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Awshah S, Mhaskar R, Diab ARF, Read M, Coughlin E, Ganam S, Saad AR, Sujka J, DuCoin C. Robotics vs Laparoscopy in Foregut Surgery: Systematic Review and Meta-Analysis Analyzing Hiatal Hernia Repair and Heller Myotomy. J Am Coll Surg 2024:00019464-990000000-00946. [PMID: 38497555 DOI: 10.1097/xcs.0000000000001074] [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: 03/19/2024]
Abstract
BACKGROUND Laparoscopic surgery remains the mainstay of treating foregut pathologies. Several studies have shown improved outcomes with the robotic approach. A systematic review and meta-analysis comparing outcomes of robotic and laparoscopic hiatal hernia repairs (HHR) and Heller myotomy (HM) repairs is needed. STUDY DESIGN PubMed, Embase and Scopus databases were searched for studies published between January 2010 and November 2022. The risk of bias was assessed using the Cochrane ROBINS-I tool. Assessed outcomes included intra- and post-operative outcomes. We pooled the dichotomous data using the Mantel-Haenszel random effects model to report odds ratio (OR) and 95% confidence intervals (95% CIs) and continuous data to report mean difference (MD) and 95% CIs. RESULTS Twenty-two comparative studies enrolling 196,339 patients were included. Thirteen (13,426 robotic, 168,335 laparoscopic patients) studies assessed HHR outcomes, while nine (2,384 robotic, 12,225 laparoscopic patients) assessed HM outcomes. Robotic HHR had a non-significantly shorter length of hospital stay (LOS) [MD -0.41 (95% CI -0.87, -0.05)], fewer conversions to open [OR 0.22 (95% CI 0.03, 1.49)], and lower morbidity rates [OR 0.76 (95% CI 0.47, 1.23)]. Robotic HM led to significantly fewer esophageal perforations [OR 0.36 (95% CI 0.15, 0.83)], reinterventions [OR 0.18 (95% CI 0.07, 0.47)] a non-significantly shorter LOS [MD -0.31 (95% CI -0.62, 0.00)]. Both robotic HM and HHR had significantly longer operative times. CONCLUSIONS Laparoscopic and robotic HHR and HM repairs have similar safety profiles and perioperative outcomes. Randomized controlled trials are warranted to compare the two methods, given the low to moderate quality of included studies.
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Affiliation(s)
- Sabrina Awshah
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Abdul-Rahman Fadi Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Meagan Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Emily Coughlin
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Samer Ganam
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Adham R Saad
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
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Diab ARF, Sher T, Awshah S, Noom M, Docimo S, Sujka JA, DuCoin CG. Reply to Letter to the Editor: Oversewing/Suturing of the Staple Line During Sleeve Gastrectomy Is an Effective and Affordable Staple Line Reinforcement Method: a Meta-analysis of Randomized Controlled Trials. Obes Surg 2023; 33:3672-3673. [PMID: 37723301 DOI: 10.1007/s11695-023-06811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Abdul-Rahman F Diab
- Department of Surgery, Division of Gastrointestinal Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Theo Sher
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL, 33602, USA
| | - Sabrina Awshah
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL, 33602, USA
| | - Madison Noom
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL, 33602, USA
| | - Salvatore Docimo
- Department of Surgery, Division of Gastrointestinal Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph A Sujka
- Department of Surgery, Division of Gastrointestinal Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Department of Surgery, Division of Gastrointestinal Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Tampa, FL, 33606, USA
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Diab ARF, Sher T, Awshah S, Noom M, Docimo S, Sujka JA, DuCoin CG. Oversewing/Suturing of the Staple Line During Sleeve Gastrectomy Is an Effective and Affordable Staple Line Reinforcement Method: a Meta-analysis of Randomized Controlled Trials. Obes Surg 2023; 33:2533-2545. [PMID: 37312007 DOI: 10.1007/s11695-023-06672-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
