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Tomasich E, Mühlbacher J, Wöran K, Hatziioannou T, Herac M, Kleinberger M, Berger JM, Dibon LK, Berchtold L, Heller G, Bergen ES, Macher-Beer A, Prager G, Schindl M, Preusser M, Berghoff AS. Immune cell distribution and DNA methylation signatures differ between tumor and stroma enriched compartment in pancreatic ductal adenocarcinoma. Transl Res 2024; 271:40-51. [PMID: 38734064 DOI: 10.1016/j.trsl.2024.05.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
The presence of abundant tumor stroma is a prominent characteristic of pancreatic ductal adenocarcinomas (PDAC) that potentially influences disease progression and therapy response. This study aims to investigate immune cell infiltration and epigenetic profiles in tumor cell enriched ("Tumor") and stroma cell enriched ("Stroma") regions within human PDAC tissue samples. By comparing those regions, we identified 25,410 differentially methylated positions (DMPs) distributed across 6,963 unique genes. Pathway enrichment analysis using the top 2,000 DMPs that were either hyper- or hypomethylated indicated that immune response pathways and the estrogen receptor pathway are epigenetically dysregulated in Tumor and Stroma regions, respectively. In terms of immune cell infiltration, we observed overall low levels of T cells in both regions. In Tumor regions however, occurrence of tumor-associated macrophages (TAMs) was higher than in Stroma regions (p = 0.02) concomitant with a dualistic distribution that stratifies PDAC patients into those with high and low TAM infiltration. By categorizing TAM levels into quartiles, our analysis revealed that PDAC patients with more than 1,515 TAMs per mm² exhibited significantly shorter overall survival (p = 0.036). Our data suggest that variations in inflammatory characteristics between the Tumor and Stroma defined compartments of PDAC may primarily stem from the presence of macrophages rather than lymphocytes. The abundance of TAMs within regions enriched with tumor cells correlates with patient survival, underscoring the potential significance of exploring therapeutic interventions targeting TAMs. Furthermore, directing attention towards the estrogen receptor pathway may represent a promising strategy to address the stroma cell component within the PDAC tumor microenvironment.
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Affiliation(s)
- Erwin Tomasich
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Austria
| | - Jakob Mühlbacher
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, Austria
| | - Katharina Wöran
- Department of Pathology, Medical University of Vienna, Austria
| | - Teresa Hatziioannou
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria
| | - Merima Herac
- Department of Pathology, Medical University of Vienna, Austria
| | - Markus Kleinberger
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Austria
| | - Julia Maria Berger
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Austria
| | - Lea Katharina Dibon
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria
| | - Luzia Berchtold
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Institute of Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Austria
| | - Gerwin Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria
| | | | | | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria
| | - Martin Schindl
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Austria.
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2
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Ressler JM, Tomasich E, Hatziioannou T, Ringl H, Heller G, Silmbrod R, Gottmann L, Starzer AM, Zila N, Tschandl P, Hoeller C, Preusser M, Berghoff AS. DNA Methylation Signatures Correlate with Response to Immune Checkpoint Inhibitors in Metastatic Melanoma. Target Oncol 2024; 19:263-275. [PMID: 38401029 DOI: 10.1007/s11523-024-01041-4] [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] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND DNA methylation profiles have emerged as potential predictors of therapeutic response in various solid tumors. OBJECTIVE This study aimed to analyze the DNA methylation profiles of patients with stage IV metastatic melanoma undergoing first-line immune checkpoint inhibitor treatment and evaluate their correlation with a radiological response according to immune-related Response Evaluation Criteria in Solid Tumors (iRECIST). METHODS A total of 81 tissue samples from 71 patients with metastatic melanoma (27 female, 44 male) were included in this study. We utilized Illumina Methylation EPIC Beadchips to retrieve their genome-wide methylation profile by interrogating >850,000 CpG sites. Clustering based on the 500 most differentially methylated genes was conducted to identify distinct methylation patterns associated with immune checkpoint inhibitor response. Results were further aligned with an independent, previously published data set. RESULTS The median progression-free survival was 8.5 months (range: 0-104.1 months), and the median overall survival was 30.6 months (range: 0-104.1 months). Objective responses were observed in 29 patients (40.8%). DNA methylation profiling revealed specific signatures that correlated with radiological response to immune checkpoint inhibitors. Three distinct clusters were identified based on the methylation patterns of the 500 most differentially methylated genes. Cluster 1 (12/12) and cluster 2 (12/24) exhibited a higher proportion of responders, while cluster 3 (39/45) predominantly consisted of non-responders. In the validation data set, responders also showed more frequent hypomethylation although differences in the data sets limit the interpretation. CONCLUSIONS These findings suggest that DNA methylation profiling of tumor tissues might serve as a predictive biomarker for immune checkpoint inhibitor response in patients with metastatic melanoma. Further validation studies are warranted to confirm the efficiency of DNA methylation profiling as a predictive tool in the context of immunotherapy for metastatic melanoma.
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Affiliation(s)
| | - Erwin Tomasich
- Department of Medicine I, Division of Oncology, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Department of Medicine I, Division of Oncology, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Helmut Ringl
- Wiener Gesundheitsverbund, Klinik Donaustadt, Vienna, Austria
| | - Gerwin Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Rita Silmbrod
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Lynn Gottmann
- Department of Medicine I, Division of Oncology, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Division of Biomedical Science, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
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3
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Berger JM, Alany A, Berchtold L, Puhr R, Friedrich A, Scheiner B, Prager GW, Preusser M, Berghoff AS, Bergen ES. Prognosticators of survival in patients with metastatic pancreatic cancer and ascites. ESMO Open 2023; 8:102048. [PMID: 37977000 PMCID: PMC10774951 DOI: 10.1016/j.esmoop.2023.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identification of factors associated with survival after ascites diagnosis in metastatic pancreatic cancer (mPC) patients may guide treatment decisions and help to maintain quality of life in this highly symptomatic patient collective. PATIENTS AND METHODS All patients treated for mPC at the Medical University of Vienna between 2010 and 2019 developing ascites throughout their course of disease were identified by retrospective chart review. General risk factors, metastatic sites, systemic inflammation and liver function parameters, as well as type of treatment after ascites diagnosis were investigated for associations with survival. RESULTS One hundred and seventeen mPC patients with ascites were included in this study. Median time from mPC to ascites diagnosis was 8.9 months (range 0-99 months) and median overall survival (OS) after ascites diagnosis was 27.4 days (range 21.3-42.6 days). Identified prognostic factors at ascites diagnosis independently associated with an impaired OS were presence of liver metastases [hazard ratio (HR): 2.07, 95% confidence interval (CI) 1.13-3.79, P = 0.018), peritoneal carcinomatosis (HR: 1.74, 95% CI 1.11-2.71, P = 0.015), and portal vein obstruction (HR: 2.52, 95% CI 1.29-4.90, P = 0.007). Compared with best supportive care, continuation of systemic therapy after ascites diagnosis was independently associated with survival (HR: 0.35, 95% CI 0.20-0.61, P < 0.001) with a median OS of 62 days (95% CI 51-129 days, P < 0.001) versus 16 days (95% CI 11-24 days), respectively. CONCLUSIONS Liver and peritoneal metastases as well as portal vein obstruction were found to be prognostic factors after ascites diagnosis in mPC patients. Continuation of systemic therapy after ascites diagnosis was associated with a longer OS, which needs to be evaluated in larger clinical trials including quality-of-life assessment.
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Affiliation(s)
- J M Berger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Alany
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - L Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - R Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Friedrich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - B Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - G W Prager
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - E S Bergen
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna.
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Lim KHJ, Westphalen CB, Berghoff AS, Cardone C, Connolly EA, Güven DC, Kfoury M, Kocakavuk E, Mandó P, Mariamidze E, Matikas A, Moutafi M, Oing C, Pihlak R, Punie K, Sánchez-Bayona R, Sobczuk P, Starzer AM, Tečić Vuger A, Zhu H, Cruz-Ordinario MVB, Altuna SC, Canário R, Vuylsteke P, Banerjee S, de Azambuja E, Cervantes A, Lambertini M, Mateo J, Amaral T. Young oncologists' perspective on the role and future of the clinician-scientist in oncology. ESMO Open 2023; 8:101625. [PMID: 37659290 PMCID: PMC10480053 DOI: 10.1016/j.esmoop.2023.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital LMU Munich, Comprehensive Cancer Centre Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E A Connolly
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - D C Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - M Kfoury
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - E Kocakavuk
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - P Mandó
- Clinical Oncology Department, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - E Mariamidze
- Todua Clinic Department of Oncology and Haematology, Tbilisi, Georgia
| | - A Matikas
- Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - M Moutafi
- Department of Oncology, Attikon University Hospital, Athens, Greece
| | - C Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK; Mildred Scheel Cancer Career Centre HaTriCS4, University Cancer Centre Hamburg, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Pihlak
- Medical Oncology Department, St Bartholomew's Hospital, London, UK
| | - K Punie
- Department of Medical Oncology, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - R Sánchez-Bayona
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Tečić Vuger
- Breast Cancer Unit, Medical Oncology Department, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - H Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M V B Cruz-Ordinario
- Section of Medical Oncology, Cancer Institute, St. Luke's Medical Center, Quezon City, Metro Manila, the Philippines
| | - S C Altuna
- Department of Medical Oncology, Oncomédica, Caracas, Venezuela
| | - R Canário
- Cancer Metastasis, i3S-Institute for Research & Innovation in Health, Porto; Research Centre, Portuguese Oncology Institute of Porto, Porto; ICBAS, School of Medicine and Biomedical Sciences, Porto, Portugal
| | - P Vuylsteke
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London; The Institute of Cancer Research, London, UK
| | - E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A Cervantes
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid; Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Universidad Valencia, Valencia, Spain
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa; Department of Medical Oncology, U.O. Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital Campus, Barcelona, Spain
| | - T Amaral
- Centre for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen; Cluster of Excellence IFIT (EXC2180), Tübingen, Germany
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5
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Tomasich E, Steindl A, Paiato C, Hatziioannou T, Kleinberger M, Berchtold L, Puhr R, Hainfellner JA, Müllauer L, Widhalm G, Eckert F, Bartsch R, Heller G, Preusser M, Berghoff AS. Frequent Overexpression of HER3 in Brain Metastases from Breast and Lung Cancer. Clin Cancer Res 2023; 29:3225-3236. [PMID: 37036472 DOI: 10.1158/1078-0432.ccr-23-0020] [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: 01/04/2023] [Revised: 02/24/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE HER3 belongs to a family of receptor tyrosine kinases with oncogenic properties and is targeted by a variety of novel anticancer agents. There is a huge unmet medical need for systemic treatment options in patients with brain metastases (BM). Therefore, we aimed to investigate HER3 expression in BM of breast (BCa) and non-small cell lung cancer (NSCLC) as the basis for future clinical trial design. EXPERIMENTAL DESIGN We analyzed 180 BM samples of breast cancer or NSCLC and 47 corresponding NSCLC extracranial tissue. IHC was performed to evaluate protein expression of HER3, and immune cells based on CD3, CD8, and CD68. To identify dysregulated pathways based on differential DNA methylation patterns, we used Infinium MethylationEPIC microarrays. RESULTS A total of 99/132 (75.0%) of BCa-BM and 35/48 (72.9%) of NSCLC-BM presented with HER3 expression. Among breast cancer, HER2-positive and HER2-low BM showed significantly higher rates of HER3 coexpression than HER2-negative BM (87.1%/85.7% vs. 61.0%, P = 0.004). Among NSCLC, HER3 was more abundantly expressed in BM than in matched extracranial samples (72.9% vs. 41.3%, P = 0.003). No correlation of HER3 expression and intratumoral immune cell density was observed. HER3 expression did not correlate with overall survival from BM diagnosis. Methylation signatures differed according to HER3 status in BCa-BM samples. Pathway analysis revealed subtype-specific differences, such as TrkB and Wnt signaling pathways dysregulated in HER2-positive and triple-negative breast cancer BM, respectively. CONCLUSIONS HER3 is highly abundant in BM of breast cancer and NSCLC. Given the promising results of antibody-drug conjugates in extracranial disease, BM-specific trials that target HER3 are warranted. See related commentary by Kabraji and Lin, p. 2961.
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Affiliation(s)
- Erwin Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christina Paiato
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Kleinberger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Luzia Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Rainer Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Franziska Eckert
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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6
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Wolff L, Steindl A, Popov P, Dieckmann K, Gatterbauer B, Widhalm G, Berghoff AS, Preusser M, Raderer M, Kiesewetter B. Clinical characteristics, treatment, and long-term outcome of patients with brain metastases from thyroid cancer. Clin Exp Metastasis 2023:10.1007/s10585-023-10208-8. [PMID: 37219741 DOI: 10.1007/s10585-023-10208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
Brain metastases (BM) in patients with thyroid cancer (TC) are rare with an incidence of 1% for papillary and follicular, 3% for medullary and up to 10% for anaplastic TC (PTC, FTC, MTC and ATC). Little is known about the characteristics and management of BM from TC. Thus, we retrospectively analyzed patients with histologically verified TC and radiologically verified BM identified from the Vienna Brain Metastasis Registry. A total of 20/6074 patients included in the database since 1986 had BM from TC and 13/20 were female. Ten patients had FTC, 8 PTC, one MTC and one ATC. The median age at diagnosis of BM was 68 years. All but one had symptomatic BM and 13/20 patients had a singular BM. Synchronous BM at primary diagnosis were found in 6 patients, while the median time to BM diagnosis was 13 years for PTC (range 1.9-24), 4 years for FTC (range 2.1-41) and 22 years for the MTC patient. The overall survival from diagnosis of BM was 13 months for PTC (range 1.8-57), 26 months for FTC (range 3.9-188), 12 years for the MTC and 3 months for the ATC patient. In conclusion, development of BM from TC is exceedingly rare and the most common presentation is a symptomatic single lesion. While BM generally constitute a poor prognostic factor, individual patients experience long-term survival following local therapy.
