1
|
Schostak M, Bradbury A, Briganti A, Gonzalez D, Gomella L, Mateo J, Penault-Llorca F, Stenzinger A, Wyatt AW, Bjartell A. Practical Guidance on Establishing a Molecular Testing Pathway for Alterations in Homologous Recombination Repair Genes in Clinical Practice for Patients with Metastatic Prostate Cancer. Eur Urol Oncol 2024; 7:344-354. [PMID: 37714762 DOI: 10.1016/j.euo.2023.08.004] [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: 10/11/2022] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023]
Abstract
CONTEXT Prostate cancer is a molecularly heterogeneous disease that is amenable to diagnostic testing to identify patients potentially eligible for personalised treatments inform familial risk and provide relevant information about potential prognosis. Several guidelines support the integration of genomic testing in a shared decision-making framework so that both health care professionals (HCPs) and patients are involved in determining the best treatment approach. OBJECTIVE To review current guidelines on molecular diagnostic testing for homologous recombination repair (HRR) gene alterations in patients with metastatic prostate cancer, with the aim of providing practical considerations for effective guideline implementation and establishment of an appropriate pathway for molecular diagnostic testing. EVIDENCE ACQUISITION We undertook a nonsystematic narrative review of the literature using PubMed to identify current guidelines and recommendations on molecular diagnostic testing for BRCA and/or homologous recombination repair gene alterations (HRRm) in patients with prostate cancer. In addition, selected articles that included BRCA/HRRm testing in clinical trials in metastatic castration-resistant prostate cancer and real-world evidence were also evaluated. Websites for relevant societies were reviewed for molecular diagnostic guidelines not published on PubMed. EVIDENCE SYNTHESIS Our review of guidelines published by several international societies that include molecular testing in prostate cancer identified variations in molecular testing approaches. The review of testing approaches used in clinical trials and real-world settings also highlighted several aspects that require improvement. Therefore, we compiled practical guidance for establishing an appropriate BRCA/HRR mutation testing pathway. CONCLUSIONS While there are several challenges to molecular testing and interpretation of test results that require enhancement, a multidisciplinary team approach will empower HCPs and their institutions to improve on or initiate their own molecular testing pathways. This in turn will lead to improvements in management strategies for patients with metastatic prostate cancer, for whom better treatment outcomes is a significant unmet need. PATIENT SUMMARY Establishing a molecular testing pathway in clinical practice for patients with metastatic castration-resistant prostate cancer will lead to fairer and more equal access to personalised treatments. This should lead to better outcomes, particularly for patients whose disease has spread to other areas of the body.
Collapse
Affiliation(s)
- Martin Schostak
- Department of Urology, Urooncology, Robot-assisted and Focal Treatment, University Hospital Magdeburg, Magdeburg, Germany.
| | - Angela Bradbury
- Perelman Center for Advanced Medicine, Philadelphia, PA, USA
| | | | - David Gonzalez
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, UK
| | - Leonard Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joaquin Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Alexander W Wyatt
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Shah YB, McPartland C, Wang KR, Simhal RK, Murphy A, Shenot P, Gomella L, Lallas CD. Early Urology Exposure Increases Success in the Residency Match: An Institutional Experience. Urology 2023; 173:230-231. [PMID: 36566786 DOI: 10.1016/j.urology.2022.11.041] [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] [Received: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Yash B Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Connor McPartland
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kerith R Wang
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Rishabh K Simhal
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alana Murphy
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Patrick Shenot
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Leonard Gomella
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
3
|
Nerli RB, Ghagane SC, Rangrez SS, Chandra S, Thakur ML, Gomella L. Author Reply Re: Nerli RB, Ghagane SC, Rangrez S, Chandra S, Thakur ML, Gomella L. Detection of bladder cancer using voided urine sample and by targeting genomic VPAC receptors. Indian J Urol 2021;37:345-9. Indian J Urol 2022; 38:78-79. [PMID: 35136304 PMCID: PMC8796771 DOI: 10.4103/iju.iju_462_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/18/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajendra B. Nerli
- Department of Urology, JN Medical College, Belagavi, Karnataka, India,Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India,E-mail:
| | - Shridhar C. Ghagane
- Department of Urology, JN Medical College, Belagavi, Karnataka, India,Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
| | | | - Shreya Chandra
- Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
| | - Madhukar L. Thakur
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA,Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA,The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leonard Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA,The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
4
|
Nerli RB, Ghagane SC, Rangrez S, Chandra S, Thakur ML, Gomella L. Detection of bladder cancer using voided urine sample and by targeting genomic VPAC receptors. Indian J Urol 2021; 37:345-349. [PMID: 34759527 PMCID: PMC8555562 DOI: 10.4103/iju.iju_132_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Cells exfoliated into urine from the bladder can help to diagnose the cancer. The objective of this study was to validate the hypothesis that bladder cancer could be detected noninvasively by a simple and reliable assay targeting genomic VPAC (combined vasoactive intestinal peptide and pituitary adenylate cyclase-activating peptide family of cell surface receptors) receptors expressed on the malignant bladder cancer cells shed in the voided urine. Methods: Patients ≥18 years of age with either imaging (ultrasonography/computed tomography [CT])-confirmed bladder tumors or those who have been previously treated for nonmuscle invasive bladder tumors and were visiting the department for check cystoscopy, formed the study group. Freshly voided urine sample was collected from these patients and sent for conventional cytology examination, 5-aminolevulinic acid (ALA) fluorescent urine cytology, and for positivity of VPAC receptors. Results: A total of 103 patients were prospectively included in the study. Of these, 65 patients (Group I) presented with image-diagnosed (ultrasonography and/or CT) bladder cancer. The remaining 38 patients (Group II) were previously diagnosed cases of nonmuscle invasive bladder cancer and presented for follow-up and check cystoscopy. The sensitivity for VPAC receptor positivity was 89.23% compared to conventional cytology (63.07%) and 5-ALA fluorescent urine cytology (87.69%). The specificity of VPAC receptor positivity was 100% compared to conventional cytology (100%) and 5-ALA-induced fluorescent cytology (90.47%). Conclusions: Our preliminary study shows encouraging results with VPAC receptor positivity studies, which has a high sensitivity when compared to the conventional cytology.
Collapse
Affiliation(s)
- Rajendra B Nerli
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Karnataka, India.,Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
| | - Shridhar C Ghagane
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Karnataka, India.,Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
| | - Shadab Rangrez
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Karnataka, India
| | - Shreya Chandra
- Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
| | - Madhukar L Thakur
- Department of Urology and Radiology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.,The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leonard Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.,The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Nerli RB, Ghagane SC, Bidi SR, Thakur ML, Gomella L. Voided urine test to diagnose prostate cancer: Preliminary report. Cytojournal 2021; 18:26. [PMID: 34754324 PMCID: PMC8571200 DOI: 10.25259/cytojournal_76_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Prostate cancer (PCa) is a common malignancy affecting elderly male. At present, PCa is estimated using serum prostate-specific antigen (PSA). Prostate biopsy remains the gold standard to confirm the diagnosis of PCa. In this preliminary study, we have assessed the feasibility of detecting PCa using voided urine by targeting the genomic vasoactive intestinal peptide receptor (VPAC) expressed on malignant PCa cells. Material and Methods Patients ≥40 years old, with no lower urinary tract symptoms (LUTS) and serum PSA levels of <1.6 ng/mL formed the control group and patients ≥40 years old, with LUTS and serum PSA >2.6 ng/ mL formed the study group. Patients were advised to give the first 50 mL of voided urine sample for the detection of malignant markers by targeting the VPAC. The results of histopathological studies were then compared to the results of urine biomarker. Results The study revealed absence of malignant markers in 75 patients (control group). In the study group, all the 33 patients with adenocarcinoma were positive for malignant markers in the biomarker study and absence of malignant markers in the 32 patients with benign histology. The results of the biomarker studies and histopathology were consistent with each other. Conclusion This preliminary study validates our belief that patients with PCa do shed malignant cells in the urine which can be identified by targeting the VPAC. The investigation is easy and our data appear to be highly encouraging and further serve as a simple, reliable, and a non-invasive tool in the detection of PCa.
