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Schweizer L, Krishnan R, Shimizu A, Metousis A, Kenny H, Mendoza R, Nordmann TM, Rauch S, Kelliher L, Heide J, Rosenberger FA, Bilecz A, Borrego SN, Strauss MT, Thielert M, Rodriguez E, Müller-Reif JB, Chen M, Yamada SD, Mund A, Lastra RR, Mann M, Lengyel E. Spatial proteo-transcriptomic profiling reveals the molecular landscape of borderline ovarian tumors and their invasive progression. medRxiv 2023:2023.11.13.23298409. [PMID: 38014221 PMCID: PMC10680885 DOI: 10.1101/2023.11.13.23298409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Serous borderline tumors (SBT) are epithelial neoplastic lesions of the ovaries that commonly have a good prognosis. In 10-15% of cases, however, SBT will recur as low-grade serous cancer (LGSC), which is deeply invasive and responds poorly to current standard chemotherapy1,2,3. While genetic alterations suggest a common origin, the transition from SBT to LGSC remains poorly understood4. Here, we integrate spatial proteomics5 with spatial transcriptomics to elucidate the evolution from SBT to LGSC and its corresponding metastasis at the molecular level in both the stroma and the tumor. We show that the transition of SBT to LGSC occurs in the epithelial compartment through an intermediary stage with micropapillary features (SBT-MP), which involves a gradual increase in MAPK signaling. A distinct subset of proteins and transcripts was associated with the transition to invasive tumor growth, including the neuronal splicing factor NOVA2, which was limited to expression in LGSC and its corresponding metastasis. An integrative pathway analysis exposed aberrant molecular signaling of tumor cells supported by alterations in angiogenesis and inflammation in the tumor microenvironment. Integration of spatial transcriptomics and proteomics followed by knockdown of the most altered genes or pharmaceutical inhibition of the most relevant targets confirmed their functional significance in regulating key features of invasiveness. Combining cell-type resolved spatial proteomics and transcriptomics allowed us to elucidate the sequence of tumorigenesis from SBT to LGSC. The approach presented here is a blueprint to systematically elucidate mechanisms of tumorigenesis and find novel treatment strategies.
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Affiliation(s)
- Lisa Schweizer
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Rahul Krishnan
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Aasa Shimizu
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Andreas Metousis
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Hilary Kenny
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Rachelle Mendoza
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Thierry M. Nordmann
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Sarah Rauch
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Lucy Kelliher
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Janna Heide
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Florian A. Rosenberger
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Agnes Bilecz
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Sanaa Nakad Borrego
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Maximillian T. Strauss
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marvin Thielert
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Edwin Rodriguez
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Johannes B. Müller-Reif
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Mengjie Chen
- Medicine/Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | - S. Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Andreas Mund
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo R. Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Matthias Mann
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
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Mendoza RP, Wang P, Schulte JJ, Tjota MY, Jani I, Martinez AC, Haridas R, Wanjari P, Steinhardt G, Brown N, Betz BL, Chapel DB, Kertowidjojo E, Yamada SD, Bennett JA. Endometrial Carcinomas With Subclonal Loss of Mismatch Repair Proteins: A Clinicopathologic and Genomic Study. Am J Surg Pathol 2023; 47:589-598. [PMID: 36866757 DOI: 10.1097/pas.0000000000002031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/27/2023] [Indexed: 03/04/2023]
Abstract
Subclonal loss of mismatch repair (MMR) proteins has been described in a small subset of endometrial carcinomas (ECs), but the genomic basis for this phenomenon has received limited attention. Herein, we retrospectively evaluated all ECs with MMR immunohistochemistry (n=285) for subclonal loss, and in those (n=6), performed a detailed clinicopathologic and genomic comparison of the MMR-deficient and MMR-proficient components. Three tumors were FIGO stage IA, and one each stage IB, II, and IIIC2. Patterns of subclonal loss were as follows: (1) 3 FIGO grade 1 endometrioid carcinomas with subclonal MLH1/PMS2, MLH1 promoter hypermethylation, and no MMR gene mutations; (2) POLE -mutated FIGO grade 3 endometrioid carcinoma with subclonal PMS2, and PMS2 and MSH6 mutations limited to the MMR-deficient component; (3) dedifferentiated carcinoma with subclonal MSH2/MSH6, as well as complete loss of MLH1/PMS2, MLH1 promoter hypermethylation, and PMS2 and MSH6 mutations in both components; (4) dedifferentiated carcinoma with subclonal MSH6, and somatic and germline MSH6 mutations in both components, but with a higher allele frequency in MMR-deficient foci. Recurrences occurred in 2 patients, one consisted of the MMR-proficient component from a FIGO 1 endometrioid carcinoma, while the other was from the MSH6 -mutated dedifferentiated endometrioid carcinoma. At the last follow-up (median: 44 mo), 4 patients were alive and disease-free and 2 were alive with disease. In summary, subclonal MMR loss reflects subclonal and often complex genomic and epigenetic alterations, which may have therapeutic implications and therefore must be reported when present. In addition, subclonal loss can occur in both POLE -mutated and Lynch syndrome-associated ECs.
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Affiliation(s)
| | | | - Jefree J Schulte
- Departments of Pathology
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI
| | | | - Ina Jani
- Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Anna C Martinez
- Departments of Pathology
- Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | | | | | | | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Bryan L Betz
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - David B Chapel
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - S D Yamada
- Obstetrics and Gynecology, University of Chicago, Chicago, IL
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Glaser GE, Lara OD, Pothuri B, Grimaldi CG, Prescott LS, Mastroyannis SA, Kim S, ElNaggar AC, Torres D, Conrad LB, McGree M, Weaver A, Huh WK, Cohn DE, Yamada SD, Fader AN. Clinical outcomes in patients with COVID-19 and gynecologic cancer: A society of gynecologic oncology COVID-19 and gynecologic cancer registry study. Gynecol Oncol 2022; 167:146-151. [PMID: 36154761 PMCID: PMC9499739 DOI: 10.1016/j.ygyno.2022.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with gynecologic malignancies may have varied responses to COVID-19 infection. We aimed to describe clinical courses, treatment changes, and short-term clinical outcomes for gynecologic oncology patients with concurrent COVID-19 in the United States. METHODS The Society of Gynecologic Oncology COVID-19 and Gynecologic Cancer Registry was created to capture clinical courses of gynecologic oncology patients with COVID-19. Logistic regression models were employed to evaluate factors for an association with hospitalization and death, respectively, within 30 days of COVID-19 diagnosis. RESULTS Data were available for 348 patients across 7 institutions. At COVID-19 diagnosis, 125 patients (36%) had active malignancy. Delay (n = 88) or discontinuation (n = 10) of treatment due to COVID-19 infection occurred in 28% with those on chemotherapy (53/88) or recently receiving surgery (32/88) most frequently delayed. In addition to age, performance status, diabetes, and specific COVID symptoms, both non-White race (adjusted odds ratio (aOR) = 3.93, 95% CI 2.06-7.50) and active malignancy (aOR = 2.34, 95% CI 1.30-4.20) were associated with an increased odds of hospitalization. Eight percent of hospitalized patients (8/101) died of COVID-19 complications and 5% (17/348) of the entire cohort died within 30 days after diagnosis. CONCLUSIONS Gynecologic oncology patients diagnosed with COVID-19 are at risk for hospitalization, delay of anti-cancer treatments, and death. One in 20 gynecologic oncology patients with COVID-19 died within 30 days after diagnosis. Racial disparities exist in patient hospitalizations for COVID-19, a surrogate of disease severity. Additional studies are needed to determine long-term outcomes and the impact of race.
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Affiliation(s)
- Gretchen E Glaser
- Mayo Clinic Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, United States of America.
| | - Olivia D Lara
- Department of Obstetrics and Gynecology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, United States of America
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, United States of America
| | | | | | | | - Sarah Kim
- University of Pennsylvania, United States of America
| | - Adam C ElNaggar
- West Cancer Center and Research Institute, Memphis, TN, United States of America
| | | | - Lesley B Conrad
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Michaela McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America
| | - Amy Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham Heersink School of Medicine, United States of America
| | - David E Cohn
- Ohio State University, James Cancer Hospital and Solove Research Institute, United States of America
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medicine, United States of America
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, United States of America
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Dholakia J, Woo Lee Y, Lu KH, Huh WK, Diane Yamada S, Fuh KC, Kumar AS, Liang MI, Nair N, Kim KH. Identity-Related Experiences of Asian American Trainees in Gynecologic Oncology. Gynecol Oncol Rep 2022; 44:101097. [DOI: 10.1016/j.gore.2022.101097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
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Yamada SD, Adams S, Fader AN. Foreword. Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01218-5] [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: 11/04/2022]
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Mai PL, Miller A, Black A, Falk RT, Boggess JF, Tucker K, Stuckey AR, Rodriguez GC, Wong C, Amatruda TT, Wilkinson KJ, Modesitt SC, Yamada SD, Bixel KL, Glaser GE, Rose PG, Greene MH, Sherman ME. Effect of risk-reducing salpingo-oophorectomy on sex steroid hormone serum levels among postmenopausal women: an NRG Oncology/Gynecologic Oncology Group study. Am J Obstet Gynecol 2022; 227:61.e1-61.e18. [PMID: 35216968 DOI: 10.1016/j.ajog.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy is an effective ovarian cancer risk reduction strategy. However, bilateral oophorectomy has also been associated with increased long-term nonneoplastic sequelae, effects suggested to be mediated through reductions in systemic sex steroid hormone levels. Currently, it is unclear whether the postmenopausal ovary contributes to the systemic hormonal milieu or whether postmenopausal ovarian volume or other factors, such as body mass index and age, affect systemic hormone levels. OBJECTIVE We examined the impact of oophorectomy on sex steroid hormone levels in postmenopausal women. Furthermore, we explored how well ovarian volume measured by transvaginal ultrasound correlated with direct ovarian measures obtained during surgical pathology evaluation and investigated the association between hormone levels and ovarian volumes. STUDY DESIGN Postmenopausal women who underwent risk-reducing salpingo-oophorectomy (180 cases) or ovarian cancer screening (38 controls) enrolled in an international, prospective study of risk-reducing salpingo-oophorectomy and risk of ovarian cancer algorithm-based screening among women at increased risk of ovarian cancer (Gynecologic Oncology Group-0199) were included in this analysis. Controls were frequency matched to the cases on age at menopause, age at study entry, and time interval between blood draws. Ovarian volume was calculated using measurements obtained from transvaginal ultrasound in both cases and controls and measurements recorded in surgical pathology reports from cases. Serum hormone levels of testosterone, androstenedione, androstenediol, dihydrotestosterone, androsterone, dehydroepiandrosterone, estrone, estradiol, and sex hormone-binding globulin were measured at baseline and follow-up. Spearman correlation coefficients were used to compare ovarian volumes as measured on transvaginal ultrasound and pathology examinations. Correlations between ovarian volumes by transvaginal ultrasound and measured hormone levels were examined using linear regression models. All models were adjusted for age. Paired t tests were performed to evaluate individual differences in hormone levels before and after risk-reducing salpingo-oophorectomy. RESULTS Ovarian volumes measured by transvaginal ultrasound were only moderately correlated with those reported on pathology reports (Spearman rho [ρ]=0.42). The median time interval between risk-reducing salpingo-oophorectomy and follow-up for the cases was 13.3 months (range, 6.0-19.3), and the median time interval between baseline and follow-up for the controls was 12.7 months (range, 8.7-13.4). Sex steroid levels decreased with age but were not correlated with transvaginal ultrasound ovarian volume, body mass index, or time since menopause. Estradiol levels were significantly lower after risk-reducing salpingo-oophorectomy (percentage change, -61.9 post-risk-reducing salpingo-oophorectomy vs +15.2 in controls; P=.02), but no significant differences were seen for the other hormones. CONCLUSION Ovarian volumes measured by transvaginal ultrasound were moderately correlated with volumes directly measured on pathology specimens and were not correlated with sex steroid hormone levels in postmenopausal women. Estradiol was the only hormone that declined significantly after risk-reducing salpingo-oophorectomy. Thus, it remains unclear whether the limited post-risk-reducing salpingo-oophorectomy changes in sex steroid hormones among postmenopausal women impact long-term adverse outcomes.
