B-cell infiltration is associated with survival outcomes following programmed cell death protein 1 inhibition in head and neck squamous cell carcinoma

BACKGROUND

Programmed cell death protein 1 (PD-1) axis blockade has become the mainstay in the treatment of recurrent and/or metastatic (R/M) head and neck squamous cell cancer (HNSCC). Programmed death-ligand 1 (PD-L1) is the only approved biomarker for patient selection; however, response rate is limited even among high expressors. Our primary objective was to investigate the association of immune cell-related biomarkers in the tumor and tumor microenvironment with PD-1 checkpoint inhibitors' outcomes in patients with R/M HNSCC.

PATIENTS AND METHODS

NCT03652142 was a prospective study in nivolumab-treated platinum-refractory R/M HNSCC, aiming to evaluate biomarkers of response to treatment. Tumor biopsies and blood samples were collected from 60 patients at baseline, post-treatment, and at progression. Immune cells in the tumor and stromal compartments were quantified by immunofluorescence using a five-protein panel (CD3, CD8, CD20, FoxP3, cytokeratin). Tertiary lymphoid structures (TLSs), PD-L1 expression, and peripheral blood immune cell composition were also evaluated for associations with outcome. Our findings were validated by gene set enrichment analysis (GSEA) messenger RNA in situ expression data from the same patients, for B-cell- and TLS-associated genes.

RESULTS

High pre-treatment density of stromal B cells was associated with prolonged progression-free survival (PFS) (P = 0.011). This result was validated by GSEA, as stromal enrichment with B-cell-associated genes showed association with response to nivolumab. PD-L1 positivity combined with high B-cell counts in stroma defined a subgroup with significantly longer PFS and overall survival (P = 0.013 and P = 0.0028, respectively).

CONCLUSIONS

Increased B cells in pre-treatment HNSCC biopsy samples correlate with prolonged benefit from PD-1-based immunotherapy and could further enhance the predictive value of PD-L1 expression.

Well-differentiated liposarcomas and dedifferentiated liposarcomas: Systemic treatment options for two sibling neoplasms

Well-differentiated liposarcomas (WDLPS) and dedifferentiated liposarcomas (DDLPS) account for 60 % of all liposarcomas, reflecting the heterogeneity of this type of sarcoma. Genetically, both types of liposarcomas are characterized by the amplification of MDM2 and CDK4 genes, which indicates an important molecular event with diagnostic and therapeutic relevance. In both localized WDLPS and DDLPS of the retroperitoneum and the extremities, between 25 % and 30 % of patients have local or distant recurrence, even when perioperatively treated, with clear margins present. The systemic treatment of WDLPS and DDLPS remains a challenge, with anthracyclines as the gold standard for first-line treatment. Several regimens have been tested with modest results regarding their efficacy. Herein we discuss the systemic treatment options for WDLPS and DDLPS and review their reported clinical efficacy results.

Immune checkpoint inhibitors in sarcomas: a systematic review

Sarcomas are tumors that originate from mesenchymal cells. The variety of sarcomas' response to chemotherapy and the wide range of prognosis reflect their heterogeneity. In order to improve the rates of response, the research has been orientated toward other forms of therapy, such as targeted therapies and immunotherapy or toward combinations of them. Immune checkpoint inhibitors (ICIs) have been the highlight of immunotherapy in the last decade. Although ICIs are already included in the guidelines of different malignancies, their clinical benefit in sarcomas is still under study. Alveolar soft part sarcomas, undifferentiated pleomorphic sarcomas and other subtypes of sarcoma with high presence of tertiary lymphoid structures tend to respond to ICIs, but further investigation is still needed. Furthermore, the search of predictive biomarkers to determine the type of sarcomas that are sensitive to ICIs is still very challenging. This review will focus on the results of clinical trials, which examine the effect of ICIs and their combination with chemotherapy, targeted therapies and other forms of immunotherapy in sarcomas.

The impact of diabetes mellitus on carotid atherosclerosis and arterial stiffness; results from the Corinthia study

Background

Evaluation of arterial stiffness and carotid atherosclerotic burden can provide important prognostic information regarding the risk for future cardiovascular events. In that context, we tried to determine those vascular properties of diabetic individuals compared to non-diabetics.

Methods

In this analysis of the observational “Corinthia” study, we included 1757 participants with determined diabetic status. Propensity scores were employed to match diabetics to non-diabetics with regards to known cardiovascular risk factors. Carotid ultrasonography was performed to evaluate intima-media thickness (cIMT) across the common carotid arteries and the carotid bulbs as well as carotid plaque burden. Arterial stiffness was estimated via assessment of carotid-to-femoral pulse wave velocity (cfPWV).

