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van ‘t Land FR, Aziz MH, Michiels N, Mieog JSD, Bonsing BA, Luelmo SA, Homs MY, Groot Koerkamp B, Papageorgiou G, van Eijck CH. Increasing Systemic Immune-inflammation Index During Treatment in Patients With Advanced Pancreatic Cancer is Associated With Poor Survival: A Retrospective, Multicenter, Cohort Study. Ann Surg 2023; 278:1018-1023. [PMID: 37010512 PMCID: PMC10631500 DOI: 10.1097/sla.0000000000005865] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND OBJECTIVES A high systemic immune-inflammation index (SIII) at diagnosis of various cancers, including pancreatic cancer, is associated with poor prognosis. The impact of FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) chemotherapy or stereotactic body radiotherapy on this index is unknown. In addition, the prognostic value of changes in the SIII during treatment is unclear. In this retrospective analysis, we aimed to find answers regarding patients with advanced pancreatic cancer. METHODS Patients with advanced pancreatic cancer treated with FOLFIRINOX chemotherapy alone or with FOLFIRINOX chemotherapy followed by stereotactic body radiotherapy between 2015 and 2021 in 2 tertiary referral centers were included. Baseline characteristics, laboratory values at 3 time points during treatment, and survival outcomes were collected. The patient-specific evolutions of SIII and their association with mortality were assessed with joint models for longitudinal and time-to-event data. RESULTS Data of 141 patients were analyzed. At a median follow-up time of 23.0 months (95% CI: 14.6-31.3), 97 (69%) patients had died. Median overall survival was 13.2 months (95% CI: 11.0-15.5). During treatment with FOLFIRINOX, the log (SIII) was reduced by -0.588 (95% CI: -0.0978, -0.197; P = 0.003). One unit increase in log (SIII) increased the hazard ratio of dying by 1.604 (95% CI: 1.068-2.409; P = 0.023). CONCLUSIONS In addition to carbohydrate antigen 19-9, the SIII is a reliable biomarker in patients with advanced pancreatic cancer.
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Affiliation(s)
| | - Mohammad H. Aziz
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Nynke Michiels
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J. Sven D. Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert A. Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia A.C. Luelmo
- Department of Oncology, Leiden University Medical Center, the Netherlands
| | - Marjolein Y.V. Homs
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Vietsch EE, Latifi D, Verheij M, van der Oost EW, de Wilde RF, Haen R, van den Boom AL, Koerkamp BG, Doornebosch PG, van Verschuer VM, Ooms AH, Mohammad F, Willemsen M, Aerts JG, Krog RT, de Miranda NF, van den Bosch TP, Mueller YM, Katsikis PD, van Eijck CH. B cell immune profiles in dysbiotic vermiform appendixes of pancreatic cancer patients. Front Immunol 2023; 14:1230306. [PMID: 38022530 PMCID: PMC10667699 DOI: 10.3389/fimmu.2023.1230306] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors and is resistant to immunotherapy. B cells play an essential role in PDAC progression and immune responses, both locally and systemically. Moreover, increasing evidence suggests that microbial compositions inside the tumor, as well as in the oral cavity and the gut, are important factors in shaping the PDAC immune landscape. However, the gut-associated lymphoid tissue (GALT) has not previously been explored in PDAC patients. In this study, we analyzed healthy vermiform appendix (VA) from 20 patients with PDAC and 32 patients with colon diseases by gene expression immune profiling, flow cytometry analysis, and microbiome sequencing. We show that the VA GALT of PDAC patients exhibits markers of increased inflammation and cytotoxic cell activity. In contrast, B cell function is decreased in PDAC VA GALT based on gene expression profiling; B cells express significantly fewer MHC class II surface receptors, whereas plasma cells express the immune checkpoint molecule HLA-G. Additionally, the vermiform appendix microbiome of PDAC patients is enriched with Klebsiella pneumoniae, Bifidobacterium animalis, and Adlercreutzia equolifaciens, while certain commensals are depleted. Our findings may suggest impaired B cell function within the GALT of PDAC patients, which could potentially be linked to microbial dysbiosis. Additional investigations are imperative to validate our observations and explore these potential targets of future therapies.