Bleeding and leaks are the most ominous postoperative complications after laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) techniques have been innovated such as oversewing/suturing (OS/S), omentopexy/gastropexy, buttressing, and gluing. Currently, no high-quality evidence supports the use of one method over the others or even supports the use of SLR over no SLR. This study aimed to compare postoperative outcomes between LSG with OS/S versus LSG without any SLR.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Theo Sher
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Sabrina Awshah
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Madison Noom
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Salvatore Docimo
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
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Padilla G, Awshah S, Mhaskar RS, Diab ARF, Sujka JA, DuCoin C, Docimo S. Spanish-language bariatric surgery patient education materials fail to meet healthcare literacy standards of readability. Surg Endosc 2023:10.1007/s00464-023-10088-9. [PMID: 37129638 DOI: 10.1007/s00464-023-10088-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Hispanic population is the fastest growing ethnic minority in the United States, contributing to nearly half of the population growth over the last decade. Unfortunately, this population suffers from lower-than-average health literacy rates, leading to poorer health outcomes. Per the American Medical Association and National Institutes of Health, patient education materials (PEMs) should be written at no higher than a 6th grade reading level. Given that US Hispanic adults have the second-highest obesity prevalence, this study aims to analyze the readability of Spanish-language PEMs regarding bariatric surgery available in US-based academic and medical centers. METHODS A total of 50 PEMs were found via the query ""cirugía de pérdida de peso" site: (edu OR.org)" on the Google search engine. Thirty-nine sources met the inclusion criteria of belonging to a US-based academic or medical center and containing information regarding the indications for bariatric surgery, descriptions of the types of bariatric surgery, what to expect before and after surgery, or the risks and benefits of bariatric surgery. The excerpts were analyzed according to three readability formulas designed specifically for the Spanish language and evaluated for their reading grade level. RESULTS All 39 sources were at the college reading level per the Fry graph corrected for Spanish. Per the Spaulding formula, 37 sources were "Grade 12 + " and two sources were "Grade 8-10." Per the Fernandez-Huerta formula, 16 sources were at the 8th/9th grade reading level, 22 sources were at the 7th grade reading level, and one was at the 6th grade reading level. CONCLUSION The Spanish-language bariatric surgery PEMs available online from US-based academic and medical centers are generally above the recommended 6th grade reading level. Failure to meet the recommended sixth-grade reading level decreases health care literacy for Spanish-speaking patients within the United States seeking bariatric surgery.
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Affiliation(s)
| | | | | | | | - Joseph A Sujka
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
| | - Christopher DuCoin
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
| | - Salvatore Docimo
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
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Koussayer B, Nehila T, Awshah S, Sujka JA, DuCoin CG. A Case Report of a Rare Hernia: Incarcerated Falciform Ligament Hernia. Cureus 2023; 15:e37386. [PMID: 37182046 PMCID: PMC10171829 DOI: 10.7759/cureus.37386] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Falciform ligament hernias are a rare type of internal hernia that occurs through an abnormal opening in the falciform ligament of the liver. This is the case of a 38-year-old female who presented with a symptomatic enlarging ventral bulge near her umbilicus and was treated with a robotic-assisted laparoscopic falciform hernia repair with mesh. The nonspecific clinical manifestation of a falciform ligament hernia and the low sensitivity of computerized tomography (CT) for these hernias make them hard to diagnose preoperatively. Falciform ligament hernias are mostly attributed to congenital defects, but recently an iatrogenic etiology has also been proposed, given the prior history of laparoscopic surgeries in more recent cases. In our case report, we demonstrate that a robotic-assisted laparoscopic approach is a safe and effective means of correcting this hernia, with an outline of the current literature.