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Affiliation(s)
- Phuong L Mai
- Center for Clinical Genetics and Genomics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA.
| | - Austin Miller
- NRG Oncology, Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - John F Boggess
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine Tucker
- Hereditary Cancer Centre, Nelune Comprehensive Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital and Community Health Services, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ashley R Stuckey
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI
| | - Gustavo C Rodriguez
- Division of Gynecologic Oncology, NorthShore University Health System, Evanston, IL
| | - Cheung Wong
- Division of Gynecologic Oncology, University of Vermont Medical Center, Burlington, VT
| | - Thomas T Amatruda
- Metro-Minnesota Community Oncology Research Consortium, Fridley Clinic, Fridley, MN
| | - Kelly J Wilkinson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Susan C Modesitt
- Division of Gynecologic Oncology, University of Virginia Health, Charlottesville, VA
| | - S Diane Yamada
- Division of Gynecologic Oncology, The University of Chicago Medicine, Chicago, IL
| | - Kristin L Bixel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Peter G Rose
- Division of Gynecologic Oncology, Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Mark H Greene
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Mark E Sherman
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
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Javellana M, Eckert MA, Heide J, Zawieracz K, Weigert M, Ashley S, Stock E, Chapel D, Huang L, Yamada SD, Ahmed AA, Lastra RR, Chen M, Lengyel E. Neoadjuvant chemotherapy induces genomic and transcriptomic changes in ovarian cancer. Cancer Res 2021; 82:169-176. [PMID: 34737212 DOI: 10.1158/0008-5472.can-21-1467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
The growing use of neoadjuvant chemotherapy to treat advanced-stage high-grade serous ovarian cancer (HGSOC) creates an opportunity to better understand chemotherapy-induced mutational and gene expression changes. Here we performed a cohort study including 34 patients with advanced stage IIIC or IV HGSOC to assess changes in the tumor genome and transcriptome in women receiving neoadjuvant chemotherapy. RNA-sequencing and panel DNA-sequencing of 596 cancer-related genes was performed on paired FFPE specimens collected before and after chemotherapy, and differentially expressed genes (DEGs) and CNVs in pre- and post-chemotherapy samples were identified. Following tissue and sequencing quality control, the final patient cohort consisted of 32 paired DNA and 20 paired RNA samples. Genomic analysis of paired samples did not reveal any recurrent chemotherapy-induced mutations. Gene expression analyses found that most DEGs were upregulated by chemotherapy, primarily in the chemotherapy resistant specimens. AP-1 transcription factor family genes (FOS, FOSB, FRA-1) were particularly upregulated in chemotherapy resistant samples. CNV analysis identified recurrent 11q23.1 amplification, which encompasses SIK2. In vitro, combined treatment with AP-1 or SIK2 inhibitors with carboplatin or paclitaxel demonstrated synergistic effects. These data suggest that AP-1 activity and SIK2 copy number amplification are induced by chemotherapy and may represent mechanisms by which chemotherapy resistance evolves in HGSOC. AP-1 and SIK2 are druggable targets with available small molecule inhibitors and represent potential targets to circumvent chemotherapy resistance.
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Affiliation(s)
| | | | - Janna Heide
- Department of Obstetrics and Gynecology, University of Chicago
| | | | | | - Sarah Ashley
- Department of Obstetrics and Gynecology, University of Chicago
| | - Elizabeth Stock
- Department of Obstetrics and Gynecology, University of Chicago
| | - David Chapel
- Department of Pathology, University of Michigan Medical School
| | - Lei Huang
- Center for Research Informatics, University of Chicago
| | - S Diane Yamada
- Departments of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago
| | | | | | | | - Ernst Lengyel
- Department of Obstetrics and Gynecology, University of Chicago
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8
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Hoppenot C, Hlubocky FJ, Chor J, Yamada SD, Lee NK. Gaps in patient-physician communication at the time of malignant bowel obstruction from recurrent gynecologic cancer: a qualitative study. Support Care Cancer 2021; 30:367-376. [PMID: 34287689 DOI: 10.1007/s00520-021-06441-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We sought to investigate the patient and physician approaches to malignant bowel obstruction (MBO) due to recurrent gynecologic cancer by (1) comparing patient and physician expectations and priorities during a new MBO diagnosis, and (2) highlighting factors that facilitate patient-doctor communication. METHODS Patients were interviewed about their experience during an admission for MBO, and physicians were interviewed about their general approach towards MBO. Interviews were analyzed for themes using QDAMiner qualitative analysis software. The analysis utilized the framework analysis and used both predetermined themes and those that emerged from the data. RESULTS We interviewed 14 patients admitted with MBO from recurrent gynecologic cancer and 15 gynecologic oncologists. We found differences between patients and physicians regarding plans for next chemotherapy treatments, foremost priorities, communication styles, and need for end-of-life discussions. Both patients and physicians felt that patient-physician communication was improved in situations of trust, understanding patient preferences, corroboration of information, and increased time spent with patients during and before the MBO. CONCLUSION Gaps in patient-physician communication could be targeted to improve the patient experience and physician counseling during a difficult diagnosis. Our findings emphasize a need for patient-physician discussions to focus on expectations for future cancer-directed treatments, support for patients at home with home health or hospice level support in line with their wishes, and acknowledgement of uncertainty while providing direct information about the MBO diagnosis.
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Affiliation(s)
- Claire Hoppenot
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA. .,Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Dan L Duncan Comprehensive Cancer Center, 7200 Cambridge St., Houston, TX, 77030, USA.
| | - Fay J Hlubocky
- Section of Hematologic Oncology, Program for Supportive Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Julie Chor
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
| | - Nita K Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
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Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. ASO Visual Abstract: Differences in Sociodemographic Disparities in Patients Undergoing Surgery for Advanced Colorectal and Ovarian Cancer. Ann Surg Oncol 2021. [PMID: 33978887 DOI: 10.1245/s10434-021-10130-x] [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: 11/18/2022]
Affiliation(s)
- Ellen M Goldberg
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
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Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. Differences in Sociodemographic Disparities Between Patients Undergoing Surgery for Advanced Colorectal or Ovarian Cancer. Ann Surg Oncol 2021; 28:7795-7806. [PMID: 33959831 DOI: 10.1245/s10434-021-10086-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/16/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) for ovarian cancer with peritoneal metastases (OPM) is an established treatment, yet access-related racial and socioeconomic disparities are well documented. CRS for colorectal cancer with peritoneal metastases (CRPM) is garnering more widespread acceptance, and it is unknown what disparities exist with regards to access. METHODS This retrospective cross-sectional multicenter study analyzed medical records from the National Cancer Database from 2010 to 2015. Patients diagnosed with CRPM or ORP only and either no or confirmed resection were included. Patient- and facility-level characteristics were analyzed using uni- and multivariable logistic regressions to identify associations with receipt of CRS. RESULTS A total of 6634 patients diagnosed with CRPM and 14,474 diagnosed with OPM were included in this study. Among patients with CRPM, 18.1% underwent CRS. On multivariable analysis, female gender (odds ratio [95% CI] 2.04 [1.77-2.35]; P < 0.001) and treatment at an academic or research facility (OR 1.55 [1.17-2.05]; P = 0.002) were associated with CRS. Among patients with OPM, 87.1% underwent CRS. On multivariable analysis, treatment at facilities with higher-income patient populations was positively associated with CRS, while age (OR 0.97 [0.96-0.98]; P < .0001), use of nonprivate insurance (OR 0.69 [0.56-0.85]; P = 0.001), and listed as Black (OR 0.62 [0.45-0.86]; P = 0.004) were negatively associated with CRS. CONCLUSION There were more systemic barriers to CRS for patients with OPM than for patients with CRPM. As CRS becomes more widely practiced for CRPM, it is likely that more socioeconomic and demographic barriers will be elucidated.
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Affiliation(s)
- Ellen M Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
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11
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Jani I, Lastra RR, Brito KS, Liao C, Lazo I, Lee NK, Yamada SD, Kurnit KC. Chemotherapy response score as a prognostic tool in patients with advanced stage endometrial carcinoma treated with neoadjuvant chemotherapy. Int J Gynecol Cancer 2021; 31:852-858. [PMID: 33833085 DOI: 10.1136/ijgc-2020-002202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chemotherapy response score (CRS) applied to interval debulking specimens quantifies histopathologic response to neoadjuvant chemotherapy in patients with advanced ovarian carcinoma and correlates with progression-free and overall survival. OBJECTIVE To investigate whether the chemotherapy response score could be applied to interval debulking specimens in patients with advanced endometrial carcinoma and be a prognostic indicator. METHODS The study included patients with clinical stage III-IV endometrial carcinoma who received neoadjuvant chemotherapy followed by interval debulking surgery. Chemotherapy response scores were assigned to omental and adnexal metastases, and categorized as no/minimal (CRS1), partial (CRS2), and complete/near-complete (CRS3) response to neoadjuvant chemotherapy. Descriptive statistics were used to evaluate baseline characteristics and feasibility of chemotherapy response score assessment. Univariate analyses were used to evaluate associations between the chemotherapy response score, complete cytoreduction, and survival. RESULTS This study included 40 patients. The median age was 63.5 years, and 31 patients (78%) had stage IV disease. Thirty patients had an omentectomy, 22 patients (73%) had an omental chemotherapy response score assigned. Thirty-nine patients had a bilateral salpingo-oophorectomy, 28 patients (72%) had an adnexal chemotherapy response score assigned. Omental CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.18, p<0.01; CRS3: HR=0.11, p<0.01) and overall survival (CRS2: HR=0.10, p<0.01; CRS3: HR=0.16, p=0.04). Adnexal CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.23, p<0.01; CRS3: HR=0.20, p=0.03). Chemotherapy response scores were also associated with an increased likelihood of having a complete cytoreduction. CONCLUSION Chemotherapy response score can be applied to omental and adnexal metastases in patients with advanced endometrial carcinoma and was associated with survival and complete cytoreduction. The score may be a prognostic indicator and help to guide first-line treatment of patients with endometrial carcinoma.
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Affiliation(s)
- Ina Jani
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Katherine S Brito
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Isabel Lazo
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Katherine C Kurnit
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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12
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Somasegar S, Han L, Miller A, Wanjari P, Wang P, Bennett JA, Yamada SD. Phyllodes tumor of the vulva: A case report and literature review highlighting a novel manifestation of Cowden syndrome. Gynecol Oncol Rep 2021; 36:100752. [PMID: 33850997 PMCID: PMC8024594 DOI: 10.1016/j.gore.2021.100752] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022] Open
Abstract
Cowden syndrome is a rare hereditary cancer syndrome characterized by a germline PTEN mutation which results in an increased risk of developing breast, thyroid, and endometrial carcinoma, as well as widespread benign hamartomas. Phyllodes tumor (PT) is a rare fibroepithelial tumor that accounts for less than 1% of all breast tumors. As mammary-type glands can be found in the anogenital region, PTs can rarely arise in this location. We describe the presentation, workup and management of a PT of the vulva that developed in a patient with Cowden syndrome. This report represents the first time a vulvar PT has been described in association with Cowden syndrome and should be considered in the differential diagnosis of a slow-growing vulvar mass.
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Affiliation(s)
- Sahana Somasegar
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Lisa Han
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Aaron Miller
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Pankhuri Wanjari
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | | - S. Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
- Corresponding author at: 5841 South Maryland Ave, Chicago, IL 60637, USA.