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Affiliation(s)
- Eveline E. Vietsch
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Diba Latifi
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Maaike Verheij
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Roel Haen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Anne Loes van den Boom
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Department of Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Ariadne H.A.G. Ooms
- Department of Pathology, Pathan BV, Rotterdam, Netherlands
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Farzana Mohammad
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marcella Willemsen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Joachim G.J.V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ricki T. Krog
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Yvonne M. Mueller
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter D. Katsikis
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
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3
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Pijnappel EN, Schuurman M, Wagner AD, de Vos-Geelen J, van der Geest LGM, de Groot JWB, Koerkamp BG, de Hingh IHJT, Homs MYV, Creemers GJ, Cirkel GA, van Santvoort HC, Busch OR, Besselink MG, van Eijck CH, Wilmink JW, van Laarhoven HWM. Sex, Gender and Age Differences in Treatment Allocation and Survival of Patients With Metastatic Pancreatic Cancer: A Nationwide Study. Front Oncol 2022; 12:839779. [PMID: 35402271 PMCID: PMC8987273 DOI: 10.3389/fonc.2022.839779] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/24/2022] [Indexed: 12/17/2022] Open
Abstract
Background Biological sex, gender and age have an impact on the incidence and outcome in patients with metastatic pancreatic cancer. The aim of this study is to investigate whether biological sex, gender and age are associated with treatment allocation and overall survival (OS) of patients with metastatic pancreatic cancer in a nationwide cohort. Methods Patients with synchronous metastatic pancreatic cancer diagnosed between 2015 and 2019 were selected from the Netherlands Cancer Registry (NCR). The association between biological sex and the probability of receiving systemic treatment were examined with multivariable logistic regression analyses. Kaplan Meier analyses with log-rank test were used to describe OS. Results A total of 7470 patients with metastatic pancreatic cancer were included in this study. Fourty-eight percent of patients were women. Women received less often systemic treatment (26% vs. 28%, P=0.03), as compared to men. Multivariable logistic regression analyses with adjustment for confounders showed that women ≤55 years of age, received more often systemic treatment (OR 1.82, 95% CI 1.24-2.68) compared to men of the same age group. In contrast, women at >55 years of age had a comparable probability to receive systemic treatment compared to men of the same age groups. After adjustment for confounders, women had longer OS compared to men (HR 0.89, 95% CI 0.84-0.93). Conclusion This study found that women in general had a lower probability of receiving systemic treatment compared to men, but this can mainly be explained by age differences. Women had better OS compared to men after adjustment for confounders.
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Affiliation(s)
- Esther N. Pijnappel
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Melinda Schuurman
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Anna D. Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW–School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, Netherlands
| | - Lydia G. M. van der Geest
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - Geert A. Cirkel
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Medical Oncology, Meander Medical Center, Amersfoort, Netherlands
| | - Hjalmar C. van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Olivier R. Busch
- Department of surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Marc G. Besselink
- Department of surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | - Johanna W. Wilmink
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- *Correspondence: Hanneke W. M. van Laarhoven,
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Farshadi EA, Chang J, Sampadi B, Doukas M, Van 't Land F, van der Sijde F, Vietsch EE, Pothof J, Koerkamp BG, van Eijck CH. Organoids Derived from Neoadjuvant FOLFIRINOX Patients Recapitulate Therapy Resistance in Pancreatic Ductal Adenocarcinoma. Clin Cancer Res 2021; 27:6602-6612. [PMID: 34580113 PMCID: PMC9401459 DOI: 10.1158/1078-0432.ccr-21-1681] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE We investigated whether organoids can be generated from resected tumors of patients who received eight cycles of neoadjuvant FOLFIRINOX chemotherapy before surgery, and evaluated the sensitivity/resistance of these surviving cancer cells to cancer therapy. EXPERIMENTAL DESIGN We generated a library of 10 pancreatic ductal adenocarcinoma (PDAC) organoid