Collapse
Affiliation(s)
- R B Nerli
- Department of Urology, Division of Urologic-Oncology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi, Karnataka, India.,Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and M.R.C, Belagavi, Karnataka, India
| | - Shridhar C Ghagane
- Department of Urology, Division of Urologic-Oncology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi, Karnataka, India.,Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and M.R.C, Belagavi, Karnataka, India
| | - Saziya R Bidi
- Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and M.R.C, Belagavi, Karnataka, India
| | - Madhukar L Thakur
- Department of Urology, Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Leonard Gomella
- Department of Urology, Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| |
Collapse
|
6
|
Narayan V, Boorjian S, Alemozaffer M, Konety B, Gomella L, Kamat A, Lerner S, Svatek R, Karsh L, Canter D, Lotan Y, Inman B, Yang M, Garcia-Horton V, Sawutz D, Parker N, Dinney C. Subgroup analyses of the phase 3 study of intravesical nadofaragene firadenovec in patients with high-grade, BCG-unresponsive Non-Muscle Invasive Bladder Cancer (NMIBC). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01121-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Narayan V, Boorjian S, Alemozaffer M, Konety B, Gomella L, Kamat A, Lerner S, Svatek R, Karsh L, Canter D, Lotan Y, Inman B, Yang M, Garcia-Horton V, Sawutz D, Parker N, Dinney C. Significant anti-adenovirus antibody response positively correlates with efficacy in patients treated with nadofaragene firadenovec for high-grade BCG-unresponsive Non-Muscle Invasive Bladder Cancer (NMIBC). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01122-2] [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: 10/20/2022]
|
8
|
Morgans AK, Shore N, Cope D, McNatty A, Moslehi J, Gomella L, Sartor O. Androgen receptor inhibitor treatments: Cardiovascular adverse events and comorbidity considerations in patients with non-metastatic prostate cancer. Urol Oncol 2020; 39:52-62. [PMID: 32958445 DOI: 10.1016/j.urolonc.2020.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/07/2020] [Revised: 06/24/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Prostate cancer and cardiovascular (CV) disease share several risk factors, with the incidence of both rising with increasing age. Systemic prostate cancer therapies may increase CV risk. For example, gonadotropic releasing hormone agonists have been associated with increased development of CV risk factors, and potentially with CV disease. For men with non-metastatic castration-resistant prostate cancer (nmCRPC), the opportunity to mitigate CV risk by appropriate selection of therapy (i.e., use of newer agents such as androgen receptor inhibitors) may be possible. The phase 3 PROSPER, SPARTAN, and ARAMIS trials for enzalutamide, apalutamide, and darolutamide, the 3 approved androgen receptor inhibitors for men with nmCRPC, were all associated with increased metastasis-free survival in patients with metastatic castration-resistant prostate cancer (mCRPC). Our objective in writing this review is to improve awareness of the relationship between long-term androgen deprivation and increased risk for CV disease and inform treatment decision making for patients with mCRPC who also have CV comorbidities. METHODS The PubMed database was searched from 2010 to November 5, 2019 for articles pertaining to androgen receptor inhibitors, androgen inhibition, apalutamide, darolutamide, enzalutamide, CV, and CaP. RESULTS We found literature describing the relationship between androgen inhibition and CV disease and risks. Given the increased risk of CV disease due to exposure to gonadotropic releasing hormone agonist therapy alone, understanding the potential for additional CV risks is important for patients with CV comorbidities when an androgen receptor inhibitor is added to their treatment. Another important consideration is the possibility of drug-drug interactions with comedications. CONCLUSION Management strategies for patients with mCRPC also treated for comorbidities including CV disease require appropriate selection of therapy, diet, and exercise to meet the needs of the individual patient profile.
Collapse
Affiliation(s)
- Alicia K Morgans
- Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Neal Shore
- Carolina Urologic Research Center, 823 82nd Pkwy Suite B, Myrtle Beach, SC 29572
| | - Diane Cope
- Florida Cancer Specialists and Research Institute, 8260 Gladiolus Dr, Fort Myers, FL 33908
| | - Andrea McNatty
- Mayo Clinic Arizona, 5881 E. Mayo Blvd., Phoenix, AZ 85054
| | - Javid Moslehi
- Cardio-Oncology Program, Vanderbilt University Medical Center, 1215 21st Ave., Nashville, TN 37232
| | - Leonard Gomella
- Sidney Kimmel Cancer Center at Thomas Jefferson University, 1025 Walnut St. Suite 1112, Philadelphia, PA 19107
| | - Oliver Sartor
- Tulane University Medical School, 1430 Tulane Ave., Box 8642, New Orleans 70112 LA
| |
Collapse
|
9
|
Carceles-Cordon M, Kelly WK, Gomella L, Knudsen KE, Rodriguez-Bravo V, Domingo-Domenech J. Cellular rewiring in lethal prostate cancer: the architect of drug resistance. Nat Rev Urol 2020; 17:292-307. [PMID: 32203305 PMCID: PMC7218925 DOI: 10.1038/s41585-020-0298-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
Over the past 5 years, the advent of combination therapeutic strategies has substantially reshaped the clinical management of patients with advanced prostate cancer. However, most of these combination regimens were developed empirically and, despite offering survival benefits, are not enough to halt disease progression. Thus, the development of effective therapeutic strategies that target the mechanisms involved in the acquisition of drug resistance and improve clinical trial design are an unmet clinical need. In this context, we hypothesize that the tumour engineers a dynamic response through the process of cellular rewiring, in which it adapts to the therapy used and develops mechanisms of drug resistance via downstream signalling of key regulatory cascades such as the androgen receptor, PI3K-AKT or GATA2-dependent pathways, as well as initiation of biological processes to revert tumour cells to undifferentiated aggressive states via phenotype switching towards a neuroendocrine phenotype or acquisition of stem-like properties. These dynamic responses are specific for each patient and could be responsible for treatment failure despite multi-target approaches. Understanding the common stages of these cellular rewiring mechanisms to gain a new perspective on the molecular underpinnings of drug resistance might help formulate novel combination therapeutic regimens.
Collapse
Affiliation(s)
- Marc Carceles-Cordon
- Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - W Kevin Kelly
- Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leonard Gomella
- Urology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen E Knudsen
- Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
- Urology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Veronica Rodriguez-Bravo
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Josep Domingo-Domenech
- Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
10
|
Woo J, Santasusagna S, Banks J, Dominguez-Andres A, Yadav K, Pippa R, Carceles-Cordon M, Lallas C, Luyao G, Rodriguez-Bravo V, Tewari A, Pastor-Lopez S, Kelly W, Leiby B, Prats J, Gomella L, Domingo-Domenech J. Urine extracellular vesicle GATA2 mRNA alone and in a multigene test predicts initial prostate biopsy result. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.044] [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: 11/14/2022] Open
|
11
|
Leong JY, Syed A, Uhr A, Chandrasekar T, Gomella L, Glassman D. Single-Institution Follow-Up Experience with Telemedicine. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.705] [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: 10/25/2022]
|
12
|
Shafi AA, Schiewer MJ, Leeuw RD, Dylgjeri E, McCue PA, Shah N, Gomella L, Lallas C, Trabulsi E, Centerera M, Hickey T, Butler L, Raj G, Tilley W, Cukierman E, Knudsen KE. Abstract 112: Patient derived models reveal impact of the tumor microenvironment on therapeutic response. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-112] [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
Prostate cancer (PCa) is the most common non-cutanenous cancer and the second leading cause of cancer-related death in American men. Androgen receptor (AR) is a hormone-activated transcription factor that plays an important role in both the development and progression of PCa. Androgen deprivation therapy is a common first-line therapy for disseminated disease. However, virtually all tumors become resistant to such therapy and the tumor recurs. Thus, there is a vital need for the development of novel, more effective drugs. One major hurdle in this aspect is the lack of adequate preclinical models. Current models do not effectively recapitulate the heterogeneity and the microenvironment of human PCa tumors, significantly hindering the ability to accurately predict therapeutic response. Our collaborative group has utilized and characterized a method to culture patient tumors ex vivo, termed Patient Derived Explant (PDE). This approach maintains the integrity of the native tumor microenvironment, tumor tissue morphology, and molecular signaling. Importantly, our PDE model can be manipulated both chemically (drugs/compounds) and genetically (shRNA) in order to determine specific reactions and mechanisms of response on individual tumor growth. Furthermore, with this model we can quantitatively assess drug efficacy on numerous parameters (i.e. AR levels, Ki67 staining, apoptosis screening, and desmoplasmic indices). Data to be discussed will assess the variances in response to AR-directed therapeutics and underlying mechanisms of action, while also utilizing TME characteristics as a means to predict response to therapy. In addition, we can potentially identify clinically relevant subpopulations of patients and molecularly profile their cultured tissue to uncover new pathways for therapeutic intervention. Thus, the PDE model allows for a comprehensive evaluation of individual tumors in their native microenvironment to ultimately develop more effective therapies. This study will have transformative clinical impact discerning novel metrics for the inclusion of precision medicine for advanced PCa.
