Acquired cancer resistance to combination immunotherapy from transcriptional loss of class I HLA

Understanding mechanisms of late/acquired cancer immunotherapy resistance is critical to improve outcomes; cellular immunotherapy trials offer a means to probe complex tumor-immune interfaces through defined T cell/antigen interactions. We treated two patients with metastatic Merkel cell carcinoma with autologous Merkel cell polyomavirus specific CD8+ T cells and immune-checkpoint inhibitors. In both cases, dramatic remissions were associated with dense infiltration of activated CD8+s into the regressing tumors. However, late relapses developed at 22 and 18 months, respectively. Here we report single cell RNA sequencing identified dynamic transcriptional suppression of the specific HLA genes presenting the targeted viral epitope in the resistant tumor as a consequence of intense CD8-mediated immunologic pressure; this is distinguished from genetic HLA-loss by its reversibility with drugs. Transcriptional suppression of Class I loci may underlie resistance to other immunotherapies, including checkpoint inhibitors, and have implications for the design of improved immunotherapy treatments.

Validation of Memorial Sloan Kettering Cancer Center nomogram to detect non-sentinel lymph node metastases in a United Kingdom cohort

AIM

Axillary lymph node dissection, although associated with long-term morbidity, has been the standard of treatment for all nodepositive breast cancer patients. We assessed the risk prediction ability (validity) of Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for non-sentinel lymph node metastases and analysed the outcome of patients with sentinel node metastases.

PATIENTS AND METHODS

All operable early breast cancer patients with sentinel node macro metastases (size > 2mm) who underwent axillary dissection from April 2009 to March 2015 were considered eligible. The risk of non-sentinel lymph node metastases was calculated using an online MSKCC calculator, and accuracy was determined based on the area under the receiver-operating characteristic curve (AUC-ROC). Tumour characteristics and overall survival were also analysed as secondary end points.

RESULTS

Of 1745 patients who were diagnosed with operable breast cancer during the study period, 114 patients were considered eligible. The AUC-ROC was 0.66 suggestive of lesser accuracy in prediction and not statistically significant (p value = 0.7303). Seventysix (50.7%) of these patients did not have any non-sentinel node metastases. At a mean follow up of four years, the disease-free survival was 86.4% and overall survival rate was 88.4%.

CONCLUSIONS

The MSKCC nomogram was unable to accurately predict the risk in our cohort of patients with more than half of this cohort of patients not requiring axillary dissection. These findings are consistent with other European studies. This study thus highlights the need for modified prediction model for European cohorts.

Proton Therapy for Craniopharyngioma - An Early Report from a Single European Centre

AIMS

Proton beam therapy (PBT) is being increasingly used for craniopharyngioma. We describe our early outcome of patients treated with PBT.

MATERIALS AND METHODS

Between August 2013 and July 2016, 18 patients with craniopharyngiomas were treated with 54 Cobalt Gray Equivalent (CGE) in 30 fractions over 6 weeks at our centre. The early outcome of 16 patients included in a registry study was analysed. Radiological response was assessed by RECIST criteria and the disease- and treatment-related toxicities were scored according to the CTCAE 4.0.

RESULTS

All patients are alive at a median follow-up of 32.6 months (range 9.2-70.6 months) from initial diagnosis. The median age at PBT was 10.2 years (range 5.4-46.9 years). One patient progressed 8.7 months after PBT and subsequently had complete resection of the tumour. At a median follow-up of 18.4 months after PBT, five patients remained in complete remission, four in partial remission and seven with stable disease. The most common adverse effects during PBT were grade 1 (cutaneous in seven patients and fatigue in six patients). There were no treatment-related grade 3 toxicities.

CONCLUSIONS

Our early results are encouraging and comparable with the limited literature on PBT for craniopharyngioma.

Abstract P1-15-03: Management and outcomes of metaplastic breast cancer

Purpose/Objectives: Metaplastic breast cancer (MBC) is a rare malignancy composed of both epithelial and mesenchymal components that accounts for less than 1% of primary breast carcinomas. Knowledge of effective management of the disease remains limited. We retrospectively evaluated the treatment and outcomes of patients with MBC from three academic hospitals.