lines: five each from treatment-naïve and FOLFIRINOX-treated patients. We first assessed the histologic, genetic, and transcriptional characteristics of the organoids and their matched primary PDAC tissue. Next, the organoids' response to treatment with single agents-5-FU, irinotecan, and oxaliplatin-of the FOLFIRINOX regimen as well as combined regimen was evaluated. Finally, global mRNA-seq analyses were performed to identify FOLFIRINOX resistance pathways. RESULTS All 10 patient-derived PDAC organoids recapitulate histologic, genetic, and transcriptional characteristics of their primary tumor tissue. Neoadjuvant FOLFIRINOX-treated organoids display resistance to FOLFIRINOX (5/5), irinotecan (5/5), and oxaliplatin (4/5) when compared with treatment-naïve organoids (FOLFIRINOX: 1/5, irinotecan: 2/5, oxaliplatin: 0/5). 5-Fluorouracil treatment responses between naïve and treated organoids were similar. Comparative global transcriptome analysis of treatment-naïve and FOLFIRINOX samples-in both organoids and corresponding matched tumor tissues-uncovered modulated pathways mainly involved in genomic instability, energy metabolism, and innate immune system. CONCLUSIONS Resistance development in neoadjuvant FOLFIRINOX organoids, recapitulating their primary tumor resistance, suggests continuation of FOLFIRINOX therapy as an adjuvant treatment may not be advantageous for these patients. Gene-expression profiles of PDAC organoids identify targetable pathways involved in chemoresistance development upon neoadjuvant FOLFIRINOX treatment, thus opening up combination therapy possibilities.
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Affiliation(s)
- Elham Aida Farshadi
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jiang Chang
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bharath Sampadi
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Freek Van 't Land
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fleur van der Sijde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eveline E. Vietsch
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joris Pothof
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Casper H.J. van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,Corresponding Author: Casper H.J. van Eijck, Department of Surgery, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands. Phone: 31-10-7-033854; E-mail:
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5
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Grevers F, Latifi D, Koning WD, Eijck CHV, Mustafa DA. Abstract B37: The complex immune-microenvironment heterogeneity in pancreatic cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.panca19-b37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy, resulting in more than 3,000 deaths per year in The Netherlands. The tumor microenvironment (TME) contributes largely to the treatment failure of the disease. TME consists of the stromal compartment, extracellular matrix, and tumor-infiltrative lymphocytes (TILs). Types and numbers of TILs are associated with clinical outcome, i.e., highCD8+: FOXP3 ratio is linked to a favorable prognosis. However, the intratumor immune variation in pancreatic cancer has not been studied so far. This study aims at investigating the differences of the immune infiltration within various areas of the same pancreatic cancer samples (intratumor variation) and comparing to healthy controls (extratumor variation). Such differences may be used for microenvironment remodeling, which may open new therapeutic approaches for PDAC patients.
Materials and Methods: Formalin-fixed, paraffin-embedded (FFPE) samples of 26 PDAC patients and 8 healthy controls were selected. RNA was isolated separately from the tumor core and from the adjacent normal-like pancreatic tissue of the same sample. Immune profiling was carried out using the PanCancer Immune Profiling Panel of Nanostring technology. Subsequently, the gene expression data were analyzed using nSolver basic software and the advanced module.
Results: The immune infiltration in the core of PDAC samples was different from that in the adjacent normal-like areas of the same patients. Tumor samples exhibited the lowest CD8+, Th1, neutrophil, and Natural Killer cell infiltration as compared to normal-like areas. In addition, the normal-like areas of PDAC samples showed a different immune profile as compared to the healthy controls. B lymphocytes were significantly higher in healthy controls compared to normal-like PDAC samples.
Discussion and Conclusion: Our results present the variation in the immune microenvironment between the normal-like pancreatic tissue and the healthy pancreas, indicating that changes at the immune levels precede morphologic changes, tumorigenesis, and tumor cell infiltration. Additionally, specific changes in TILs occur in a gradient fashion from adjacent normal-like tissue to the tumor core. Understanding the differences of the immune microenvironment in the same tissue samples will enable developing an accurate microenvironment remodeling therapeutic approaches to treat PCDA patients.