Citation Format: Ayesha A. Shafi, Matthew J. Schiewer, Renée de Leeuw, Emanuela Dylgjeri, Peter A. McCue, Neelima Shah, Leonard Gomella, Costas Lallas, Edouard Trabulsi, Margaret Centerera, Theresa Hickey, Lisa Butler, Ganesh Raj, Wayne Tilley, Edna Cukierman, Karen E. Knudsen. Patient derived models reveal impact of the tumor microenvironment on therapeutic response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 112.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh Raj
- 4University of Texas Southwestern, Dallas, TX
| | | | | | | |
Collapse
|
13
|
Joseph JV, Brasacchio R, Fung C, Reeder J, Bylund K, Sahasrabudhe D, Yeh SY, Ghazi A, Fultz P, Rubens D, Wu G, Singer E, Schwarz E, Mohile S, Mohler J, Theodorescu D, Lee YF, Okunieff P, McConkey D, Rashid H, Chang C, Fradet Y, Guru K, Kukreja J, Sufrin G, Lotan Y, Bailey H, Noyes K, Schwartz S, Rideout K, Bratslavsky G, Campbell SC, Derweesh I, Abrahamsson PA, Soloway M, Gomella L, Golijanin D, Svatek R, Frye T, Lerner S, Palapattu G, Wilding G, Droller M, Trump D. A Festschrift in Honor of Edward M. Messing, MD, FACS. Bladder Cancer 2018; 4:S1-S43. [PMID: 30443561 PMCID: PMC6226303 DOI: 10.3233/blc-189037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Jean V. Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jay Reeder
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Bylund
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Shu Yuan Yeh
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Fultz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah Rubens
- University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Edward Schwarz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Yi Fen Lee
- University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Okunieff
- UF Health Proton Therapy Institute, Gainesville, FL, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Hani Rashid
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Yves Fradet
- CHU de Quebec-Hotel-Dieu de Quebec, Quebec, QC, Canada
| | | | | | - Gerald Sufrin
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Yair Lotan
- UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Howard Bailey
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Kathy Rideout
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Leonard Gomella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Thomas Frye
- University of Rochester Medical Center, Rochester, NY, USA
| | - Seth Lerner
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | | | | | - Donald Trump
- Virginia Commonwealth University, Fairfax, VA, USA
| |
Collapse
|
14
|
Schiewer MJ, Mandigo A, Gordon N, Huang F, Gaur S, Zhao G, Evans J, Han S, Parsons T, Birbe R, McCue P, Visakorpi T, Raj G, Rubin M, Bono JD, Lallas C, Trabulsi E, Gomella L, Dicker A, Kelly WK, Knudsen B, Feng F, Knudsen KE. Abstract B017: PARP-1 and E2F1 collaborate to transcriptionally regulate DNA repair factor availability. Cancer Res 2018. [DOI: 10.1158/1538-7445.prca2017-b017] [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
PARP-1 holds at least four major functions on chromatin: DNA damage repair, telomeric maintenance, chromatin dynamics, and transcriptional regulation—all of which are relevant in the context of cancer. Notably, PARP-1 has been found to be a key modulator of androgen receptor (AR) function and AR-dependent phenotypes, which is a driving factor in prostate cancer (PCa) biology and therapeutic management. Recent studies indicate an unanticipated prevalence of DNA repair alterations in advanced PCa and showed that PARP-1 inhibitors (PARPi) can effectively manage a subset of these tumors. Despite the functions of PARP-1 in DNA repair having been exploited as a therapeutic target for tumors with BRCA1/2 aberrations, factors beyond DNA repair alterations clearly play a role in the response to PARPi. Notably, while DNA repair defects enrich for PARPi responders, BRCA1/2 alterations do not appear to be necessary or sufficient to induce PARPi clinical response. Given the preclinical and clinical data, pursuing a deeper understanding of the molecular underpinnings of PARPi action in PCa may yield significant benefit. Human tissue microarrays were utilized to quantify PARP-1 levels and activity as a function of PCa progression. Genome-wide transcriptional profiling in response to PARPi was performed and the PARP-1-regulated transcriptome was identified. Both the PARP-1-regulated transcriptome and PARP-1 enzymatic activity were found to be elevated as a function of PCa progression. Further interrogation of the PARP-1-regulated transcriptome revealed a major impact on E2F1-regulated genes, and chromatin immunoprecipitation analyses indicated that PARP-1 functions to regulate the chromatin architecture and E2F1 occupancy at E2F1 target gene loci. Most prominent among the E2F1-regulated genes responsive to PARPi were genes associated with DNA damage repair, with a particular enrichment for genes involved in homologous recombination (HR). In sum, these data indicate that PARP-1 regulates the function of key oncogenic transcription factors (AR and E2F1) in PCa, and part of the effect of PARPi may be through downregulation of DNA repair factors.
Citation Format: Matthew J. Schiewer, Amy Mandigo, Nicolas Gordon, Fangjin Huang, Sanchaika Gaur, George Zhao, Joseph Evans, Sumin Han, Theodore Parsons, Ruth Birbe, Peter McCue, Tapio Visakorpi, Ganesh Raj, Mark Rubin, Johann de Bono, Costas Lallas, Edouard Trabulsi, Leonard Gomella, Adam Dicker, Wm. Kevin Kelly, Beatrice Knudsen, Felix Feng, Karen E. Knudsen. PARP-1 and E2F1 collaborate to transcriptionally regulate DNA repair factor availability [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B017.
Collapse
Affiliation(s)
| | - Amy Mandigo
- 1Thomas Jefferson University, Philadelphia, PA,
| | | | | | | | | | | | - Sumin Han
- 3University of Michigan, Ann Arbor, MI,
| | | | - Ruth Birbe
- 1Thomas Jefferson University, Philadelphia, PA,
| | - Peter McCue
- 1Thomas Jefferson University, Philadelphia, PA,
| | | | | | | | - Johann de Bono
- 7Institute for Cancer Research, Royal Marsden, London, United Kingdom,
| | | | | | | | - Adam Dicker
- 1Thomas Jefferson University, Philadelphia, PA,
| | | | | | | | | |
Collapse
|
15
|
Rodriguez-Bravo V, Pippa R, Song WM, Carceles-Cordon M, Dominguez-Andres A, Fujiwara N, Woo J, Koh AP, Ertel A, Lokareddy RK, Cuesta-Dominguez A, Kim RS, Rodriguez-Fernandez I, Li P, Gordon R, Hirschfield H, Prats JM, Reddy EP, Fatatis A, Petrylak DP, Gomella L, Kelly WK, Lowe SW, Knudsen KE, Galsky MD, Cingolani G, Lujambio A, Hoshida Y, Domingo-Domenech J. Nuclear Pores Promote Lethal Prostate Cancer by Increasing POM121-Driven E2F1, MYC, and AR Nuclear Import. Cell 2018; 174:1200-1215.e20. [PMID: 30100187 DOI: 10.1016/j.cell.2018.07.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 12/19/2022]
Abstract
Nuclear pore complexes (NPCs) regulate nuclear-cytoplasmic transport, transcription, and genome integrity in eukaryotic cells. However, their functional roles in cancer remain poorly understood. We interrogated the evolutionary transcriptomic landscape of NPC components, nucleoporins (Nups), from primary to advanced metastatic human prostate cancer (PC). Focused loss-of-function genetic screen of top-upregulated Nups in aggressive PC models identified POM121 as a key contributor to PC aggressiveness. Mechanistically, POM121 promoted PC progression by enhancing importin-dependent nuclear transport of key oncogenic (E2F1, MYC) and PC-specific (AR-GATA2) transcription factors, uncovering a pharmacologically targetable axis that, when inhibited, decreased tumor growth, restored standard therapy efficacy, and improved survival in patient-derived pre-clinical models. Our studies molecularly establish a role of NPCs in PC progression and give a rationale for NPC-regulated nuclear import targeting as a therapeutic strategy for lethal PC. These findings may have implications for understanding how NPC deregulation contributes to the pathogenesis of other tumor types.
Collapse
Affiliation(s)
- Veronica Rodriguez-Bravo
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Raffaella Pippa
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Won-Min Song
- Genetic and Genomic Sciences Department. Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Marc Carceles-Cordon
- Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ana Dominguez-Andres
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Naoto Fujiwara
- Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jungreem Woo
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anna P Koh
- Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Adam Ertel
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ravi K Lokareddy
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alvaro Cuesta-Dominguez
- Oncological Sciences Department. Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Division of Liver Diseases, Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rosa S Kim
- Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Peiyao Li
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ronald Gordon
- Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hadassa Hirschfield
- Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Josep M Prats
- Urology Department, Hospital de Calella, Barcelona 08370, Spain
| | - E Premkumar Reddy
- Oncological Sciences Department. Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alessandro Fatatis
- Pharmacology and Physiology Department, Drexler University, Philadelphia, PA 19104, USA
| | - Daniel P Petrylak
- Medical Oncology Department, Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT 06520, USA
| | - Leonard Gomella
- Urology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - W Kevin Kelly
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Urology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Scott W Lowe
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Karen E Knudsen
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Urology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew D Galsky
- Medical Oncology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gino Cingolani
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Amaia Lujambio
- Oncological Sciences Department. Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Division of Liver Diseases, Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yujin Hoshida
- Liver Tumor Translational Research Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Josep Domingo-Domenech
- Cancer Biology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Medical Oncology Department, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Pathology Department, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| |
Collapse
|
16
|
Mann M, Calio B, Reese A, Chelluri R, Hufnagel E, Mark JR, Lallas C, Trabulsi E, Gomella L. MP15-18 HOSPITAL-SPECIFIC ANTIBIOGRAMS AND ANTIBIOTIC PROPHYLAXIS FOR PROSTATE BIOPSIES: A REEXAMINATION OF AUA RECOMMENDATIONS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.531] [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: 10/17/2022]
|
17
|
Mark JR, Kucherov V, Den RB, Dicker AP, Giri V, Godwin JL, Hoffman-Censits J, Lallas C, Mann M, McCue P, Trabulsi E, Knudsen K, Kelly WK, Gomella L. MP51-08 PRELIMINARY EXPERIENCE WITH COMPREHENSIVE GENOMIC PROFILING OF GENITOURINARY TUMORS; A TOOL TO DIRECT CLINICAL DECISIONS? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1639] [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: 10/17/2022]
|
18
|
Tripathi SK, Kumar P, Trabulsi EJ, Kim S, McCue PA, Intenzo C, Berger A, Gomella L, Thakur ML. VPAC1 Targeted 64Cu-TP3805 kit preparation and its evaluation. Nucl Med Biol 2017; 51:55-61. [PMID: 28577428 DOI: 10.1016/j.nucmedbio.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Previously, our laboratory has shown that 64Cu-TP3805 can specifically target VPAC1 receptors and be used for positron emission tomography (PET) imaging of breast (BC) and prostate cancer (PC) in humans. Present work is aimed at the formulation of a freeze-dried diaminedithiol-peptide (N2S2-TP3805) kit and it's evaluation for the preparation of 64Cu labeled TP3805. Parameters such as pH, temperature and incubation time were examined that influenced the radiolabeling efficiency and stability of the product. METHODS Kits were prepared under different conditions and radiolabeling efficiency of TP3805 kit was evaluated for a range of pH3.5-8.5, after addition of 64Cu in 30μl, 0.1M HCl. Incubation temperature (37-90°C) and time (30-120min.) were also investigated. Kits were stored at -10°C and their long term stability was determined as a function of their radiolabeling efficiency. Further, stability of 64Cu-TP3805 complex was evaluated in presence of fetal bovine serum and bovine serum albumin by using SDS polyacrylamide gel electrophoresis. Kits were then used for PET imaging of BC and PC following eIND (101550) and institutional approvals. Specificity of 64Cu-TP3805 for VPAC1 was examined with digital autoradiography (DAR) of prostate tissues obtained after prostatectomy, benign prostatic hyperplasia (BPH) tissue, and benign and malignant lymph nodes. Results were compared with corresponding tissue histology. RESULTS Radiolabeling efficiency was ≥95% at final pH ~7.2 when incubated at 50°C for 90min. Kits were stable up to 18months when stored at -10°C, and 64Cu-TP3805 complex exhibited excellent stability for up to 4h at room temperature. 64Cu-TP3805 complex did not show any transchelation even after 2h incubation at 37°C in 10% FBS as well as in BSA as determined by SDS PAGE analysis. DAR identified ≥95% of malignant lesions 11 new PC lesions, 20 high grade prostatic intraepithelial neoplasia, 2/2 ejaculatory ducts and 5/5 urethra verumontanum not previously identified The malignant lymph nodes were correctly identified by DAR and for 3/3 BPH patients, and 5/5 cysts, DAR was negative. In human BC (n=19) and PC (n=26) were imaged with 100% sensitivity. CONCLUSION Availability of ready to use N2S2-peptide kits for 64Cu labeling is convenient and eliminates possible day to day variation during its routine preparation for clinical use.