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13
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Mullany S, Miller DS, Robison K, Levinson K, Lee YC, Yamada SD, Walker J, Markman M, Marin A, Mast P, diZerega G. Phase II study of intraperitoneal submicron particle paclitaxel (SPP) plus IV carboplatin and paclitaxel in patients with epithelial ovarian cancersurgery. Gynecol Oncol Rep 2020; 34:100627. [PMID: 32953961 PMCID: PMC7486435 DOI: 10.1016/j.gore.2020.100627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
Patients with ovarian cancer were treated with intraperitoneal submicron particle paclitaxel after debulking surgery. Following surgery, patients received IV chemotherapy without evidence of enhanced systemic toxicity. By RECIST 1.1 criteria, 66% of patients had progression free survival at 6 months and 1-year following surgery.
Submicron particles (~800 nm) of paclitaxel (SPP) contain 1–2 billion molecules of pure drug that release tumoricidal levels of paclitaxel over many weeks. This study compared two dose-levels of SPP instilled into the peritoneal cavity (IP) in 200 ml of saline post-cytoreductive surgery. Eligible patients with primary (n = 6) or recurrent (n = 4) epithelial ovarian cancer who underwent complete cytoreductive surgery were enrolled to receive a single instillation of IP SPP followed by standard IV carboplatin and paclitaxel. Endpoints were PFS and evaluation of treatment emergent adverse events. Clinical response was determined by symptoms, physical exams, CT scans, and serum CA-125 measurements. Of the 24 subjects screened, 10 were enrolled and received treatment: seven patients received 100 mg/m2 and three received 200 mg/m2. Seven subjects completed the 12-month follow-up period. Six patients were evaluable due to one subject who had unevaluable scans throughout the follow-up period and was thus excluded from PFS determination. Upon completion of planned chemotherapy post-SPP instillation, the PFS at 6 months was 66% (4/6) and at 12-months 66% (4/6) using RECIST 1.1. One subject had a complete response at the end of IV treatment but died (unrelated to study treatment) before PFS evaluation. There was one case of incision dehiscence and one case of vaginal cuff leakage after surgery. This pilot study supports further evaluation of IP SPP to treat peritoneal carcinomas.
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Affiliation(s)
- Sally Mullany
- University of Minnesota Medical Center, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - David Scott Miller
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Katina Robison
- Women & Infants Hospital, 101 Dudley St, Providence, RI 02905, USA
| | - Kimberly Levinson
- Johns Hopkins Gynecologic Oncology at GBMC, 6569 Charles St #306, Towson, MD 21204, USA
| | - Yi-Chun Lee
- SUNY DownState Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - S Diane Yamada
- University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Joan Walker
- University of Oklahoma, Stephenson Cancer Center, 800 NE 10th St, Oklahoma City, OK 73104, USA
| | - Maurie Markman
- Cancer Treatment Centers of America, 1331 E Wyoming Ave, Philadelphia, PA 19124, USA
| | - Alyson Marin
- US Biotest Inc., 231 Bonetti Dr # 240, San Luis Obispo, CA 93401, USA
| | - Peter Mast
- US Biotest Inc., 231 Bonetti Dr # 240, San Luis Obispo, CA 93401, USA
| | - Gere diZerega
- US Biotest Inc., 231 Bonetti Dr # 240, San Luis Obispo, CA 93401, USA.,NanOlogy, 3909 Hulen St, Fort Worth, TX 76107, USA
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14
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Laibangyang A, Alter R, Hasan Y, Yamada SD. Superior vena cava syndrome associated with uterine serous carcinoma. Gynecol Oncol Rep 2020; 33:100593. [PMID: 32577490 PMCID: PMC7300129 DOI: 10.1016/j.gore.2020.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
Extensive nodal metastases from uterine serous carcinoma can lead to SVC syndrome. Prevention of nodal metastases is an important goals of care discussion. Radiation, steroids and/or chemotherapy must all be considered in this setting.
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15
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Hoppenot C, Hlubocky FJ, Chor J, Yamada SD, Lee NK. Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives. JCO Oncol Pract 2020; 16:483-489. [PMID: 32240072 DOI: 10.1200/jop.19.00710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist's approach to palliative care consultation in the setting of MBO has not been well studied-it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION Participants' expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.
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Affiliation(s)
- Claire Hoppenot
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
| | - Fay J Hlubocky
- Section of Hematologic Oncology, Program for Supportive Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL
| | - Julie Chor
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
| | - Nita K Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
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16
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Kenny HA, Lal M, Shen M, Nahotko D, Fazal S, Chen S, Chiang CY, Kara B, Yamada SD, Brimacombe K, Marugan J, Ferrer M, Lengyel E. Abstract NT-097: QUANTITATIVE HIGH-THROUGHPUT SCREENING USING AN ORGANOTYPIC MODEL IDENTIFIES TWO KINASE INHIBITORS THAT INHIBIT OVARIAN CANCER METASTASIS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-nt-097] [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
The cancer cells, stromal cells and stroma in the tumor microenvironment contribute to cancer metastasis and drug resistance. Therefore we applied an organotypic, robust and reliable assay for quantitative high throughput screening (qHTS) in drug discovery. This 1536-well HTS culture contains primary human mesothelial cells, fibroblasts, fibronectin and collagen type I and reproduces the human ovarian cancer (OvCa) metastatic microenvironment. The qHTS assay identifies small molecule compounds that inhibit OvCa adhesion/migration/invasion to the organotypic metastatic microenvironment.
Over 44,000 small molecules were screened in the primary qHTS assay. A counter screen was performed to eliminate any compounds toxic to the mesothelial cells or fibroblasts within the metastatic microenvironment. The activity of hit compounds was confirmed using five OvCa cell lines, and validated in secondary in vitro and in vivo biological assays. The active compounds directly inhibit at least two of three OvCa functions: adhesion, invasion and growth. In vivo, these compounds prevent OvCa adhesion/invasion and metastasis, and improve survival in mouse models.
Collectively, these data indicate that the three compounds, two tyrosine kinase inhibitors and one novel compound, identified using an complex organtoypic culture of the tumor microenvironment for qHTS are potential therapeutics for OvCa metastasis.
Citation Format: Hilary A. Kenny, Madhu Lal, Min Shen, Dominik Nahotko, Sarah Fazal, Siquan Chen, Chun-Yi Chiang, Betul Kara, S. Diane Yamada, Kyle Brimacombe, Juan Marugan, Marc Ferrer and Ernst Lengyel. QUANTITATIVE HIGH-THROUGHPUT SCREENING USING AN ORGANOTYPIC MODEL IDENTIFIES TWO KINASE INHIBITORS THAT INHIBIT OVARIAN CANCER METASTASIS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-097.
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Affiliation(s)
- Hilary A. Kenny
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
| | - Madhu Lal
- 2Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD USA 20892,
| | - Min Shen
- 2Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD USA 20892,
| | - Dominik Nahotko
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
| | - Sarah Fazal
- 3Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL USA 60637
| | - Siquan Chen
- 3Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL USA 60637
| | - Chun-Yi Chiang
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
| | - Betul Kara
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
| | - S. Diane Yamada
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
| | - Kyle Brimacombe
- 2Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD USA 20892,
| | - Juan Marugan
- 2Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD USA 20892,
| | - Marc Ferrer
- 2Division of Preclinical Innovation, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD USA 20892,
| | - Ernst Lengyel
- 1Department of Obstetrics and Gynecology/Section of Gynecologic Oncology,
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17
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Hoppenot C, Peters P, Cowan M, Moore ED, Hurteau J, Lee NK, Yamada SD. Malignant bowel obstruction due to uterine or ovarian cancer: Are there differences in outcome? Gynecol Oncol 2019; 154:177-182. [DOI: 10.1016/j.ygyno.2019.04.681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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18
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Coscia F, Lengyel E, Duraiswamy J, Ashcroft B, Bassani-Sternberg M, Wierer M, Johnson A, Wroblewski K, Montag A, Yamada SD, López-Méndez B, Nilsson J, Mund A, Mann M, Curtis M. Multi-level Proteomics Identifies CT45 as a Chemosensitivity Mediator and Immunotherapy Target in Ovarian Cancer. Cell 2019; 175:159-170.e16. [PMID: 30241606 DOI: 10.1016/j.cell.2018.08.065] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/23/2018] [Accepted: 08/29/2018] [Indexed: 12/14/2022]
Abstract
Most high-grade serous ovarian cancer (HGSOC) patients develop resistance to platinum-based chemotherapy and recur, but 15% remain disease free over a decade. To discover drivers of long-term survival, we quantitatively analyzed the proteomes of platinum-resistant and -sensitive HGSOC patients from minute amounts of formalin-fixed, paraffin-embedded tumors. This revealed cancer/testis antigen 45 (CT45) as an independent prognostic factor associated with a doubling of disease-free survival in advanced-stage HGSOC. Phospho- and interaction proteomics tied CT45 to DNA damage pathways through direct interaction with the PP4 phosphatase complex. In vitro, CT45 regulated PP4 activity, and its high expression led to increased DNA damage and platinum sensitivity. CT45-derived HLA class I peptides, identified by immunopeptidomics, activate patient-derived cytotoxic T cells and promote tumor cell killing. This study highlights the power of clinical cancer proteomics to identify targets for chemo- and immunotherapy and illuminate their biological roles.
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Affiliation(s)
- Fabian Coscia
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany; Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA.
| | | | - Bradley Ashcroft
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Michal Bassani-Sternberg
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Michael Wierer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Alyssa Johnson
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - Anthony Montag
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Blanca López-Méndez
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jakob Nilsson
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Andreas Mund
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany; Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark.
| | - Marion Curtis
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
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19
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Eckert MA, Coscia F, Chryplewicz A, Chang JW, Hernandez KM, Pan S, Tienda SM, Nahotko DA, Li G, Blaženović I, Lastra RR, Curtis M, Yamada SD, Perets R, McGregor SM, Andrade J, Fiehn O, Moellering RE, Mann M, Lengyel E. Proteomics reveals NNMT as a master metabolic regulator of cancer-associated fibroblasts. Nature 2019; 569:723-728. [PMID: 31043742 PMCID: PMC6690743 DOI: 10.1038/s41586-019-1173-8] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 03/27/2019] [Indexed: 12/23/2022]
Abstract
High-grade serous carcinoma has a poor prognosis, owing primarily to its early dissemination throughout the abdominal cavity. Genomic and proteomic approaches have provided snapshots of the proteogenomics of ovarian cancer1,2, but a systematic examination of both the tumour and stromal compartments is critical in understanding ovarian cancer metastasis. Here we develop a label-free proteomic workflow to analyse as few as 5,000 formalin-fixed, paraffin-embedded cells microdissected from each compartment. The tumour proteome was stable during progression from in situ lesions to metastatic disease; however, the metastasis-associated stroma was characterized by a highly conserved proteomic signature, prominently including the methyltransferase nicotinamide N-methyltransferase (NNMT) and several of the proteins that it regulates. Stromal NNMT expression was necessary and sufficient for functional aspects of the cancer-associated fibroblast (CAF) phenotype, including the expression of CAF markers and the secretion of cytokines and oncogenic extracellular matrix. Stromal NNMT expression supported ovarian cancer migration, proliferation and in vivo growth and metastasis. Expression of NNMT in CAFs led to depletion of S-adenosyl methionine and reduction in histone methylation associated with widespread gene expression changes in the tumour stroma. This work supports the use of ultra-low-input proteomics to identify candidate drivers of disease phenotypes. NNMT is a central, metabolic regulator of CAF differentiation and cancer progression in the stroma that may be therapeutically targeted.