Citation Format: Frederieke Grevers, Diba Latifi, Willem de Koning, Casper H.J. van Eijck, Dana A. Mustafa. The complex immune-microenvironment heterogeneity in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr B37.
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Suker M, Nuyttens JJ, Eskens FA, Haberkorn BC, Coene PPL, van der Harst E, Bonsing BA, Vahrmeijer AL, Mieog JD, Jan Swijnenburg R, Roos D, Koerkamp B, van Eijck CH. Efficacy and feasibility of stereotactic radiotherapy after folfirinox in patients with locally advanced pancreatic cancer (LAPC-1 trial). EClinicalMedicine 2019; 17:100200. [PMID: 31891135 PMCID: PMC6933188 DOI: 10.1016/j.eclinm.2019.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/29/2019] [Accepted: 10/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). METHODS Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatment-related toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. FINDINGS Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity (n = 12), disease progression (n = 6), or patients' preference (n = 1). Thirty-nine (78%) patients received the SBRT treatment. The 1-year OS and PFS were 64% (95% CI: 50%-76%) and 34% (95% CI: 22%-48%), respectively. Thirty grade 3 or 4 adverse events were observed during FOLFIRINOX. Two (5%) grade 3 or 4 adverse events after SBRT were observed. Two (5%) patients died due to a gastro-intestinal bleeding within three months after SBRT were observed. Six (12%) patients underwent a resection, all resulting in a complete (R0) resection. Two patients had a complete pathological response. INTERPRETATION FOLFIRINOX followed by SBRT in patients with LAPC is feasible and shows relevant antitumor activity. In 6 (12%) patients a potentially curative resection could be pursued following this combined treatment, with a complete histological response being observed in two patients.
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Affiliation(s)
- Mustafa Suker
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost J. Nuyttens
- Department of Radiotherapy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ferry A.L.M. Eskens
- Department of Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Bert A. Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - J.Sven D. Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Daphne Roos
- Department of Surgery, Reinier de Graaf Group, Delft, Netherlands
| | - B.Groot. Koerkamp
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Casper H.J. van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Corresponding author.
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Lau SP, van Montfoort N, Kinderman P, Lukkes M, Dumas J, van Nimwegen M, Mustafa D, Vroman H, van Hall T, van der Burg SH, Aerts JG, Dammeijer F, van Eijck CH. Effect of targeting CD40 for DC vaccination in pancreatic adenocarcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15783] [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
e15783 Background: Although immunotherapy yields striking results in various malignancies, results in pancreatic cancer have been disappointing. Both a highly immunosuppressive tumor microenvironment and a dense desmoplastic stroma have been found to prohibit proper T-cell infiltration in these tumors, thereby preventing immunotherapy efficacy. We hypothesize that a rational and translational multistep approach is needed to sensitize pancreatic cancer to immunotherapy. In an aggressive murine pancreatic ductal adenocarcinoma model, we assessed the effectiveness of dendritic cell (DC) vaccination in combination with αCD40 treatment, as these treatments are known to induce effector T cells and degrade stroma, respectively. Methods: Immune competent C57BL/6 mice were inoculated subcutaneously with pancreatic tumor cells (KPC3). Mice with established tumors were vaccinated with tumor-loaded monocyte derived DCs and consequently treated with αCD40 agonistic antibodies. Tumor sizes were monitored over time. Immune responses were determined by flow cytometry of cells in peripheral blood, spleen and tumor. NanoString Technologies were applied on tumor samples. Results: A significant delay in tumor growth was found in the combination therapy arm compared to untreated mice and mice treated with DCs or αCD40 alone. Monotherapy had no effect on tumor growth. Survival of mice treated with the combination therapy was also improved compared to untreated mice or mice treated with monotherapy (P < 0.001). Interim blood analysis showed significant increases in frequencies of activated and proliferating T cells in treated animals and those cells also displayed an effector memory phenotype. This was more pronounced for CD4 T cells in mice treated with DCs while αCD40 therapy induced a confined response in CD8 T cells. Increased frequencies of tumor infiltrating lymphocytes were found in all treated mice compared to untreated mice. mRNA expression analysis indicated less exhausted phenotype of intratumoral lymphoid cells in mice treated with DCs and αCD40 compared to monotherapy DCs or αCD40. Conclusions: These results demonstrate the potency of this novel form of combination immunotherapy and reveals a mechanistic insight into the requirements of effective immunotherapy in pancreatic cancer.