Collapse
Affiliation(s)
| | - Pardeep Kumar
- Thomas Jefferson University, Department of Radiology
| | | | - Sung Kim
- Thomas Jefferson University, Department of Radiology
| | - Peter A McCue
- Thomas Jefferson University, Department of Pathology
| | | | - Adam Berger
- Thomas Jefferson University, Department of Surgery
| | - Leonard Gomella
- Thomas Jefferson University, Department of Urology; The Sidney Kimmel Cancer Center
| | - Mathew L Thakur
- Thomas Jefferson University, Department of Radiology; The Sidney Kimmel Cancer Center.
| |
Collapse
|
19
|
Trabulsi EJ, Tripathi SK, Gomella L, Solomides C, Wickstrom E, Thakur ML. Development of a voided urine assay for detecting prostate cancer non-invasively: a pilot study. BJU Int 2017; 119:885-895. [PMID: 28075510 DOI: 10.1111/bju.13775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/14/2022]
Abstract
OBJECTIVE To validate a hypothesis that prostate cancer can be detected non-invasively by a simple and reliable assay by targeting genomic VPAC receptors expressed on malignant prostate cancer cells shed in voided urine. PATIENTS/SUBJECTS AND METHODS VPAC receptors were targeted with a specific biomolecule, TP4303, developed in our laboratory. With an Institutional Review Board exempt approval of use of de-identified discarded samples, an aliquot of urine collected as a standard of care, from patients presenting to the urology clinic (207 patients, 176 men and 31 women, aged ≥21 years) was cytospun. The cells were fixed and treated with TP4303 and 4,6-diamidino-2-phenylindole (DAPI). The cells were then observed under a microscope and cells with TP4303 orange fluorescence around the blue (DAPI) nucleus were considered 'malignant' and those only with a blue nucleus were regarded as 'normal'. VPAC presence was validated using receptor blocking assay and cell malignancy was confirmed by prostate cancer gene profile examination. RESULTS The urine specimens were labelled only with gender and presenting diagnosis, with no personal health identifiers or other clinical data. The assay detected VPAC positive cells in 98.6% of the men with a prostate cancer diagnosis (141), and none of the 10 men with benign prostatic hyperplasia. Of the 56 'normal' patients, 62.5% (35 patients, 10 men and 25 women) were negative for VPAC cells; 19.6% (11, 11 men and no women) had VPAC positive cells; and 17.8% (10, four men and six women) were uninterpretable due to excessive crystals in the urine. Although data are limited, the sensitivity of the assay was 99.3% with a confidence interval (CI) of 96.1-100% and the specificity was 100% with a CI of 69.2-100%. Receptor blocking assay and fluorescence-activated cell sorting (FACS) analyses demonstrated the presence of VPAC receptors and gene profiling examinations confirmed that the cells expressing VPAC receptors were malignant prostate cancer cells. CONCLUSION These preliminary data are highly encouraging and warrant further evaluation of the assay to serve as a simple and reliable tool to detect prostate cancer non-invasively.
Collapse
Affiliation(s)
- Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sushil K Tripathi
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leonard Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charalambos Solomides
- Departments of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Wickstrom
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA.,The Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mathew L Thakur
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
20
|
Lallas CD, Scotland K, Zhang M, Schaeffer D, Calvaresi AE, Gomella L, Brown D, Shaw C, Trabulsi EJ. Clinical Influences in the Multidisciplinary Management of Small Renal Masses at a Tertiary Referral Center. Urol Pract 2016; 3:468-474. [PMID: 37592537 DOI: 10.1016/j.urpr.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We designed a multidisciplinary Small Renal Mass Center to help patients decide among treatment options and individualize therapy for small renal masses. In this model physicians and support staff from multiple specialties work as a team to evaluate and devise a treatment plan for patients at the same organized visit. METHODS We retrospectively reviewed the records of 263 patients seen from 2009 to 2014. Monitored patient characteristics included age, Charlson comorbidity index, body mass index, nephrometry score, tumor size and estimated glomerular filtration rate. Univariate and multivariate analyses were performed to identify patient characteristics associated with each treatment choice. RESULTS Of the cohort 88 patients elected active surveillance, 64 underwent ablation and 111 were treated with surgery, including partial and radical nephrectomy in 74 and 37, respectively. There were significant associations between treatment modality and age, Charlson comorbidity index, tumor size and estimated glomerular filtration rate. Mean patient age at presentation was 61.1 years. Patients with a high Charlson comorbidity index score (greater than 5) or a decreased estimated glomerular filtration rate (less than 60 ml/minute/1.73 m2) were more likely to undergo active surveillance (41.6% and 35%) and ablative therapy (29.6% and 34%) vs partial nephrectomy (10.6% and 9%, respectively, each p <0.001). On multivariable analysis age, tumor size and estimated glomerular filtration rate remained significantly associated with modality after adjustment for all other factors (each p <0.001). CONCLUSIONS The Small Renal Mass Center enables patients to assess the various treatment modalities for a small renal mass in a single setting. By providing simultaneous access to the various specialists it provides an invaluable opportunity for informed patient decision making.
Collapse
Affiliation(s)
- Costas D Lallas
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kymora Scotland
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael Zhang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daisey Schaeffer
- Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Anne E Calvaresi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Leonard Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Daniel Brown
- Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Colette Shaw
- Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Shafi A, Schiewer M, Leeuw RD, McCue P, Birbe R, Gomella L, Lallas C, Trabulsi E, Raj G, Knudsen K. Abstract A12: Developing PDeX (Patient Derived Explant) to determine the basis for response to AR-directed therapeutics. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.pdx16-a12] [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
Prostate cancer (PCa) is the most common non-cutanenous cancer and the second leading cause of cancer-related death in American men. Androgen receptor (AR) is a hormone-activated transcription factor that plays an important role in both the development and progression of PCa. Androgen deprivation therapy is a common first-line therapy. However, many patients become resistant to such therapy and the tumor recurs. Thus, there is a vital need for the development of novel, more effective drugs. One major hurdle in this aspect is the lack of adequate preclinical models. Current models do not effectively recapitulate the heterogeneity and the microenvironment of human PCa tumors hindering the ability to accurately predict therapeutic response. Our lab has generated a method to culture patient tumors ex vivo termed patient derived explant (PDeX). This approach maintains the integrity of the native tumor microenvironment, tumor tissue morphology, and molecular signaling. Intriguingly, our PDEX model can be targeted with various therapeutic agents or lentiviral-based shRNAs to determine specific responses on individual tumor growth. Furthermore, with this model we can quantitatively assess drug efficacy on numerous parameters (i.e. AR levels, Ki67 staining, apoptosis screening). Data to be discussed will assess the variances in response to AR-directed therapeutics and underlying mechanisms of action. In addition, we can potentially identify clinically relevant subpopulations of patients and molecularly profile their cultured tissue to uncover new pathways for therapeutic intervention. Thus, the PDeX model allows for a comprehensive evaluation of individual tumors in their native microenvironment to ultimately develop more effective therapies.
Citation Format: Ayesha Shafi, Matthew Schiewer, Renee de Leeuw, Peter McCue, Ruth Birbe, Leonard Gomella, Costas Lallas, Edouard Trabulsi, Ganesh Raj, Karen Knudsen. Developing PDeX (Patient Derived Explant) to determine the basis for response to AR-directed therapeutics. [abstract]. In: Proceedings of the AACR Special Conference: Patient-Derived Cancer Models: Present and Future Applications from Basic Science to the Clinic; Feb 11-14, 2016; New Orleans, LA. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(16_Suppl):Abstract nr A12.