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Affiliation(s)
- Bilal Koussayer
- Surgery, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
| | - Timothy Nehila
- Surgery, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
| | - Sabrina Awshah
- Surgery, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
| | - Joseph A Sujka
- General, Bariatric, Foregut, Hernia, University of South Florida (USF) Health Tampa General Hospital, Tampa, USA
| | - Christopher G DuCoin
- General, Bariatric, Foregut, Hernia, University of South Florida (USF) Health Tampa General Hospital, Tampa, USA
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Basu A, Albert GK, Awshah S, Datta J, Kodumudi KN, Gallen C, Beyer A, Smalley KS, Rodriguez PC, Duckett DR, Forsyth PA, Soyano A, Koski GK, Lima Barros Costa R, Han H, Soliman H, Lee MC, Kalinski P, Czerniecki BJ. Identification of Immunogenic MHC Class II Human HER3 Peptides that Mediate Anti-HER3 CD4 + Th1 Responses and Potential Use as a Cancer Vaccine. Cancer Immunol Res 2022; 10:108-125. [PMID: 34785506 PMCID: PMC9414303 DOI: 10.1158/2326-6066.cir-21-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/01/2021] [Accepted: 11/16/2021] [Indexed: 01/11/2023]
Abstract
The HER3/ERBB3 receptor is an oncogenic receptor tyrosine kinase that forms heterodimers with EGFR family members and is overexpressed in numerous cancers. HER3 overexpression associates with reduced survival and acquired resistance to targeted therapies, making it a potential therapeutic target in multiple cancer types. Here, we report on immunogenic, promiscuous MHC class II-binding HER3 peptides, which can generate HER3-specific CD4+ Th1 antitumor immune responses. Using an overlapping peptide screening methodology, we identified nine MHC class II-binding HER3 epitopes that elicited specific Th1 immune response in both healthy donors and breast cancer patients. Most of these peptides were not identified by current binding algorithms. Homology assessment of amino acid sequence BLAST showed >90% sequence similarity between human and murine HER3/ERBB3 peptide sequences. HER3 peptide-pulsed dendritic cell vaccination resulted in anti-HER3 CD4+ Th1 responses that prevented tumor development, significantly delayed tumor growth in prevention models, and caused regression in multiple therapeutic models of HER3-expressing murine tumors, including mammary carcinoma and melanoma. Tumors were robustly infiltrated with CD4+ T cells, suggesting their key role in tumor rejection. Our data demonstrate that class II HER3 promiscuous peptides are effective at inducing HER3-specific CD4+ Th1 responses and suggest their applicability in immunotherapies for human HER3-overexpressing tumors.
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Affiliation(s)
- Amrita Basu
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gabriella K. Albert
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sabrina Awshah
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jashodeep Datta
- Department of Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Krithika N. Kodumudi
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Corey Gallen
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Amber Beyer
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Keiran S.M. Smalley
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paulo C. Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Derek R. Duckett
- Department of Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A. Forsyth
- Department of NeuroOncology and the NeuroOncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aixa Soyano
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gary K. Koski
- Department of Biological Sciences, Kent State University, Kent, Ohio
| | | | - Heather Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hatem Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marie Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Pawel Kalinski
- Department of Immunology, Roswell Park Comprehensive Cancer Center, New York, New York
| | - Brian J. Czerniecki
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Corresponding Author: Brian J. Czerniecki, Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612. E-mail:
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7
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Kodumudi KN, Ramamoorthi G, Snyder C, Basu A, Jia Y, Awshah S, Beyer AP, Wiener D, Lam L, Zhang H, Greene MI, Costa RLB, Czerniecki BJ. Sequential Anti-PD1 Therapy Following Dendritic Cell Vaccination Improves Survival in a HER2 Mammary Carcinoma Model and Identifies a Critical Role for CD4 T Cells in Mediating the Response. Front Immunol 2019; 10:1939. [PMID: 31475002 PMCID: PMC6702967 DOI: 10.3389/fimmu.2019.01939] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/31/2019] [Indexed: 12/27/2022] Open
Abstract
Patients with metastatic HER2 breast cancer (MBC) often become resistant to HER 2 targeted therapy and have recurrence of disease. The Panacea trial suggested that HER2 MBC patients were more likely to respond to checkpoint therapy if TIL were present or if tumor expressed PD-L1. We assessed whether type I polarized dendritic cells (DC1) could improve checkpoint therapy in a preclinical model of HER2+ breast cancer. TUBO bearing mice were vaccinated with either MHC class I or class II HER2 peptide pulsed DC1 (class I or class II HER2-DC1) concurrently or sequentially with administration of anti-PD-1 or anti-PDL1. Infiltration of tumors by immune cells, induction of anti-HER2 immunity and response to therapy was evaluated. Class I or class II HER2-DC1 vaccinated mice generated anti-HER2 CD8 or CD4+ T cell immune responses and demonstrated delayed tumor growth. Combining both MHC class I and II HER2-pulsed DC1 did not further result in inhibition of tumor growth or enhanced survival compared to individual administration. Interestingly