Materials/Methods: Patients diagnosed with MBC between June 2, 1993 and May 6, 2016 were identified. Demographic and clinical variables were extracted via primary chart review. Descriptive statistics were utilized to summarize the patient cohort's clinical course. The Kaplan-Meier method was used to obtain estimates of local control (LC) and survival.

Results: Seventy-six patients were identified with a median follow-up of 7.6 years (range: 0.18-19.9 years). The median age at diagnosis was 54 (range 28-81). About two-thirds of patients (67%, n=51) presented with a palpable mass while the remaining patients were screen-detected via mammogram (32%, n=24). The majority of patients were AJCC-7 stage I (38%, n=29) or stage II (49%, n=37), while 10% (n=8) were stage III and 3% (n= 2) stage IV. About half of tumors (46%, n=35) were subtyped using WHO histologic classification of MBC. Over half of subtyped cases were spindle cell carcinoma (51%, n=18), 17% were matrix-producing carcinoma (n=6), 23% were adenocarcinoma with squamous differentiation (n=8), 6% were carcinosarcoma (n=2), and 3% were mixed (n=1).The majority of patients had triple negative disease (82%, n=62), while 13% (n=10) had HR+/HER2- disease, and 5% (n=4) had HER2+ disease. Most patients had high grade tumors (84%, n=64) and received breast conserving surgery (61%, n=46) while 39% (n=29) had mastectomies. Seventy-six percent (n=58) of patients received chemotherapy and 61% (n=46) received radiation therapy. All HR+ patients received adjuvant endocrine therapy, and 1 patient received immunotherapy. Of patients who received chemotherapy, 78% (n=45) received adjuvant therapy alone, 17% (n=10) neoadjuvant therapy alone, and 5% (n=3) both. Seventy percent (n=41) of chemotherapy regimens included a taxane. Among 74 patients without metastatic disease at presentation, recurrences were observed in 18% (n=13). Most patients recurred distantly (69%, n=9), while the remainder had isolated local recurrences (n=4). Of 9 distant failures, 3 had MBC subtype information and all 3 were spindle cell carcinoma. Of 4 local recurrences, 3 of 4 were adenocarcinoma with squamous cell differentiation and 1 was spindle cell carcinoma. At a median follow-up of 7.6 years, the local recurrence-free survival was 88%, disease-free survival was 80%, and overall survival was 80%. Kaplan-Meier point estimates for remaining free of local recurrence versus distant recurrence were 99% (95% C.I., 90- 100) versus 96% (95% C.I., 87- 99) at 2 years and 88% (95% C.I., 76-94) versus 87% (95% C.I., 75- 93) at 5 years.

Conclusions: MBC is a rare histologic subtype that commonly presents with high-grade disease and triple-negative receptor status. In contrast to other smaller series, local and distant failure rates in this cohort were consistent with non-MBC triple negative cohorts. Additional molecular based research is warranted to further characterize features associated with local and distant failure.

Citation Format: Thomas H, Horick N, Spring LM, Brachtel EF, Jimenez RB. Management and outcomes of metaplastic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-03.

Resolving the test–retest agreement or reliability dilemma

Agreement refers to the degree to which an individual i’s test scores match in test–retest settings. Agreement has been thought to be unapproachable with correlational reliability indices. Stable unstable reliability theory extends Spearman’s reliability model and specifies the probability that i’s test–retest true scores match. Thus, agreement and reliability are simultaneously addressed. Two examples, one using longitudinal data, illustrate the procedure.