Collapse
Affiliation(s)
| | | | | | - Peter McCue
- 1Thomas Jefferson University, Philadelphia, PA,
| | - Ruth Birbe
- 1Thomas Jefferson University, Philadelphia, PA,
| | | | | | | | | | | |
Collapse
|
22
|
Crawford ED, Rosenberg MT, Partin AW, Cooperberg MR, Maccini M, Loeb S, Pettaway CA, Shore ND, Arangua P, Hoenemeyer J, Leveridge M, Leapman M, Pinto P, Thompson IM, Carroll P, Eastham J, Gomella L, Klein EA. An Approach Using PSA Levels of 1.5 ng/mL as the Cutoff for Prostate Cancer Screening in Primary Care. Urology 2016; 96:116-120. [PMID: 27450937 DOI: 10.1016/j.urology.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Alan W Partin
- Department of Pathology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | - Stacy Loeb
- Department of Urology and Population Health, New York University, New York, NY
| | - Curtis A Pettaway
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neal D Shore
- Atlantic Urology Clinics, Carolina Urologic Research Center, Myrtle Beach, SC
| | - Paul Arangua
- University of Colorado Health Science Center, Aurora, CO
| | | | - Mike Leveridge
- Department of Urology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON
| | - Michael Leapman
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Peter Pinto
- National Cancer Institute, Center for Cancer Research, Bethesda, MD
| | - Ian M Thompson
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Peter Carroll
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - James Eastham
- Department of Urology, Memorial Sloan Kettering Cancer Institute, New York, NY
| | - Leonard Gomella
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Eric A Klein
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH
| |
Collapse
|
23
|
Talati PG, Gu L, Ellsworth EM, Girondo MA, Trerotola M, Hoang DT, Leiby B, Dagvadorj A, McCue PA, Lallas CD, Trabulsi EJ, Gomella L, Aplin AE, Languino L, Fatatis A, Rui H, Nevalainen MT. Jak2-Stat5a/b Signaling Induces Epithelial-to-Mesenchymal Transition and Stem-Like Cell Properties in Prostate Cancer. Am J Pathol 2016; 185:2505-22. [PMID: 26362718 DOI: 10.1016/j.ajpath.2015.04.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/24/2015] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
Abstract
Active Stat5a/b predicts early recurrence and disease-specific death in prostate cancer (PC), which both typically are caused by development of metastatic disease. Herein, we demonstrate that Stat5a/b induces epithelial-to-mesenchymal transition (EMT) of PC cells, as shown by Stat5a/b regulation of EMT marker expression (Twist1, E-cadherin, N-cadherin, vimentin, and fibronectin) in PC cell lines, xenograft tumors in vivo, and patient-derived PCs ex vivo using organ explant cultures. Jak2-Stat5a/b signaling induced functional end points of EMT as well, indicated by disruption of epithelial cell monolayers and increased migration and adhesion of PC cells to fibronectin. Knockdown of Twist1 suppressed Jak2-Stat5a/b-induced EMT properties of PC cells, which were rescued by re-introduction of Twist1, indicating that Twist1 mediates Stat5a/b-induced EMT in PC cells. While promoting EMT, Jak2-Stat5a/b signaling induced stem-like properties in PC cells, such as sphere formation and expression of cancer stem cell markers, including BMI1. Mechanistically, both Twist1 and BMI1 were critical for Stat5a/b induction of stem-like features, because genetic knockdown of Twist1 suppressed Stat5a/b-induced BMI1 expression and sphere formation in stem cell culture conditions, which were rescued by re-introduction of BMI1. By using human prolactin knock-in mice, we demonstrate that prolactin-Stat5a/b signaling promoted metastases formation of PC cells in vivo. In conclusion, our data support the concept that Jak2-Stat5a/b signaling promotes metastatic progression of PC by inducing EMT and stem cell properties in PC cells.
Collapse
Affiliation(s)
- Pooja G Talati
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lei Gu
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elyse M Ellsworth
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Melanie A Girondo
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marco Trerotola
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David T Hoang
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ayush Dagvadorj
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Peter A McCue
- Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leonard Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew E Aplin
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lucia Languino
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania; Prostate Cancer Discovery and Development Program, Wistar Institute, Philadelphia, Pennsylvania
| | - Alessandro Fatatis
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Hallgeir Rui
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marja T Nevalainen
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania; Prostate Cancer Discovery and Development Program, Wistar Institute, Philadelphia, Pennsylvania; Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
| |
Collapse
|
24
|
Mann M, Cleary R, Gomella L, Hubosky S, McCue P, Bagley D, Lallas C, Trabulsi E. PD13-05 FLUORESCENCE IN SITU HYBRIDIZATION (FISH) IN THE DIAGNOSIS OF BLADDER AND UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE-INSTITUTION EXPERIENCE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.976] [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: 11/29/2022]
|
25
|
Trabulsi E, Tripathi S, Calvaresi A, Solomides C, Gomella L, Thakur M. MP02-08 VPAC1 IN SHED URINARY CELLS – A POTENTIAL GENITOURINARY CANCER BIOMARKER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1880] [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: 10/22/2022]
|
26
|
Chu FM, Sartor O, Gomella L, Rudo T, Somerville MC, Hereghty B, Manyak MJ. A randomised, double-blind study comparing the addition of bicalutamide with or without dutasteride to GnRH analogue therapy in men with non-metastatic castrate-resistant prostate cancer. Eur J Cancer 2015; 51:1555-69. [DOI: 10.1016/j.ejca.2015.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 04/28/2015] [Indexed: 01/29/2023]
|
27
|
Trabulsi EJ, Kumar P, Tripathi S, Birbe R, McCue P, Wickstrom E, Intenzo C, Kim S, Den R, Gomella L, Thakur ML. Abstract 1485: Pilot study of VPAC1 targeted PET imaging of prostate cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1485] [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: Vasoactive Intestinal Peptide and Pituitary Adenylate Cyclase Activating Peptide Receptor 1 (VPAC1) is over-expressed in prostate cancer (PC), representing a highly suitable target for imaging and treatment. VPAC1 expression occurs at the onset of the malignancy, before alterations of cell morphology, which may be prior to elevation of serum PSA. We have successfully used VPAC1 receptor-specific peptide constructs to image breast cancer in experimental animal models, and in humans. We hypothesized that VPAC1 expressed in high density on PC can be targeted for detection of intraprostatic tumor foci, as correlated with whole mount radical prostatectomy specimens, using TP3805, a VPAC1 specific biomolecule labeled with Cu-64 a PET imaging radionuclide.
Methods: Twenty five men with prostate cancer undergoing radical prostatectomy were imaged preoperatively as part of a PET imaging protocol targeting VPAC1. The PET images were compared to whole mount radical prostatectomy pathologic analysis. De-paraffinized whole mount pathology slides from two patients who participated in VPAC1 PET imaging protocol, as well as slides from 3 BPH patients, one malignant lymph node and one benign lymph node were incubated with Cu-64-TP3805, washed thoroughly with PBS, dried and subjected to 15 second digital autoradiography. Slides were then H&E stained and autoradiography images were compared with prostate H&E staining in which tumor foci were delineated.
Results: Prostate cancer foci (n = 30/31) were identified by autoradiography imaging. Autoradiography missed one malignant lesion due to technical artifact. Additionally 6 small cancerous lesions were identified by autoradiography that were not previously noted by histologic examinations. A total of 7 additional lesions seen by autoradiography in areas without prostate cancer foci corresponded to areas of high grade prostatic intraepithelial neoplasia (HGPIN). The positive lymph node and the benign lymph node were correctly identified by autoradiography. For the three BPH patients without any cancer, no lesions were noted by autoradiography.
Conclusion: VPAC1 peptide analog constructs accurately identified foci of prostate cancer on whole mount radical prostatectomy specimens. Several additional lesions were also identified. Detection of HGPIN is consistent with the early expression of VPAC1 prior to the modulations in cell morphology. The PPV (97%) and NPV(100%) were excellent, validating VPAC1 as a potential theranostic target for prostate cancer imaging and treatment.
Support: NIH R01 CA157372-01 and by NuView, Inc. (MLT).
Citation Format: Edouard J. Trabulsi, Pradeep Kumar, Sushil Tripathi, Ruth Birbe, Peter McCue, Eric Wickstrom, Charles Intenzo, Sung Kim, Robert Den, Leonard Gomella, Mathew L. Thakur. Pilot study of VPAC1 targeted PET imaging of prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1485. doi:10.1158/1538-7445.AM2015-1485
Collapse
Affiliation(s)
| | - Pradeep Kumar
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sushil Tripathi
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ruth Birbe
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Peter McCue
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Eric Wickstrom
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Charles Intenzo
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sung Kim
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Robert Den
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Leonard Gomella
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Mathew L. Thakur
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
28
|
de Leeuw R, Berman-Booty L, Schiewer M, Ciment S, Den R, Dicker A, Kelly W, Trabulsi E, Lallas C, Gomella L, Knudsen K. Abstract 1843: Novel actions of next-generation taxanes benefit advanced stages of prostate cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1843] [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
Purpose: To improve the outcomes of patients with castrate resistant prostate cancer (CRPC), there is an urgent need for more effective therapies and approaches that individual specific treatments for patients with CRPC. The current studies compared the novel taxane, cabazitaxel with the previous generation docetaxel, and aimed to determine which tumors are most likely to respond.
Experimental design: Cabazitaxel (CBTX) and docetaxel (DCTX) were compared via in vitro modeling to determine molecular mechanism, biochemical and cell biological impact, and cell proliferation, which was further assessed ex vivo in human tumor explants. Isogenic pairs of RB knockdown and control cells were interrogated in vitro, and in xenograft tumors for cabazitaxel response.