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Affiliation(s)
- Ladislaia Wolff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ariane Steindl
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Petar Popov
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
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7
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Linardou H, Adjei AA, Bajpai J, Banerjee S, Berghoff AS, Mathias CC, Choo SP, Dent R, Felip E, Furness AJS, Garassino MC, Garralda E, Konsoulova-Kirova A, Letsch A, Menzies AM, Mukherji D, Peters S, Sessa C, Tsang J, Yang JCH, Garrido P. Challenges in oncology career: are we closing the gender gap? Results of the new ESMO Women for Oncology Committee survey. ESMO Open 2023; 8:100781. [PMID: 36842299 PMCID: PMC10163010 DOI: 10.1016/j.esmoop.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Following a European Society for Medical Oncology Women for Oncology (ESMO W4O) survey in 2016 showing severe under-representation of female oncologists in leadership roles, ESMO launched a series of initiatives to address obstacles to gender equity. A follow-up survey in October 2021 investigated progress achieved. MATERIALS AND METHODS The W4O questionnaire 2021 expanded on the 2016 survey, with additional questions on the impact of ethnicity, sexual orientation and religion on career development. Results were analysed according to respondent gender and age. RESULTS The survey sample was larger than in 2016 (n = 1473 versus 482), especially among men. Significantly fewer respondents had managerial or leadership roles than in 2016 (31.8% versus 51.7%). Lack of leadership development for women and unconscious bias were considered more important in 2021 than in 2016. In 2021, more people reported harassment in the workplace than in 2016 (50.3% versus 41.0%). In 2021, ethnicity, sexual orientation and religion were considered to have little or no impact on professional career opportunities, salary setting or related potential pay gap. However, gender had a significant or major impact on career development (25.5% of respondents), especially in respondents ≤40 years of age and women. As in 2016, highest ranked initiatives to foster workplace equity were promotion of work-life balance, development and leadership training and flexible working. Significantly more 2021 respondents (mainly women) supported the need for culture and gender equity education at work than in 2016. CONCLUSIONS Gender remains a major barrier to career progression in oncology and, although some obstacles may have been reduced since 2016, we are a long way from closing the gender gap. Increased reporting of discrimination and inappropriate behaviour in the workplace is a major, priority concern. The W4O 2021 survey findings provide new evidence and highlight the areas for future ESMO interventions to support equity and diversity in oncology career development.
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Affiliation(s)
- H Linardou
- 4th Oncology Department & Comprehensive Clinical Trials Centre, Metropolitan Hospital, Athens, Greece.
| | | | - J Bajpai
- Tata Memorial Centre, Homi-bhabha National Institute, Mumbai, India
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, Institute of Cancer Research, London, UK
| | - A S Berghoff
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | | | - S P Choo
- Curie Oncology Singapore, National Cancer Centre Singapore
| | - R Dent
- National Cancer Center Singapore, Duke-NUS Medical School, Singapore
| | - E Felip
- Medical Oncology Department, Vall d'Hebron University Hospital, Thoracic Oncology and H&N Cancer Unit, Vall d'Hebron Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
| | | | - M C Garassino
- University of Chicago Medicine & Biological Sciences, Section of Hematology/Oncology, Chicago, USA
| | - E Garralda
- Early Drug Development Unit, VHIO-Vall d'Hebron Institute of Oncology, HUVH-Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - A Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - D Mukherji
- Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - S Peters
- Oncology Department-CHUV, Lausanne University, Lausanne
| | - C Sessa
- Ente Ospedaliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - J Tsang
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - J C-H Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - P Garrido
- Universidad de Alcalá, Medical Oncology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
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8
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Fendl B, Berghoff AS, Preusser M, Maier B. Macrophage and monocyte subsets as new therapeutic targets in cancer immunotherapy. ESMO Open 2023; 8:100776. [PMID: 36731326 PMCID: PMC10024158 DOI: 10.1016/j.esmoop.2022.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 02/04/2023] Open
Abstract
The introduction of immune checkpoint inhibitors (ICIs) for the treatment of solid cancers dramatically turned the tables in clinical routine. However, therapy success is still limited with up to 70% of non-responders in patients with ICI treatment. Traditionally, most immunotherapy approaches aim at directly stimulating anti-tumor T cell responses. More recently, tumor-associated macrophages have come into focus due to their predominance in solid tumors. Intensive cross-talk with tumor cells and immune as well as stromal cells within the tumor microenvironment can drive either pro- or anti-tumorigenic macrophage phenotypes. In turn, tumor-associated macrophages strongly shape cytokine and metabolite levels in the tumor microenvironment and thus are central players in anti-tumor immunity. Thus, ambivalent macrophage populations exist which raises therapeutic possibilities to either enhance or diminish their functionality. However, molecular signals controlling tumor-associated macrophage polarization are incompletely understood. Gaining in-depth understanding of monocyte/macrophage properties both in circulation and within distinct tumor microenvironments would (i) allow the development of new therapeutic approaches, and (ii) could additionally aid our understanding of underlying mechanisms limiting current therapy with the option of combinatorial therapies to increase efficacy. In this review, we summarize recent data addressing heterogeneity of tumor-associated macrophage populations and we discuss strategies to target macrophages using known molecular pathways with the potential for straight-forward clinical application.
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Affiliation(s)
- B Fendl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - B Maier
- CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.
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9
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Hewitt KJ, Löffler CML, Muti HS, Berghoff AS, Eisenlöffel C, van Treeck M, Carrero ZI, El Nahhas OSM, Veldhuizen GP, Weil S, Saldanha OL, Bejan L, Millner TO, Brandner S, Brückmann S, Kather JN. Direct image to subtype prediction for brain tumors using deep learning. Neurooncol Adv 2023; 5:vdad139. [PMID: 38106649 PMCID: PMC10724115 DOI: 10.1093/noajnl/vdad139] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background Deep Learning (DL) can predict molecular alterations of solid tumors directly from routine histopathology slides. Since the 2021 update of the World Health Organization (WHO) diagnostic criteria, the classification of brain tumors integrates both histopathological and molecular information. We hypothesize that DL can predict molecular alterations as well as WHO subtyping of brain tumors from hematoxylin and eosin-stained histopathology slides. Methods We used weakly supervised DL and applied it to three large cohorts of brain tumor samples, comprising N = 2845 patients. Results We found that the key molecular alterations for subtyping, IDH and ATRX, as well as 1p19q codeletion, were predictable from histology with an area under the receiver operating characteristic curve (AUROC) of 0.95, 0.90, and 0.80 in the training cohort, respectively. These findings were upheld in external validation cohorts with AUROCs of 0.90, 0.79, and 0.87 for prediction of IDH, ATRX, and 1p19q codeletion, respectively. Conclusions In the future, such DL-based implementations could ease diagnostic workflows, particularly for situations in which advanced molecular testing is not readily available.
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Affiliation(s)
- Katherine J Hewitt
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
| | - Chiara M L Löffler
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Saxony, Germany
| | - Hannah Sophie Muti
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Dresden, Saxony, Germany
| | - Anna Sophie Berghoff
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Vienna, Vienna, Austria
| | - Christian Eisenlöffel
- Department of Pathology, St. Georg Teaching Hospital, University of Leipzig, Leipzig, Saxony, Germany
| | - Marko van Treeck
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
| | - Zunamys I Carrero
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
| | - Omar S M El Nahhas
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
| | - Gregory P Veldhuizen
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
| | - Sophie Weil
- Neurology Clinic, Department of Neurology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Baden- Württemberg, Germany
- Clinical Cooperation Unit Neuro-oncology, Department of Neurology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Baden- Württemberg, Germany
| | - Oliver Lester Saldanha
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
| | - Laura Bejan
- School of Medicine, Faculty of Medicine and Dentistry, University College London, London, Greater London, UK
| | - Thomas O Millner
- Division of Neuropathology, Queen Square Institute of Neurology, University College London, London, Greater London, UK
- Blizard Institute, Faculty of Medicine and Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, Greater London, UK
| | - Sebastian Brandner
- Division of Neuropathology, Queen Square Institute of Neurology, University College London, London, Greater London, UK
| | - Sascha Brückmann
- Institut für Pathologie, University Hospital Carl Gustav Carus, Dresden, Saxony, Germany
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
- Clinical Artificial Intelligence, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Saxony, Germany
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Saxony, Germany
- Pathology & Data Analytics, Faculty of Medicine and Health, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, West Yorkshire, UK
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Baden- Württemberg, Germany
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10
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Kiesel B, Kerschbaumer J, Prihoda R, Borkovec M, Thakur S, Mercea P, Feucht D, Steindl A, Berghoff AS, Furtner J, Leitner J, Romagna A, Schwartz C, Stefanits H, Marhold F, Rötzer T, Preusser M, Freyschlag C, Widhalm G. P11.55.B Postoperative MRI is able to detect an unexpected residual tumor after surgery of brain metastases: experience from 5 specialized centers. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.244] [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: 11/13/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) constitute the most common central nervous system tumors. The treatment options of BM consist of surgery, radiotherapy, radiosurgery, chemotherapy, and immunotherapy. Regarding surgery in BM, the extent of resection (EOR) represents a crucial factor for patient prognosis. However, first studies using postoperative MRI demonstrated that an unexpected residual tumor after surgery of BM is not uncommon despite these tumors were considered to be well-demarcated. The aim of this study was thus to investigate in a large cohort including multiple neurosurgical centers the EOR following BM resection, potential risk factors for incomplete resection and postsurgical follow-up data.
Material and Methods
In the current retrospective study conducted at 5 specialized neurosurgical centers in Austria, we included patients with BM resection and available postoperative MRI. The EOR following BM resection was determined by postoperative MRI (complete vs incomplete resection). Additionally, the data on the intraoperative judgement of the EOR of the performing neurosurgeon were collected. Moreover, potential factors for incomplete resection including tumor localization, tumor volume, primary tumor, pattern of contrast media enhancement on imaging and tumor eloquence were investigated. Finally, the rate of local progression of BM after initial surgery was analyzed in the follow-up period and overall survival data were collected.
Results
Altogether, 548 patients with 649 surgically treated BM were included. According to postoperative MRI, complete resection was achieved in 407 (66%) of 649 BM and incomplete resection in 176 (29%) of 649 BM. Misjudgment of the EOR by the neurosurgeon was found in 25% of cases and resulted in an unexpected residual tumor which was evident on postoperative MRI in 122 (22%) BM. Preoperative tumor volume was significantly larger in incompletely resected BM. Moreover, local progression was significantly more common in cases with incompletely resected BM and was also associated with shorter overall survival.
Conclusion
Our data of this study including multiple centers indicate that postoperative MRI is capable to detect a relatively high rate of unexpected residual tumors following resection of BM. Since local progression was more common in BM with residual tumors and this was associated with shorter survival, special attention should be paid to achieve a complete tumor resection.
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Affiliation(s)
- B Kiesel
- Medical University Vienna , Vienna , Austria
| | | | - R Prihoda
- Universitätsklinikum St. Pölten , St. Pölten , Austria
| | - M Borkovec
- Medical University Vienna , Vienna , Austria
| | - S Thakur
- University Hospital Salzburg , Salzburg , Austria
| | - P Mercea
- Medical University Vienna , Vienna , Austria
| | - D Feucht
- Medical University Vienna , Vienna , Austria
| | - A Steindl
- Medical University Vienna , Vienna , Austria
| | | | - J Furtner
- Medical University Vienna , Vienna , Austria
| | - J Leitner
- Medical University Vienna , Vienna , Austria
| | - A Romagna
- University Hospital Salzburg , Salzburg , Austria
| | - C Schwartz
- University Hospital Salzburg , Salzburg , Austria
| | - H Stefanits
- Kepler Universitätsklinikum , Linz , Austria
| | - F Marhold
- Universitätsklinikum St. Pölten , St. Pölten , Austria
| | - T Rötzer
- Medical University Vienna , Vienna , Austria
| | - M Preusser
- Medical University Vienna , Vienna , Austria
| | | | - G Widhalm
- Medical University Vienna , Vienna , Austria
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11
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Berghoff AS, Bartsch R, Furtner J, Marhold M, Bergen ES, Roider-Schur S, Starzer AM, Forstner H, Rottenmanner B, Dieckmann K, Bago-Horvath Z, Widhalm G, Ilhan-Mutlu A, Minichsdorfer C, Fuereder T, Singer CF, Weltermann A, Haslacher H, Szekeres T, Puhr R, Preusser M. OS01.5.A Neuron-specific enolase (NSE) and S100 serum levels in patients with active brain metastases from HER2-positive breast cancer treated with trastuzumab-deruxtecan (T-DXd): A biomarker analysis from the TUXEDO-1 trial. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.030] [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: 11/14/2022] Open
Abstract
Abstract
Background
T-DXd is a novel antibody-drug conjugate with high activity in HER2-positive metastatic breast cancer. The prospective, single-arm, single-centre phase II TUXEDO-1 trial showed clinically relevant activity of T-DXd in HER2-positive BC pts with active BM with an intracranial response rate of 73.3%. This biomarker sub-study of TUXEDO-1 aimed to investigate changes in the extent of metastases-induced brain damage in patients with and without response to therapy by measuring the serum levels of two proteins constitutively expressed in the human brain and measurable upon brain damage in the blood serum: NSE and S100.
Material and Methods
We assessed serum NSE (sNSE) and serum S100 (sS100) levels in a total of 37 blood samples drawn at cycles 1, 4 and end of treatment (EOT) in all patients of the intent-to-treat population of the TUXEDO-1 trial using commercially available ELISA assays. Intracranial radiological response was centrally assessed by a board-certified neuro-radiologist using RANO criteria. sNSE and sS100 levels were compared between responders and non-responders using the Mann Whitney U test and a significance level of 0.05.