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Affiliation(s)
- Mark A Eckert
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Fabian Coscia
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Agnieszka Chryplewicz
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Jae Won Chang
- Department of Chemistry, University of Chicago, Chicago, IL, USA
| | - Kyle M Hernandez
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Shawn Pan
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Samantha M Tienda
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Dominik A Nahotko
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Gang Li
- Department of Chemistry, University of Chicago, Chicago, IL, USA
| | - Ivana Blaženović
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Marion Curtis
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Ruth Perets
- Division of Oncology, Clinical Research Institute at Rambam, Rambam Health Care Campus, Haifa, Israel
| | | | - Jorge Andrade
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, USA
| | | | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
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20
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Eckert MA, Coscia F, Chryplewicz AA, Chang JW, Hernandez KM, Pan S, Tienda SM, Nahotko DA, Li G, Blaženović I, Lastra RR, Curtis M, Yamada SD, Perets R, McGregor S, Andrade J, Fiehn O, Moellering RE, Mann M, Lengyel E. Metabolic reprogramming of the stromal epigenome in ovarian cancer metastasis. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.lb240] [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: 11/11/2022]
Affiliation(s)
- Mark A Eckert
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Fabian Coscia
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | | | | | | | - Shawn Pan
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Samantha M Tienda
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Dominik A Nahotko
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Gang Li
- ChemistryUniversity of ChicagoChicagoIL
| | - Ivana Blaženović
- West Coast Metabolomics Center, University of California, DavisDavisCA
| | | | - Marion Curtis
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - S. Diane Yamada
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Ruth Perets
- Division of OncologyRambam Health Care CampusHaifaIsrael
| | | | - Jorge Andrade
- Center for Research InformaticsUniversity of ChicagoChicagoIL
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, DavisDavisCA
| | | | - Matthias Mann
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | - Ernst Lengyel
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
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Curtis M, Kenny HA, Ashcroft B, Mukherjee A, Johnson A, Zhang Y, Helou Y, Batlle R, Liu X, Gutierrez N, Gao X, Yamada SD, Lastra R, Montag A, Ahsan N, Locasale JW, Salomon AR, Nebreda AR, Lengyel E. Fibroblasts Mobilize Tumor Cell Glycogen to Promote Proliferation and Metastasis. Cell Metab 2019; 29:141-155.e9. [PMID: 30174305 PMCID: PMC6326875 DOI: 10.1016/j.cmet.2018.08.007] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/22/2018] [Accepted: 08/02/2018] [Indexed: 12/29/2022]
Abstract
Successful metastasis requires the co-evolution of stromal and cancer cells. We used stable isotope labeling of amino acids in cell culture coupled with quantitative, label-free phosphoproteomics to study the bidirectional signaling in ovarian cancer cells and human-derived, cancer-associated fibroblasts (CAFs) after co-culture. In cancer cells, the interaction with CAFs supported glycogenolysis under normoxic conditions and induced phosphorylation and activation of phosphoglucomutase 1, an enzyme involved in glycogen metabolism. Glycogen was funneled into glycolysis, leading to increased proliferation, invasion, and metastasis of cancer cells co-cultured with human CAFs. Glycogen mobilization in cancer cells was dependent on p38α MAPK activation in CAFs. In vivo, deletion of p38α in CAFs and glycogen phosphorylase inhibition in cancer cells reduced metastasis, suggesting that glycogen is an energy source used by cancer cells to facilitate metastatic tumor growth.
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Affiliation(s)
- Marion Curtis
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Hilary A Kenny
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Bradley Ashcroft
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Abir Mukherjee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Alyssa Johnson
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Yilin Zhang
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Ynes Helou
- Department of Molecular Biology, Cell Biology, and Biochemistry/Center of Genomics and Proteomics, Brown University, Providence, RI 02903, USA
| | - Raquel Batlle
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
| | - Xiaojing Liu
- Department of Pharmacology and Cancer Biology, Duke Cancer Institute, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Nuria Gutierrez
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
| | - Xia Gao
- Department of Pharmacology and Cancer Biology, Duke Cancer Institute, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Ricardo Lastra
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Anthony Montag
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Nagib Ahsan
- Division of Biology and Medicine, Alpert Medical School, Brown University, Providence, RI 02903, USA; Center for Cancer Research Development, Proteomics Core Facility, Rhode Island Hospital, Providence, RI 02903, USA
| | - Jason W Locasale
- Department of Pharmacology and Cancer Biology, Duke Cancer Institute, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Arthur R Salomon
- Department of Molecular Biology, Cell Biology, and Biochemistry/Center of Genomics and Proteomics, Brown University, Providence, RI 02903, USA; Center for Cancer Research Development, Proteomics Core Facility, Rhode Island Hospital, Providence, RI 02903, USA
| | - Angel R Nebreda
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, 08028 Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637, USA.
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Ross JGC, Escamilla V, Lee NK, Diane Yamada S, Lindau ST. Geospatial patterns of access to self-care resources for obesity among endometrial cancer survivors in a high poverty urban community. Gynecol Oncol 2018; 152:322-327. [PMID: 30581035 DOI: 10.1016/j.ygyno.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine endometrial cancer survivors' access to recommended obesity-related self-care resources. METHODS Participants included women treated 2010-2015 for endometrial cancer at an academic medical center who lived in the surrounding 16 ZIP code area on Chicago's South Side. Demographic and health data were abstracted from medical records. A socioeconomic status (SES) score (SES-1 = low, SES-5 = high) was generated for each patient using census block group-level data. Self-care resources for exercise, healthy weight, and diet were obtained from a community resource census. Geospatial techniques assessed "walkable access" (~½-mile radius around a patient's home) to obesity-related resources. Multivariable logistic regression investigated associations between access to obesity-related resources and patient characteristics. RESULTS Of 195 endometrial cancer survivors, 81% identified as Black/African American and 34% lived in an SES-1 census block. Two thirds (68%) had Stage I or II endometrial cancer. Nearly two thirds (62%) were obese (BMI ≥ 30 kg/m2). Obesity was inversely associated with SES (p = 0.05). Two thirds of survivors had access to at least one of all three recommended resource types. Access was lower in low SES regions and among Black/African American women. Lower SES was associated with lower odds of walkable access to recommended resources (AOR for access to two of each resource type 0.75, 95%CI 0.59, 0.97; AOR for access to three or more of each 0.44, 95%CI 0.32, 0.61). CONCLUSIONS Obesity rates were higher and access to recommended resources was lower for Black/African American endometrial cancer survivors living in high poverty areas in Chicago.
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Affiliation(s)
- Jerlinda G C Ross
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | - Veronica Escamilla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA; Department of Medicine-Geriatrics, The University of Chicago, Chicago, IL, USA; The Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA; The MacLean Center on Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
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23
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Cowan M, Suntum T, Olivas AD, Perpich M, Applebaum MA, Lastra RR, Yamada SD. Second primary rhabdomyosarcoma of the uterine cervix presenting with synchronous ovarian Sertoli-Leydig cell tumor: An illustrative case of DICER1 syndrome. Gynecol Oncol Rep 2018; 25:94-97. [PMID: 30014022 PMCID: PMC6019406 DOI: 10.1016/j.gore.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/16/2022] Open
Abstract
•Embryonal rhabdomyosarcoma of the uterine cervix and ovarian Sertoli-Leydig cell tumors are associated with DICER1 mutation•DICER1-associated tumors should prompt genetic counseling and testing•Somatic and germline genetic mutation profiles can be used to differentiate second primary from recurrent tumors.
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Affiliation(s)
- Matthew Cowan
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Tara Suntum
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Andrea D Olivas
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Melody Perpich
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Mark A Applebaum
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
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24
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Chapel DB, Yamada SD, Cowan M, Lastra RR. Immunohistochemistry for mismatch repair protein deficiency in endometrioid endometrial carcinoma yields equivalent results when performed on endometrial biopsy/curettage or hysterectomy specimens. Gynecol Oncol 2018; 149:570-574. [DOI: 10.1016/j.ygyno.2018.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
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25
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Eckert MA, Coscia F, Pan S, Chiang CY, McGregor S, Lastra R, Yamada SD, Mann M, Lengyel E. Abstract TMEM-118: ROLES OF T-LAK CELL-ORIGINATED KINASE (TOPK) AND THE MICROENVIRONMENT IN DRIVING OVARIAN CANCER PROGRESSION. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-tmem-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Ovarian cancer (OvCa) therapy is confounded by late detection and a lack of effective therapeutics. After debulking surgery, most patients initially respond to platinum-based chemotherapeutics, however their tumors inevitably develop resistance and recur. Developing new treatments for OvCa will depend on a thorough understanding of OvCa biology. We recently identified T-LAK cell-originated kinase (TOPK), a serine-threonine kinase, as highly expressed in OvCa. A member of the cancer/testis antigen (CTA) family, TOPK is induced by mutant TP53 and is expressed in early, in situ serous tubal intraepithelial carcinoma lesions. Targeting TOPK with a small-molecule inhibitor in a mouse model of OvCa led to significant reductions in tumor burden. To better understand the interplay between TOPK and the tumor and stroma in ovarian cancer progression, we performed compartment-resolved, quantitative shotgun proteomics on microdissected tumor and stromal samples across a hypothetical progression series of ovarian cancer from in situ STIC to omental metastases. With a highly-sensitive platform, we were able to accurately quantify proteins across the progression series and confirmed expression of known tumor and stromal markers in the data set. Interestingly, we observed a conserved stromal response associated with metastasis. This signature included both genes known to play a role in cancer-associated fibroblasts, as well as proteins with no previously described roles in the tumor stroma. Many components of the signature are also representative of the previously described “mesenchymal” subgroup of ovarian cancer. In vitro and in vivo functional assays have confirmed essential roles for several of these proteins in regulating the cancer-associated fibroblast phenotype. This work establishes TOPK as a potential therapeutic target for ovarian cancer and emphasizes the importance of compartment resolved studies in understanding the individual roles of the tumor and stroma in ovarian cancer progression.
Citation Format: Mark A. Eckert, Fabian Coscia, Shawn Pan, Chun-Yi Chiang, Stephanie McGregor, Ricardo Lastra, S. Diane Yamada, Matthias Mann, and Ernst Lengyel. ROLES OF T-LAK CELL-ORIGINATED KINASE (TOPK) AND THE MICROENVIRONMENT IN DRIVING OVARIAN CANCER PROGRESSION [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr TMEM-118.
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Affiliation(s)
- Mark A. Eckert
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
| | - Fabian Coscia
- 2Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Shawn Pan
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
| | - Chun-Yi Chiang
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
| | | | - Ricardo Lastra
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
| | - S. Diane Yamada
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
| | - Matthias Mann
- 2Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Ernst Lengyel
- 1Department of Obstetrics and Gynecology, University of Chicago, USA
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Chiyoda T, Hart PC, Eckert MA, McGregor SM, Lastra RR, Hamamoto R, Nakamura Y, Yamada SD, Olopade OI, Lengyel E, Romero IL. Loss of BRCA1 in the Cells of Origin of Ovarian Cancer Induces Glycolysis: A Window of Opportunity for Ovarian Cancer Chemoprevention. Cancer Prev Res (Phila) 2017; 10:255-266. [PMID: 28264838 PMCID: PMC5425093 DOI: 10.1158/1940-6207.capr-16-0281] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/06/2017] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
Mutations in the breast cancer susceptibility gene 1 (BRCA1) are associated with an increased risk of developing epithelial ovarian cancer. However, beyond the role of BRCA1 in DNA repair, little is known about other mechanisms by which BRCA1 impairment promotes carcinogenesis. Given that altered metabolism is now recognized as important in the initiation and progression of cancer, we asked whether the loss of BRCA1 changes metabolism in the cells of origin of ovarian cancer. The findings show that silencing BRCA1 in ovarian surface epithelial and fallopian tube cells increased glycolysis. Furthermore, when these cells were transfected with plasmids carrying deleterious BRCA1 mutations (5382insC or the P1749R), there was an increase in hexokinase-2 (HK2), a key glycolytic enzyme. This effect was mediated by MYC and the STAT3. To target the metabolic phenotype induced by loss of BRCA1, a drug-repurposing approach was used and aspirin was identified as an agent that counteracted the increase in HK2 and the increase in glycolysis induced by BRCA1 impairment. Evidence from this study indicates that the tumor suppressor functions of BRCA1 extend beyond DNA repair to include metabolic endpoints and identifies aspirin as an ovarian cancer chemopreventive agent capable of reversing the metabolic derangements caused by loss of BRCA1. Cancer Prev Res; 10(4); 255-66. ©2017 AACR.