Results: The data herein show that i. CBTX exerts stronger cytostatic and cytotoxic response compared to DCTX, especially in CRPC; ii. CBTX induces aberrant mitosis, leading to pyknotic and multinucleated cells; iii. taxanes do not act through the androgen receptor (AR); iv. Gene expression profiling reveals distinct molecular actions for CBTX v. tumors that have progressed to castration resistance via loss of RB show enhanced sensitivity to CBTX.
Conclusions: CBTX not only induces improved cytostatic and cytotoxic effects, but also impacts distinct molecular pathways, compared to DCTX, which could underlie its efficacy after DCTX treatment has failed in CRPC patients. Finally, RB is identified as the first potential biomarker that could define the therapeutic response to taxanes in metastatic CRPC. This would suggest that loss of RB function induces sensitization taxanes, which could benefit up to 50% of CRPC cases.
Citation Format: Renee de Leeuw, Lisa Berman-Booty, Matthew Schiewer, Stephen Ciment, Robert Den, Adam Dicker, William Kelly, Edouard Trabulsi, Costas Lallas, Leonard Gomella, Karen Knudsen. Novel actions of next-generation taxanes benefit advanced stages of prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1843. doi:10.1158/1538-7445.AM2015-1843
Collapse
Affiliation(s)
| | | | | | | | - Robert Den
- Thomas Jefferson University, Philadelphia, PA
| | - Adam Dicker
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | | |
Collapse
|
29
|
Rosenthal SA, Hunt D, Sartor AO, Pienta KJ, Gomella L, Grignon D, Rajan R, Kerlin KJ, Jones CU, Dobelbower M, Shipley WU, Zeitzer K, Hamstra DA, Donavanik V, Rotman M, Hartford AC, Michalski J, Seider M, Kim H, Kuban DA, Moughan J, Sandler H. A Phase 3 Trial of 2 Years of Androgen Suppression and Radiation Therapy With or Without Adjuvant Chemotherapy for High-Risk Prostate Cancer: Final Results of Radiation Therapy Oncology Group Phase 3 Randomized Trial NRG Oncology RTOG 9902. Int J Radiat Oncol Biol Phys 2015. [PMID: 26209502 DOI: 10.1016/j.ijrobp.2015.05.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Long-term (LT) androgen suppression (AS) with radiation therapy (RT) is a standard treatment of high-risk, localized prostate cancer (PCa). Radiation Therapy Oncology Group 9902 was a randomized trial testing the hypothesis that adjuvant combination chemotherapy (CT) with paclitaxel, estramustine, and oral etoposide plus LT AS plus RT would improve overall survival (OS). METHODS AND MATERIALS Patients with high-risk PCa (prostate-specific antigen 20-100 ng/mL and Gleason score [GS] ≥ 7 or clinical stage ≥ T2 and GS ≥ 8) were randomized to RT and AS (AS + RT) alone or with adjuvant CT (AS + RT + CT). CT was given as four 21-day cycles, delivered beginning 28 days after 70.2 Gy of RT. AS was given as luteinizing hormone-releasing hormone for 24 months, beginning 2 months before RT plus an oral antiandrogen for 4 months before and during RT. The study was designed based on a 6% improvement in OS from 79% to 85% at 5 years, with 90% power and a 2-sided alpha of 0.05. RESULTS A total of 397 patients (380 eligible) were randomized. The patients had high-risk PCa, 68% with GS 8 to 10 and 34% T3 to T4 tumors, and median prostate-specific antigen of 22.6 ng/mL. The median follow-up period was 9.2 years. The trial closed early because of excess thromboembolic toxicity in the CT arm. The 10-year results for all randomized patients revealed no significant difference between the AS + RT and AS + RT + CT arms in OS (65% vs 63%; P=.81), biochemical failure (58% vs 54%; P=.82), local progression (11% vs 7%; P=.09), distant metastases (16% vs 14%; P=.42), or disease-free survival (22% vs 26%; P=.61). CONCLUSIONS NRG Oncology RTOG 9902 showed no significant differences in OS, biochemical failure, local progression, distant metastases, or disease-free survival with the addition of adjuvant CT to LT AS + RT. The trial results provide valuable data regarding the natural history of high-risk PCa treated with LT AS + RT and have implications for the feasibility of clinical trial accrual and tolerability using CT for PCa.
Collapse
Affiliation(s)
- Seth A Rosenthal
- Radiation Oncology, Sutter Cancer Centers, Roseville, California.
| | - Daniel Hunt
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Leonard Gomella
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Kevin J Kerlin
- Community Clinical Oncology Program, Southeast Cancer Control Consortium, Inc, Winston-Salem, North Carolina
| | - Christopher U Jones
- Radiation Oncology, Sutter Cancer Centers, Roseville, California; Radiological Associates of Sacramento, Sacramento, California
| | | | - William U Shipley
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Marvin Rotman
- State University of New York Health Science Center-Brooklyn, Brooklyn, New York
| | | | | | | | - Harold Kim
- Wayne State University, Detroit, Michigan
| | - Deborah A Kuban
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | |
Collapse
|
30
|
Canter D, Boorjian S, Ogan K, Shore N, Bivalacqua T, Bochner B, Downs T, Gomella L, Grubb R, Inman B, Kamat A, Karsh L, Krupski T, Lerner S, Lotan Y, Milowsky M, Schoenberg M, Svatek R, Woods M, Dinney C. PD17-06 RANDOMIZED PHASE II TRIAL OF INTRAVESICAL ADENOVIRAL MEDIATED INTERFERON-α GENE THERAPY WITH THE EXCIPIENT SYN3 (RAD-IFNα/SYN3) IN PATIENTS WITH BCG REFRACTORY OR RELAPSING HIGH GRADE (HG) NON MUSCLE INVASIVE BLADDER CANCER (NMIBC). J Urol 2015. [DOI: 10.1016/j.juro.2015.02.663] [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: 10/23/2022]
|
31
|
Trabulsi E, Tripathi S, McCue P, Birbe R, Wickstrom E, Gomella L, Kim S, Intenzo C, Thakur M. PD4-09 VASOACTIVE INTESTINAL PEPTIDE AND PITUITARY ADENYLATE CYCLASE ACTIVATING PEPTIDE RECEPTOR 1 (VPAC1) TARGETED IMAGING OF PROSTATE CANCER: A PILOT STUDY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.321] [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: 11/26/2022]
|
32
|
Lin J, Zhan T, Duffy D, Hoffman-Censits J, Kilpatrick D, Trabulsi EJ, Lallas CD, Chervoneva I, Limentani K, Kennedy B, Kessler S, Gomella L, Antonarakis ES, Carducci MA, Force T, Kelly WK. A pilot phase II Study of digoxin in patients with recurrent prostate cancer as evident by a rising PSA. Am J Cancer Ther Pharmacol 2014; 2:21-32. [PMID: 25580468 PMCID: PMC4287984] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Digoxin was found to inhibit prostate cancer (PCa) growth via the inhibition of HIF-1α synthesis in a mouse model. We hypothesized that a therapeutic dose of digoxin could inhibit human PCa growth and disease progression. METHODS An open label, single arm pilot study was performed. Patients (pts) with non-metastatic, biochemically relapsed PCa with prostate specific antigen doubling time (PSADT) of 3-24 months and no hormonal therapy within the past 6 months were enrolled. All pts had testosterone > 50 ng/dL at baseline. Digoxin was taken daily with dose titration to achieve a target therapeutic level (0.8 - 2 ng/ml); patients had routine follow-up including cardiac monitoring with 12-lead electrocardiograms (ECGs) and digoxin levels. The primary endpoint was the proportion of pts at 6 months post-treatment with a PSADT ≥ 200% from the baseline. HIF-1α downstream molecule vascular endothelial growth factor (VEGF) was measured in plasma. RESULTS Sixteen pts were enrolled and 14 pts finished the planned 6 months of treatment. Twenty percent (3/15) of the pts had PSA decrease >25% from baseline with a medium duration of 14 months. At 6 months, 5 of 13 (38%) pts had PSADT ≥ 200% of the baseline PSADT and were continued on study for an additional 24 weeks of treatment. Two patients had durable PSA response for more than 1 year. Digoxin was well tolerated with possible relation of one grade 3 back pain. No patients had evidence of digoxin toxicity. The digoxin dose was lowered in 2 patients for significant ECGs changes (sinus bradycardia and QT prolongation), and there were probable digoxin-related ECG changes in 3 patients. Plasma VEGF was detected in 4 (25%) patients. CONCLUSIONS Digoxin was well tolerated and showed a prolongation of PSDAT in 38% of the patients. However, there was no significant difference comparing that of similar patients on placebo from historical data. Digoxin at the dose used in this study may have limited benefit for patients with biochemically relapsed prostate cancer.