Results
At baseline, we detected no significant difference of sNSE or sS100 levels between T-DXd responders and non-responders, respectively. Baseline median sNSE level was 10.6 ng/ml (interquartile range (IQR) 8.6-12.2) in T-DXd responders as compared with median 12.5 ng/ml (IQR 12.2-12.9) in the non-responder group (n.s.). At cycle 4, corresponding numbers were 8.1 ng/ml in responding patients (IQR 7-11.2) and 12.7 ng/ml (IQR 12.2-12.9) in non-responders, respectively (p=0.009). No differences in sS100 levels were observed between the groups at any time point.
Conclusion
In patients showing intracranial objective response to T-Dxd, sNSE levels were significantly lower at cycle 4 as compared with non-responders, suggesting a reduction in metastases-induced brain damage as a direct treatment effect. sNSE may be a clinically useful biomarker for longitudinal assessment of brain metastasis burden.
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Affiliation(s)
- A S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - R Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - J Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna , Vienna , Austria
| | - M Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - E S Bergen
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - S Roider-Schur
- Department of Medicine I, Oncology, St. Josef Krankenhaus , Vienna , Austria
| | - A M Starzer
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - H Forstner
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - B Rottenmanner
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - K Dieckmann
- Department of Radiotherapy, Medical University of Vienna , Vienna , Austria
| | - Z Bago-Horvath
- Department of Pathology, Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - A Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - C Minichsdorfer
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - T Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - C F Singer
- Departments of Gynaecology, Medical University of Vienna , Vienna , Austria
| | - A Weltermann
- Department of Medicine 1, Academic Teaching Hospital Elisabethinen Linz , Vienna , Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna , Vienna , Austria
| | - T Szekeres
- Department of Laboratory Medicine, Medical University of Vienna , Vienna , Austria
| | - R Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - M Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
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12
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Starzer AM, Kleinberger M, Feldmann K, Tomasich E, Hatziioannou T, Paiato C, Heller G, Kreminger J, Traint S, Steindl A, Ressler JM, Widhalm G, Gatterbauer B, Dieckmann K, Müllauer L, Preusser M, Berghoff AS. OS03.5.A Characterization of the inflammatory tumor microenvironment composition in solid cancer patients with brain metastases after progression to immune checkpoint inhibitor therapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.037] [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: 11/14/2022] Open
Abstract
Abstract
Background
Immunotherapy (IO) has changed the treatment landscape of metastatic cancer patients, however, treatment resistance is frequent. We aimed to characterize the inflammatory tumor microenvironment in brain metastases (BM) after IO to gain a deeper understanding of immunologic escape mechanisms.
Material and Methods
Solid cancer patients who had BM resection after IO progression (IO cohort) were retrospectively identified. We analyzed tumor-infiltrating immune cell subsets (CD3, CD8, CD45RO, FOXP3) and expression of immune checkpoint molecules (PD-L1, PD-1, LAG-3) by immunohistochemistry. A control cohort of BM tissue samples without prior IO served for comparison (no immunotherapy cohort, NIO).
Results
Twenty-eight IO patients (12/28, 42.9% females; 16/28, 57.1% males; median 61 years; 14/28, 50% lung cancer; 5/28, 17.9% melanoma; 4/28, 14.3% renal cell carcinoma; 1/28, 3.6% breast cancer; 4/28, 14.3% other cancer entities) and 57 NIO patients (28/57, 49.1% females; 29/57, 50.9% males; median 58 years; 35/57, 61.4% lung cancer; 9/57, 15.8% breast cancer; 4/57, 7.0% melanoma; 3/57, 5.3% renal cell carcinoma; 6/57, 10.5% other cancer entities) were included. IO patients had a median of one (range 0-4) systemic therapy line prior to IO. Median time from last IO application until BM resection was 5.6 months (range 0.2-49.8 months). Patients received a median number of 7 (range 1-56) IO applications (14/28, 50% PD-1-targeting IO; 8/28, 28.6% PD-L1; 2/28, 7.1% CTLA4; 4/28, 14.3% CTLA4+PD-1; 3/28, 10.7% IO+chemotherapy). No statistically significant differences in the densities of investigated TILs or PD-L1 expression between the IO and the NIO cohort were observed. Patients of the IO cohort showed higher PD-L1 expression compared to the NIO cohort (57.1 vs. 42.1%, Chi-square, p>0.05). Overall survival (OS) was similar in both cohorts, with a median OS of 11.0 months (range 5.0-17.0) in the IO cohort and 11.0 months (range 5.5-16.5) in the NIO cohort.
Conclusion
Our findings show an upregulation of PD-L1 in BM occurring after prior IO therapy in the absence of other overt changes in the inflammatory microenvironment. Ongoing analyses in this cohort are investigating possible molecular driver of resistance by analyzing DNA methylation profiles of pre-and post-IO tissue samples of the IO cohort to potentially gain insights on inflammatory IO resistance mechanisms in BM patients.
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Affiliation(s)
- A M Starzer
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - M Kleinberger
- Medical University of Vienna, Division of Oncology , Vienna , Austria
| | - K Feldmann
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - E Tomasich
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - T Hatziioannou
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - C Paiato
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - G Heller
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - J Kreminger
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - S Traint
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - A Steindl
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - J M Ressler
- Medical University of Vienna, Department of Dermatology , Vienna , Austria
| | - G Widhalm
- Medical University of Vienna, Department of Neurosurgery , Vienna , Austria
| | - B Gatterbauer
- Medical University of Vienna, Department of Neurosurgery , Vienna , Austria
| | - K Dieckmann
- Medical University of Vienna, Department of Radiotherapy , Vienna , Austria
| | - L Müllauer
- Medical University of Vienna, Department of Pathology , Vienna , Austria
| | - M Preusser
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - A S Berghoff
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
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13
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Mair MJ, Leibetseder A, Heller G, Puhr R, Tomasich E, Hatziioannou T, Woehrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Pichler J, Preusser M, Berghoff AS. P11.27.B Whole genome DNA methylation as predictive biomarker in CNS WHO grade 2 and 3 oligodendroglioma patients receiving early postoperative treatment. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.216] [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: 11/14/2022] Open
Abstract
Abstract
Background
Oligodendrogliomas are glial tumors with a relatively favorable survival prognosis of >10 years. While immediate postoperative treatment prolongs survival, long-term toxicities of adjuvant radio-chemotherapy remain a concern. Predictive biomarkers guiding postoperative treatment decisions are limited.
Material and Methods
In this retrospective study, we included patients treated for a newly diagnosed oligodendroglioma (isocitrate dehydrogenase (IDH)-mutated, 1p/19q-codeleted, CNS WHO grades 2 and 3) in 1992 - 2019 at the Medical University of Vienna or the Kepler University Hospital Linz (Austria). Early treatment was defined as radiotherapy, chemotherapy, or both within 6 months after resection, whereas benefit from early treatment was defined as progression-free survival (PFS) above the median in the overall cohort. DNA methylation analysis was performed using Illumina MethylationEPIC 850k microarrays.
Results
Of all 201 eligible patients, sufficient tumor tissue for DNA methylation analysis was available in 46 patients. Of these, 25/46 (54.3%) were diagnosed with CNS WHO grade 2 and 21/46 (45.6%) with grade 3 oligodendroglioma. Median age at diagnosis was 41 years (range: 23-70). In total, 21/46 (45.6%) patients received early treatment, of whom 13/21 (61.9%) received radio-chemotherapy, 6/21 (28.6%) radiotherapy only and 2/21 (9.5%) chemotherapy only. Median PFS was 134.0 months (95%CI: 78.3 - not reached) in patients receiving early treatment versus 87.2 months (95%CI: 66.8 - 150) in patients who did not. In patients receiving early treatment, differences in DNA methylation profiles could be detected between patients who drew benefit from postoperative treatment (group 1) versus those who did not (group 2). Based on the top 1000 differentially methylated CpG sites between both groups, two clusters were detected which comprised either patients of group 1 or 2. Clustering was independent from gender, WHO grade, extent of resection, type of postoperative treatment, treating center, and O6-methylguanine-methyltransferease (MGMT) promoter methylation status. Gene set enrichment analysis of the top 1000 differentially methylated gene sites mapped to 694 genes showed differential methylation in genes involved in fibroblast growth receptor 1 (FGFR1) signaling, Wnt signaling, integrin signaling, and actin cytoskeleton regulation. Conversely, in patients not receiving early treatment, PFS did neither correlate with DNA methylation clustering nor with MGMT promoter methylation.
Conclusion
In our cohort, whole genome DNA methylation was associated with PFS in patients who received early postoperative treatment, suggesting a predictive but not prognostic role. As the predictive value of MGMT promoter methylation is limited in oligodendroglioma, whole genome DNA methylation should be considered in future clinical trials.
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Affiliation(s)
- M J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - G Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - R Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - E Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - T Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna , Vienna , Austria
| | - M Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - S Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - T von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - J Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
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14
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Puhr HC, Puhr R, Kuchling DA, Jahic L, Takats J, Reiter TJ, Paireder M, Jomrich G, Schoppmann SF, Berghoff AS, Preusser M, Ilhan-Mutlu A. Development of an alarm symptom-based risk prediction score for localized oesophagogastric adenocarcinoma (VIOLA score). ESMO Open 2022; 7:100519. [PMID: 35759854 PMCID: PMC9434169 DOI: 10.1016/j.esmoop.2022.100519] [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] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Gastroesophageal adenocarcinoma is a major contributor to global disease burden with poor prognosis even in resectable, regionally limited stages. Feasible prognostic tools are crucial to improve patient management, yet scarce. PATIENTS AND METHODS Disease-related symptoms, patient, tumour, treatment as well as laboratory parameters at initial diagnosis and overall survival (OS) of patients with stage II and III gastroesophageal adenocarcinoma, who were treated between 1990 and 2020 at the Medical University of Vienna, were evaluated in a cross-validation model to develop a feasible risk prediction score. RESULTS In total, 628 patients were included in this single-centre analysis. The final score ranked from 0 to 10 and included the factors sex (female +1), age, years (30-59 +1, >60 +2), underweight classified by body mass index (+2), location of the tumour (stomach +1), stage (III +2), stenosis in endoscopy (+1) and weight loss (+1). The score was grouped into low- (0-3), medium- (4-6) and high-risk (7+) subgroups. The median OS were 70.3 [95% confidence interval (CI) 51.2-111.8], 23.4 (95% CI 21.2-26.7) and 12.6 (7.0-16.1) months, respectively. The 1-year survival probabilities were 0.88 (95% CI 0.83-0.93), 0.75 (95% CI 0.70-0.79) and 0.54 (95% CI 0.39-0.74), whereas the 5-year survival probabilities were 0.57 (95% CI 0.49-0.66), 0.24 (95% CI 0.20-0.28) and 0.09 (95% CI 0.03-0.28), respectively. CONCLUSIONS The VIennese risk prediction score for Oesophagogastric Localized Adenocarcinoma (VIOLA) risk prediction score poses a feasible tool for the estimation of OS in patients with regionally limited gastroesophageal adenocarcinoma and, thus, may improve patient management in clinical routine. Prospective analyses should be carried out to confirm our findings.
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Affiliation(s)
- H C Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - R Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - D A Kuchling
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - L Jahic
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J Takats
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - T J Reiter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Paireder
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - G Jomrich
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - S F Schoppmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
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15
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Millesi M, Ryba AS, Hainfellner JA, Roetzer T, Berghoff AS, Preusser M, Heller G, Tomasich E, Sahm F, Roessler K, Wolfsberger S. DNA Methylation Associates With Clinical Courses of Atypical Meningiomas: A Matched Case-Control Study. Front Oncol 2022; 12:811729. [PMID: 35356207 PMCID: PMC8959647 DOI: 10.3389/fonc.2022.811729] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023] Open
Abstract
Background Accounting for 15–20% of all meningiomas, WHO grade II meningiomas represent an intermediate group regarding risk of tumor recurrence. However, even within this subgroup varying clinical courses are observed with potential occurrence of multiple recurrences. Recently, DNA methylation profiles showed their value for distinguishing biological behaviors in meningiomas. Therefore, aim of this study was to investigate DNA methylation profiles in WHO grade II meningiomas. Methods All patients that underwent resection of WHO grade II meningiomas between 1993 and 2015 were screened for a dismal course clinical course with ≥2 recurrences. These were matched to control cases with benign clinical courses without tumor recurrence. DNA methylation was assessed using the Infinium Methylation EPIC BeadChip microarray. Unsupervised hierarchical clustering was performed for identification of DNA methylation profiles associated with such a dismal clinical course. Results Overall, 11 patients with WHO grade II meningiomas with ≥2 recurrences (Group dismal) and matched 11 patients without tumor recurrence (Group benign) were identified. DNA methylation profiles revealed 3 clusters—one comprising only patients of group dismal, a second cluster comprising mainly patients from group benign and a third cluster comprising one group dismal and one group benign patient. Based on differential methylation pattern associations with the Wnt and the related cadherin signaling pathway was observed. Conclusion DNA methylation clustering showed remarkable differences between two matched subgroups of WHO grade II meningiomas. Thus, DNA methylation profiles may have the potential to support prognostic considerations regarding meningioma recurrence and radiotherapeutic treatment allocation after surgical resection.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Alice Senta Ryba
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit (CCU), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
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16
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Starzer AM, Heller G, Tomasich E, Melchardt T, Feldmann K, Hatziioannou T, Traint S, Minichsdorfer C, Schwarz-Nemec U, Nackenhorst M, Müllauer L, Preusser M, Berghoff AS, Fuereder T. DNA methylation profiles differ in responders versus non-responders to anti-PD-1 immune checkpoint inhibitors in patients with advanced and metastatic head and neck squamous cell carcinoma. J Immunother Cancer 2022; 10:jitc-2021-003420. [PMID: 35338086 PMCID: PMC8961155 DOI: 10.1136/jitc-2021-003420] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Biomarkers for response prediction to anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors (ICI) in patients with head and neck squamous cell carcinoma (HNSCC) are urgently needed for a personalized therapy approach. We investigated the predictive potential of inflammatory parameters and DNA methylation profiling in patients with HNSCC treated with anti-PD-1 ICI. METHODS We identified patients with HNSCC that were treated with anti-PD-1 ICI therapy in the recurrent or metastatic setting after progression to platinum-based chemotherapy in two independent centers. We analyzed DNA methylation profiles of >850.000 CpG sites in tumor specimens of these patients by Infinium MethylationEPIC microarrays, immune cell density in the tumor microenvironment (CD8, CD3, CD45RO, forkhead box P3 (FOXP3), CD68), PD-1 and programmed cell death ligand 1 (PD-L1) expression by immunohistochemistry, and blood inflammation markers (platelet-to-lymphocyte ratio, leucocyte-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio). DNA methylation profiles and immunological markers were bioinformatically and statistically correlated with radiological response to anti-PD-1 ICI. RESULTS 37 patients with HNSCC (median age of 62 years; range 49-83; 8 (21.6%) women, 29 (78.4%) men) were included (Center 1 N=26, 70.3%; Center 2 N=11, 29.7%). Median number of prior systemic therapies was 1 (range 1-4). Five out of 37 (13.5%) patients achieved an objective response to ICI. Median progression-free survival and median overall survival times were 3.7 months (range 0-22.9) and 9.0 months (range 0-38.8), respectively. Microarray analyses revealed a methylation signature including both hypomethylation and hypermethylation which was predictive for response to ICI and included several genes involved in cancer-related molecular pathways. Over-represented differentially methylated genes between responders and non-responders were associated with 'Axon guidance', 'Hippo signaling', 'Pathways in cancer' and 'MAPK signaling'. A statistically significant correlation of PD-L1 expression and response was present (p=0.0498). CONCLUSIONS Our findings suggest that tumor DNA methylation profiling may be useful to predict response to ICI in patients with HNSCC.