Results

Diabetic individuals had increased mean cIMT (diabetics: 1.12±0.50mm vs. 0.94±0.38mm, p<0.001) and maximum cIMT (diabetics: 1.50±0.93mm vs. 1.20±0.71mm, p<0.001) when compared to non-diabetics (Figure 1, Panel A and B). Carotid plaque burden was also increased in diabetics (34.4% vs. 19.4% in non-diabetics, p<0.001) while bilateral plaques were observed in 14.2% of diabetics opposed to 8.2% of non-diabetics (p<0.001). Concerning arterial stiffness, individuals with DM had significantly higher values of cfPWV (10.6±3.4m/s vs. 8.8±2.5m/s in non-diabetics, p<0.001) (Figure 1, Panel C). In the propensity-matched cohort, mean cIMT (diabetics: 1.13±0.51mm vs. 0.98±0.38mm, p<0.001) and maximum cIMT (diabetics: 1.53±0.95mm vs. 1.24±0.73mm, p<0.001) were significantly higher in diabetics (Figure 2, Panel A and B), as well as carotid plaque burden (36.6% vs. 21.9% in non-diabetics, p<0.001). Analysis according to territory of cIMT measurement displayed substantial differences in left (diabetics: 1.30±0.76mm vs. non-diabetics: 1.06±0.58mm, p<0.001) and right carotid bulbs (diabetics: 1.30±0.82mm vs. non-diabetics: 1.07±0.57mm, p<0.001) with respect to DM (Figure 2, Panel C) but, unexpectedly, non-significant variations were observed in left (diabetics: 0.97±0.48mm vs. non-diabetics: 0.90±0.42mm, p=0.06) and right common carotid artery (diabetics: 0.95±0.50mm vs. non-diabetics: 0.90±0.40mm, p=0.21) (Figure 2, Panel D).

Conclusion

We observed increased carotid artery intima-media thickness and cfPWV in individuals with diabetes mellitus. As opposed to non-diabetics, carotid lesions in diabetics were more pronounced in the carotid bulb and not in the common carotid artery. Our findings may raise awareness regarding the focus of atherosclerotic echocardiographic examination in subjects with diabetes mellitus while the impact of glucose-lowering therapies on these specific vascular lesions merits further assessment.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

The impact of physical activity on arterial stiffness and inflammation; results from the “Corinthia” study

Background

Diminished physical activity (PA) is associated with cardiovascular morbidity and mortality. Arterial stiffness and inflammation are associated with atherosclerosis and are established risk factors for cardiovascular disease.

Purpose

We investigated the association of PA status on arterial stiffness and inflammation.

Methods

Classification of PA was performed in 2053 participants of the cross-sectional “Corinthia” study using the International Physical Activity Questionnaire (IPAQ). In accordance with the standard IPAQ scoring procedures, participants were classified into one of the following groups: upper tertile: “vigorous” PA-IPAQ 2, middle tertile: “moderate” PA-IPAQ 1 or lower tertile: “low” PA-IPAQ 0. Arterial stiffness was estimated via carotid-femoral pulse wave velocity (cfPWV) estimation and inflammatory burden was assessed via high sensitivity C reactive protein (hsCRP) measurement.

Results

Participants with low PA had impaired cfPWV values (IPAQ 0: 9.5±3.2 m/s vs. IPAQ 1: 8.7±2.4 m/s vs. IPAQ 2: 8.7±2.2 m/s, p<0.001) (Figure 1, Panel A) while abnormal cfPWV –adjusted for age and blood pressure- were more frequently encountered in low PA individuals (IPAQ 0: 14% vs. IPAQ 1: 7.8% vs. IPAQ 2: 7.3%, p=0.001) (Figure 1, Panel B). Participants characterized as having vigorous physical activity had the lowest inflammatory burden, as estimated by hsCRP (IPAQ 0: 4.8±6.4 g/l vs. IPAQ 1: 4.6±5.2 g/l vs. IPAQ 2: 3.6±4.2 g/l, p=0.001) (Figure 1, Panel C). Importantly, results remained unaffected even after adjustment for confounders (Figure 1, Panel D). A correlation analysis between the total weekly physical activity (expressed as MET minutes/week) and arterial stiffness was performed demonstrating a statistically significant negative correlation was noted (r=−0.120, p<0.001) (Figure 1, Panel E).

