Abstract 4407: Clinicopathologic characteristics and mutational analysis of MYC amplified head and neck squamous cell carcinoma (HNSCC)

Amplification of MYC proto-oncogene is commonly found in many types of cancer, and frequently associated with poor clinical outcomes. Analysis of the TCGA-HNSCC dataset indicates that MYC amplification is estimated to be present in ~12% of HNSCC cases, and has a significant impact on patients’ median survival (32.2 vs 56.9 months for patients with wild-type MYC). While the association between MYC amplification and HNSCC progression was previously reported, its role in regulating mechanisms of acquired resistance to therapy remain under investigated. In this study, we seek to further characterize the clinicopathological features associated with MYC amplified HNSCC, and highlight the molecular changes that may contribute to acquired resistance to treatment.

Seven HNSCC patients with MYC amplification were identified by searching the Oncoplus database at the University of Chicago. A retrospective chart review was conducted to collect demographic and clinical data for each patient, and mutational landscape was characterized. In a single patient, MYC amplification was acquired following treatment with chemoimmunotherapy (nivolumab, carboplatin, paclitaxel), chemoradiation, and maintenance nivolumab resulting in rapidly progressive disease despite an initial response to therapy. RNA sequencing and immunohistochemical staining was performed to compare specimens collected before and after progression.

Seven patients were diagnosed with HNSCC and were found to have MYC amplification on molecular testing of their cancer between 2018 and 2021. Four were male, median age 61 (range 46-71), stage T2-4 (n=6), N2-3 (n=6), p16+ (n=2). All patients (n=7) developed recurrent and/or metastatic disease following primary therapy with locoregional recurrence (n=3), metastatic recurrence (n=2), or both (n=2). Median survival for the cohort was 3.1 years. Previous therapy included surgery (n=4), radiotherapy (n=7), chemotherapy (n=7), targeted therapy (n=4), and immunotherapy (n=4). The most common mutations co-occurring with MYC amplification were CDKN2A loss (n=5), TP53 loss (n=5), CCND1 amplification (n=2) and KDM6A loss (n=2). Acquisition of MYC amplification and acquired resistance to chemoimmunotherapy was associated with upregulation of glycolysis pathway, WNT/beta-catenin signaling, and significant changes to tumor microenvironment (TME) such as tumor infiltrating lymphocytes repertoire and PD1/PD-L1 expression levels.

Alongside the data from TCGA, the cases described in this study highlight the poor prognosis associated with MYC amplified HNSCC. While loss of function mutations in CDKN2A and TP53, upregulation of glycolysis pathway, and TME reprogramming may contribute to treatment resistance and secondary immune evasion, further studies in larger cohorts are warranted to develop therapies that target MYC mediated mechanisms of resistance in HNSCC.

Citation Format: Thomas Cyberski, Alka Singh, Mark Lingen, Alexander Pearson, Nishant Agrawal, Evgeny Izumchenko, Ari Rosenberg. Clinicopathologic characteristics and mutational analysis of MYC amplified head and neck squamous cell carcinoma (HNSCC). [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4407.

Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE

To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE).

DATA SOURCES

Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021.

MATERIALS AND METHODS

Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non-randomized Studies-of Interventions method.

RESULTS

There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non-embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group.

CONCLUSIONS

We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA.

LEVEL OF EVIDENCE

NA Laryngoscope, 2023.

Otolaryngology Away Subinternships: An Analysis of the Application Process and Survey of Current Applicants' Perspectives

Objective

To assess the availability and uniformity of application information for away subinternships and survey 4th-year medical students on their experiences obtaining away subinternships in otolaryngology-head and neck surgery (OHNS) during the 2022 to 2023 application cycle.

Study Design

Cross-sectional study.

Setting

Online survey.

Methods

The Association of American Medical College's Visiting Student Learning Opportunities (VSLO) program was queried for information on OHNS away subinternship applications. A survey assessing 4th-year medical students' perceptions of the away subinternship application process was distributed via OHNS residency program directors and Otomatch.