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Affiliation(s)
- Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Peter C Hart
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Mark A Eckert
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | | | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ryuji Hamamoto
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Yusuke Nakamura
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Olufunmilayo I Olopade
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Iris L Romero
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois.
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Eckert MA, Pan S, Hernandez KM, Loth RM, Andrade J, Volchenboum SL, Faber P, Montag A, Lastra R, Peter ME, Yamada SD, Lengyel E. Genomics of Ovarian Cancer Progression Reveals Diverse Metastatic Trajectories Including Intraepithelial Metastasis to the Fallopian Tube. Cancer Discov 2016; 6:1342-1351. [PMID: 27856443 PMCID: PMC5164915 DOI: 10.1158/2159-8290.cd-16-0607] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 01/02/2023]
Abstract
Accumulating evidence has supported the fallopian tube rather than the ovary as the origin for high-grade serous ovarian cancer (HGSOC). To understand the relationship between putative precursor lesions and metastatic tumors, we performed whole-exome sequencing on specimens from eight HGSOC patient progression series consisting of serous tubal intraepithelial carcinomas (STIC), invasive fallopian tube lesions, invasive ovarian lesions, and omental metastases. Integration of copy number and somatic mutations revealed patient-specific patterns with similar mutational signatures and copy-number variation profiles across all anatomic sites, suggesting that genomic instability is an early event in HGSOC. Phylogenetic analyses supported STIC as precursor lesions in half of our patient cohort, but also identified STIC as metastases in 2 patients. Ex vivo assays revealed that HGSOC spheroids can implant in the fallopian tube epithelium and mimic STIC lesions. That STIC may represent metastases calls into question the assumption that STIC are always indicative of primary fallopian tube cancers. SIGNIFICANCE We find that the putative precursor lesions for HGSOC, STIC, possess most of the genomic aberrations present in advanced cancers. In addition, a proportion of STIC represent intraepithelial metastases to the fallopian tube rather than the origin of HGSOC. Cancer Discov; 6(12); 1342-51. ©2016 AACR.See related commentary by Swisher et al., p. 1309This article is highlighted in the In This Issue feature, p. 1293.
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Affiliation(s)
- Mark A Eckert
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Shawn Pan
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Kyle M Hernandez
- Center for Research Informatics, The University of Chicago, Chicago, Illinois
| | - Rachel M Loth
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Jorge Andrade
- Center for Research Informatics, The University of Chicago, Chicago, Illinois
| | - Samuel L Volchenboum
- Center for Research Informatics, The University of Chicago, Chicago, Illinois
- Department of Pediatrics, The University of Chicago, Chicago, Illinois
| | - Pieter Faber
- University of Chicago Genomics Facility, The University of Chicago, Chicago, Illinois
| | - Anthony Montag
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ricardo Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Marcus E Peter
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois.
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He C, Poon C, Chan C, Yamada SD, Lin W. Nanoscale Coordination Polymers Codeliver Chemotherapeutics and siRNAs to Eradicate Tumors of Cisplatin-Resistant Ovarian Cancer. J Am Chem Soc 2016; 138:6010-9. [PMID: 27088560 DOI: 10.1021/jacs.6b02486] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Drug resistance impedes the successful treatment of many types of cancers, especially ovarian cancer (OCa). To counter this problem, we developed novel long-circulating, self-assembled core-shell nanoscale coordination polymer (NCP) nanoparticles that efficiently deliver multiple therapeutics with different mechanisms of action to enhance synergistic therapeutic effects. These NCP particles contain high payloads of chemotherapeutics cisplatin or cisplatin plus gemcitabine in the core and pooled siRNAs that target multidrug resistant (MDR) genes in the shell. The NCP particles possess efficient endosomal escape via a novel carbon dioxide release mechanism without compromising the neutral surface charge required for long blood circulation and effectively downregulate MDR gene expression in vivo to enhance chemotherapeutic efficacy by several orders of magnitude. Even at low doses, intraperitoneal injections of nanoparticles led to effective and long-lasting tumor regression/eradication in subcutaneous and intraperitoneal xenograft mouse models of cisplatin-resistant OCa. By silencing MDR genes in tumors, self-assembled core-shell nanoparticles promise a more effective chemotherapeutic treatment for many challenging cancers.
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Affiliation(s)
- Chunbai He
- Department of Chemistry, The University of Chicago , Chicago, Illinois 60637, United States
| | - Christopher Poon
- Department of Chemistry, The University of Chicago , Chicago, Illinois 60637, United States
| | - Christina Chan
- Department of Chemistry, The University of Chicago , Chicago, Illinois 60637, United States
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, The University of Chicago , Chicago, Illinois 60637, United States
| | - Wenbin Lin
- Department of Chemistry, The University of Chicago , Chicago, Illinois 60637, United States
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Fehniger J, Thomas S, Lengyel E, Liao C, Tenney M, Oto A, Yamada SD. A prospective study evaluating diffusion weighted magnetic resonance imaging (DW-MRI) in the detection of peritoneal carcinomatosis in suspected gynecologic malignancies. Gynecol Oncol 2016; 142:169-175. [PMID: 27103176 DOI: 10.1016/j.ygyno.2016.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate and compare the ability of DW-MRI and CT to detect sites of peritoneal dissemination in gynecologic malignancies. The reproducibility of DW-MRI and CT interpretation between radiologists was also assessed. METHODS Single institution prospective cohort study of women with suspected advanced gynecologic cancer who underwent surgical staging from 2010 to 2013. Participants underwent both DW-MRI and contrast-enhanced CT prior to surgery. Radiologists and surgeons were blinded, respectively, to surgical and DW-MRI results. The area under the receiver operator characteristic curve (AUC) was calculated for each disease site for CT and DW-MRI and compared to surgical findings. Kappa statistics quantified interobserver agreement between both radiologists. RESULTS Twenty seven patients were enrolled. Mean age at surgery was 59years. Ninety percent of participants had stage IIIC/IV disease. For right diaphragm disease, the AUC for DW-MRI was 0.95 compared to 0.81 for CT. For left diaphragm disease, the AUC was 0.89 for DW-MRI compared to 0.74 for CT. The AUC was similar for DW-MRI and CT for omental disease (0.79 versus 0.64); the liver surface (0.61 versus 0.67); bowel mesentery (0.73 versus 0.64); and cul de sac (0.75 versus 0.64). Interobserver agreement for DW-MRI was greater than CT for omental, Morrison's pouch, liver surface, and right diaphragm disease. CONCLUSIONS DW-MRI detects right diaphragmatic disease found at surgery with greater accuracy than CT. For other disease sites key to surgical planning, DW-MRI is equivalent to CT. Interobserver agreement was superior for a majority of disease sites evaluated by DW-MRI compared to CT.
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Affiliation(s)
- Julia Fehniger
- The University of Chicago Medicine, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, 5841 S. Maryland Avenue, MC 2050, Chicago, IL 60637, United States
| | - Stephen Thomas
- The University of Chicago Medicine, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637, United States
| | - Ernst Lengyel
- The University of Chicago Medicine, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, 5841 S. Maryland Avenue, MC 2050, Chicago, IL 60637, United States
| | - Chuanhong Liao
- The University of Chicago, Department of Public Health Sciences, 5841 S. Maryland Avenue, MC 2000, Chicago, IL 60637, United States
| | - Meaghan Tenney
- The University of Chicago Medicine, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, 5841 S. Maryland Avenue, MC 2050, Chicago, IL 60637, United States
| | - Aytekin Oto
- The University of Chicago Medicine, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637, United States
| | - S Diane Yamada
- The University of Chicago Medicine, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, 5841 S. Maryland Avenue, MC 2050, Chicago, IL 60637, United States.
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30
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Affiliation(s)
- Chunbai He
- Department of Chemistry, The University of Chicago, Chicago, IL 60637, USA
| | - Christina Chan
- Department of Chemistry, The University of Chicago, Chicago, IL 60637, USA
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, The Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL 60637, USA
| | - Gini F Fleming
- Department of Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Wenbin Lin
- Department of Chemistry, The University of Chicago, Chicago, IL 60637, USA
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31
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Kennedy V, Abramsohn E, Makelarski J, Barber R, Wroblewski K, Tenney M, Lee NK, Yamada SD, Lindau ST. Can you ask? We just did! Assessing sexual function and concerns in patients presenting for initial gynecologic oncology consultation. Gynecol Oncol 2015; 137:119-24. [PMID: 25582823 PMCID: PMC4518539 DOI: 10.1016/j.ygyno.2015.01.451] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/02/2015] [Accepted: 01/03/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe patterns of response to, and assess sexual function and activity elicited by, a self-administered assessment incorporated into a new patient intake form for gynecologic oncology consultation. METHODS A cross-sectional study of patients presenting to a single urban academic medical center between January 2010 and September 2012. New patients completed a self-administered intake form, including six brief sexual activity and function items. These items, along with abstracted medical record data, were descriptively analyzed. Logistic regression was used to assess the association between sexual activity and function and disease status, adjusting for age. RESULTS Median age was 50 years (range 18-91, N=499); more than half had a final diagnosis of cancer. Most patients completed all sex-related items on the intake form; 98% answered at least one. Among patients who were sexually active in the prior 12 months (57% with cancer, 64% with benign disease), 52% indicated on the intake form having, during that period, a sexual problem lasting several months or more. Of these, 15% had physician documentation of the sexual problem. Eighteen women were referred for care. Providers reported no patient complaints about the inclusion of sexual items on the intake form. CONCLUSIONS Nearly all new patients presenting for gynecologic oncology consultation answered self-administered items to assess sexual activity and function. Further study is needed to determine the role of pre-treatment identification of sexual function concerns in improving sexual outcomes associated with cancer diagnosis and treatment.
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Affiliation(s)
- Vanessa Kennedy
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA, United States; Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States.
| | - Emily Abramsohn
- Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; Chicago Core on Biomeasures in Population-Based Aging Research at the NORC and University of Chicago Center on Demography and Economics of Aging, United States
| | - Jennifer Makelarski
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Rachel Barber
- Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Meaghan Tenney
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
| | - S Diane Yamada
- Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
| | - Stacy Tessler Lindau
- Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States; University of Chicago Comprehensive Cancer Center, Chicago, IL, United States; Department of Medicine - Geriatrics, University of Chicago, Chicago, IL, United States; Chicago Core on Biomeasures in Population-Based Aging Research at the NORC and University of Chicago Center on Demography and Economics of Aging, United States
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Hunn J, Tenney ME, Tergas AI, Bishop EA, Moore K, Watkin W, Kirschner C, Hurteau J, Rodriguez GC, Lengyel E, Lee NK, Yamada SD. Patterns and utility of routine surveillance in high grade endometrial cancer. Gynecol Oncol 2015; 137:485-9. [PMID: 25838164 DOI: 10.1016/j.ygyno.2015.03.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate surveillance methods and their utility in detecting recurrence of disease in a high grade endometrial cancer population. METHODS We performed a multi-institutional retrospective chart review of women diagnosed with high grade endometrial cancer between the years 2000 and 2011. Surveillance data was abstracted and analyzed. Surveillance method leading to detection of recurrence was identified and compared by stage of disease and site of recurrence. RESULTS Two hundred and fifty-four patients met the criteria for inclusion. Vaginal cytology was performed in the majority of early stage patients, but was utilized less in advanced stage patients. CA-125 and CT imaging were used more frequently in advanced stage patients compared to early stage. Thirty-six percent of patients experienced a recurrence and the majority of initial recurrences (76%) had a distant component. Modalities that detected cancer recurrences were: symptoms (56%), physical exam (18%), surveillance CT (15%), CA-125 (10%), and vaginal cytology (1%). All local recurrences were detected by symptoms or physical exam findings. While the majority of loco-regional and distant recurrences (68%) were detected by symptoms or physical exam, 28% were detected by surveillance CT scan or CA 125. One loco-regional recurrence was identified by vaginal cytology but no recurrences with a distant component detected by this modality. CONCLUSIONS Symptoms and physical examination identify the majority of high grade endometrial cancer recurrences, while vaginal cytology is the least likely surveillance modality to identify a recurrence. The role of CT and CA-125 surveillance outside of a clinical trial needs to be further reviewed.