Conclusion

A significant association between physical activity, arterial stiffness and inflammation was observed, even after adjusting for known cardiovascular risk factors. Our findings should raise public awareness about the beneficial effects of exercise on cardiovascular health.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Emotional and cardiovascular health: the impact of depression on cardiac autonomic activity

Background

The coexistence of depression and cardiovascular diseases is frequently accompanied by an increased risk of adverse outcomes. QTc, an indicator of ventricular depolarization and cardiac autonomic activity, has been proposed as a biomarker of this interplay.

Purpose

We aimed to investigate the possible association of depression with QTc interval.

Methods

Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung self-rating depression scale in those younger than 65 years of age (Group 1) and with the geriatric depression scale in elderly individuals (>65 years, Group 2). Moreover, electrocardiogram was performed and measurement of the QT interval was derived after correction for heart rate (QTc) using the Bazett's formula. Abnormal QTc was present when QTc duration exceeded 440 ms.

Results

Group 1 individuals classified as having depression had longer QTc duration (No depression: 389.3±27.0 ms vs. Depression: 401.1±32.9 ms, p<0.001) and percentage of abnormal QTc (No depression: 2.0% vs. Depression: 10.8%, p=0.001) (Figure 1, Panels A and B). Elderly individuals had similar values of QTc (No depression: 409.9±29.6 ms vs. Depression: 405.2±46.4 ms, p=0.37) and percentage of abnormal QTc (No depression: 13.2% vs. Depression: 12.3%, p=0.78) irrespective of depression status (Figure 1, Panels C and D). The presence of depression in Group 1 subjects was associated with an increased QTc- by 10.8 ms and with an approximately 7-fold higher prevalence of abnormal QTc duration, even after adjustment for confounders (). Such finding was not detected in elderly individuals (Figure 1, Panel F).

Conclusion

Depression might adversely affect ventricular repolarization especially in middle-aged subjects. These findings highlight the interrelationship between emotional and cardiovascular health and the role of depression as a cardiovascular risk factor.

Funding Acknowledgement

Type of funding sources: None. Figure 1

The DNA damage response network in the treatment of head and neck squamous cell carcinoma

BACKGROUND

We sought to determine whether DNA damage response (DDR)-related aberrations predict therapeutic benefit in cisplatin-treated head and neck squamous cell carcinoma (HNSCC) patients and how DDR pathways are modulated after treatment with olaparib alone or in combination with cisplatin or durvalumab.

PATIENTS AND METHODS

Oxidative stress, abasic sites and DDR-related parameters, including endogenous DNA damage, DNA repair mechanisms and apoptosis rates, were evaluated in HNSCC cell lines and peripheral blood mononuclear cells from 46 healthy controls (HC) and 70 HNSCC patients at baseline and following treatment with cisplatin-containing chemoradiation or nivolumab or enrolled in the OPHELIA phase II trial (NCT02882308; olaparib alone, olaparib plus cisplatin, olaparib plus durvalumab).

RESULTS

HNSCC patients at diagnosis exhibited deregulated DDR-related parameters and higher levels of oxidative stress and abasic sites compared with HC (all P < 0.05). Accordingly, nucleotide excision repair (NER; ERCC1, ERCC2/XPD, XPA, XPC) and base excision repair (APEX1, XRCC1) genes were downregulated in patients versus HC whereas double-strand breaks repair (MRE11A, RAD50, RAD51, XRCC2) and mismatch repair (MLH1, MSH2, MSH3) genes were overexpressed. Corresponding results were obtained in cell lines (all P < 0.001). Excellent correlations were observed between individual ex vivo and in vivo/therapeutic results, with cisplatin non-responders showing higher levels of endogenous DNA damage, augmented oxidative stress and abasic sites, increased NER capacities and reduced apoptosis than responders (all P < 0.05). Also, longer progression-free survival correlated with lower NER capacity (P = 0.037) and increased apoptosis (P = 0.029). Interestingly, treatment with olaparib-containing regimens results in the accumulation of cytotoxic DNA damage and exerts an extra antitumor effect by elevating oxidative stress (all P < 0.05). Nivolumab induced no significant changes in the DDR parameters examined.

CONCLUSIONS

Aberrations in DDR signals are implicated in the response to HNSCC chemotherapy and can be exploited as novel therapeutic targets, sensitive/effective non-invasive biomarkers as well as for the design of novel clinical trials.

Differential effect of anthracycline and trastuzumab cancer therapeutic related vascular toxicity in patients with breast cancer

Introduction

Both anthracyclines and trastuzumab are key regiments for the treatment of breast cancer, but their concurrent use is contraindicated because of their cardiotoxicity. Their effects on vascular function have been less well studied.