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Affiliation(s)
- Angelika Martina Starzer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Melchardt
- Laboratory for Immunological and Molecular Cancer Research, Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Katharina Feldmann
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Traint
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Minichsdorfer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria .,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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17
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Kaul D, Sophie Berghoff A, Grosu AL, Weiss Lucas C, Guckenberger M. Focal Radiotherapy of Brain Metastases in Combination With Immunotherapy and Targeted Drug Therapy. Dtsch Arztebl Int 2021; 118:arztebl.m2021.0332. [PMID: 34730083 PMCID: PMC8841640 DOI: 10.3238/arztebl.m2021.0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advances in systemic treatment and in brain imaging have led to a higher incidence of diagnosed brain metastases. In the treatment of brain metastases, stereotactic radiotherapy and radiosurgery, systemic immunotherapy, and targeted drug therapy are important evidence-based options. In this review, we summarize the available evidence on the treatment of brain metastases of the three main types of cancer that give rise to them: non-small-cell lung cancer, breast cancer, and malignant melanoma. METHODS This narrative review is based on pertinent original articles, meta-analyses, and systematic reviews that were retrieved by a selective search in PubMed. These publications were evaluated and discussed by an expert panel including radiation oncologists, neurosurgeons, and oncologists. RESULTS There have not yet been any prospective randomized trials concerning the optimal combination of local stereotactic radiotherapy/radiosurgery and systemic immunotherapy or targeted therapy. Retrospective studies have consistently shown a benefit from early combined treatment with systemic therapy and (in particular) focal radiotherapy, compared to sequential treatment. Two metaanalyses of retrospective data from cohorts consisting mainly of patients with non-small-cell lung cancer and melanoma revealed longer overall survival after combined treatment with focal radiotherapy and checkpoint inhibitor therapy (rate of 12-month overall survival for combined versus non-combined treatment: 64.6% vs. 51.6%, p <0.001). In selected patients with small, asymptomatic brain metastases in non-critical locations, systemic therapy without focal radiotherapy can be considered, as long as follow-up with cranial magnetic resonance imaging can be performed at close intervals. CONCLUSION Brain metastases should be treated by a multidisciplinary team, so that the optimal sequence of local and systemic therapies can be determined for each individual patient.
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Affiliation(s)
- David Kaul
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
| | - Anna Sophie Berghoff
- Department of Medicine 1 and Comprehensive Cancer Center Vienna, Medical University of Vienna
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg
| | - Carolin Weiss Lucas
- Center of Neurosurgery, University of Cologne, Faculty of Medicine und University Hospital Cologne
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18
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Le Rhun E, Guckenberger M, Smits M, Dummer R, Bachelot T, Sahm F, Galldiks N, de Azambuja E, Berghoff AS, Metellus P, Peters S, Hong YK, Winkler F, Schadendorf D, van den Bent M, Seoane J, Stahel R, Minniti G, Wesseling P, Weller M, Preusser M. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol 2021; 32:1332-1347. [PMID: 34364998 DOI: 10.1016/j.annonc.2021.07.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 66.3] [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: 04/27/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- E Le Rhun
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - R Dummer
- Department of Dermatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - T Bachelot
- Département de Cancérologie Médicale, Centre Léon Bérard, Lyon, France
| | - F Sahm
- Department of Neuropathology, University of Heidelberg and Clinical Cooperation Unit Neuropathology, German Consortium for Transnational Cancer Research (DKTK), German Cancer Research Center (DKFZ) and Hopp Children's Cancer Center, Heidelberg, Germany
| | - N Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center of Integrated Oncology (CIO) Aachen, Bonn, Cologne and Duesseldorf, University of Cologne, Cologne, Germany
| | - E de Azambuja
- Medical Oncology Department, Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A S Berghoff
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - P Metellus
- Ramsay Santé, Hôpital Privé Clairval, Department of Neurosurgery, Marseille; Aix-Marseille University, CNRS, INP, Neurophysiopathology Institute, Marseille, France
| | - S Peters
- Department of Oncology, University Hospital, Lausanne, Switzerland
| | - Y-K Hong
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - F Winkler
- Neurology Clinic, Heidelberg University Medical Center, Clinical Cooperation Unit, Neuro-oncology, German Cancer Research Center, Heidelberg, Germany
| | - D Schadendorf
- University Hospital Essen, Department of Dermatology, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - M van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J Seoane
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Universitat Autònoma de Barcelona. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona; CIBERONC, Madrid, Spain
| | - R Stahel
- Department for Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - G Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - P Wesseling
- Department of Pathology, Amsterdam University Medical Centers/VUmc and Brain Tumour Center, Amsterdam, the Netherlands; Laboratory for Childhood Cancer Pathology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - M Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Preusser
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
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19
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Steindl A, Brunner TJ, Heimbach K, Schweighart K, Moser GM, Niziolek HM, Moor E, Kreminger J, Starzer AM, Dieckmann K, Gatterbauer B, Widhalm G, Preusser M, Berghoff AS. P14.03 Shifting trends and entity-specific aspects in patients with brain metastasis: real-life analysis from 6031 individuals over an observation period of 30 years. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.132] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
We aimed to investigate the changing clinical characteristics of patients with brain metastases (BM) over the last three decades as the foundation for modern BM specific clinical trial planning.
MATERIAL AND METHODS
6031 patients with newly diagnosed BM from different solid tumors treated between 1986–2020 were identified from the Vienna Brain Metastasis Registry.
RESULTS
The fraction of BM originating from the most common BM causing primary tumors (lung cancer, breast cancer and melanoma) was stable over the observation period from 1986–2020. BM from renal cell carcinoma, colorectal cancer and cancer of unknown primary (CUP) decreased over time (p<0.001). Synchronous diagnosis of BM and primary tumor was more frequently observed in lung cancer and CUP patients compared to breast cancer patients (p<0.001). An increasing fraction of patients presented with asymptomatic BM (1986–1999: 20.2% vs. 2010–2020: 30.4%; p<0.001), specifically in lung cancer (p<0.001), melanoma (p<0.001) and renal cell cancer (p=0.004). A decrease of neurosurgical procedures (1986–1999: 39.3% vs. 2010–2020: 20.4%) and an increase of radiation treatments (1986–1999: 56.5% vs. 2010–2020: 73.0%) and systemic therapies (1986–1999: 0.6% vs. 2010–2020: 2.4%; p<0.001) was observed. Furthermore, median overall survival significantly increased across entities (1986–1999: 5 months vs. 2010–2020: 7 months; p=0.001). Intracranial progression as the cause of death increased across entities (p< 0.001). The prognostic DS-GPA (Hazard ratio [HR] 1.42; p< 0.001) and the Lung-molGPA (HR 1.67; p<0.001) could be validated.
CONCLUSION
We observed changes of BM presentation and clinical parameters during the observation period depending on primary tumor origins. Future BM studies should follow an entity-specific approach and address the characteristics of modern BM cohorts.
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Affiliation(s)
- A Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - T J Brunner
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Heimbach
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Schweighart
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - G M Moser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - H M Niziolek
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - E Moor
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J Kreminger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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20
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Mair MJ, Leibetseder A, Wöhrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Pichler J, Preusser M, Berghoff AS. P14.14 Adjuvant treatment versus initial observation in newly diagnosed WHO grade II and grade III oligodendroglioma: real-life data from two academic, tertiary care centers in Austria. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.139] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Oligodendrogliomas are rare, slow-growing brain tumors with a survival prognosis of >10 years. Although adjuvant radio-chemotherapy has been shown to prolong survival, aggressive treatment comes at the cost of increased toxicity. Systematic data on the optimal timing of adjuvant treatment in oligodendroglioma are lacking.
MATERIAL AND METHODS
Patients treated for a newly diagnosed IDH-mutated, 1p/19q-codeleted oligodendroglioma (WHO grades II/III) in 2000 - 2018 at the Medical University of Vienna or the Kepler University Hospital Linz (Austria) were included in this retrospective study. Adjuvant treatment was defined as radiotherapy (RT), chemotherapy (CHT) or radio-chemotherapy (R-CHT) within 6 months after resection in the absence of progression. “Wait and see” was defined as regular follow up with magnetic resonance imaging and treatment at progression.
RESULTS
185 patients were identified, comprising 123/185 (66.5%) WHO grade II and 62/185 (33.5%) WHO grade III oligodendrogliomas. Median age at diagnosis was 42 years (range: 20–82). Gross total resection (GTR) could be achieved in 77/178 (42.3%) evaluable patients. Adjuvant treatment was applied in 63/185 (38.2%) patients, of whom 43/63 (68.3%) underwent R-CHT, 9/63 (14.3%) CHT only and 11/63 (17.5%) RT only. 43/52 (82.7%) received temozolomide-based treatment, 1/52 (1.9%) procarbazine, lomustine and vincristine (PCV), 1/52 dacarbazine/fotemustine and in 7/52 (13.5%) patients, no data on used regimens was available. Adjuvant treatment was more frequently applied in WHO grade 3 tumors (p<0.001), while there was no association of adjuvant treatment with extent of resection (p=0.24). Patients after GTR who underwent adjuvant therapy presented with longer progression-free survival (PFS) compared to patients initially managed with observation (median: 150 months, 95%CI: 100 - not reached (n.r.) vs. median: 101 months, 95%CI: 73.2–115; p=0.053). In non-GTR tumors, patients with adjuvant therapy presented with a significantly longer median PFS of 107.5 months (95%CI: 62.8-n.r.) as compared to patients initially managed with observation (45.3 months, 95%CI: 41.2–78.8; p=0.025).
CONCLUSION
The application of adjuvant therapy was associated with favorable PFS in patients who underwent resection of newly diagnosed oligodendroglioma in this retrospective study. Prospective clinical trials should investigate the risks and benefits of adjuvant treatment versus initial observation in patients with oligodendroglioma.
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Affiliation(s)
- M J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - A Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - M Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - S Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - T von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - J Pichler
- Department of Internal Medicine and Neurooncology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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21
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Bergen ES, Scherleitner P, Ferreira P, Kiesel B, Müller C, Widhalm G, Dieckmann K, Prager G, Preusser M, Berghoff AS. Primary tumor side is associated with prognosis of colorectal cancer patients with brain metastases. ESMO Open 2021; 6:100168. [PMID: 34098230 PMCID: PMC8190486 DOI: 10.1016/j.esmoop.2021.100168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background Brain metastases (BM) are a rare complication in colorectal cancer (CRC) patients and associated with an unfavorable survival prognosis. Primary tumor side (PTS) was shown to act as a prognostic and predictive biomarker in several trials including metastatic CRC (mCRC) patients. Here, we aim to investigate whether PTS is also associated with the outcome of CRC patients with BM. Methods Patients treated for CRC BM between 1988 and 2017 at an academic care center were included. Right-sided CRC was defined as located in the appendix, cecum and ascending colon and left-sided CRC was defined as located in the descending colon, sigma and rectum. Results Two hundred and eighty-one CRC BM patients were available for this analysis with 239/281 patients (85.1%) presenting with a left-sided and 42/281 patients (14.9%) with a right-sided primary CRC. BM-free survival (BMFS) was significantly longer in left-sided compared with right-sided CRC patients (33 versus 20 months, P = 0.009). Overall survival from CRC diagnosis as well as from diagnosis of BM was significantly longer in patients with a left-sided primary (42 versus 25 months, P = 0.002 and 5 versus 4 months, P = 0.005, respectively). In a multivariate analysis including graded prognostic assessment, PTS remained significantly associated with prognosis after BM (hazard ratio 0.65; 95% confidence interval: 0.46-0.92 months, P = 0.0016). Conclusions PTS was associated with survival times after the rare event of BM development in CRC patients. Therefore, its prognostic value remains significant even thereafter. Primary tumor side is a relevant and independent prognostic factor in mCRC. Left-sided CRC was associated with a significantly longer BMFS compared with right-sided CRC. OS from initial diagnosis of CRC as well as from BM was significantly longer in patients with left-sided primaries.