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Affiliation(s)
- Jessica Hunn
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Meaghan E Tenney
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Erin A Bishop
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kathleen Moore
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - William Watkin
- Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Carolyn Kirschner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jean Hurteau
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Gustavo C Rodriguez
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
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Kenny HA, Chiang CY, White EA, Schryver EM, Habis M, Romero IL, Ladanyi A, Penicka CV, George J, Matlin K, Montag A, Wroblewski K, Yamada SD, Mazar AP, Bowtell D, Lengyel E. Mesothelial cells promote early ovarian cancer metastasis through fibronectin secretion. J Clin Invest 2014; 124:4614-28. [PMID: 25202979 DOI: 10.1172/jci74778] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 07/31/2014] [Indexed: 12/16/2022] Open
Abstract
Ovarian cancer (OvCa) metastasizes to organs in the abdominal cavity, such as the omentum, which are covered by a single layer of mesothelial cells. Mesothelial cells are generally thought to be "bystanders" to the metastatic process and simply displaced by OvCa cells to access the submesothelial extracellular matrix. Here, using organotypic 3D cultures, we found that primary human mesothelial cells secrete fibronectin in the presence of OvCa cells. Moreover, we evaluated the tumor stroma of 108 human omental metastases and determined that fibronectin was consistently overexpressed in these patients. Blocking fibronectin production in primary mesothelial cells in vitro or in murine models, either genetically (fibronectin 1 floxed mouse model) or via siRNA, decreased adhesion, invasion, proliferation, and metastasis of OvCa cells. Using a coculture model, we determined that OvCa cells secrete TGF-β1, which in turn activates a TGF-β receptor/RAC1/SMAD-dependent signaling pathway in the mesothelial cells that promotes a mesenchymal phenotype and transcriptional upregulation of fibronectin. Additionally, blocking α5 or β1 integrin function with antibodies reduced metastasis in an orthotopic preclinical model of OvCa metastasis. These findings indicate that cancer-associated mesothelial cells promote colonization during the initial steps of OvCa metastasis and suggest that mesothelial cells actively contribute to metastasis.
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Sherman ME, Piedmonte M, Mai PL, Ioffe OB, Ronnett BM, Van Le L, Ivanov I, Bell MC, Blank SV, DiSilvestro P, Hamilton CA, Tewari KS, Wakeley K, Kauff ND, Yamada SD, Rodriguez G, Skates SJ, Alberts DS, Walker JL, Minasian L, Lu K, Greene MH. Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199. J Clin Oncol 2014; 32:3275-83. [PMID: 25199754 DOI: 10.1200/jco.2013.54.1987] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Risk-reducing salpingo-oophorectomy (RRSO) lowers mortality from ovarian/tubal and breast cancers among BRCA1/2 mutation carriers. Uncertainties persist regarding potential benefits of RRSO among high-risk noncarriers, optimal surgical age, and anatomic origin of clinically occult cancers detected at surgery. To address these topics, we analyzed surgical treatment arm results from Gynecologic Oncology Group Protocol-0199 (GOG-0199), the National Ovarian Cancer Prevention and Early Detection Study. PARTICIPANTS AND METHODS This analysis included asymptomatic high-risk women age ≥ 30 years who elected RRSO at enrollment. Women provided risk factor data and underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound (TVU). RRSO specimens were processed according to a standardized tissue processing protocol and underwent central pathology panel review. Research-based BRCA1/2 mutation testing was performed when a participant's mutation status was unknown at enrollment. Relationships between participant characteristics and diagnostic findings were assessed using univariable statistics and multivariable logistic regression. RESULTS Invasive or intraepithelial ovarian/tubal/peritoneal neoplasms were detected in 25 (2.6%) of 966 RRSOs (BRCA1 mutation carriers, 4.6%; BRCA2 carriers, 3.5%; and noncarriers, 0.5%; P < .001). In multivariable models, positive BRCA1/2 mutation status (P = .0056), postmenopausal status (P = .0023), and abnormal CA-125 levels and/or TVU examinations (P < .001) were associated with detection of clinically occult neoplasms at RRSO. For 387 women with negative BRCA1/2 mutation testing and normal CA-125 levels, findings at RRSO were benign. CONCLUSION Clinically occult cancer was detected among 2.6% of high-risk women undergoing RRSO. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or TVU were associated with cancer detection at RRSO. These data can inform management decisions among women at high risk of ovarian/tubal cancer.
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Affiliation(s)
- Mark E Sherman
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Marion Piedmonte
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Phuong L Mai
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Olga B Ioffe
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Brigitte M Ronnett
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Linda Van Le
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Iouri Ivanov
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Maria C Bell
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Stephanie V Blank
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Paul DiSilvestro
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Chad A Hamilton
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Krishnansu S Tewari
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Katie Wakeley
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Noah D Kauff
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - S Diane Yamada
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Gustavo Rodriguez
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Steven J Skates
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - David S Alberts
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Joan L Walker
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Lori Minasian
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Karen Lu
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Mark H Greene
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX.
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Habis M, Wroblewski K, Bradaric M, Ismail N, Yamada SD, Litchfield L, Lengyel E, Romero IL. Statin therapy is associated with improved survival in patients with non-serous-papillary epithelial ovarian cancer: a retrospective cohort analysis. PLoS One 2014; 9:e104521. [PMID: 25118694 PMCID: PMC4131884 DOI: 10.1371/journal.pone.0104521] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/10/2014] [Indexed: 12/31/2022] Open
Abstract
AIM To determine whether statin use is associated with improved epithelial ovarian cancer (OvCa) survival. METHODS This is a single-institution retrospective cohort review of patients treated for OvCa between 1992 and 2013. Inclusion criteria were International Federation of Gynecology and Obstetrics (FIGO) stage I-IV OvCa. The primary exposures analyzed were hyperlipidemia and statin use. The primary outcomes were progression-free survival (PFS) and disease-specific survival (DSS). RESULTS 442 patients met inclusion criteria. The cohort was divided into three groups: patients with hyperlipidemia who used statins (n = 68), patients with hyperlipidemia who did not use statins (n = 28), and patients without hyperlipidemia (n = 346). OvCa outcomes were evaluated. When we analyzed the entire cohort, we found no significant differences in PFS or DSS among the groups. The median PFS for hyperlipidemics using statins, hyperlipidemics not using statins, and non-hyperlipidemics was 21.7, 13.6, and 14.7 months, respectively (p = 0.69). Median DSS for hyperlipidemics using statins, hyperlipidemics not using statins, and non-hyperlipidemics was 44.2, 75.7, and 41.5 months, respectively (p = 0.43). These findings did not change after controlling for confounders. However, a secondary analysis revealed that, among patients with non-serous-papillary subtypes of OvCa, statin use was associated with a decrease in hazards of both disease recurrence (adjusted HR = 0.23, p = 0.02) and disease-specific death (adjusted HR = 0.23, p = 0.04). To augment the findings in the retrospective cohort, the histology-specific effects of statins were also evaluated in vitro using proliferation assays. Here, statin treatment of cell lines resulted in a variable level of cytotoxicity. CONCLUSION Statin use among patients with non-serous-papillary OvCa was associated with improvement in both PFS and DSS.
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Affiliation(s)
- Mohammed Habis
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
| | - Kristen Wroblewski
- Department of Health Studies, University of Chicago, Chicago, Illinois, United States of America
| | - Michael Bradaric
- Department of Pharmaceutical Sciences, Chicago State University, Chicago, Illinois, United States of America
| | - Nadia Ismail
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
| | - S. Diane Yamada
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
| | - Lacey Litchfield
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
| | - Ernst Lengyel
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
| | - Iris L. Romero
- Department of Obstetrics & Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America
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West AH, Yamada SD, MacMahon H, Acharya SS, Ali SM, He J, Lukas RV, Miller VA, Salgia R. Unique metastases of ALK mutated lung cancer activated to the adnexa of the uterus. ACTA ACUST UNITED AC 2014; 1:151-154. [PMID: 25541622 DOI: 10.5430/crcp.v1n2p151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anaplastic lymphoma kinase (ALK) fusion positive non-small cell lung cancer (NSCLC) is a relatively novel molecular subtype in lung cancer. ALK targeted therapies such as crizotinib increase survival benefit in this patient population. However, further understanding of the disease subtype including patterns of metastasis and pathways of treatment resistance are needed. We describe a 50 year-old-woman diagnosed with stage IV NSCLC, T2N3M1b, ALK fusion positive disease. Although her initial sites of metastasis included the liver and bone, her story is notable for crizotinib resistant growth of a metastatic lesion to her adnexa. This report brings to attention unique mechanisms of metastasis in ALK positive patients.
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Affiliation(s)
- Allison H West
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - S Diane Yamada
- Department of Obstetrics/ Gynecology, The University of Chicago, Chicago, IL, United States
| | - Heber MacMahon
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | | | - Siraj M Ali
- Foundation Medicine, Cambridge, MA, United States
| | - Jie He
- Foundation Medicine, Cambridge, MA, United States
| | - Rimas V Lukas
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | | | - Ravi Salgia
- Department of Medicine, The University of Chicago, Chicago, IL, United States
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Brown J, Brady WE, Schink J, Van Le L, Leitao M, Yamada SD, de Geest K, Gershenson DM. Efficacy and safety of bevacizumab in recurrent sex cord-stromal ovarian tumors: results of a phase 2 trial of the Gynecologic Oncology Group. Cancer 2013; 120:344-51. [PMID: 24166194 DOI: 10.1002/cncr.28421] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/15/2013] [Accepted: 08/22/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Gynecologic Oncology Group conducted this phase 2 trial to estimate the antitumor activity of bevacizumab and to determine the nature and degree of toxicity in patients with recurrent sex cord-stromal tumors of the ovary. METHODS A prospective, multi-institutional cooperative group trial was performed in women with recurrent, measurable ovarian stromal tumors. Patients were allowed to have unlimited prior therapy, excluding bevacizumab. Bevacizumab 15 mg/kg was administered intravenously on day 1 of every 21-day cycle until patients developed disease progression or adverse effects that prohibited further treatment. The primary endpoint was the response rate (RR). Inhibin A and B levels were measured before each cycle, and the values were examined in relation to response and progression. RESULTS Thirty-six patients were enrolled, and all were eligible and evaluable. Patients received a median of 9 cycles of treatment (range, 2-37 cycles). Six patients (16.7%) had partial responses (90% confidence interval, 7.5%-30.3%), 28 patients (77.8%) had stable disease, and 2 patients (5.6%) had progressive disease. This met the criterion for declaring the regimen active. The median progression-free survival was 9.3 months, and the median overall survival was not reached in during reporting period. Two grade 4 toxicities occurred, including hypertension and proteinuria; and the most common grade 3 toxicities were hypertension (n = 5) and pain (n = 5). Inhibin A and B values were lower in patients who responded to treatment. CONCLUSIONS Bevacizumab has activity in the treatment of recurrent sex cord-stromal tumors of the ovary, and its toxicity is acceptable. Further investigation is warranted.