Purpose

We explored the effects of the anthracycline-based chemotherapy followed by trastuzumab-based treatment on endothelial function and arterial stiffness in patients with breast cancer.

Methods

46 female patients (54.56±11.5 years old) with breast cancer scheduled for anthracycline-based chemotherapy followed by the combination of trastuzumab and taxane were enrolled. Trastuzumab was continued until the completion of one-year treatment. All participants underwent assessment of the brachial flow mediated dilatation (FMD), endothelial independent dilatation (EID), carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) at baseline (BL), at the end of anthracycline treatment (FU1), 3 months following initiation of trastuzumab with taxane (FU2) and at the completion of treatment with trastuzumab (FU3).

Results

Over the follow-up period (15 months) there was significant deterioration in FMD (p=0.04) (Table 1, Figure 1). Importantly, while there was no significant difference in FMD between BL vs FU1 (p=0.6), FMD has been significantly deteriorated over the treatment with trastuzumab with taxane FU1 vs FU2 (p=0.01) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). EID did not change over the follow-up period (Figure 1). Similarly, PWV has been significantly increased over the follow up period (p=0.03). There was no significant difference in PWV BL vs FU1 (p=0.1), however PWV has been significantly increased over the treatment with trastuzumab with taxane FU1 vs FU 2 (p=0.02) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). A similar pattern of impairment was observed with AIx (Table 1, Figure 1).

Conclusion

We report a significant adverse effect of the anthracycline- and trastuzumab-based therapy on the arterial stiffness and endothelial function. This effect is more considerable after the exposure to trastuzumab.

Figure 1. Changes of FMD, PWV, Alx, EID during FU

Funding Acknowledgement

Type of funding source: None

Erratum: Measurement of d+^{7}Be Cross Sections for Big-Bang Nucleosynthesis [Phys. Rev. Lett. 122, 182701 (2019)]

This corrects the article DOI: 10.1103/PhysRevLett.122.182701.

P5312Sleep duration and carotid atheromatic burden. Insights from the Corinthia study

Background

Sleep is an essential physiological process and disturbance of sleeping pattern may be associated with cardiovascular risk profile and atheromatosis. Short but also long sleep duration (LSD) may be adversely affect cardiovascular parameters.

Purpose

To study how sleep duration is associated with cardiovascular risk profile and carotid atherosclerotic burden.

Methods

Corinthia study is a cross sectional epidemiological study based on 2043 inhabitants (age 40–99 years) of Corinthia region in Greece. Ultrasonography was used to measure intima media thickness (IMT) in the left and right common carotid artery, carotid bulb and internal carotid artery. The mean IMT (meanIMT) were determined as representative values of carotid atherosclerosis burden. Thickness of IMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque. Based on questionnaires of Corinthia study, total sleeping time per day was recorded. A sleep duration of 7 to 8 h was consider normal (NSD), sleep duration <6 h was consider very short (VSSD), 6–7 h sleep duration was considered short (SSD) and participants with >8 h sleep duration was categorized as LSD.

Results

Concerning gender more men than women were categorized in the NSD (26% vs. 21%, p<0.001). Subjects in the NSD were also younger compared to subjects categorized in other sleeping patterns (VSSD: 66±12 y vs. SSD: 63±12 y vs. NSD: 62±12 y vs. LSD: 66±12 y, p<0.001), have less prevalence of diabetes mellitus (p<0.05). There was no difference according to sleeping pattern in body mass index, prevalence of hypertension, cardiovascular disease, hyperlipidemia and on current smoking habits according to sleeping patterns. Interestingly, meanIMT (VSSD: 1.08±0.51 mm vs. SSD: 0.97±0.42 mm vs. NSD: 0.97±0.41 mm vs. LSD: 1.14±1.64 mm, p=0.04) and carotid atherosclerotic plaque (VSSD: 35% vs. SSD: 25% vs. NSD: 20% vs. LSD: 30%, p=0.006) was decreased in NSD subjects. Importantly, even after adjustment for the confounders logistic regression analysis revealed that subjects in the NSD group have 50% less odds of carotid atheromatic plaque than subjects in the VSSD (Odds ratio: 0.5, 95% CI 0.28–0.90, p=0.02) (Figure).

Conclusion

A balanced sleeping pattern with 8h of sleep daily can act as an additive cardioprotective factor in the modern western type societies. Short especially less than 6 hours and long (>8 hours) sleeping duration may act as a cardiovascular risk factor.

P1573Chemotherapy-induced vasotoxicity in patients undergoing therapy for breast cancer

Background

Cardiotoxicity is a well-known adverse effect of anthracycline and HER-2 monoclonal antibodies, however the vascular effects of these agents remain less-well studied.