Collapse
Affiliation(s)
- Jianqing Lin
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics (Biostatistics), Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Danielle Duffy
- Department of Medicine (Cardiology), Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Jean Hoffman-Censits
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Deborah Kilpatrick
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Edouard J. Trabulsi
- Department of Urology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Costas D. Lallas
- Department of Urology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Inna Chervoneva
- Department of Pharmacology and Experimental Therapeutics (Biostatistics), Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Kimberly Limentani
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Brooke Kennedy
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Sarah Kessler
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Leonard Gomella
- Department of Medicine (Cardiology), Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | | | | | - Thomas Force
- Department of Medicine (Cardiology), Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Wm. Kevin Kelly
- Department of Medical Oncology, Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| |
Collapse
|
33
|
Trabulsi E, Karnes J, Feng F, Showalter T, Mishra M, Lallas C, Gomella L, Birbe R, McCue P, Ghadessi M, Buerki C, Davicioni E, Knudsen K, Dicker A, Den R. MP79-01 VALIDATION OF A GENOMIC CLASSIFIER FOR PREDICTING CLINICAL PROGRESSION FOLLOWING POST-OPERATIVE RADIATION THERAPY IN HIGH-RISK PROSTATE CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2504] [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: 10/25/2022]
|
34
|
Gu L, Liao Z, Hoang DT, Dagvadorj A, Gupta S, Blackmon S, Ellsworth E, Talati P, Leiby B, Zinda M, Lallas CD, Trabulsi EJ, McCue P, Gomella L, Huszar D, Nevalainen MT. Pharmacologic inhibition of Jak2-Stat5 signaling By Jak2 inhibitor AZD1480 potently suppresses growth of both primary and castrate-resistant prostate cancer. Clin Cancer Res 2013; 19:5658-74. [PMID: 23942095 DOI: 10.1158/1078-0432.ccr-13-0422] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Progression of prostate cancer to the lethal castrate-resistant stage coincides with loss of responsiveness to androgen deprivation and requires development of novel therapies. We previously provided proof-of-concept that Stat5a/b is a therapeutic target protein for prostate cancer. Here, we show that pharmacologic targeting of Jak2-dependent Stat5a/b signaling by the Jak2 inhibitor AZD1480 blocks castrate-resistant growth of prostate cancer. EXPERIMENTAL DESIGN Efficacy of AZD1480 in disrupting Jak2-Stat5a/b signaling and decreasing prostate cancer cell viability was evaluated in prostate cancer cells. A unique prostate cancer xenograft mouse model (CWR22Pc), which mimics prostate cancer clinical progression in patients, was used to assess in vivo responsiveness of primary and castrate-resistant prostate cancer (CRPC) to AZD1480. Patient-derived clinical prostate cancers, grown ex vivo in organ explant cultures, were tested for responsiveness to AZD1480. RESULTS AZD1480 robustly inhibited Stat5a/b phosphorylation, dimerization, nuclear translocation, DNA binding, and transcriptional activity in prostate cancer cells. AZD1480 reduced prostate cancer cell viability sustained by Jak2-Stat5a/b signaling through induction of apoptosis, which was rescued by constitutively active Stat5a/b. In mice, pharmacologic targeting of Stat5a/b by AZD1480 potently blocked growth of primary androgen-dependent as well as recurrent castrate-resistant CWR22Pc xenograft tumors, and prolonged survival of tumor-bearing mice versus vehicle or docetaxel-treated mice. Finally, nine of 12 clinical prostate cancers responded to AZD1480 by extensive apoptotic epithelial cell loss, concurrent with reduced levels of nuclear Stat5a/b. CONCLUSIONS We report the first evidence for efficacy of pharmacologic targeting of Stat5a/b as a strategy to inhibit castrate-resistant growth of prostate cancer, supporting further clinical development of Stat5a/b inhibitors as therapy for advanced prostate cancer.
Collapse
Affiliation(s)
- Lei Gu
- Authors' Affiliations: Departments of Cancer Biology, Urology, Pathology, and Medical Oncology, Kimmel Cancer Center; Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania; and Oncology iMED, AstraZeneca R&D Boston, Waltham, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Haddad BR, Gu L, Mirtti T, Dagvadorj A, Vogiatzi P, Hoang DT, Bajaj R, Leiby B, Ellsworth E, Blackmon S, Ruiz C, Curtis M, Fortina P, Ertel A, Liu C, Rui H, Visakorpi T, Bubendorf L, Lallas CD, Trabulsi EJ, McCue P, Gomella L, Nevalainen MT. STAT5A/B gene locus undergoes amplification during human prostate cancer progression. Am J Pathol 2013; 182:2264-75. [PMID: 23660011 DOI: 10.1016/j.ajpath.2013.02.044] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 02/22/2013] [Accepted: 02/28/2013] [Indexed: 12/17/2022]
Abstract
The molecular mechanisms underlying progression of prostate cancer (PCa) to castrate-resistant (CR) and metastatic disease are poorly understood. Our previous mechanistic work shows that inhibition of transcription factor Stat5 by multiple alternative methods induces extensive rapid apoptotic death of Stat5-positive PCa cells in vitro and inhibits PCa xenograft tumor growth in nude mice. Furthermore, STAT5A/B induces invasive behavior of PCa cells in vitro and in vivo, suggesting involvement of STAT5A/B in PCa progression. Nuclear STAT5A/B protein levels are increased in high-grade PCas, CR PCas, and distant metastases, and high nuclear STAT5A/B expression predicts early disease recurrence and PCa-specific death in clinical PCas. Based on these findings, STAT5A/B represents a therapeutic target protein for advanced PCa. The mechanisms underlying increased Stat5 protein levels in PCa are unclear. Herein, we demonstrate amplification at the STAT5A/B gene locus in a significant fraction of clinical PCa specimens. STAT5A/B gene amplification was more frequently found in PCas of high histologic grades and in CR distant metastases. Quantitative in situ analysis revealed that STAT5A/B gene amplification was associated with increased STAT5A/B protein expression in PCa. Functional studies showed that increased STAT5A/B copy numbers conferred growth advantage in PCa cells in vitro and as xenograft tumors in vivo. The work presented herein provides the first evidence of somatic STAT5A/B gene amplification in clinical PCas.
Collapse
Affiliation(s)
- Bassem R Haddad
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Gomella L, Grossman HB, Droller M, Schmidbauer J, Hermann G, Dragoescu O, Ray E, Witjes A, Karl A, Stenzl A, Fradet Y, Burgues J, Jocham D. 1293 A META-ANALYSIS OF BLUE LIGHT CYSTOSCOPY WITH HEXAMINOLEVULINATE IN PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2647] [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: 10/27/2022]
|
37
|
Zaorsky NG, Studenski MT, Dicker AP, Gomella L, Den RB. Stereotactic body radiation therapy for prostate cancer: is the technology ready to be the standard of care? Cancer Treat Rev 2012; 39:212-8. [PMID: 23218442 DOI: 10.1016/j.ctrv.2012.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 08/21/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 11/17/2022]
Abstract
Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Stereotactic body radiation therapy (SBRT) is touted as a superior type of external beam radiation therapy (EBRT) for the treatment of various tumors. SBRT developed from the theory that high doses of radiation from brachytherapy implant seeds could be recapitulated from advanced technology of radiation treatment planning and delivery. Moreover, SBRT has been theorized to be advantageous compared to other RT techniques because it has a treatment course shorter than that of conventionally fractionated EBRT (a single session, five days per week, for about two weeks vs. eight weeks), is non-invasive, is more effective at killing tumor cells, and is less likely to cause damage to normal tissue. In areas of the US and Europe where there is limited access to RT centers, SBRT is frequently being used to treat prostate cancer, even though long-term data about its efficacy and safety are not well established. We review the impetus behind SBRT and the current clinical evidence supporting its use for prostate cancer, thus providing oncologists and primary care physicians with an understanding of the continually evolving field of prostate radiation therapy. Studies of SBRT provide encouraging results of biochemical control and late toxicity. However, they are limited by a number of factors, including short follow-up, exclusion of intermediate- and high-risk patients, and relatively small number of patients treated. Currently, SBRT regimens should only be used in the context of clinical trials.
Collapse
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | |
Collapse
|
38
|
Gomella L, Nabhan C, DeVries T, Whitmore J, Frohlich M, George D. 683 ESTIMATING THE OVERALL SURVIVAL BENEFIT OF SIPULEUCEL-T IN THE IMPACT TRIAL ACCOUNTING FOR CROSSOVER TREATMENT IN CONTROL SUBJECTS WITH AUTOLOGOUS IMMUNOTHERAPY GENERATED FROM CYROPRESERVED CELLS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
39
|
Djavan B, Eastham J, Gomella L, Tombal B, Taneja S, Dianat SS, Kazzazi A, Shore N, Abrahamsson PA, Cheetham P, Moul J, Lepor H, Crawford ED. Testosterone in prostate cancer: the Bethesda consensus. BJU Int 2011; 110:344-52. [PMID: 22129242 DOI: 10.1111/j.1464-410x.2011.10719.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE • Androgen stimulation of prostate cancer (PCa) cells has been extensively studied. The increasing trend of using serum testosterone as an absolute surrogate for castration state means that the diagnostic measurement of testosterone and the values potentially influencing prognosis must be better understood. This is especially important when PCa progresses from an endocrine to an intracrine status. PATIENTS AND METHODS • We performed a literature review using the MEDLINE database for publications on: (i) hormonal changes with androgen deprivation therapy (ADT); (ii) monitoring hormonal therapy with testosterone measurement; (iii) the efficacy of intermittent androgen deprivation (IAD) compared with continuous androgen deprivation; (iv) the underlying mechanisms of castration-resistance; and (v) novel treatments for castration-resistant PCa (CRPCa). RESULTS • The optimum serum castration levels to be achieved with ADT are still debated. Recently, the 50 ng/dL threshold has been questioned because of reports indicating worse outcomes when levels between 20 and 50 ng/dL were studied. Instead, a 20 ng/dL threshold for serum testosterone after ADT in patients with advanced prostate cancer was recommended. CONCLUSION • Understanding the mechanisms of androgen biosynthesis relating to PCa as well as prognostic implications might achieve a consensus regarding the role of ADT for both the androgen-sensitive and -insensitive disease state.