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Affiliation(s)
- Jubilee Brown
- Department of Gynecologic Oncology and Reproductive Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Goldfarb SB, Abramsohn E, Andersen BL, Baron SR, Carter J, Dickler M, Florendo J, Freeman L, Githens K, Kushner D, Makelarski JA, Yamada SD, Lindau ST. A national network to advance the field of cancer and female sexuality. J Sex Med 2013; 10:319-25. [PMID: 23350613 DOI: 10.1111/jsm.12061] [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] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Understanding sexual health issues in cancer patients is integral to care for the continuously growing cancer survivor population. AIM To create a national network of active clinicians and researchers focusing on the prevention and treatment of sexual problems in women and girls with cancer. METHODS Interdisciplinary teams from the University of Chicago and Memorial Sloan-Kettering Cancer Center jointly developed the mission for a national conference to convene clinicians and researchers in the field of cancer and female sexuality. The invitee list was developed by both institutions and further iterated through suggestions from invitees. The conference agenda focused on three high-priority topics under the guidance of a professional facilitator. Breakout groups were led by attendees recognized by collaborators as experts in those topics. Conference costs were shared by both institutions. MAIN OUTCOME MEASURE Development of Scientific Working Groups (SWGs). RESULTS One hundred two clinicians and researchers were invited to attend the 1st National Conference on Cancer and Female Sexuality. Forty-three individuals from 20 different institutions across 14 states attended, including representation from eight National Cancer Institute (NCI)-funded cancer centers. Attendees included PhD researchers (N = 19), physicians (N = 16), and other healthcare professionals (N = 8). Breakout groups included (i) Defining key life course sexuality issues; (ii) Building a registry; and (iii) Implementing sexual health assessment. Breakout group summaries incorporated group consensus on key points and priorities. These generated six SWGs with volunteer leaders to accelerate future research and discovery: (i) Technology-based interventions; (ii) Basic science; (iii) Clinical trials; (iv) Registries; (v) Measurement; and (vi) Secondary data analysis. Most attendees volunteered for at least one SWG (N = 35), and many volunteered for two (N = 21). CONCLUSION This 1st National Conference demonstrated high motivation and broad participation to address research on cancer and female sexuality. Areas of need were identified, and SWGs established to help promote research in this field.
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Affiliation(s)
- Shari B Goldfarb
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Ladanyi A, Nieman K, Penicka C, Mitra A, Kenny H, Gwin K, Wolsky R, Yamada SD, Lengyel E. Abstract 1870: Omental adipocytes promote overexpression of CD36 in ovarian cancer cells and enhance tumorigenicity. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1870] [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
OBJECTIVES: Epithelial ovarian cancers frequently metastasize and grow to a considerable size in the omentum, a peritoneal fold largely comprised of adipocytes. We have previously shown ovarian cancer cells induce lipolysis in adipocytes and utilize adipocyte-derived fatty acids as an energy source. However, the mechanism of adipocyte-induced fatty acid uptake in ovarian cancer has not yet been established.
The goal of this study was to determine whether adipocytes alter the expression of fatty acid transport receptors in ovarian cancer cells and whether inhibition of these receptors impedes tumor progression.
METHODS: Immunofluorescence microscopy and western blot analysis were used to study the expression profile of fatty acid transport receptors in a panel of ovarian cancer cell lines cultured in the presence and absence of omental adipocytes. To determine the impact of the identified fatty acid receptor on tumor progression, its expression was silenced in SKOV3ip1 cells using a short hairpin RNA (shRNA) lentiviral vector. Stably-transfected SKOV3ip1-shRNA cells (1x10ˆ6) were injected intraperitoneally into nude mice. Fatty acid transporter mRNA levels of laser-microdissected human high-grade serous ovarian cancer cells and their corresponding omental metastases were measured using real-time quantitative PCR analysis.
RESULTS: Among the fatty acid transport receptors evaluated, CD36 was found to be selectively upregulated in ovarian cancer cells in the presence of omental adipocytes. CD36 knockdown in SKOV3ip1 cells reduced lipid accumulation and fatty acid uptake (81% and 35%, respectively, p<0.01) and prevented adhesion to extracellular matrix proteins (collagen I and laminin). CD36-shRNA cells exhibited reduced clone formation (5-fold, p<0.01) in a soft agar clonogenicity assay, compared to scrambled shRNA controls. Metastatic tumor burden was significantly reduced in CD36-shRNA injected mice compared to scrambled shRNA controls, as assessed by tumor weight and number of metastatic foci (1.19g vs. 0.20g, p<0.01 and 188 vs. 18, p<0.01, respectively). In human omental metastases samples (n=10), CD36 mRNA levels were elevated 6-fold as compared to their primary tumor counterparts.
CONCLUSIONS: In the presence of omental adipocytes, CD36 is an important regulator of fatty acid uptake in ovarian cancer cells. Disruption of fatty acid trafficking may offer a novel treatment approach in reducing tumor dissemination within the abdominal cavity.
Citation Format: Andras Ladanyi, Kristin Nieman, Carla Penicka, Anirban Mitra, Hilary Kenny, Katja Gwin, Rebecca Wolsky, S Diane Yamada, Ernst Lengyel. Omental adipocytes promote overexpression of CD36 in ovarian cancer cells and enhance tumorigenicity. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1870. doi:10.1158/1538-7445.AM2013-1870
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Affiliation(s)
| | | | | | | | | | - Katja Gwin
- University of Chicago Medicine, Chicago, IL
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Alvarez EA, Brady WE, Walker JL, Rotmensch J, Zhou XC, Kendrick JE, Yamada SD, Schilder JM, Cohn DE, Harrison CR, Moore KN, Aghajanian C. Phase II trial of combination bevacizumab and temsirolimus in the treatment of recurrent or persistent endometrial carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol 2013; 129:22-7. [DOI: 10.1016/j.ygyno.2012.12.022] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 01/12/2023]
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Tergas AI, Buell-Gutbrod R, Gwin K, Kocherginsky M, Temkin SM, Fefferman A, Lengyel E, Yamada SD. Clinico-pathologic comparison of type II endometrial cancers based on tamoxifen exposure. Gynecol Oncol 2012; 127:316-20. [PMID: 22835717 DOI: 10.1016/j.ygyno.2012.07.105] [Citation(s) in RCA: 16] [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: 05/08/2012] [Revised: 07/09/2012] [Accepted: 07/15/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare clinico-pathologic variables and protein expression of potential regulatory components in patients who develop type II endometrial cancer with and without antecedent tamoxifen. METHODS Clinico-pathologic variables were compared for all surgically staged patients (2000-2008) with grade 3 endometrioid, papillary serous, clear cell, and carcinosarcoma of the uterus based on tamoxifen exposure [Tam (+) vs. Tam (-)]. Overall survival was analyzed using a multivariable Cox regression model and Kaplan-Meier estimates. Protein expression of ERα, PR, mTOR, p-mTOR, IGF-1R, EGFR, VEGF and HER-2/neu was compared by immunohistochemistry using a semiquantitative scoring system. RESULTS Of 115 patients with high grade endometrial cancers, 15 received tamoxifen. These patients were older at diagnosis than Tam (-) patients. A higher percentage of Tam (+) patients had carcinosarcoma compared to Tam (-) patients (60% vs. 30%, P=0.038). Overall survival for Tam (+) patients was shorter than Tam (-) patients (16.6 vs. 32.2 months, P=0.004). The hazard ratio for death for Tam (+) patients was 2.53 (P=0.014), controlling for age and stage. Intensity and extent of staining were similar for ERα, PR, VEGF, EGFR, p-mTOR and HER-2/neu. The average expression score for IGF-1R and mTOR in the Tam (+) group was significantly higher than the Tam (-) group: 10.3 vs 7.0, P=0.001 and 6.0 vs 3.1, P=0.029, respectively. CONCLUSION There are differences in the biology of type II endometrial cancers that develop in women with prior tamoxifen exposure. Tamoxifen associated cancers show higher expression of IGF-1R and mTOR, which should be further investigated.
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Affiliation(s)
- Ana I Tergas
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, USA
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Song S, Rudra S, Hasselle MD, Dorn PL, Mell LK, Mundt AJ, Yamada SD, Lee NK, Hasan Y. The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy. Cancer 2012; 119:325-31. [PMID: 22806897 DOI: 10.1002/cncr.27652] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/22/2012] [Accepted: 03/23/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Suisui Song
- Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, Illinois 60637, USA
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Gotlieb WH, Amant F, Advani S, Goswami C, Hirte H, Provencher D, Somani N, Yamada SD, Tamby JF, Vergote I. Intravenous aflibercept for treatment of recurrent symptomatic malignant ascites in patients with advanced ovarian cancer: a phase 2, randomised, double-blind, placebo-controlled study. Lancet Oncol 2012; 13:154-62. [DOI: 10.1016/s1470-2045(11)70338-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gould N, Sill MW, Mannel RS, Thaker PH, Disilvestro P, Waggoner S, Yamada SD, Armstrong DK, Wenzel L, Huang H, Fracasso PM, Walker JL. A phase I study with an expanded cohort to assess the feasibility of intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel in patients with untreated ovarian, fallopian tube or primary peritoneal carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2011; 125:54-8. [PMID: 22155262 DOI: 10.1016/j.ygyno.2011.12.417] [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] [Received: 10/25/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To define the maximum tolerated dose (MTD) and assess the feasibility of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin, and IP paclitaxel in women with newly diagnosed Stages II-IV ovarian, fallopian tube, or primary peritoneal carcinoma. METHODS Patients received escalating doses of paclitaxel IV and carboplatin IP on day 1 and paclitaxel IP 60 mg/m(2) on day 8. A standard 3+3 design was used in the escalation phase. A two-stage group sequential design with 20 patients at the MTD was used in the feasibility phase. Patient-reported neurotoxicity was assessed pre and post treatment. RESULTS Patients were treated with paclitaxel 175 mg/m(2) IV and carboplatin IP from AUC 5-7 on day 1 and paclitaxel 60 mg/m(2) IP on day 8. The MTD was estimated at carboplatin AUC 6 IP and 25 patients enrolled at this dose level. Within the first 4 cycles, seven (35%) of twenty evaluable patients had dose-limiting toxicities (DLTs) including grade 4 thrombocytopenia (1), grade 3 neutropenic fever (3), >2 week delay due to ANC recovery (1), grade 3 LFT (1), and grade 3 infection (1). De-escalation to paclitaxel 135 mg/m(2) IV was given to improve the safety. After six evaluable patients completed 4 cycles without a DLT, bevacizumab was added and six evaluable patients completed 4 cycles with one DLT (grade 3 hyponatremia). CONCLUSIONS Paclitaxel at 175 mg/m(2) IV, carboplatin AUC 6 IP day 1 and paclitaxel 60 mg/m(2) IP day 8 yield 18-56% patients with DLTs. The tolerability of the regimen in combination with bevacizumab was indicated in a small cohort.
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Affiliation(s)
- Natalie Gould
- Division of Gynecologic Oncology, Women's Cancer Center of Nevada, Las Vegas, NV 89169, USA.