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Van Tienhoven G, Versteijne E, Suker M, Groothuis KB, Busch OR, Bonsing BA, de Hingh IH, Festen S, Patijn GA, de Vos-Geelen J, Zwinderman AH, Punt CJA, van Eijck CH. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC-1): A randomized, controlled, multicenter phase III trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.18_suppl.lba4002] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
LBA4002 Background: Standard of care for patients with (borderline) resectable pancreatic adenocarcinoma is resection followed by adjuvant chemotherapy. Previous studies suggest a benefit of neoadjuvant treatment. We conducted a multicenter phase III randomized controlled trial to evaluate the effect of preoperative chemoradiotherapy. Methods: Patients with (borderline) resectable pancreatic cancer, pathologically confirmed, were randomized between immediate surgery (arm A) and preoperative chemoradiotherapy (arm B), both followed by adjuvant chemotherapy. The preoperative chemoradiotherapy consisted of 15 times of 2.4 Gray (Gy) combined with gemcitabine, 1,000 mg/m2 on days 1, 8 and 15, preceded and followed by a cycle of gemcitabine. Primary endpoint was overall survival (OS), secondary endpoints were (R0) resection rate, disease free survival (DFS), distant metastases free interval (DMFI), locoregional recurrence free interval (LRFI) and toxicity. Accrual was completed between April 23, 2013 and July 25, 2017. Results: In total, 246 patients were included in the intention-to-treat analysis (127 patients in arm A and 119 in arm B). Currently, 142 of the 176 needed events for the primary outcome are observed. OS was significantly better in arm B (median 13.5 vs. 17.1 months; HR 0.71; p = 0.047). This was also the case for R0 resection rate (31% vs. 65%, p = < 0.001), DFS (median 7.9 vs. 11.2 months; HR 0.67; p = 0.010), DMFI (median 10.2 vs 17.1 months; HR 0.63; p = 0.012) and LRFI (median 11.8 vs not reached; HR 0.47; p < 0.001). Resection rates were 72% (91/127) in arm A vs. 62% (74/119) in arm B (p = 0.15). No significant difference was observed in grade ≥ 3 adverse events between both groups (p = 0.17). A subgroup analysis of patients who actually underwent a resection was performed which showed a median OS of 16.8 and 29.9 months respectively (p < 0.001). Conclusion: Our preliminary data show that preoperative chemoradiotherapy significantly improves outcome in (borderline) resectable pancreatic cancer compared to immediate surgery. Updated results will be presented at the meeting. Clinical trial information: NTR3709.