Resistance of Arctic phytoplankton to ocean acidification and enhanced irradiance

The Arctic Ocean is a region particularly prone to ongoing ocean acidification (OA) and climate-driven changes. The influence of these changes on Arctic phytoplankton assemblages, however, remains poorly understood. In order to understand how OA and enhanced irradiances (e.g., resulting from sea–ice retreat) will alter the species composition, primary production, and eco-physiology of Arctic phytoplankton, we conducted an incubation experiment with an assemblage from Baffin Bay (71°N, 68°W) under different carbonate chemistry and irradiance regimes. Seawater was collected from just below the deep Chl a maximum, and the resident phytoplankton were exposed to 380 and 1000 µatm pCO₂ at both 15 and 35% incident irradiance. On-deck incubations, in which temperatures were 6 °C above in situ conditions, were monitored for phytoplankton growth, biomass stoichiometry, net primary production, photo-physiology, and taxonomic composition. During the 8-day experiment, taxonomic diversity decreased and the diatom Chaetoceros socialis became increasingly dominant irrespective of light or CO₂ levels. We found no statistically significant effects from either higher CO₂ or light on physiological properties of phytoplankton during the experiment. We did, however, observe an initial 2-day stress response in all treatments, and slight photo-physiological responses to higher CO₂ and light during the first five days of the incubation. Our results thus indicate high resistance of Arctic phytoplankton to OA and enhanced irradiance levels, challenging the commonly predicted stimulatory effects of enhanced CO₂ and light availability for primary production.

Modeling Infant i's Look on Trial t: Race-Face Preference Depends on i's Looking Style

When employing between-infant designs young infants' looking style is related to their development: Short looking (SL) infants are cognitively accelerated over their long looking (LL) peers. In fact, looking style is a within-infant variable, and depends on infant i's look distribution over trials. For the paired array setting, a model is provided which specifies the probability, π_i ∈ [0, 1], that i is SL. The model is employed in a face preference study; 74 Caucasian infants were longitudinally assessed at 3, 6, and 9 months. Each i viewed same race (Caucasian) vs. other race (African) faces. Infants become SL with development, but there are huge individual differences in rate of change over age. Three month LL infants, π^i<1/2, preferred other race faces. SL infants, π^i>1/2, preferring same race faces at 3, and other race faces at 6 and 9 months. Looking style changes precede and may control changes in face preference. Ignoring looking style can be misleading: Without considering looking style, 3 month infants show no face preference.

Immune responses in the aquatic gastropod Lymnaea stagnalis under short-term exposure to pharmaceuticals of concern for immune systems: Diclofenac, cyclophosphamide and cyclosporine A

This is a pioneering study in the ecotoxicological assessment of immunotoxic effects of the three selected drugs of concern to a freshwater gastropod species. Lymnaea stagnalis was exposed in the laboratory for 3 days to three drugs used for immune systems: diclofenac (nonsteroidal anti-inflammatory drug), cyclophosphamide (anti-cancer immunosuppressive drug) or cyclosporine A (anti-xenograft immunosuppressive drug). Exposure ranges included environmental realistic (1-10μgL^-1) and therapeutic concentrations (100-1000μgL^-1). At the end of exposure times, the immune parameters of individual snails were measured: hemocyte density and viability, hemocyte phagocytosis capacity and hemocyte-related oxidative activities (basal and NADPH-oxidase stimulated with zymosan particles). Diclofenac and cyclosporine A induced immune responses, although the effects were not strong. No immunosuppression was observed. Such subtle immunomodulations bring further interrogations regarding their long-term immunotoxicity and possible resulting tradeoffs with life-history traits. On the other hand, the prodrug cyclophosphamide did not induce significant immune responses. Since metabolism pathways differ greatly between vertebrates and invertebrates, this study also suggests that relevant vertebrate metabolites should be included in the immunotoxicity assessment of pharmaceuticals in non-target invertebrate species. Finally, the possible interactive effects of these pharmaceuticals sharing similar modes of action or effects features should also be explored.

Public health matters: Innovative approaches for engaging medical students

BACKGROUND

Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern.

METHODS

We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline.

RESULTS

Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level.

CONCLUSIONS

The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student-teacher interface.