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Nieman KM, Kenny HA, Penicka CV, Ladanyi A, Buell-Gutbrod R, Zillhardt MR, Romero IL, Carey MS, Mills GB, Hotamisligil GS, Yamada SD, Peter ME, Gwin K, Lengyel E. Adipocytes promote ovarian cancer metastasis and provide energy for rapid tumor growth. Nat Med 2011; 17:1498-503. [PMID: 22037646 PMCID: PMC4157349 DOI: 10.1038/nm.2492] [Citation(s) in RCA: 1549] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 08/23/2011] [Indexed: 12/12/2022]
Abstract
Intra-abdominal tumors, such as ovarian cancer, have a clear predilection for metastasis to the omentum, an organ primarily composed of adipocytes. Currently, it is unclear why tumor cells preferentially home to and proliferate in the omentum, yet omental metastases typically represent the largest tumor in the abdominal cavities of women with ovarian cancer. We show here that primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells, and that adipokines including interleukin-8 (IL-8) mediate these activities. Adipocyte-ovarian cancer cell coculture led to the direct transfer of lipids from adipocytes to ovarian cancer cells and promoted in vitro and in vivo tumor growth. Furthermore, coculture induced lipolysis in adipocytes and β-oxidation in cancer cells, suggesting adipocytes act as an energy source for the cancer cells. A protein array identified upregulation of fatty acid-binding protein 4 (FABP4, also known as aP2) in omental metastases as compared to primary ovarian tumors, and FABP4 expression was detected in ovarian cancer cells at the adipocyte-tumor cell interface. FABP4 deficiency substantially impaired metastatic tumor growth in mice, indicating that FABP4 has a key role in ovarian cancer metastasis. These data indicate adipocytes provide fatty acids for rapid tumor growth, identifying lipid metabolism and transport as new targets for the treatment of cancers where adipocytes are a major component of the microenvironment.
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Affiliation(s)
- Kristin M Nieman
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, Center for Integrative Science, University of Chicago, Chicago, IL, USA
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Dizon DS, Sill MW, Gould N, Rubin SC, Yamada SD, Debernardo RL, Mannel RS, Eisenhauer EL, Duska LR, Fracasso PM. Phase I feasibility study of intraperitoneal cisplatin and intravenous paclitaxel followed by intraperitoneal paclitaxel in untreated ovarian, fallopian tube, and primary peritoneal carcinoma: a gynecologic oncology group study. Gynecol Oncol 2011; 123:182-6. [PMID: 21820161 DOI: 10.1016/j.ygyno.2011.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Intraperitoneal chemotherapy has shown a survival advantage over intravenous chemotherapy for women with newly diagnosed optimally debulked epithelial ovarian, fallopian tube, or primary peritoneal carcinoma. However, significant toxicity has limited its acceptance. In an effort to reduce toxicity, the Gynecologic Oncology Group conducted a Phase I study to evaluate the feasibility of day 1 intravenous (IV) paclitaxel and intraperitoneal (IP) cisplatin followed by day 8 IP paclitaxel on an every 21-day cycle. METHODS Patients with Stage IIB-IV epithelial ovarian, fallopian tube, primary peritoneal carcinomas or carcinosarcoma received paclitaxel 135mg/m(2) IV over 3h followed by cisplatin 75mg/m(2) IP on day 1 and paclitaxel 60 mg/m(2) IP on day 8 of a 21 day cycle with 6 cycles planned. Dose-limiting toxicity (DLT) was defined as febrile neutropenia or dose-delay of greater than 2 weeks due to failure to recover counts, or Grade 3-5 non-hematologic toxicity occurring within the first 4 cycles of treatment. RESULTS Twenty of 23 patients enrolled were evaluable and nineteen (95%) completed all six cycles of therapy. Three patients experienced a DLT consisting of infection with normal absolute neutrophil count, grade 3 hyperglycemia, and grade 4 abdominal pain. CONCLUSIONS This modified IP regimen which administers both IV paclitaxel and IP cisplatin on day one, followed by IP paclitaxel on day eight, of a twenty-one day cycle appears feasible and is an attractive alternative to the intraperitoneal treatment regimen administered in GOG-0172.
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Affiliation(s)
- Don S Dizon
- The Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
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Zillhardt M, Park SM, Romero IL, Sawada K, Montag A, Krausz T, Yamada SD, Peter ME, Lengyel E. Foretinib (GSK1363089), an orally available multikinase inhibitor of c-Met and VEGFR-2, blocks proliferation, induces anoikis, and impairs ovarian cancer metastasis. Clin Cancer Res 2011; 17:4042-51. [PMID: 21551255 PMCID: PMC3169439 DOI: 10.1158/1078-0432.ccr-10-3387] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Currently, there are no approved targeted therapies for the treatment of ovarian cancer, despite the fact that it is the most lethal gynecological malignancy. One proposed target is c-Met, which has been shown to be an important prognostic indicator in a number of malignancies, including ovarian cancer. The objective of this study was to determine whether an orally available multikinase inhibitor of c-Met and vascular endothelial growth factor receptor-2 (foretinib, GSK1363089) blocks ovarian cancer growth. EXPERIMENTAL DESIGN The effect of foretinib was tested in a genetic mouse model of endometrioid ovarian cancer, several ovarian cancer cell lines, and an organotypic 3D model of the human omentum. RESULTS In the genetic mouse model, treatment with foretinib prevented the progression of primary tumors to invasive adenocarcinoma. Invasion through the basement membrane was completely blocked in treated mice, whereas in control mice, invasive tumors entirely replaced the normal ovary. In 2 xenograft mouse models using human ovarian cancer cell lines, the inhibitor reduced overall tumor burden (86% inhibition, P < 0.0001) and metastasis (67% inhibition, P < 0.0001). The mechanism of inhibition by foretinib involved (a) inhibition of c-Met activation and downstream signaling, (b) reduction of ovarian cancer cell adhesion, (c) a block in migration and invasion, (d) reduced proliferation mediated by a G(2)-M cell-cycle arrest, and (e) induction of anoikis. CONCLUSIONS This study shows that foretinib blocks tumorigenesis and reduces invasive tumor growth in different models of ovarian cancer by affecting several critical tumor functions. We believe that it provides a rationale for the further clinical development of foretinib for the treatment of ovarian cancer.
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Affiliation(s)
- Marion Zillhardt
- Departments of Obstetrics and Gynecology/Section of Gynecologic Oncology-Center for Integrative Science and Pathology, University of Chicago, Chicago, Illinois, USA
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Bishop EA, Lengyel ER, Yamada SD, Montag A, Temkin SM. The expression of hepatocyte growth factor (HGF) and c-Met in uterine serous carcinoma. Gynecol Oncol 2011; 121:218-23. [DOI: 10.1016/j.ygyno.2010.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/13/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
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Kenny HA, Leonhardt P, Ladanyi A, Yamada SD, Montag A, Im HK, Jagadeeswaran S, Shaw DE, Mazar AP, Lengyel E. Targeting the urokinase plasminogen activator receptor inhibits ovarian cancer metastasis. Clin Cancer Res 2011; 17:459-71. [PMID: 21149615 PMCID: PMC3073583 DOI: 10.1158/1078-0432.ccr-10-2258] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To understand the functional and preclinical efficacy of targeting the urokinase plasminogen activator receptor (u-PAR) in ovarian cancer. EXPERIMENTAL DESIGN Expression of u-PAR was studied in 162 epithelial ovarian cancers, including 77 pairs of corresponding primary and metastatic tumors. The effect of an antibody against u-PAR (ATN-658) on proliferation, adhesion, invasion, apoptosis, and migration was assessed in 3 (SKOV3ip1, HeyA8, and CaOV3) ovarian cancer cell lines. The impact of the u-PAR antibody on tumor weight, number, and survival was examined in corresponding ovarian cancer xenograft models and the mechanism by which ATN-658 blocks metastasis was explored. RESULTS Only 8% of all ovarian tumors were negative for u-PAR expression. Treatment of SKOV3ip1, HeyA8, and CaOV3 ovarian cancer cell lines with the u-PAR antibody inhibited cell invasion, migration, and adhesion. In vivo, anti-u-PAR treatment reduced the number of tumors and tumor weight in CaOV3 and SKOV3ip1 xenografts and reduced tumor weight and increased survival in HeyA8 xenografts. Immunostaining of CaOV3 xenograft tumors and ovarian cancer cell lines showed an increase in active-caspase 3 and TUNEL staining. Treatment with u-PAR antibody inhibited α(5)-integrin and u-PAR colocalization on primary human omental extracellular matrix. Anti-u-PAR treatment also decreased the expression of urokinase, u-PAR, β(3)-integrin, and fibroblast growth factor receptor-1 both in vitro and in vivo. CONCLUSIONS This study shows that an antibody against u-PAR reduces metastasis, induces apoptosis, and reduces the interaction between u-PAR and α(5)-integrin. This provides a rationale for targeting the u-PAR pathway in patients with ovarian cancer and for further testing of ATN-658 in this indication.
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Affiliation(s)
- Hilary A. Kenny
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
| | - Payton Leonhardt
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
| | - Andras Ladanyi
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
| | - S. Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
| | - Anthony Montag
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Hae Kyung Im
- Department of Health Studies, University of Chicago, Chicago, IL, 60637, USA
| | - Sujatha Jagadeeswaran
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
| | - David E. Shaw
- D. E. Shaw Research and Center for Computational Biology and Bioinformatics, Columbia University, New York, NY, 10032, USA
| | - Andrew P. Mazar
- Chemistry of Life Processes Institute and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL 60208, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology – Center for Integrative Science, University of Chicago, Chicago, IL, 60637, USA
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Kunos CA, Sill MW, Buekers TE, Walker JL, Schilder JM, Yamada SD, Waggoner SE, Mohiuddin M, Fracasso PM. Low-dose abdominal radiation as a docetaxel chemosensitizer for recurrent epithelial ovarian cancer: a phase I study of the Gynecologic Oncology Group. Gynecol Oncol 2011; 120:224-8. [PMID: 21075438 PMCID: PMC3026069 DOI: 10.1016/j.ygyno.2010.10.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/13/2010] [Accepted: 10/17/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to determine the maximum tolerated dose and dose-limiting toxicity (DLT) of whole abdomen radiation as a chemosensitizer of weekly docetaxel for women with recurrent epithelial ovarian fallopian tube, or peritoneal cancers. PATIENTS AND METHODS Women were enrolled on one of three dose levels of docetaxel (20, 25, or 30 mg/m(2)) administered weekly with concurrent low-dose whole abdominal radiation given as 60 cGy bid 2 days weekly for a total of 6 weeks. RESULTS Thirteen women were enrolled and received 70 weekly treatments of docetaxel in combination with radiation therapy. At the first dose level, docetaxel 25mg/m(2), grade 3 fatigue and thrombocytopenia were observed. At the next dose level, docetaxel 30 mg/m(2), grade 3 febrile neutropenia, grade 4 thrombocytopenia with epistaxis, and grade 3 diarrhea were observed. Given these dose-limiting toxicities, a lower dose of docetaxel 20mg/m(2) was administered and found to be tolerable. No objective responses were observed among the 10 patients with measurable disease; however, the median progression-free survival (PFS) in all patients was 3.3 months, and 3 of the patients with measurable disease were free of tumor progression after 6 months (30%; 90% confidence interval 8.7-61%). CONCLUSIONS Twice weekly low-dose whole abdomen radiation during weekly docetaxel 20 mg/m(2) was well-tolerated. Given the PFS demonstrated in these women with resistant ovarian cancer, further study of whole abdominal radiation and concurrent chemotherapy may be warranted.
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Affiliation(s)
- Charles A. Kunos
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106
| | - Michael W. Sill
- Gynecologic Oncology Group Statistical and Data Center, Buffalo, NY 14263
| | | | - Joan L. Walker
- Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma 73190
| | - Jeanne M. Schilder
- Section of GYN Oncology, Indiana University Medical Center, Indianapolis, IN 46202
| | - S. Diane Yamada
- Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637
| | - Steven E. Waggoner
- Department of Obstetrics and Gynecology, University Hospital Case Western Medical Center, Cleveland, OH 44106
| | - Mohammed Mohiuddin
- Department of Radiation Oncology, University of Kentucky, Lexington, KY 40536
| | - Paula M. Fracasso
- Department of Medicine, University of Virginia, Charlottesville, VA 22908
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