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Affiliation(s)
- E S Bergen
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - P Scherleitner
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - P Ferreira
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - B Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - C Müller
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiooncology, Medical University of Vienna, Vienna, Austria
| | - G Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
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22
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Steindl A, Nackenhorst M, Puhr HC, Marhold M, Sinn K, Hoetzenecker K, Hoda MA, Preusser M, Berghoff AS. Systemic and local inflammation characteristics in patients with cancer after lung transplantation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14527 Background: Immune suppressive treatment is associated with an increased cancer risk due to its negative impact on immunosurveillance. We analyzed the association of immune suppressive treatment with the inflammatory tumor microenvironment and systemic inflammation parameters in patients with solid cancers after lung transplantation. Methods: Systemic inflammation was measured by neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and CRP/albumin ratio (CRP/Alb) and analyzed at time of lung transplantation and time of tumor diagnosis. In tumor samples, the expression of tumor infiltrating lymphocytes (TIL) including CD3, CD8, CD45RO and PD-L1 using the Ventana Benchmark Ultra system for immunohistochemistry were investigated. Automated tissue analyses were performed for CD3, CD8 and CD45RO TIL (Definiens software). PD-L1 expression was determined by using the combined positive score (CPS). Results: 28 patients with cancer (10 lung cancer, 4 colorectal cancer, 2 renal cell carcinoma, 2 gastric cancer, 2 pancreatic cancer, 2 head&neck tumor, and others) were included in the study. Median time from transplantation to cancer diagnosis was 45 months (range 29-61). 57% (16/28) experienced a period of transplant rejection between transplantation and tumor diagnosis. Therefore, 25% (7/28) of the patients received intensified immunosuppression up to 8 weeks before tumor diagnosis. Median density of CD3+TIL was 5742 cells/ mm2 (range 3,203-8,429), median density of CD8+TIL was 6,363 cells/ mm2 (range 3,643-8,190), median density of CD45RO TIL was 72 cells/ mm2 (range 4-635) and median expression of PD-L1 was 60 (range 5-100) in tumor samples. No statistically significant changes in systemic inflammation were observed from time of transplantation to time of tumor diagnosis (p>0.05; Wilcoxon Signed-Rank Test). Furthermore, a history of transplant rejection before tumor diagnosis was not statistically significant associated with changes in TIL densities or systemic inflammation parameters (p>0.05; Mann Whitney U test). Conclusions: An activated local inflammatory tumor microenvironment as well as stable systemic inflammation characteristics were observed in our cohort. These results support the further development of immunotherapy as treatment approach also in cancer patients under immunosuppression after lung transplantation.[Table: see text]
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Affiliation(s)
- Ariane Steindl
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Hannah Christina Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Katharina Sinn
- Medical University of Vienna, Division of Thoracic Surgery, Vienna, Austria
| | | | - Mir Alireza Hoda
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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23
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Bergen ES, Binter A, Starzer AM, Heller G, Kiesel B, Tendl-Schulz K, Bago-Horvath Z, Furtner J, Leitner J, Exner R, Fitzal F, Dieckmann K, Widhalm G, Preusser M, Berghoff AS, Bartsch R. Favourable outcome of patients with breast cancer brain metastases treated with dual HER2 blockade of trastuzumab and pertuzumab. Ther Adv Med Oncol 2021; 13:17588359211009002. [PMID: 33995593 PMCID: PMC8072867 DOI: 10.1177/17588359211009002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/17/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Dual human epidermal growth factor receptor 2 (HER2) blockade with trastuzumab and pertuzumab (TP) is a standard therapy of metastatic and localized HER2-positive breast cancer (BC), but its activity in breast cancer brain metastases (BCBM) is unknown. Methods: Patients with HER2-positive BCBM were identified from the Vienna Brain Metastasis Registry and clinical data including patient characteristics, therapies and overall survival (OS) were obtained. Patients were grouped into ‘TP’, ‘other-HER2-targeted therapy’ and ‘no-HER2-targeted therapy’ according to received first-line systemic therapy after diagnosis of BCBM. Radiological re-assessment of intracranial lesions was performed in patients treated with TP as systemic first-line therapy according to RANO response criteria for brain metastases (BM). Results: A total of 252 HER2-positive BC patients with BM were available for this analysis. Patients treated with TP as systemic first-line therapy after diagnosis of BM had a significantly longer OS compared with treatment with other-HER2-targeted therapy and no-HER2-targeted therapy (44 versus 17 versus 3 months, p < 0.001; log-rank test). Among radiologically re-assessed patients treated with TP as systemic first-line therapy after diagnosis of BM, 5/14 patients (35.7%) had complete intracranial remission (CR), 8/14 patients (57.1%) partial intracranial remission (PR), 1/14 patients (7.1%) stable intracranial disease (SD) and 0/14 patients (0.0%) progressive intracranial disease (PD) as best response resulting in an intracranial objective response rate (iORR) of 92.9% and an intracranial clinical benefit rate (iCBR) of 100.0%. Conclusion: First-line therapy with dual HER2-inhibition of TP after BM diagnosis was associated with the longest median OS times in patients with BCBM.
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Affiliation(s)
| | - Amelie Binter
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | | | - Gerwin Heller
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | - Julia Furtner
- Department of Radiology, Medical University of Vienna, Austria
| | | | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Austria
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiooncology, Medical University of Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
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24
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Steindl A, Alpar D, Heller G, Mair MJ, Gatterbauer B, Dieckmann K, Widhalm G, Hainfellner JA, Schmidinger M, Bock C, Müllauer L, Preusser M, Berghoff AS. Tumor mutational burden and immune infiltrates in renal cell carcinoma and matched brain metastases. ESMO Open 2021; 6:100057. [PMID: 33588158 PMCID: PMC7890370 DOI: 10.1016/j.esmoop.2021.100057] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tumor mutational burden (TMB) and density of tumor-infiltrating lymphocytes (TIL) have been postulated as predictive biomarkers for immunotherapy. Therefore, we investigated the concordance of TMB and TIL of primary/extracranial renal cell carcinoma (RCC) specimens and matched brain metastases (BM). PATIENTS AND METHODS Twenty specimens from 10 patients were retrieved from the Vienna Brain Metastasis Registry (6/10 primary tumor, 4/10 lung metastasis, 10/10 matched BM). TMB was assessed using the TruSight Oncology 500 gene panel with libraries sequenced on a NextSeq instrument. TIL subsets (CD3+, CD8+, CD45RO+, FOXP3+, PD-L1+) were investigated using immunohistochemistry (Ventana Benchmark Ultra system) and automated tissue analysis (Definiens software). RESULTS No significant difference in TMB, CD3+, CD8+, CD45RO+, FOXP3+ or PD-L1+ expression was observed between extracranial and matched intracranial specimens (P > 0.05). Higher CD8+ TIL (P = 0.053) and CD45RO+ TIL (P = 0.030) densities in the primary tumor compared with the intracranial samples were observed in specimens collected after exposure to systemic treatment. Neither extracranial sample origin (lung metastasis versus primary RCC) nor extracranial disease status at BM diagnosis (progressive versus stable disease) were significantly associated with TMB or TIL densities in extracranial and intracranial samples (P > 0.05). No significant correlation was found between the median differences of TMB or TIL densities from extracranial to intracranial samples and BM-free survival. CONCLUSION The comparable immunological microenvironment of extra- and intracranial tumor samples in our study underscores the immunological activation also in BM from RCC, and therefore, supports the development of immune modulatory treatments also in patients with brain metastatic RCC.
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Affiliation(s)
- A Steindl
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - D Alpar
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - G Heller
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M J Mair
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - J A Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Schmidinger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Institute of Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - L Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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25
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Le Rhun E, Devos P, Weller J, Seystahl K, Mo F, Compter A, Berghoff AS, Jongen J, Wolpert F, Rudà R, Brandsma D, Preusser M, van den Bent M, Herrlinger U, Weller M. NCOG-02. PROGNOSTIC VALIDATION OF THE EANO ESMO CLASSIFICATION OF LEPTOMENINGEAL METASTASIS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.541] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The EANO ESMO guidelines have proposed a classification of leptomeningeal metastases (LM) based on clinical (typical/atypical), cytological (positive/negative/equivocal) and MRI (A linear, B nodular, C linear and nodular, D normal or hydrocephalus only) presentation. Type I LM is defined by the presence of tumor cells in the cerebrospinal fluid (CSF) (confirmed LM) whereas type II LM is defined by typical clinical and MRI signs (probable or possible LM). Here we explored the clinical utility of these EANO ESMO LM subtypes for choice of treatment and outcome.
PATIENTS AND METHODS
We retrospectively assembled data from 254 patients with newly diagnosed LM from different solid tumors, including as main primary tumors breast cancer (n=98, 45%), lung cancer (n=65, 25.5%) and melanoma (n=51, 13.5%). Survival curves were estimated using the Kaplan-Meier method and compared by Log-rank test.
RESULTS
Median age at LM diagnosis was 56.5 years (range 20-82 years). Typical clinical LM symptoms or signs were noted in 225 patients (88.5%); only 13 patients (5%) were clinically asymptomatic. The most common MRI subtype was A seen in 117 patients (46%). Types B (n=33, 13%), C (n=54, 21%) and D (n=50, 19.5%) were less common. Tumor cells in the CSF were observed in 186 patients (73%) whereas the CSF was equivocal in 24 (9.5%) and negative in 44 (17.5%) patients. Patients with confirmed LM had inferior outcome than patients with probable or possible LM (p=0.0063). Type I patients had inferior outcome than type II patients (p=0.0019). Nodular disease was a negative prognostic factor in type II LM, but not in type I LM (p=0.0138).
CONCLUSION
The EANO ESMO LM subtypes are highly prognostic and should be considered for stratification and overall design of clinical trials.
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Affiliation(s)
| | | | - Johannes Weller
- Division of Clinical Neurooncology, Dept. of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Francesca Mo
- Dept Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Annette Compter
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Joost Jongen
- Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, Turin, Italy
| | - Dieta Brandsma
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | | | | | - Michael Weller
- UniversitätsSpital Zürich - Klinik für Neurologie, Zurich, Switzerland
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26
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Steindl A, Yadavalli S, Gruber K, Seiwald M, Gatterbauer B, Dieckmann K, Frischer JM, Klikovits T, Zöchbauer‐Müller S, Grisold A, Hoda MAR, Marosi C, Widhalm G, Preusser M, Berghoff AS. Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non-small cell lung cancer brain metastases. Cancer 2020; 126:4341-4352. [PMID: 32678971 PMCID: PMC7540353 DOI: 10.1002/cncr.33085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 03/09/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM. METHODS Patients with newly diagnosed BM from non-small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM. RESULTS A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis-specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33-1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23-1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM. CONCLUSIONS Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non-small cell lung cancer. LAY SUMMARY Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real-life cohort of patients with BM from non-small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non-small cell lung cancer.
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Affiliation(s)
- Ariane Steindl
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Sarah Yadavalli
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Katharina‐Anna Gruber
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Maria Seiwald
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Brigitte Gatterbauer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Karin Dieckmann
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of RadiotherapyMedical University of ViennaViennaAustria
| | - Josa M. Frischer
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Thomas Klikovits
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Grisold
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Mir Ali Reza Hoda
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Christine Marosi
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Georg Widhalm
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Matthias Preusser
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Anna Sophie Berghoff
- Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
- Comprehensive Cancer CenterMedical University of ViennaViennaAustria
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27
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Fuereder T, Berghoff AS, Heller G, Haslacher H, Perkmann T, Strassl R, Berger JM, Puhr HC, Kreminger J, Moik F, Schubert L, Starzer AM, Steindl A, Winkler S, Preusser M, Tobudic S. SARS-CoV-2 seroprevalence in oncology healthcare professionals and patients with cancer at a tertiary care centre during the COVID-19 pandemic. ESMO Open 2020; 5:e000889. [PMID: 32878898 PMCID: PMC7470513 DOI: 10.1136/esmoopen-2020-000889] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background During the COVID-19 outbreak, healthcare professionals (HCP) are at the frontline of clinical management and at increased risk for infection. The SARS-CoV-2 seroprevalence of oncological HCP and their patients has significant implications for oncological care. Methods HCP and patients with cancer at the Division of Oncology, Medical University of Vienna were included between 21 March and 4 June and tested for total antibodies against SARS-CoV-2 employing the Roche Elecsys Anti-SARS-CoV-2 immunoassay. Reactive samples were confirmed or disproved by the Abbott SARS-CoV-2 IgG test. Additionally, a structured questionnaire regarding basic demographic parameters, travel history and COVID-19-associated symptoms had to be completed by HCP. Results 146 subjects (62 HCP and 84 patients with cancer) were enrolled. In the oncological HCP cohort, 20 (32.3%) subjects were medical oncologists, 28 (45.2%) nurses at our ward and 14 (22.6%) fulfil other functions such as study coordinators. In the patient cohort, most individuals are on active anticancer treatment (96.4%). 26% of the HCP and 6% of the patients had symptoms potentially associated with COVID-19 since the end of February 2020. However, only in 2 (3.2%) HCP and in 3 (3.6%) patients, anti-SARS-Cov-2 total antibodies were detected. The second assay for anti-SARS-Cov-2 IgG antibodies confirmed the positive result in all HCP and in 2 (2.4%) patients, suggesting an initial assay’s unspecific reaction in one case. In individuals with a confirmed test result, an active COVID-19 infection was documented by a positive SARS-CoV-2 RNA PCR test. Conclusion Specific anti-SARS-CoV-2 antibodies were found solely in persons after a documented SARS-CoV-2 viral infection, thus supporting the test methods’ high sensitivity and specificity. The low prevalence of anti-SARS-CoV-2 antibodies in our cohorts indicates a lack of immunity against SARS-CoV-2. It highlights the need for continued strict safety measures to prevent uncontrolled viral spread among oncological HCPs and patients with cancer.