Collapse
Affiliation(s)
- Bob Djavan
- Department of Urology, New York University School of Medicine, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Affiliation(s)
- Susan Miller-Samuel
- Thomas Jefferson University Hospital, Jefferson Breast Care Center, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|
41
|
Lawton CA, Hunt D, Lee WR, Gomella L, Grignon D, Gillin M, Morton G, Pisansky TM, Sandler H. Long-term results of a phase II trial of ultrasound-guided radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98-05). Int J Radiat Oncol Biol Phys 2011; 81:1-7. [PMID: 21470793 DOI: 10.1016/j.ijrobp.2010.05.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/28/2010] [Accepted: 05/06/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the long-term effectiveness of transrectal ultrasound-guided permanent radioactive I125 implantation of the prostate for organ confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting. METHODS AND MATERIALS Patients accrued to this study had histologically confirmed, locally confined adenocarcinoma of the prostate clinical stage T1b, T1c, or T2a; no nodal or metastatic disease; prostate-specific antigen level of ≤10 ng/ml; and a Gleason score of ≤6. All patients underwent transrectal ultrasound-guided radioactive I125 seed implantation into the prostate. The prescribed dose was 145 Gy to the prostate planning target volume. RESULTS A total of 101 patients from 27 institutions were accrued to this protocol; by design, no single institution accrued more than 8 patients. There were 94 eligible patients. The median follow up was 8.1 years (range, 0.1-9.2 years). After 8 years, 8 patients had protocol-defined biochemical (prostate-specific antigen) failure (cumulative incidence, 8.0%); 5 patients had local failure (cumulative incidence, 5.5%); and 1 patient had distant failure (cumulative incidence, 1.1%; this patient also had biochemical failure and died of causes not related to prostate cancer). The 8-year overall survival rate was 88%. At last follow-up, no patient had died of prostate cancer or related toxicities. Three patients had maximum late toxicities of Grade 3, all of which were genitourinary. No Grade 4 or 5 toxicities were observed. CONCLUSIONS The long-term results of this clinical trial have demonstrated that this kind of trial can be successfully completed through the RTOG and that results in terms of biochemical failure and toxicity compare very favorably with other brachytherapy published series as well as surgical and external beam radiotherapy series. In addition, the prospective, multicenter design highlights the probable generalizability of the outcomes.
Collapse
Affiliation(s)
- Colleen A Lawton
- Radiation Oncology Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Andriole GL, Bostwick D, Brawley OW, Gomella L, Marberger M, Montorsi F, Pettaway C, Tammela TL, Teloken C, Tindall D, Freedland SJ, Somerville MC, Wilson TH, Fowler I, Castro R, Rittmaster RS. The Effect of Dutasteride on the Usefulness of Prostate Specific Antigen for the Diagnosis of High Grade and Clinically Relevant Prostate Cancer in Men With a Previous Negative Biopsy: Results From the REDUCE Study. J Urol 2011; 185:126-31. [DOI: 10.1016/j.juro.2010.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Gerald L. Andriole
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Otis W. Brawley
- American Cancer Society and Emory University, Atlanta, Georgia
| | - Leonard Gomella
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Curtis Pettaway
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Claudio Teloken
- UFCSPA - Federal University of Health Sciences and Santa Casa Hospital, Porto Alegre, Brazil
| | | | | | | | | | - Ivy Fowler
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Ramiro Castro
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | | | | |
Collapse
|
43
|
Sharma A, Yeow WS, Ertel A, Coleman I, Clegg N, Thangavel C, Morrissey C, Zhang X, Comstock CES, Witkiewicz AK, Gomella L, Knudsen ES, Nelson PS, Knudsen KE. The retinoblastoma tumor suppressor controls androgen signaling and human prostate cancer progression. J Clin Invest 2010; 120:4478-92. [PMID: 21099110 DOI: 10.1172/jci44239] [Citation(s) in RCA: 236] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/13/2010] [Indexed: 12/20/2022] Open
Abstract
Retinoblastoma (RB; encoded by RB1) is a tumor suppressor that is frequently disrupted in tumorigenesis and acts in multiple cell types to suppress cell cycle progression. The role of RB in tumor progression, however, is poorly defined. Here, we have identified a critical role for RB in protecting against tumor progression through regulation of targets distinct from cell cycle control. In analyses of human prostate cancer samples, RB loss was infrequently observed in primary disease and was predominantly associated with transition to the incurable, castration-resistant state. Further analyses revealed that loss of the RB1 locus may be a major mechanism of RB disruption and that loss of RB function was associated with poor clinical outcome. Modeling of RB dysfunction in vitro and in vivo revealed that RB controlled nuclear receptor networks critical for tumor progression and that it did so via E2F transcription factor 1-mediated regulation of androgen receptor (AR) expression and output. Through this pathway, RB depletion induced unchecked AR activity that underpinned therapeutic bypass and tumor progression. In agreement with these findings, disruption of the RB/E2F/nuclear receptor axis was frequently observed in the transition to therapy resistance in human disease. Together, these data reveal what we believe to be a new paradigm for RB function in controlling prostate tumor progression and lethal tumor phenotypes.
Collapse
Affiliation(s)
- Ankur Sharma
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Eldredge H, Studenski M, Keith S, Trabulsi E, Harvey A, Lallas C, Gomella L, Dicker A, Showalter T. IGRT after Prostatectomy: Evaluation of Corrective Shifts and Toxicity using Online Conebeam CT vs. Weekly Port Films for Target Localization. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.896] [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: 10/19/2022]
|
45
|
Gupta S, Gu L, Liao Z, Huszar D, McCue P, Trabulsi EJ, Gomella L, Nevalainen MT. Personalized Medicine in Prostate Cancer: Using a Novel Ex VivoProstate Cancer Organ Culture Model System to Test Novel Targeted Therapies in Prostate Cancer and Offer a Patient-Tailored Approach. Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.086] [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: 10/19/2022] Open
|
46
|
Thumar A, Johannes J, Cleary R, Brown T, McCue P, Lallas C, Trabulsi E, Gomella L. 164 FLUORESENCE IN SITU HYBRIDIZATION (FISH) IN THE DIAGNOSIS OF BLADDER CANCER AND UPPER TRACT TCC: A SINGLE-INSTITUTION EXPERIENCE. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.218] [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: 10/19/2022]
|
47
|
Thumar A, Chandrasekar T, Lee F, Lappe S, McCue P, Lallas C, Gomella L, Trabulsi E. 1946 INVERSE CORRELATION BETWEEN PROSTATE SIZE AND POSITIVE SURGICAL MARGINS IN ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY AND RADICAL RETROPUBIC PROSTATECTOMY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1935] [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: 11/30/2022]
|
48
|
Lawton C, Hunt D, Lee W, Gomella L, Grignon D, Gillin M, Morton G, Pisansky T, Sandler H. Long Term Results of a Phase II Trial of Ultrasound-guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG 98–05). Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Andriole G, Brawley O, Gomella L, Marberger M, Montorsi F, Pettaway C, Teloken C, Tammela T, Tindall D, Rittmaster R. 7006 Effect of baseline characteristics on prostate cancer rates and risk reduction in the Reduction by Dutasteride of prostate Cancer Events REDUCE) trial. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71384-9] [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: 11/25/2022] Open
|
50
|
Abstract
In 1989, Crawford and colleagues suggested that combined androgen blockade with castration plus antiandrogen therapy provided significantly improved survival compared with castration alone. Since then, some studies have supported these results, whereas others have not. To resolve this discrepancy, the Prostate Cancer Trialists' Collaborative Group conducted a metaanalysis of 27 randomized trials to evaluate whether combined androgen blockade has benefits compared with castration alone. The results published in 2000 showed that combined androgen blockade using a nonsteroidal antiandrogen treatment (nilutamide or flutamide) improved survival compared with castration alone, whereas combined androgen blockade using a steroidal antiandrogen agent (cyproterone acetate) reduced survival compared with castration alone. In 2004, an analysis was carried out to evaluate the nonsteroidal antiandrogen agent bicalutamide in the combined androgen blockade setting, by incorporating the data from a trial of combined androgen blockade with bicalutamide versus combined androgen blockade with flutamide with the Prostate Cancer Trialists' Collaborative Group metaanalysis data for combined androgen blockade with flutamide versus castration. This analysis showed that combined androgen blockade with bicalutamide was associated with a 20% reduction in the risk of death compared with castration alone. The survival benefit associated with combined androgen blockade using a nonsteroidal antiandrogen agent should be weighed against the potential for increased toxicity and expense compared with castration alone. Studies have shown that bicalutamide has a better tolerability profile than flutamide or nilutamide. Furthermore, cost-benefit analyses of combined androgen blockade with bicalutamide suggest it is a cost-effective option versus castration alone and versus combined androgen blockade with flutamide. In summary, the present evidence suggests that combined androgen blockade with a nonsteroidal antiandrogen agent should be a first-line therapy option in patients with advanced disease.
Collapse
Affiliation(s)
- Gerald Chodak
- Midwest Prostate and Urology Health Center, Weiss Memorial Hospital, Chicago, IL 60640, and Department of Urology, Jefferson Medical College, Philadelphia, PA, USA.
| | | | | |
Collapse
|