Results

Of 129 OHNS residency programs, 103 (80%) offered away subinternship opportunities on VSLO. Variability in application release dates (January 18 to June 3, 2022), offer release dates (January 27 to August 7, 2022), and estimated cost ($22-$5500) were found. The most common application requirements were a transcript (98.1%) and a CV/resume (90.3%). There were 64 survey respondents, for a 13% response rate. The most common concerns include applying to too few programs (80%) and not knowing offer release dates (77%). The most common stressors include choosing a number of programs to which to apply (48%) and cost (35%). The majority (76%) reported difficulty finding updated information on program websites. Among the proposed changes, the greatest support was found for having all applications on VSLO (88%), uniform application release date (84%), and uniform application requirements (82%).

Conclusion

The OHNS away subinternship application process is a significant source of anxiety for medical students due to the tremendous variability in application and acceptance procedures. Having all applications on VSLO, uniform application requirements, and uniform application opening and offer release dates would better facilitate this process.

Laryngeal and pharyngeal actinomycosis: a systematic review and report of 3 cases

INTRODUCTION

Actinomycosis is a granulomatous infection that rarely involves the larynx or pharynx. Three cases of actinomycosis of the larynx or pharynx from our institution were reviewed and a systematic literature review was performed to better define surgical management, antibiotic therapy, risk factors, and incidence of recurrence or complications.

MATERIALS AND METHODS

PubMed/Medline, Cochrane, Embase, and Google Scholar were searched on November 30, 2021 using the terms "laryngeal actinomycosis", "pharyngeal actinomycosis", "actinomycosis AND larynx", and "actinomycosis AND pharynx." Articles which did not describe appropriate sites or were non-English were excluded. Results were collected for demographic information, site(s) of infection, comorbidities, lesion characteristics and treatments.

RESULTS

Along with three cases reported from our institution, 40 unique cases were reviewed from 37 studies for a total of 43 patients (Table 1). 34 (81.0 %) of the patients were male with the highest incidence of infection in the seventh decade (54.8 %). The most common site for the infection was the larynx (69.0 %) followed by the pharynx (16.7 %). Risk factors included a history of radiation therapy, immunosuppression, inhalational irritant, and diabetes (Table 3). The duration of antibiotic therapy varied greatly, from one month to one year and total follow up ranged from 1 month to 2.5 years (Table 1).

CONCLUSIONS

A comprehensive review of the literature on pharyngolaryngeal actinomycosis shows that this infection has increased prevalence within the head and neck cancer patient population. Similar to cervicofacial actinomycosis, these atypical sites have shown favorable responses to extended antibiotic therapy and generally do not require aggressive surgical management.

Measuring SARS-CoV-2 aerosolization in rooms of hospitalized patients

Objective

Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant risk for healthcare workers. Understanding transmission of SARS-CoV-2 in the hospital could help minimize nosocomial infection. The objective of this pilot study was to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients.

Methods

Two air samplers (Inspirotec) were placed 1 and 4 m away from adults with SARS-CoV-2 infection hospitalized at an urban, academic tertiary care center from June to October 2020. Airborne SARS-CoV-2 concentration was measured by quantitative reverse transcription polymerase chain reaction and analyzed by clinical parameters and patient demographics.

Results

Thirteen patients with COVID-19 (eight females [61.5%], median age: 57 years old, range 25-82) presented with shortness of breath (100%), cough (38.5%) and fever (15.4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n = 3), high flow nasal cannula (n = 4), nasal cannula (n = 4), respiratory helmet (n = 1), and room air (n = 1). SARS-CoV-2 RNA was identified in rooms of three out of three intubated patients compared with one out of 10 of the non-intubated patients (p = .014). Airborne SARS-CoV-2 tended to decrease with distance (1 vs. 4 m) in rooms of intubated patients.

Conclusions

Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased aerosolization of virus in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. While preliminary, these data have safety implications for health care workers and design of protective measures in the hospital.

Level of Evidence

2.