Purpose

To explore the effects of breast chemotherapy on vascular function.

Methods

A total of 57 female patients undergoing breast diagnosed with breast cancer and scheduled for anthracycline-based and HER-2 chemotherapy were included in this study. At baseline, at 3, 6 and 12 months, patients underwent assessment of cardiac function by transthoracic echocardiography, endothelial function assessment by brachial flow mediated dilation (FMD) and assessment of arterial stiffness by carotid-radial pulse wave velocity (PWV) and augmentation index (Aix).

Results

There was a significant decrease in left ventricular ejection fraction (LVEF) overtime compared to baseline (A). This was paralleled by a significant decrease in brachial FMD at 6 months (B) and a significant increase in PWV compared to baseline (C). There was no significant change in Aix compared to baseline levels (D). Chemotherapy-induced cardiotoxicity (expressed by the change in LVEF) was not associated with either the change in FMD or PWV at 6 months.

Conclusions

Breast chemotherapy-induced cardiotoxicity is paralleled by vasotoxicity, which is manifested as endothelial dysfunction and increased arterial stiffness. Systemic vasotoxicity is not directly related to cardiotoxicity, suggesting that monitoring of both cardiac and vascular function could be useful in identifying early signs of cardiovascular toxicity.

P6255Impact of whole grain consumption on arterial stiffness. Results of the Corinthian cross-sectional survey

Introduction

The benefits of certain dietary patterns on cardiovascular diseases has been questioned over the last years. Whole grain consumption has been one of the controversial issues regarding the effect on cardiovascular disease. In Greek rural population consumptions of bread is part of the daily meal and a possible source of whole grain.

Purpose

To investigated the effect of whole grain bread consumption on arterial stiffness in Mediterranean population.

Methods

In a cross-sectional survey (Corinthia study) volunteers subjects completed a food frequency questioner (FFQ), including a question of consumption of bread on regular basis, whole grain (group I) or not (group II). Medical history, lifestyle habits, anthropometric and vital signs, as well as, laboratory blood test were performed. All patients underwent carotid-femoral pulse wave velocity (C-F PWV) measurements which were obtained noninvasively by SphygmoCor devise.

Results

Among the 2043 volunteers 1389 patients had adequate quality of pulse wave velocity recordings and were regular consumers of bread. Whole grain bread was consumed by 473 subjects (male 37%, female 63%,) but 916 (male 43.1%, female 56.9%) did not consume. Subjects consuming whole grain bread were younger compare to those who were not (group I: 62±11 years vs. group II: 64±12 years, p=0.02), have lower C-F PWV (group I: 9.04±2.93 m/sec vs. group II: 9.57±2.76 m/sec, p=0.01) but no other statistical difference were observe among other parameters (i.e. hypertension, diabetes mellitus, BMI, smoking etc). Hierarchical multiple regression showed that whole grain consumption predicted pulse wave velocity statistically significantly (b=−0.33, 95% CI: −0.62, −0.17, p=0.03) in addition to age (b=0.09, 95% CI 0.08–0.10, p<0.001), systolic blood pressure (b=0.02, 95% CI 0.01, 0.03, p<0.001) beta=0.157) and diabetes mellitus (b=0.75, 95% CI 0.40, 1.09, p<0.001).

Conclusion

Whole grain bread consumption has a beneficial effect on arterial stiffness as detected by better carotid femoral pulse wave velocity. This may have a positively effect on cardiovascular diseases.

Measurement of d+^{7}Be Cross Sections for Big-Bang Nucleosynthesis

The cross sections of nuclear reactions between the radioisotope ^{7}Be and deuterium, a possible mechanism of reducing the production of mass-7 nuclides in big-bang nucleosynthesis, were measured at center-of-mass energies between 0.2 and 1.5 MeV. The measured cross sections are dominated by the (d,α) reaction channel, towards which prior experiments were mostly insensitive. A new resonance at 0.36(5) MeV with a strength of ωγ=1.7(5)  keV was observed inside the relevant Gamow window. Calculations of nucleosynthesis outcomes based on the experimental cross section show that the resonance reduces the predicted abundance of primordial ^{7}Li, but not sufficiently to solve the primordial lithium problem.

Developing radiation tolerant polymer nanocomposites using C60as an additive

The attenuation of alpha particles is modelled using Monte-Carlo N-Particle Extended software. Using tandem Van de Graaff accelerator tests, it is shown that doping with C₆₀fullerene can significantly enhance the lifetime of polymers in alpha radiation environments.