (median 5, range 2-19). All patients completed at least two cycles. In 30 patients who were evaluable for response, there were 16 overall responses [53%, 95% confidence interval (CI) 34-72%], including 5 complete responses (17%, 95% CI 3-31%). The median progression-free survival and overall survival were 16 (95% CI 9-24) months and 29 (95% CI 24-36) months, respectively. Overall treatment was well tolerated, and no myelosuppression >grade 3 was reported during this study. A grade 3 dyspnea was noted in one patient, but it recovered spontaneously, and subsequent administration of paclitaxel was successfully given with no specific treatment. No other toxicity greater than grade 3 was demonstrated. CONCLUSION Paclitaxel as a first-line therapy at this dose and schedule is an effective and well-tolerated treatment regimen in Japanese patients with advanced or recurrent breast cancer.
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