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Affiliation(s)
- Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Maria Berger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hannah Christina Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Judith Kreminger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lorenz Schubert
- Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
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28
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Le Rhun E, Devos P, Weller J, Seystahl K, Mo F, Compter A, Sophie Berghoff A, Jongen J, Wolpert F, Rudà R, Brandsma D, van den Bent M, Preusse M, Herrlinger U, Weller M. 41. PROGNOSTIC VALIDATION OF THE EANO ESMO CLASSIFICATION OF LEPTOMENINGEAL METASTASIS. Neurooncol Adv 2020. [PMCID: PMC7401337 DOI: 10.1093/noajnl/vdaa073.029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The EANO ESMO guidelines have proposed a classification of leptomeningeal metastases (LM) based on clinical (typical/atypical), cytological (positive/negative/equivocal) and MRI (A linear, B nodular, C linear and nodular, D normal or hydrocephalus only) presentation. Type I LM is defined by the presence of tumor cells in the cerebrospinal fluid (CSF) (confirmed LM) whereas type II LM is defined by typical clinical and MRI signs (probable or possible LM). Here we explored the clinical utility of these EANO ESMO LM subtypes.
PATIENTS AND METHODS
We retrospectively assembled data from 254 patients with newly diagnosed LM from different solid tumors, including as main primary tumors breast cancer (n=98, 45%), lung cancer (n=65, 25.5%) and melanoma (n=51, 13.5%). Survival curves were estimated using the Kaplan-Meier method and compared by Log-rank test.
RESULTS
Median age at LM diagnosis was 56.5 years (range 20–82 years). Typical clinical LM symptoms or signs were noted in 225 patients (88.5%); only 13 patients (5%) were clinically asymptomatic. The most common MRI subtype was A seen in 117 patients (46%). Types B (n=33, 13%), C (n=54, 21%) and D (n=50, 19.5%) were less common. Tumor cells were observed in the CSF in 186 patients (73%) whereas the CSF was equivocal in 24 (9.5%) and negative in 44 (17.5%) patients. Patients with confirmed LM had inferior outcome than patients with probable or possible LM (p=0.0063). Type I patients had inferior outcome than type II patients (p=0.0019). Nodular disease was a negative prognostic factor in type II LM, but not in type I LM (p=0.0138).
CONCLUSION
The presence of tumor cells in the CSF appears to have a greater prognostic role than the neuroimaging presentation. EANO ESMO LM subtypes are highly prognostic and should be considered in the design of clinical trials.
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Affiliation(s)
- Emilie Le Rhun
- University of Lille, Inserm, U-1192; Neuro-oncology, General and Stereotaxic Neurosurgery service, University Hospital of Lille; Breast Cancer Department, Oscar Lambret Center, Lille, France
- Departments of Neurology & Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | - Katharina Seystahl
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Francesca Mo
- Department of Neuro-oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Annette Compter
- Department of Neuro-oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Joost Jongen
- Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Fabian Wolpert
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Rudà
- Department of Neuro-oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Dieta Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Martin van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Matthias Preusse
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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Steindl A, Mair M, Starzer AM, Dieckmann K, Widhalm G, Hainfellner JA, Schmidinger M, Preusser M, Berghoff AS. Radiation-induced changes in the inflammatory microenvironment composition of lung cancer brain metastases. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2528 Background: Radiotherapy was postulated to impact the inflammatory microenvironment composition in patients with lung cancer brain metastases (BM). Methods: Formalin fixed and paraffin embedded BM specimens from treatment naïve patients (group 1) and from patients treated with radiation therapy including whole brain radiotherapy and/or stereotactic radiosurgery (group 2) or prophylactic cranial irradiation (group 3) before BM resection were identified from the Vienna Brain Metastasis Registry. T cell subsets (CD3+,CD8+,CD45RO+,FOXP3+,PD-L1+) were investigated using the Ventana Benchmark Ultra system Definiens software. Results: Specimens from 41 patients (28/41;68.3% NSCLC, 13/41;31.7% SCLC) were included in the study. A significant difference in CD3+TIL density between group 1 (median: 964.5cells/mm2) and group 2 (median: 283.4cells/mm2; p-value=0.021; Mann-Whitney-U test), as well as group 3 (median: 168.8 cells/mm2; p-value= 0.028; Mann-Whitney-U test) were observed. Furthermore, CD8+ and FOXP3+TIL densities of group 2 (CD8+ median: 172.1cells/mm2; FOXP3+ median: 210.7cells/mm2) were numerically lower compared to group 1 (CD8+ median: 190.1 cells/mm2; FOXP3+ median: 221.2 cells/mm2). Of 10/41 (24.4%) patients further resected BM tissue specimens after initial resection were available. Here, the inflammatory microenvironment of BM treated with radiation therapy between the resections was significantly associated with lower densities of CD3+ (median: 105.1 cells/mm2) and CD8+ (median: 20.3cells/mm2) compared to radiation-naïve patients (CD3+ median: 825.4cells/mm2; CD8+median: 105.5cells/mm2; p=0.037; Mann-Whitney U-test). Conclusions: Radiation treatment was associated with lower densities of TIL subsets in our BM cohort. Although results have to be interpreted with caution due to the limited sample size, further studies investigating the sequencing of radiotherapy and immune modulating therapies might be of interest. [Table: see text]
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Affiliation(s)
| | - Maximilian Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Matthias Preusser
- Medical University Vienna, Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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30
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Starzer AM, Heller G, Tomasich E, Feldmann K, Hatziioannou T, Traint S, Minichsdorfer C, Schwarz-Nemec U, Nackenhorst M, Muellauer L, Preusser M, Berghoff AS, Fuereder T. DNA methylation profiling in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18527] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18527 Background: Biomarkers for response prediction to immune checkpoint inhibitors in head and neck squamous cell carcinoma (HNSCC) patients are needed for a personalized therapy regimen. Therefore, we investigated the predictive potential of inflammatory biomarkers and DNA methylation. Methods: We profiled the methylation status of 850.000 CpG sites in formalin-fixed, paraffin-embedded primary HNSCC samples collected before ICI therapy start using Infinium Methylation EPIC microarrays. Tumor-infiltrating lymphocytes (TILs) and programmed cell death ligand 1 (PD-L1) expression were analyzed employing immunohistochemistry staining. Methylation profile, TIL density and PD-L1 expression were correlated with best radiological response to ICI treatment. Results: 29 patients (median age of 61; range 28-80) years; 8 (27.6%) females, 21 (72.4%) males) with HNSCC were included. Median number of prior systemic therapies was 1 (range 0-3). Median number of ICI applications was 6 (range 1-45). 2/29 (6.9%) patients achieved an objective response (complete response or partial response) under anti-PD-1 therapy. Median progression-free survival (PFS) and median overall survival (OS) were 3.3 months (range 0-28.8) and 7.2 months (range 0-29.4), respectively. 7/29 (24.1%) patients were still alive and one of these patients was still on ICI therapy at data cut-off. Methylation analyses revealed a combination of methylation changes (both hypo- and hypermethylation) that was predictive for response to ICI. 11/27 (40.7%) patients had PD-L1 expressing tumor cells ( > 1% PD-L1 expression). Median density of CD8+ TILs was 423.49 cells/mm2 tumor (range 5.71-11528.43 cells/mm2) and median density of CD3+ TILs was 794.82 cells/mm2 tumor (range 1.68-8811.74 cells/mm2). There was no correlation of PD-L1 expression, density of CD8+ or CD3+ TILs with response or disease control (p > 0.05). Conclusions: In contrast to PD-L1 expression and TIL density, methylation profiles were associated with response to ICI treatment in HNSCC patients.
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Affiliation(s)
| | - Gerwin Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Katharina Feldmann
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Stefan Traint
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Minichsdorfer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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Mair M, Kiesel B, Feldmann K, Widhalm G, Dieckmann K, Woehrer A, Muellauer L, Preusser M, Berghoff AS. Lymphocyte-activation gene 3 (LAG-3) expression in the inflammatory microenvironment of glioma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2553 Background: The blockade of lymphocyte-activation gene 3 (LAG-3), an inhibitory receptor on tumor-infiltrating lymphocytes, is currently under investigation in many extracranial tumor entities. Methods: 54 patients with diffuse glioma were included: 35 patients with glioblastoma (GBM, median age at diagnosis: 61 years) as well as 14 with WHO grade II and 5 with WHO grade III glioma (lower-grade glioma, LGG, median age at diagnosis: 45 years). Isocitrate dehydrogenase 1/2 mutations (IDH-mt) were present in 17/54 patients and 37/54 patients had IDH wildtype (IDH-wt) tumors. LAG-3 expression on tumor-infiltrating lymphocytes (TILs) was analyzed by immunohistochemistry (monoclonal anti-LAG-3 antibody, clone 17B4, LSBio Inc.). Results: LAG-3+ TILs could be observed in 5/54 (9.3%) samples, while CD3+ TILs were present in 32/54 (59.3%) and CD8+ TILs in 24/54 (44.4%) samples. Only IDH-wt glioma presented with LAG-3+ TILs (p = 0.168). Samples with LAG-3+ TILs presented with a numerical trend towards higher presence of CD3+ (5/27 CD3+ vs. 0/22 CD3−, p = 0.072) and CD8+ TILs (4/24 CD8+ vs. 1/30 CD8−, p = 0.159). 4/7 (57.1%) samples presenting with PD-1+ TILs also presented with LAG-3+ TILs (p = 0.001). Furthermore, glioma samples with LAG3+ TILs presented with higher expression of PD-L1 (median: 1% vs. 0%; p = 0.166). There was no difference in overall survival (OS) according to LAG-3+ TIL infiltration (median OS in LAG-3+: 21.7 months vs. LAG-3−: 41.4 months, p > 0.05). Conclusions: LAG-3+ TILs are rarely observed in IDH-wt and absent in IDH-mt glioma. Gliomas with an active inflammatory microenvironment present more frequently with LAG3+ TILs. The diverse composition of the inflammatory microenvironment and particular inflammatory subgroups should be considered in future clinical trials on immune-modulating therapies in glioma.
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Affiliation(s)
- Maximilian Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Katharina Feldmann
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Department of Neurology, Division of Neuropathology and Neurochemistry, Vienna, Austria
| | | | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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Berghoff AS, Breckwoldt MO, Riedemann L, Karimian-Jazi K, Loew S, Schlieter F, Furtner J, Cinci M, Thomas M, Strowitzki MJ, Marmé F, Michel LL, Schmidt T, Jäger D, Bendszus M, Preusser M, Wick W, Winkler F. Bevacizumab-based treatment as salvage therapy in patients with recurrent symptomatic brain metastases. Neurooncol Adv 2020; 2:vdaa038. [PMID: 32642693 PMCID: PMC7212911 DOI: 10.1093/noajnl/vdaa038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Salvage treatment for recurrent brain metastases (BM) of solid cancers is challenging due to the high symptomatic burden and the limited local treatment options. Methods Patients with recurrent BM with no option for further local therapies were retrospectively identified from BM databases. Bevacizumab-based treatment was initiated as a salvage treatment. Radiological imaging before and after bevacizumab-based treatment was reevaluated for treatment response using the Response Assessment in Neuro-Oncology (RANO) BM criteria. Results Twenty-two patients (36.4% male) with recurrent BM from breast cancer (40.9%), colorectal cancer (31.8%), or lung cancer (27.3%) were identified. Previous BM-directed therapies were radiosurgery in 16/22 (72.7%) patients, whole-brain radiotherapy in 8/22 (36.4%), and neurosurgical resection in 11/22 (50.0%). Time since BM diagnosis to initiation of bevacizumab treatment was 16.5 months. Of 22 patients 14 (63.6%) received concurrent systemic therapies. Neurological symptom improvement could be achieved in 14/22 (63.6%) and stabilization in 6/22 (27.3%) patients, resulting in a clinical benefit in 20/22 (90.9%) patients. Steroids could be reduced or stopped in 15/22 (68.2%) patients. Rate of improvement on T1-weighted imaging was 15/19 (78.9%; median reduction: -26.0% ± 32.9) and 19/20 (95%; median reduction: -36.2% ± 22.2) on T2-weighted FLAIR imaging. According to RANO-BM best response was partial response in 7/19 (36.8%), stable disease in 9/19 (47.3%), and progressive disease in 3/19 (15.7%) patients. Median CNS-specific progression-free survival was 8 months and median overall survival after initiation of bevacizumab treatment was 17 months. Conclusions Bevacizumab-based treatment had clinically relevant intracranial activity in the vast majority of patients suffering from recurrent, symptomatic BM. The data supports a prospective clinical trial of bevacizumab as a salvage treatment in BM.