class II HER2-DC1 led to both increased CD4 and CD8 T cells in the tumor microenvironment while class I peptides typically resulted in only increased CD8 T cells. Anti-PD-1 but not anti-PD-L1 administered sequentially with class I or class II HER2-DC1 vaccine could improve the efficacy of HER2-DC1 vaccine as measured by tumor growth, survival, infiltration of tumors by T cells and increase in systemic anti-HER2 immune responses. Depletion of CD4+ T cells abrogated the anti-tumor efficacy of combination therapy with class II HER2-DC1 and anti-PD-1, suggesting that tumor regression was CD4 dependent. Since class II HER2-DC1 was as effective as class I, we combined class II HER2-DC1 vaccine with anti-rat neu antibodies and anti-PD-1 therapy. Combination therapy demonstrated further delay in tumor growth, and enhanced survival compared to control mice. In summary, Class II HER2-DC1 drives both a CD4 and CD8 T cell tumor infiltration that leads to increased survival, and in combination with anti-HER2 therapy and checkpoint blockade can improve survival in preclinical models of HER2 positive breast cancer and warrants exploration in patients with HER2 MBC.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/pharmacology
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- B7-H1 Antigen/metabolism
- Breast Neoplasms/immunology
- Breast Neoplasms/metabolism
- Breast Neoplasms/therapy
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/immunology
- Cell Line, Tumor
- Combined Modality Therapy
- Dendritic Cells/immunology
- Female
- Humans
- Mammary Neoplasms, Experimental/immunology
- Mammary Neoplasms, Experimental/metabolism
- Mammary Neoplasms, Experimental/therapy
- Mice, Inbred BALB C
- Mice, Transgenic
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Programmed Cell Death 1 Receptor/metabolism
- Rats
- Receptor, ErbB-2/immunology
- Receptor, ErbB-2/metabolism
- Survival Analysis
- Treatment Outcome
- Tumor Burden/drug effects
- Tumor Burden/immunology
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Affiliation(s)
- Krithika N. Kodumudi
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Ganesan Ramamoorthi
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Colin Snyder
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Amrita Basu
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Yongsheng Jia
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Sabrina Awshah
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Amber P. Beyer
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Doris Wiener
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Lian Lam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Hongtao Zhang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark I. Greene
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ricardo L. B. Costa
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Brian J. Czerniecki
- Clinical Science & Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, United States
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
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Basu A, Ramamoorthi G, Jia Y, Faughn J, Wiener D, Awshah S, Kodumudi K, Czerniecki BJ. Immunotherapy in breast cancer: Current status and future directions. Adv Cancer Res 2019; 143:295-349. [PMID: 31202361 DOI: 10.1016/bs.acr.2019.03.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer, one of the leading causes of death in women in the United States, challenges therapeutic success in patients due to tumor heterogeneity, treatment resistance, metastasis and disease recurrence. Knowledge of immune system involvement in normal breast development and breast cancer has led to extensive research into the immune landscape of breast cancer and multiple immunotherapy clinical trials in breast cancer patients. However, poor immunogenicity and T-cell infiltration along with heightened immunosuppression in the tumor microenvironment have been identified as potential challenges to the success of immunotherapy in breast cancer. Oncodrivers, owing to their enhanced expression and stimulation of tumor cell proliferation and survival, present an excellent choice for targeted immunotherapy development in breast cancer. Loss of anti-tumor immune response specific to oncodrivers has been reported in breast cancer patients as well. Dendritic cell vaccines have been tested for their efficacy in generating anti-tumor T-cell response against specific tumor-associated antigens and oncodrivers and have shown improved survival outcome in patients. Here, we review the current status of immunotherapy in breast cancer, focusing on dendritic cell vaccines and their therapeutic application in breast cancer. We further discuss future directions of breast cancer immunotherapy and potential combination strategies involving dendritic cell vaccines and existing chemotherapeutics for improved efficacy and better survival outcome in breast cancer.
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Affiliation(s)
- Amrita Basu
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Yongsheng Jia
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States; Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Jon Faughn
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States
| | - Doris Wiener
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States
| | - Sabrina Awshah
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States; University of South Florida, Tampa, FL, United States
| | - Krithika Kodumudi
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States; University of South Florida, Tampa, FL, United States.
| | - Brian J Czerniecki
- Clinical Science Division, Moffitt Cancer Center, Tampa, FL, United States; Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL, United States; University of South Florida, Tampa, FL, United States.
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