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Affiliation(s)
| | - Eva Versteijne
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Mustafa Suker
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Olivier R. Busch
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Bert A. Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Gijs A. Patijn
- Department of Surgery, Isala Clinics, Zwolle, Netherlands
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiologic Biostatics, Academic Medical Center, Amsterdam, Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, Netherlands
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9
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Janssen Q, Buettner S, Suker M, Margonis GA, Paniccia A, El-Rayes BF, Bahary N, Chau I, Hosein PJ, Ko AH, Lacy J, Jamieson N, Tinchon C, Kim KP, Besselink MG, Wilmink J, Homs MY, van Eijck CH, Katz MHG, Groot Koerkamp B. Neoadjuvant FOLFIRINOX in patients with (borderline) resectable pancreatic cancer: A systematic review and patient-level meta-analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Stefan Buettner
- Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mustafa Suker
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios A Margonis
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Bassel F. El-Rayes
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nathan Bahary
- University of Pittsburgh Medical Center Cancer Center Pavilion, Pittsburgh, PA
| | - Ian Chau
- Royal Marsden Hospital, London & Sutton, United Kingdom
| | - Peter Joel Hosein
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew H. Ko
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Jill Lacy
- Smilow Cancer Hospital, Yale University, New Haven, CT
| | - Nigel Jamieson
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | | | - Kyu-Pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Johanna Wilmink
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Nonnekens J, van Kranenburg M, Beerens CE, Suker M, Doukas M, van Eijck CH, de Jong M, van Gent DC. Potentiation of Peptide Receptor Radionuclide Therapy by the PARP Inhibitor Olaparib. Am J Cancer Res 2016; 6:1821-32. [PMID: 27570553 PMCID: PMC4997239 DOI: 10.7150/thno.15311] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/16/2016] [Indexed: 01/02/2023] Open
Abstract
Metastases expressing tumor-specific receptors can be targeted and treated by binding of radiolabeled peptides (peptide receptor radionuclide therapy or PRRT). For example, patients with metastasized somatostatin receptor-positive neuroendocrine tumors (NETs) can be treated with radiolabeled somatostatin analogues, resulting in strongly increased progression-free survival and quality of life. There is nevertheless still room for improvement, as very few patients can be cured at this stage of disease. We aimed to specifically sensitize replicating tumor cells without further damage to healthy tissues. Thereto we investigated the DNA damaging effects of PRRT with the purpose to enhance these effects through modulation of the DNA damage response. Although PRRT induces DNA double strand breaks (DSBs), a larger fraction of the induced lesions are single strand breaks (expected to be similar to those induced by external beam radiotherapy) that require poly-[ADP-ribose]-polymerase 1 (PARP-1) activity for repair. If these breaks cannot be repaired, they will cause replication fork arrest and DSB formation during replication. Therefore, we used the PARP-1 inhibitor Olaparib to increase the number of cytotoxic DSBs. Here we show that this new combination strategy synergistically sensitized somatostatin receptor expressing cells to PRRT. We observed increased cell death and reduced cellular proliferation compared to the PRRT alone. The enhanced cell death was caused by increased numbers of DSBs that are repaired with remarkably slow kinetics, leading to genome instability. Furthermore, we validated the increased DSB induction after PARP inhibitor addition in the clinically relevant model of living human NET slices. We expect that this combined regimen can thus augment current PRRT outcomes.
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11
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van Rijssen LB, Narwade P, van Huijgevoort NC, Tseng DS, van Santvoort HC, Molenaar IQ, van Laarhoven HW, van Eijck CH, Busch OR, Besselink MG. Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis. HPB (Oxford) 2016; 18:559-66. [PMID: 27346135 PMCID: PMC4925793 DOI: 10.1016/j.hpb.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or periampullary cancer. Some surgeons will continue the resection while others abort the exploration. METHODS A systematic search was performed in PubMed, EMBASE and Cochrane Library for studies investigating survival in patients with intra-operatively detected hepatic-artery or para-aortic LNM. Survival was stratified for node positive (N1) disease. RESULTS After screening 3088 studies, 13 studies with 2045 patients undergoing pancreatoduodenectomy were included. No study reported survival data after detection of LNM and aborted surgical exploration. In 110 patients with hepatic-artery LNM, median survival ranged between 7 and 17 months. Estimated pooled mean survival in 84 patients with hepatic-artery LNM was 15 [95%CI 12-18] months (13 months in PDAC), compared to 19 [16-22] months in 270 patients with N1-disease without hepatic-artery LNM (p = 0.020). In 192 patients with para-aortic LNM, median survival ranged between 5 and 32 months. Estimated pooled mean survival in 169 patients with para-aortic LNM was 13 [8-17] months (11 months in PDAC), compared to 17 (6-27) months in 506 patients with N1-disease without para-aortic LNM (p < 0.001). Data on the impact of (neo)adjuvant therapy on survival were lacking. CONCLUSION Survival after pancreatoduodenectomy in patients with intra-operatively detected hepatic-artery and especially para-aortic LNM is inferior to patients undergoing pancreatoduodenectomy with other N1 disease. It remains unclear what the consequence of this should be since data on (neo-)adjuvant therapy and survival after aborted exploration are lacking.