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Affiliation(s)
- Anna Sophie Berghoff
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Lars Riedemann
- Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sarah Loew
- Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Franziska Schlieter
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marc Cinci
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | - Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Frederik Marmé
- National Center for Tumor Disease, Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor Disease, Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Preusser
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Winkler
- Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Puhr HC, Pablik E, Berghoff AS, Jomrich G, Schoppmann SF, Preusser M, Ilhan-Mutlu A. Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms (VAGAS score): characterisation of alarm symptoms in advanced gastro-oesophageal cancer and its correlation with outcome. ESMO Open 2020; 5:e000623. [PMID: 32188713 PMCID: PMC7078766 DOI: 10.1136/esmoopen-2019-000623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The prognostic value of symptoms at disease presentation of advanced gastro-oesophageal cancer is unknown. Thus, the aim of this study was to characterise these symptoms and correlate them with the outcome, so new prognostic markers can be defined. METHODS We analysed clinical data including symptoms, therapies and survival of patients with stage IV gastro-oesophageal cancer treated between 2002 and 2018 at the Vienna General Hospital, Austria. Initial symptoms as well as stenosis in endoscopy and HER2 positivity were evaluated in a cross-validation model to ascertain the impact of each variable on patient survival. RESULTS In total, 258 patients were evaluated. Five factors (stenosis in endoscopy, weight loss, HER2 positivity, dyspepsia, ulcer or active bleeding) have proven to be statistically relevant prognostic factors and were given a count of +1 and -1, if applicable. The resulting score ranges between -3 and +2. The survival probability for 180 days with a score of -3/-2, -1, 0, +1 and +2 is 90%, 80%, 73%, 72% and 42%, whereas for 2 years, it is 30%, 30%, 8%, 7% and 3%, respectively. The median overall survival of a score of -3/-2, -1, 0, +1 and +2 was 579 (95% CI 274 to not measurable), 481 (95% CI 358 to 637), 297 (95% CI 240 to 346), 284 (95% CI 205 to 371), 146 (95% CI 120 to 229) days, respectively. CONCLUSION The data from this retrospective study indicate that the Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms score provides independent prognostic information that may support clinical decision making at diagnosis of advanced gastro-oesophageal cancer. Our findings should be evaluated in prospective studies.
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Affiliation(s)
- Hannah Christina Puhr
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
| | - Eleonore Pablik
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | | | - Gerd Jomrich
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
- Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Sebastian Friedrich Schoppmann
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
- Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Matthias Preusser
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
| | - Aysegül Ilhan-Mutlu
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
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Mir Seyed Nazari P, Marosi C, Moik F, Riedl J, Özer Ö, Berghoff AS, Preusser M, Hainfellner JA, Pabinger I, Zlabinger GJ, Ay C. Low Systemic Levels of Chemokine C-C Motif Ligand 3 (CCL3) are Associated with a High Risk of Venous Thromboembolism in Patients with Glioma. Cancers (Basel) 2019; 11:cancers11122020. [PMID: 31847343 PMCID: PMC6966639 DOI: 10.3390/cancers11122020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
A tight interplay between inflammation and hemostasis has been described as a potential driver for developing venous thromboembolism (VTE). Here, we investigated the association of systemic cytokine levels and risk of VTE in patients with glioma. This analysis was conducted within the prospective, observational Vienna Cancer and Thrombosis Study. Patients with glioma were included at time of diagnosis or progression and were observed for a maximum of two years. Primary endpoint was objectively confirmed VTE. At study entry, a single blood draw was performed. A panel of nine cytokines was measured in serum samples with the xMAP technology developed by Luminex. Results: Overall, 76 glioma patients were included in this analysis, and 10 (13.2%) of them developed VTE during the follow-up. Chemokine C-C motif ligand 3 (CCL3) levels were inversely associated with risk of VTE (hazard ratio [HR] per double increase, 95% confidence interval [CI]: 0.385, 95% CI: 0.161–0.925, p = 0.033), while there was no association between the risk of VTE and serum levels of interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-10, IL-11, tumor necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF), respectively. In conclusion, low serum levels of CCL3 were associated with an increased risk of VTE. CCL3 might serve as a potential biomarker to predict VTE risk in patients with glioma.
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Affiliation(s)
- Pegah Mir Seyed Nazari
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Christine Marosi
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Florian Moik
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Julia Riedl
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Öykü Özer
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (C.M.); (A.S.B.); (M.P.)
| | - Johannes A. Hainfellner
- Institute of Neurology and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
| | - Gerhard J. Zlabinger
- Institute of Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Cihan Ay
- Division of Hematology and Hemostaseology, Department of Medicine I and Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria; (P.M.S.N.); (F.M.); (J.R.); (Ö.Ö.); (I.P.)
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia
- Correspondence:
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Piechutta M, Berghoff AS. New emerging targets in cancer immunotherapy: the role of Cluster of Differentiation 40 (CD40/TNFR5). ESMO Open 2019; 4:e000510. [PMID: 31275618 PMCID: PMC6579575 DOI: 10.1136/esmoopen-2019-000510] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 01/19/2023] Open
Abstract
Cluster of differentiation 40 (CD40) is a member of the tumour necrosis factor family and a new immune-modulating target in cancer treatment. B cells, myeloid cells and dendritic cells can express CD40 and mediate via the ligand cluster of differentiation 40 ligand (CD40L) cytotoxic T cell priming under physiological conditions. Therapeutically, recombinant CD40L molecules, intratumour application of adenoviral vectors leading to CD40L expression and agonistic monoclonal CD40 antibodies are currently tested in various cancer entities for their immune-modulating potential. Early clinical trials suggest safety for agonistic CD40 antibodies with encouraging antitumour effects. Adverse events encompass cytokine release storm, hepatoxicity, thromboembolic events and were so far reported to be clinically manageable and transient. Ongoing studies investigate CD40 activation in combination with chemotherapy, radiation, targeted therapies and immunomodulatory agents. Further studies are awaited to specifically identify patients with the greatest clinical benefit based on predictive biomarkers.
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Affiliation(s)
- Manuel Piechutta
- Clinical Cooperation Unit Neurooncology, German Cancer Research Centre, Heidelberg, Germany; University of Bonn Medical Center, Bonn, Germany
| | - Anna Sophie Berghoff
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Mir Seyed Nazari P, Ay C, Marosi C, Moik F, Riedl J, Ricken G, Hainfellner JA, Preusser M, Pabinger I, Berghoff AS. Correlation of systemic and local inflammation with survival prognosis in glioma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2052 Background: Immune modulating therapies have been a long withstanding treatment approach in glioma. However, gliomas are characterized by a particular absence of tumor infiltrating lymphocytes in the local tumor microenvironment. We aimed to gain insight on the distinct patterns of inflammation associated with survival prognosis in glioma. Methods: Patients were recruited at time of glioma diagnosis or progression in the prospective observational Vienna Cancer and Thrombosis Study (CATS). A single blood draw was performed at study inclusion. PD-L1 expression in the tumor tissue was investigated via immunohistochemistry. Optimal cut-off according to ROC curve was used to assess cut off values for survival analysis. Results: 193 patients with glioma (75.6% glioblastoma (WHO grade IV), 19.7% anaplastic glioma (WHO grade III), and 4.7% diffuse glioma (WHO grade II)) were included. 40/193 (20.7%) glioma had an IDH1 mutation. Membranous PDL1 expression in the tumor tissue was observed in 20/193 (10.4%) patients. 1/20 patient presented with PD-L1 expression and IDH1 mutation ( p = 0.082). PD-L1 significantly correlated with increased monocyte count (median: 0.657 vs. 0.450 [G/L], p = 0.008), higher C-reactive protein (CRP) (0.43 vs. 0.1 [mg/dL], p = 0.005) and higher fibrinogen (379 vs. 303 [mg/dL], p = 0.001). Presence of IDH1 mutation significantly correlated with increased platelet count (303 vs. 232 [G/L], p = 0.001) and lower Neutrophil/Lymphocyte (N/L) ratio (3.34 vs. 5.13, p = 0.016). Higher lymphocyte count ( > 1.484 [G/L], log-rank: p = 0.011), higher platelet count ( > 245.5 [G/L], p = 0.0001), as well as decreased N/L ratio ( < 5.13, p = 0.001) were significantly associated with increased survival prognosis. Conclusions: PD-L1 expression in tumor tissue was associated with markers of systemic inflammation in glioma patients. Systemic inflammation markers furthermore predicted improved survival. Immune modulating therapy approaches might be a promising approach in subgroups of glioma associated with increased baseline interaction of immune system and glioma.
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Affiliation(s)
- Pegah Mir Seyed Nazari
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Julia Riedl
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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37
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Füreder LM, Widhalm G, Gatterbauer B, Dieckmann K, Hainfellner JA, Bartsch R, Zielinski CC, Preusser M, Berghoff AS. Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center. Clin Exp Metastasis 2018; 35:727-738. [PMID: 30421093 PMCID: PMC6267666 DOI: 10.1007/s10585-018-9947-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/25/2018] [Accepted: 10/30/2018] [Indexed: 01/14/2023]
Abstract
Symptomatic brain metastases (BM) are a frequent and late complication in cancer patients. However, a subgroup of cancer patients presents with BM as the first symptom of metastatic cancer. Here we aimed to analyze the clinical course and prognostic factors of this particular BM patient population. Patients presenting with newly diagnosed BM without a history of metastatic cancer were identified from the Vienna Brain Metastasis Registry. Clinical characteristics and overall survival were retrieved by chart review. 459/2419 (19.0%) BM patients presented with BM as first symptom of advanced cancer. In 374/459 (81.5%) patients, an extracranial primary tumor, most commonly lung cancer, could be identified within 3 months after BM diagnosis. In 85/459 (18.5%) patients no extracranial primary tumor could be identified despite comprehensive diagnostic workup within the first 3 months after diagnosis of BM. Survival of patients with identified extracranial tumor differed only numerically from patients with cancer of unknown primary (CUP), however patients receiving targeted therapy after molecular workup showed significantly enhanced survival (20 months vs. 7 months; p = 0.003; log rank test). The GPA score showed a statistically significant association with median overall survival times in the CUP BM patients (class I: 46 months; class II: 7 months; class III: 4 months; class IV: 2 months; p < 0.001; log rank test). The GPA score has a strong prognostic value in patients with CUP BM and may be useful for patient stratification in the clinical setting. Comprehensive diagnostic workup including advanced imaging techniques and molecular tissue analyses appears to benefit patients by directing specific molecular targeted therapies.
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Affiliation(s)
- L M Füreder
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - J A Hainfellner
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Sievers P, Stichel D, Hielscher T, Schrimpf D, Reinhardt A, Wefers AK, Reuss D, Jones DTW, Bewerunge-Hudler M, Hartmann C, Baumgarten P, Wirsching HG, Winther-Kristensen B, Brokinkel B, Ketter R, Idoate Gastearena MA, Lamszus K, Seiz-Rosenhagen M, Mawrin C, Harter PN, Felsberg J, Hänggi D, Herold-Mende C, Berghoff AS, Weller M, Pfister SM, Wick W, Reifenberger G, Preusser M, von Deimling A, Sahm F. Chordoid meningiomas can be sub-stratified into prognostically distinct DNA methylation classes and are enriched for heterozygous deletions of chromosomal arm 2p. Acta Neuropathol 2018; 136:975-978. [PMID: 30382370 DOI: 10.1007/s00401-018-1924-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Baumgarten
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bjarne Winther-Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | | | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Mawrin
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.
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Karreman MA, Berghoff AS, Gunkel K, Piechutta M, Feinauer M, Wick W, Winkler F. P02.13 Before requiring a cure: towards preventing the outgrowth of brain metastases. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.223] [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: 11/12/2022] Open
Affiliation(s)
- M A Karreman
- University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - K Gunkel
- University Hospital Heidelberg, Heidelberg, Germany
| | - M Piechutta
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Feinauer
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - W Wick
- University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F Winkler
- University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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40
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Berghoff AS, Ricken G, Rajky U, Marosi C, Hainfellner JA, von Deimling A, Sahm F, Preusser M. P05.51 Prognostic impact of genetic alterations and methylation class in meningioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.377] [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: 11/12/2022] Open
Affiliation(s)
| | - G Ricken
- Medical University of Vienna, Vienna, Austria
| | - U Rajky
- Medical University of Vienna, Vienna, Austria
| | - C Marosi
- Medical University of Vienna, Vienna, Austria
| | | | | | - F Sahm
- University Hospital Heidelberg, Heidelberg, Germany
| | - M Preusser
- Medical University of Vienna, Vienna, Austria
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41
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Grosch J, Osswald M, Berghoff AS, Wick W, Winkler F. P04.69 Differential microglia - glioma cell interaction during tumor progression. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.303] [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: 11/15/2022] Open
Affiliation(s)
- J Grosch
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - M Osswald
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - A S Berghoff
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- 3. Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - W Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - F Winkler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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42
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Piechutta M, Berghoff AS, Karreman MA, Gunkel K, Wick W, Winkler F. P02.08 Visualizing tumor cell - lymphocyte interactions in the brain metastatic cascade using in vivo two photon microscopy. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.218] [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: 11/14/2022] Open
Affiliation(s)
- M Piechutta
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - A S Berghoff
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - M A Karreman
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - K Gunkel
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - W Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - F Winkler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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43
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Berghoff AS, Kiesel B, Widhalm G, Wilhelm D, Rajky O, Kurscheid S, Kresl P, Wöhrer A, Marosi C, Hegi ME, Preusser M. Correlation of immune phenotype with IDH mutation in diffuse glioma. Neuro Oncol 2018; 19:1460-1468. [PMID: 28531337 DOI: 10.1093/neuonc/nox054] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [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: 12/20/2022] Open
Abstract
Background Tumor infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) are targets of immune checkpoint inhibitors. Methods Forty-three World Health Organization (WHO) grade II/III gliomas (39 IDH-mutant [mut], 4 IDH-wildtype [wt]) and 14 IDH-mut glioblastomas (GBM) were analyzed for TIL (CD3+; PD1+) infiltration and PD-L1 expression. Results were compared with the data of a previously published series of 117 IDH-wt glioblastomas. PD-L1 gene expression levels were evaluated in 677 diffuse gliomas grades II-IV from The Cancer Genome Atlas (TCGA) database. Results TIL and PD-L1 expression were observed in approximately half of WHO grade II/III gliomas. IDH-wt status was associated with significantly higher TIL infiltration and PD-L1 expression among all (grades II-IV) cases (n = 174, P < 0.001) and within the cohort of glioblastomas (n = 131, P < 0.001). In low-grade glioma (LGG) and glioblastoma cohorts of TCGA, significantly higher PD-L1 gene expression levels were evident in IDH-wt compared with IDH-mut samples (LGG: N = 516; P = 1.933e-11, GBM: N = 161; P < 0.009). Lower PD-L1 gene expression was associated with increased promoter methylation (Spearman correlation coefficient -0.36; P < 0.01) in the LGG cohort of TCGA. IDH-mut gliomas had higher PD-L1 gene promoter methylation levels than IDH-wt gliomas (P < 0.01). Conclusions The immunological tumor microenvironment of diffuse gliomas differs in association with IDH mutation status. IDH-wt gliomas display a more prominent TIL infiltration and higher PD-L1 expression than IDH-mut cases. Mechanistically this may be at least in part due to differential PD-L1 gene promoter methylation levels. Our findings may be relevant for immune modulatory treatment strategies in glioma patients.