Optical analysis of samarium doped sodium bismuth silicate glass

Samarium doped sodium bismuth silicate glass was synthesized using the melt quenching method. Detailed optical spectroscopic studies of the glassy material were carried out in the UV-Vis-NIR spectral range. Using the optical absorption spectra Judd-Ofelt (JO) parameters are derived. The calculated values of the JO parameters are utilized in evaluating the various radiative parameters such as electric dipole line strengths (S_ed), radiative transition probabilities (A_rad), radiative lifetimes (τ_rad), fluorescence branching ratios (β) and the integrated absorption cross- sections (σ_a) for stimulated emission from various excited states of Sm³⁺‡ ion. The principal fluorescence transitions are identified by recording the fluorescence spectrum. Our analysis revealed that the novel glassy system has the optimum values for the key parameters viz. spectroscopic quality factor, optical gain, stimulated emission cross section and quantum efficiency, which are required for a high performance optical amplifier. Calculated chromaticity co-ordinates (0.61, 0.38) also confirm its application potential in display devices.

Recommendations for the Analysis of Hemocyte-related Immunocompetent Oxidative Activity in the Freshwater Snail Activity in the Freshwater Snail Lymnaea Stagnalis

Not available

Effect Size Standard Errors for the Non-Normal Non-Identically Distributed Case

Suppose there are k independent studies and for each study the experimental and control groups have been sampled from independent but essentially arbitrary populations. The problem is to construct a plausible standard error of the effect size mean (effect sizes are standardized experimental-control group mean differences) when given only minimal sample statistic information. Standard errors based on the sample standard error, or bootstrap, will typically be much too large and have very large variance. A normal theory estimator may prove practically useful in more general settings. Asymptotic distribution-free estimators are provided for two cases.

The Limits of Property-Led Regeneration

In this paper, the role of property development in city revitalization is considered. Case study material is used to analyze the changing organizational nature of property development, especially the interrelationships between property developers and the traditional purveyors of urban policy: Local authorities. It is shown how the property industry is dependent on the development of organizational capacities with public authorities in a manner not anticipated by the rhetoric of central government, a rhetoric which has pushed the property-led approach as an alternative to development by, and through, the public sector. In contrast to this view, illustrative material is presented which indicates how property-led development is highly dependent on the public sector. Also illustrated is how the process of property-led regeneration has the capacity to undermine a range of local, community, interests in areas affected by redevelopment schemes, a situation which has been exacerbated by the prioritization of the shorter-term development goals of the property industry. In conclusion, it is noted that property-led approaches to regeneration, although a necessary component of urban revitalization, are neither a sufficient nor an adequate response to the multiple tasks involved in the revitalization of cities.

Studies on the V2O5-TiO2 System. IV. Oxygen Chemisorption

The chemical adsorption of oxygen on V2O5 and V2O5 -TiO2 over the temperature range 100–450°C and at pressures between 10−2 and 3 Torr has been studied. Assays have been performed using a volumetric method, the isotherms obtained being in accordance with Langmuir's adsorption model.

Isobaric plots at 1.5 Torr of these isotherms exhibit two maxima, at 250 and 400°C, respectively. These maxima have been interpreted in terms of the surface chemisorption of O2− and its diffusion into the bulk solid.

The amount adsorbed at the 250°C maximum depends on the sample composition in the following decreasing adsorption order: VT80, VT50, VT10, VT20 and VT0.

At the 400°C maximum, the same amount of O2 is adsorbed experimentally by all the TiO2-containing samples, this value being quite different from that corresponding to pure V2O5 (VTO). Possible explanations for this observation are based on (i) the relative magnitudes of the V/Ti surface ratios and (ii) the presence of Ti4+ in V2O5 crystals.

Assessing particle kinematics via template matching algorithms

Template matching algorithms represent a viable tool to locate particles in optical images. A crucial factor of the performance of these methods is the choice of the similarity measure. Recently, it was shown in [Gao and Helgeson, Opt. Express 22 (2014)] that the correlation coefficient (CC) leads to good results. Here, we introduce the mutual information (MI) as a nonlinear similarity measure and compare the performance of the MI and the CC for different noise scenarios. It turns out that the mutual information leads to superior results in the case of signal dependent noise. We propose a novel approach to estimate the velocity of particles which is applicable in imaging scenarios where the particles appear elongated due to their movement. By designing a bank of anisotropic templates supposed to fit the elongation of the particles we are able to reliably estimate their velocity and direction of motion out of a single image.

National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis

Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart-lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p < 0.001). In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68-0.90,p = 0.001 and UK: HR0.63,0.41-0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.