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Affiliation(s)
| | - Poorvi Narwade
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Hjalmar C. van Santvoort
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands,Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | | | | | | | - Marc G.H. Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands,Correspondence: Marc G. Besselink, Academic Medical Center Amsterdam, Department of Surgery, G4.196, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Tel: +31 20 5662666.Academic Medical Center AmsterdamDepartment of SurgeryG4.196, PO Box 22660Amsterdam1100 DDThe Netherlands
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12
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Genc CG, Partelli S, Falconi M, Muffatti F, van Dieren S, Klumpen HJ, van Eijck CH, Nieveen van Dijkum EJ. Nomogram to predict recurrence after curative resection of pancreatic neuroendocrine tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Genc CG, van Eijck CH, Nieveen van Dijkum EJ. Overview of pancreatic neuroendocrine tumor management and survival in the Netherlands. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Dulfer R, Geilvoet W, Morks A, van Lieshout EM, Smit CP, Nieveen van Dijkum EJ, in't Hof K, van Dam F, van Eijck CH, de Graaf PW, van Ginhoven TM. Impact of parathyroidectomy for primary hyperparathyroidism on quality of life: A case-control study using Short Form Health Survey 36. Head Neck 2016; 38:1213-20. [DOI: 10.1002/hed.24499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Roderick Dulfer
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Wanda Geilvoet
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Annelien Morks
- Department of Surgery; Groene Hart Ziekenhuis; Gouda The Netherlands
| | | | - Casper P.C Smit
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | | | - Klaas in't Hof
- Department of Surgery; Flevoziekenhuis; Almere The Netherlands
| | | | | | - Peter W. de Graaf
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | - Tessa M. van Ginhoven
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
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15
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Pool SE, Kam BL, Koning GA, Konijnenberg M, ten Hagen TL, Breeman WA, Krenning EP, de Jong M, van Eijck CH. [111In-DTPA]octreotide Tumor Uptake in GEPNET Liver Metastases After Intra-Arterial Administration: An Overview of Preclinical and Clinical Observations and Implications for Tumor Radiation Dose After Peptide Radionuclide Therapy. Cancer Biother Radiopharm 2014; 29:179-87. [DOI: 10.1089/cbr.2013.1552] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Stefan E. Pool
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Boen L.R. Kam
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mark Konijnenberg
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Eric P. Krenning
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marion de Jong
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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16
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Morak MJ, van Koetsveld PM, Kanaar R, Hofland LJ, van Eijck CH. Type I interferons as radiosensitisers for pancreatic cancer. Eur J Cancer 2011; 47:1938-45. [DOI: 10.1016/j.ejca.2011.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/08/2011] [Indexed: 01/02/2023]
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17
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Erdmann J, Vitale G, van Koetsveld PM, Croze E, Sprij-Mooij DM, Hofland LJ, van Eijck CH. Effects of Interferons α/β on the Proliferation of Human Micro- and Macrovascular Endothelial Cells. J Interferon Cytokine Res 2011; 31:451-8. [DOI: 10.1089/jir.2009.0103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Joris Erdmann
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Division Endocrinology, Erasmus MC, Rotterdam, The Netherlands
| | - Giovanni Vitale
- Department of Internal Medicine, Division Endocrinology, Erasmus MC, Rotterdam, The Netherlands
- Chair of Endocrinology, Department of Medical Sciences, Faculty of Medicine, University of Milan, Milan, Italy
- IRCCS, Instituto Auxologico Italiano, Milan, Italy
| | - Peter M. van Koetsveld
- Department of Internal Medicine, Division Endocrinology, Erasmus MC, Rotterdam, The Netherlands
| | - Ed Croze
- Department of Immunology, Berlex Bioscience, Inc., Richmond, California
| | - Diane M. Sprij-Mooij
- Department of Internal Medicine, Division Endocrinology, Erasmus MC, Rotterdam, The Netherlands
| | - Leo J. Hofland
- Department of Internal Medicine, Division Endocrinology, Erasmus MC, Rotterdam, The Netherlands
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