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Affiliation(s)
- Anna Sophie Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Barbara Kiesel
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Georg Widhalm
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dorothee Wilhelm
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Orsolya Rajky
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sebastian Kurscheid
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philip Kresl
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Christine Marosi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Monika E Hegi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthias Preusser
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Kather JN, Berghoff AS, Ferber D, Suarez-Carmona M, Reyes-Aldasoro CC, Valous NA, Rojas-Moraleda R, Jäger D, Halama N. Large-scale database mining reveals hidden trends and future directions for cancer immunotherapy. Oncoimmunology 2018; 7:e1444412. [PMID: 29900054 PMCID: PMC5993505 DOI: 10.1080/2162402x.2018.1444412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 02/08/2023] Open
Abstract
Cancer immunotherapy has fundamentally changed the landscape of oncology in recent years and significant resources are invested into immunotherapy research. It is in the interests of researchers and clinicians to identify promising and less promising trends in this field in order to rationally allocate resources. This requires a quantitative large-scale analysis of cancer immunotherapy related databases. We developed a novel tool for text mining, statistical analysis and data visualization of scientific literature data. We used this tool to analyze 72002 cancer immunotherapy publications and 1469 clinical trials from public databases. All source codes are available under an open access license. The contribution of specific topics within the cancer immunotherapy field has markedly shifted over the years. We show that the focus is moving from cell-based therapy and vaccination towards checkpoint inhibitors, with these trends reaching statistical significance. Rapidly growing subfields include the combination of chemotherapy with checkpoint blockade. Translational studies have shifted from hematological and skin neoplasms to gastrointestinal and lung cancer and from tumor antigens and angiogenesis to tumor stroma and apoptosis. This work highlights the importance of unbiased large-scale database mining to assess trends in cancer research and cancer immunotherapy in particular. Researchers, clinicians and funding agencies should be aware of quantitative trends in the immunotherapy field, allocate resources to the most promising areas and find new approaches for currently immature topics.
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Affiliation(s)
- Jakob Nikolas Kather
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Site, German Cancer Consortium (DKTK), Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Sophie Berghoff
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Unit for Experimental Oncology Therapy, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Dyke Ferber
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Meggy Suarez-Carmona
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantino Carlos Reyes-Aldasoro
- Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK
| | - Nektarios A Valous
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rodrigo Rojas-Moraleda
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Site, German Cancer Consortium (DKTK), Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Niels Halama
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Site, German Cancer Consortium (DKTK), Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, D120, German Cancer Research Center (DKFZ), Heidelberg, Germany
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45
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Wolpert F, Weller M, Berghoff AS, Rushing EJ, Füreder LM, Petyt G, Leske H, Andratschke N, Regli L, Neidert MC, Stupp R, Stahel R, Dummer R, Frauenfelder T, Roth P, Reyns N, Kaufmann PA, Rhun EL. CMET-26. DIAGNOSTIC VALUE OF FDG-PET/CT FOR PATIENTS WITH BRAIN METASTASIS FROM UNKNOWN PRIMARY SITE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.174] [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: 11/13/2022] Open
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46
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Kiesel B, Kerschbaumer J, Furtner J, Prihoda R, Marhold F, Mischkulnig M, Berghoff AS, Preusser M, Widhalm G, Freyschlag C. CMET-18. EARLY POSTOPERATIVE MRI DETECTS UNEXPECTED RESIDUAL BRAIN METASTASES AFTER RESECTION IN A HIGH FREQUENCY OF CASES: A RETROSPECTIVE ANALYSIS IN THREE SPECIALIZED CENTERS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.167] [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: 11/13/2022] Open
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47
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Balendran S, Liebmann-Reindl S, Berghoff AS, Reischer T, Popitsch N, Geier CB, Kenner L, Birner P, Streubel B, Preusser M. Next-Generation Sequencing-based genomic profiling of brain metastases of primary ovarian cancer identifies high number of BRCA-mutations. J Neurooncol 2017; 133:469-476. [PMID: 28497333 PMCID: PMC5537326 DOI: 10.1007/s11060-017-2459-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 02/07/2017] [Accepted: 04/30/2017] [Indexed: 12/31/2022]
Abstract
Ovarian cancer represents the most common gynaecological malignancy and has the highest mortality of all female reproductive cancers. It has a rare predilection to develop brain metastases (BM). In this study, we evaluated the mutational profile of ovarian cancer metastases through Next-Generation Sequencing (NGS) with the aim of identifying potential clinically actionable genetic alterations with options for small molecule targeted therapy. Library preparation was conducted using Illumina TruSight Rapid Capture Kit in combination with a cancer specific enrichment kit covering 94 genes. BRCA-mutations were confirmed by using TruSeq Custom Amplicon Low Input Kit in combination with a custom-designed BRCA gene panel. In our cohort all eight sequenced BM samples exhibited a multitude of variant alterations, each with unique molecular profiles. The 37 identified variants were distributed over 22 cancer-related genes (23.4%). The number of mutated genes per sample ranged from 3 to 7 with a median of 4.5. The most commonly altered genes were BRCA1/2, TP53, and ATM. In total, 7 out of 8 samples revealed either a BRCA1 or a BRCA2 pathogenic mutation. Furthermore, all eight BM samples showed mutations in at least one DNA repair gene. Our NGS study of BM of ovarian carcinoma revealed a significant number of BRCA-mutations beside TP53, ATM and CHEK2 mutations. These findings strongly suggest the implication of BRCA and DNA repair malfunction in ovarian cancer metastasizing to the brain. Based on these findings, pharmacological PARP inhibition could be one potential targeted therapeutic for brain metastatic ovarian cancer patients.
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Affiliation(s)
- S Balendran
- Department of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - S Liebmann-Reindl
- Core Facility Genomics, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Central Nervous System Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Neurology Clinic, Heidelberg University Medical Center and Neurooncology Program, National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - T Reischer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - N Popitsch
- Children's Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - C B Geier
- Immunology Outpatient Clinic, Schwarzspanierstraße 15/1/9, Vienna, Austria
| | - L Kenner
- Department of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cancer Research LBI-CR, Vienna, Austria
| | - P Birner
- Department of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Central Nervous System Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - B Streubel
- Department of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Core Facility Genomics, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center, Central Nervous System Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.
| | - M Preusser
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Central Nervous System Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
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48
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Le Rhun E, Weller M, Berghoff AS, Rushing EJ, Fuereder L, Petyt G, Leske H, Andrastschke N, Regli L, Neidert MC, Stupp R, Dummer R, Frauenfelder T, Roth P, Reyns N, Kaufmann PA, Preusser M, Wolpert F. The value of 18F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) in the detection of the primary lesion and for staging in brain metastasis (BM) patients with cancer of unknown primary site (CUPS). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2076 Background: Brain metastasis (BM) are the first clinical presentation of cancer in around 30% of patients. They are then referred as BM from cancer of unknown primary site (BM-CUPS). The value of 18F-fluordesoxyglucose positron emission tomography (FDG-PET)/CT has not yet be determined for the management of these patients. Methods: A total of 566 patients were operated for BM at the University Hospital Zurich between 2004 and 2014, of whom 127 were identified as BM-CUPS patients. Two cohorts from other independent centers (n = 100 and 120) were used for the validation of data. Results: No difference in determining the localization of the primary lesion was observed between FDG-PET/CT and CT (FDG-PET/CT: 73/78, 93.6%; CT: n = 70/78, 89.7%; p = 0.25, McNemar’s test). The same pattern of primary lesion and other extracranial lesions was observed in 36 of 64 patients (56.3%). Additional suspicious extracranial metastases were identified by FDG-PET/CT in 28 patients (43.7%). The median graded prognostic assessment (GPA) scores were 2.5 determined according to FDG-PET/CT and 3 according to CT alone (p = 3.8x10-5), resulting in predicted survival times of 3.8 versus 5.3 months (p = 6.1x10-5; Wilcoxon’s test). Conclusions: A similar sensitivity of FDG-PET/CT and chest CT was observed for the detection of the primary tumor in BM-CUPS, however, FDG-PET/CT significantly improved the accuracy of staging. FDG-PET/CT should be preferred for the management of BM-CUPS and may help to avoid redundant CT imaging.
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Affiliation(s)
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | | | - Gregory Petyt
- Department of Nuclear Medicine, Lille University, Lille, France
| | | | | | - Luca Regli
- University Hospital Zurich, Zurich, Switzerland
| | | | - Roger Stupp
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Patrick Roth
- Department of Neurology, University Hospital, Zürich, Switzerland
| | | | | | - Matthias Preusser
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
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49
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Berghoff AS, Ferreira P, Plazer H, Widhalm G, Birner P, Bartsch R, Prager GW, Zielinski C, Preusser M. Primary tumor sidedness associates with prognosis of patients with brain metastases of colorectal cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3562 Background: Brian metastases (BM) are a rare but devastating complication of colorectal cancer. We aimed to analyse prognostic factors in patients suffering from colorectal cancer (CRC) BM. Methods: Patients with histological proven CRC and BM were identified from the brain metastasis database of the Comprehensive Cancer Center Vienna. Clinical characteristics including established prognostic factors were retrieved by chart review. Established clinical prognostic scores for BM patients including the graded prognostic assessment (GPA) and the GPA for gastrointestinal tumours (GI-GPA) were calculated based on clinical characteristics as previously published. Results: 215 (male: 125/215 (58.1%); female 90/215 (41.9%)) patients with CRC BM were available for this study. The following established clinical prognostic factors showed a significant association with median overall survival (OS) times from BM diagnosis: number of brain metastases (n = 1: 6 months; n = 2-3: 4 months; n > 3: 3 months; p = 0.001), age at BM diagnosis ( < 65 years: 6 months; > 65 years: 4 months; p = 0.047), extracranial disease (present: 4 months; absent: 8 months; p = 0.002) and Karfnofsky performance score (KPS < 70%: 3 months; KPS > 70%: 5 months; p = 0.002), graded prognostic assessment (GPA) class (class I: 15 months; class II: 13 months; class III: 4 months; class IV: 4 months) and the gastro-intestinal disease-specific GI-GPA (class I: 11 months; class II: 6 months; class III: 6 months; class IV: 3 months; p < 0.001). In addition, the location of the primary tumour in the left colon (n = 176 (81.9%); 5 months) was associated with significantly longer median overall survival times from diagnosis of BM than primary tumour location in the right colon (n = 39 (18.1%); 3 months; p = 0.010). Primary tumor sidedness (HR 0.577; 95% CI 0.397-0.841; p = 0.004) remained a strong prognostic factor at multivariate analysis independently of GI-GPA (HR 0.718; 95% CI 0.612-0.842). Conclusions: Primary tumor sidedness is an independent prognostic factor in patients with CRC BM and should be included in disease-specific prognostic scores.
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Affiliation(s)
| | | | | | | | - Peter Birner
- Department of Pathology and Comprehensive Cancer Center CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Matthias Preusser
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
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50
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Masel EK, Berghoff AS, Füreder LM, Heicappell P, Schlieter F, Widhalm G, Gatterbauer B, Dieckmann U, Birner P, Bartsch R, Schur S, Watzke HH, Zielinski CC, Preusser M. Decreased body mass index is associated with impaired survival in lung cancer patients with brain metastases: A retrospective analysis of 624 patients. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28488812 DOI: 10.1111/ecc.12707] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/30/2022]
Abstract
Body mass index (BMI) is a prognostic factor in several cancer types. We investigated the prognostic role of BMI in a large patient cohort with newly diagnosed lung cancer brain metastases (BM) between 1990 and 2013. BMI at diagnosis of BM and graded prognostic assessment (GPA) were calculated. Definitions were underweight (BMI <18.50), weight within normal range (BMI 18.50-24.99) and overweight (BMI ≥ 25.00). A total of 624 patients (men 401/624 [64.3%]; women 223/624 [35.7%]; median age of 61 [range 33-88]) were analysed. Histology was non-small cell lung cancer in 417/622 (66.8%), small cell lung cancer (SCLC) in 205/624 (32.9%) and not otherwise specified in 2/624 (0.3%) patients. About 313/624 (50.2%) had normal BMI, 272/624 (43.5%) were overweight and 39/624 (6.3%) were underweight. Underweight patients had shorter median overall survival (3 months) compared to patients with normal BMI (7 months) and overweight (8 months; p < .001; log rank test). At multivariate analysis, higher GPA class (HR 1.430; 95% cumulative incidence, CI 1.279-1.598; p < .001; Cox regression model), SCLC histology (HR 1.310; 95% CI 1.101-1.558) and presence of underweight (HR 1.845; 95% CI 1.317-2.585; p = .014; Cox regression model) were independent prognostic factors. Underweight at diagnosis of BM in lung cancer is associated with an unfavourable prognosis.
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Affiliation(s)
- E K Masel
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - L M Füreder
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - P Heicappell
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - F Schlieter
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - U Dieckmann
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - P Birner
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - S Schur
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - H H Watzke
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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