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Wimmer K, Sachet M, Ramos C, Frantal S, Birnleitner H, Brostjan C, Exner R, Filipits M, Bago-Horvath Z, Rudas M, Bartsch R, Gnant M, Singer CF, Balic M, Egle D, Oehler R, Fitzal F. Differential immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel in breast cancer patients. J Exp Clin Cancer Res 2023; 42:300. [PMID: 37957750 PMCID: PMC10644559 DOI: 10.1186/s13046-023-02876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Epirubicin/cyclophosphamide (EC) and docetaxel (D) are commonly used in a sequential regimen in the neoadjuvant treatment of early, high-risk or locally advanced breast cancer (BC). Novel approaches to increase the response rate combine this treatment with immunotherapies such as PD-1 inhibition. However, the expected stimulatory effect on lymphocytes may depend on the chemotherapy backbone. Therefore, we separately compared the immunomodulatory effects of EC and D in the setting of a randomized clinical trial. METHODS Tumor and blood samples of 154 patients from the ABCSG-34 trial were available (76 patients received four cycles of EC followed by four cycles of D; 78 patients get the reverse treatment sequence). Tumor-infiltrating lymphocytes, circulating lymphocytes and 14 soluble immune mediators were determined at baseline and at drug change. Furthermore, six BC cell lines were treated with E, C or D and co-cultured with immune cells. RESULTS Initial treatment with four cycles of EC reduced circulating B and T cells by 94% and 45%, respectively. In contrast, no comparable effects on lymphocytes were observed in patients treated with initial four cycles of D. Most immune mediators decreased under EC whereas D-treatment resulted in elevated levels of CXCL10, urokinase-type plasminogen activator (uPA) and its soluble receptor (suPAR). Accordingly, only the exposure of BC cell lines to D induced similar increases as compared to E. While treatment of BC cells with E was associated with cell shrinkage and apoptosis, D induced cell swelling and accumulation of cells in G2 phase. CONCLUSION The deleterious effect of EC on lymphocytes indicates strong immunosuppressive properties of this combination therapy. D, in contrast, has no effect on lymphocytes, but triggers the secretion of stimulatory proteins in vivo and in vitro, indicating a supportive effect on the immune system. Underlying differences in the induced cell death might be causal. These divergent immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel should be considered when planning future combinations with immunotherapies in breast cancer.
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Affiliation(s)
- Kerstin Wimmer
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Monika Sachet
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Cristiano Ramos
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Hanna Birnleitner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Ruth Exner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Martin Filipits
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Center for Cancer Research, Medical University of Vienna, 1090, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rupert Bartsch
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, 1090, Vienna, Austria
| | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian F Singer
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Department of Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Marija Balic
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Daniel Egle
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Oehler
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria.
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
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Ceppi M, Smolkova B, Staruchova M, Kazimirova A, Barancokova M, Volkovova K, Collins A, Kocan A, Dzupinkova Z, Horska A, Buocikova V, Tulinska J, Liskova A, Mikusova ML, Krivosikova Z, Wsolova L, Kuba D, Rundén-Pran E, El Yamani N, Longhin EM, Halašová E, Kyrtopoulos S, Bonassi S, Dusinska M. Genotoxic effects of occupational exposure to glass fibres - A human biomonitoring study. Mutat Res Genet Toxicol Environ Mutagen 2023; 885:503572. [PMID: 36669817 DOI: 10.1016/j.mrgentox.2022.503572] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/07/2022]
Abstract
As part of a large human biomonitoring study, we conducted occupational monitoring in a glass fibre factory in Slovakia. Shopfloor workers (n = 80), with a matched group of administrators in the same factory (n = 36), were monitored for exposure to glass fibres and to polycyclic aromatic hydrocarbons (PAHs). The impact of occupational exposure on chromosomal aberrations, DNA damage and DNA repair, immunomodulatory markers, and the role of nutritional and lifestyle factors, as well as the effect of polymorphisms in metabolic and DNA repair genes on genetic stability, were investigated. The (enzyme-modified) comet assay was employed to measure DNA strand breaks (SBs) and apurinic sites, oxidised and alkylated bases. Antioxidant status was estimated by resistance to H2O2-induced DNA damage. Base excision repair capacity was measured with an in vitro assay (based on the comet assay). Exposure of workers to fibres was low, but still was associated with higher levels of SBs, and SBs plus oxidised bases, and higher sensitivity to H2O2. Multivariate analysis showed that exposure increased the risk of high levels of SBs by 20%. DNA damage was influenced by antioxidant enzymes catalase and glutathione S-transferase (measured in blood). DNA repair capacity was inversely correlated with DNA damage and positively with antioxidant status. An inverse correlation was found between DNA base oxidation and the percentage of eosinophils (involved in the inflammatory response) in peripheral blood of both exposed and reference groups. Genotypes of XRCC1 variants rs3213245 and rs25487 significantly decreased the risk of high levels of base oxidation, to 0.50 (p = 0.001) and 0.59 (p = 0.001), respectively. Increases in DNA damage owing to glass fibre exposure were significant but modest, and no increases were seen in chromosome aberrations or micronuclei. However, it is of concern that even low levels of exposure to these fibres can cause significant genetic damage.
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Affiliation(s)
- Marcello Ceppi
- Biostatistics Unit, San Martino Policlinic Hospital, Genoa, Italy.
| | - Bozena Smolkova
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Slovakia.
| | - Marta Staruchova
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Alena Kazimirova
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Magdalena Barancokova
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Katarina Volkovova
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Andrew Collins
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Anton Kocan
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Zuzana Dzupinkova
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia; Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria.
| | - Alexandra Horska
- Department of Biology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Verona Buocikova
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Slovakia.
| | - Jana Tulinska
- Laboratory of Immunotoxicology, Slovak Medical University in Bratislava, Slovakia.
| | - Aurelia Liskova
- Laboratory of Immunotoxicology, Slovak Medical University in Bratislava, Slovakia.
| | | | - Zora Krivosikova
- Department of Clinical and Experimental Pharmacotherapy, Slovak Medical University, Bratislava, Slovakia.
| | - Ladislava Wsolova
- Institute of Biophysics, Informatics and BioStatistics, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia.
| | - Daniel Kuba
- National Transplant Organization, Bratislava, Slovakia.
| | - Elise Rundén-Pran
- Health Effects Laboratory, Department for Environmental Chemistry, NILU - Norwegian Institute for Air Research, Kjeller, Norway.
| | - Naouale El Yamani
- Health Effects Laboratory, Department for Environmental Chemistry, NILU - Norwegian Institute for Air Research, Kjeller, Norway.
| | - Eleonora Martha Longhin
- Health Effects Laboratory, Department for Environmental Chemistry, NILU - Norwegian Institute for Air Research, Kjeller, Norway.
| | - Erika Halašová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
| | - Soterios Kyrtopoulos
- Institute of Biology, Medicinal Chemistry, and Biotechnology, National Hellenic Research Foundation, Athens, Greece.
| | - Stefano Bonassi
- IRCCS San Raffaele Pisana, Unit of Clinical and Molecular Epidemiology, Rome, Italy.
| | - Maria Dusinska
- Health Effects Laboratory, Department for Environmental Chemistry, NILU - Norwegian Institute for Air Research, Kjeller, Norway.
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