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Pasquali S, Vallacchi V, Lalli L, Collini P, Barisella M, Romagosa C, Bague S, Coindre JM, Dei Tos AP, Palmerini E, Quagliuolo V, Martin-Broto J, Lopez-Pousa A, Grignani G, Blay JY, Beveridge RD, Casiraghi E, Brich S, Renne SL, Bergamaschi L, Vergani B, Sbaraglia M, Casali PG, Rivoltini L, Stacchiotti S, Gronchi A. Spatial distribution of tumour immune infiltrate predicts outcomes of patients with high-risk soft tissue sarcomas after neoadjuvant chemotherapy. EBioMedicine 2024; 106:105220. [PMID: 39018755 PMCID: PMC11287012 DOI: 10.1016/j.ebiom.2024.105220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Anthracycline-based neoadjuvant chemotherapy (NAC) may modify tumour immune infiltrate. This study characterized immune infiltrate spatial distribution after NAC in primary high-risk soft tissue sarcomas (STS) and investigate association with prognosis. METHODS The ISG-STS 1001 trial randomized STS patients to anthracycline plus ifosfamide (AI) or a histology-tailored (HT) NAC. Four areas of tumour specimens were sampled: the area showing the highest lymphocyte infiltrate (HI) at H&E; the area with lack of post-treatment changes (highest grade, HG); the area with post-treatment changes (lowest grade, LG); and the tumour edge (TE). CD3, CD8, PD-1, CD20, FOXP3, and CD163 were analyzed at immunohistochemistry and digital pathology. A machine learning method was used to generate sarcoma immune index scores (SIS) that predict patient disease-free and overall survival (DFS and OS). FINDINGS Tumour infiltrating lymphocytes and PD-1+ cells together with CD163+ cells were more represented in STS histologies with complex compared to simple karyotype, while CD20+ B-cells were detected in both these histology groups. PD-1+ cells exerted a negative prognostic value irrespectively of their spatial distribution. Enrichment in CD20+ B-cells at HI and TE areas was associated with better patient outcomes. We generated a prognostic SIS for each tumour area, having the HI-SIS the best performance. Such prognostic value was driven by treatment with AI. INTERPRETATION The different spatial distribution of immune populations and their different association with prognosis support NAC as a modifier of tumour immune infiltrate in STS. FUNDING Pharmamar; Italian Ministry of Health [RF-2019-12370923; GR-2016-02362609]; 5 × 1000 Funds-2016, Italian Ministry of Health; AIRC Grant [ID#28546].
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Affiliation(s)
- Sandro Pasquali
- Molecular Pharmacology, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Viviana Vallacchi
- Translational Immunology Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luca Lalli
- Translational Immunology Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Paola Collini
- Soft Tissue Tumor Pathology Unit, Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | | | - Cleofe Romagosa
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Silvia Bague
- Pathology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jean Michel Coindre
- Department of Pathology, Institut Bergonié, 33000, Bordeaux, France; INSERM U1218 ACTION, Institut Bergonié, 33000, Bordeaux, France
| | - Angelo Paolo Dei Tos
- Surgical Pathology & Cytopathology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Javier Martin-Broto
- Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Antonio Lopez-Pousa
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Giovanni Grignani
- Medical Oncology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Jean-Yves Blay
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France
| | - Robert Diaz Beveridge
- Department of Cancer Medicine, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Elena Casiraghi
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Milan, Italy
| | - Silvia Brich
- Soft Tissue Tumor Pathology Unit, Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Salvatore Lorenzo Renne
- Pathology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Laura Bergamaschi
- Translational Immunology Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Barbara Vergani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Marta Sbaraglia
- Surgical Pathology & Cytopathology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Licia Rivoltini
- Translational Immunology Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
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Sicinska E, Kola VSR, Kerfoot JA, Taddei ML, Al-Ibraheemi A, Hsieh YH, Church AJ, Landesman-Bollag E, Landesman Y, Hemming ML. ASPSCR1::TFE3 Drives Alveolar Soft Part Sarcoma by Inducing Targetable Transcriptional Programs. Cancer Res 2024; 84:2247-2264. [PMID: 38657118 PMCID: PMC11250573 DOI: 10.1158/0008-5472.can-23-2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/09/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare mesenchymal malignancy driven by the ASPSCR1::TFE3 fusion. A better understanding of the mechanisms by which this oncogenic transcriptional regulator drives cancer growth is needed to help identify potential therapeutic targets. In this study, we characterized the transcriptional and chromatin landscapes of ASPS tumors and preclinical models, identifying the essential role of ASPSCR1::TFE3 in tumor cell viability by regulating core transcriptional programs involved in cell proliferation, angiogenesis, and mitochondrial biology. ASPSCR1::TFE3 directly interacted with key epigenetic regulators at enhancers and promoters to support ASPS-associated transcription. Among the effector programs driven by ASPSCR1::TFE3, cell proliferation was driven by high levels of cyclin D1 expression. Disruption of cyclin D1/CDK4 signaling led to a loss of ASPS proliferative capacity, and combined inhibition of CDK4/6 and angiogenesis halted tumor growth in xenografts. These results define the ASPS oncogenic program, reveal mechanisms by which ASPSCR1::TFE3 controls tumor biology, and identify a strategy for therapeutically targeting tumor cell-intrinsic vulnerabilities. Significance: The ASPSCR1::TFE3 fusion propels the growth of alveolar soft part sarcoma by activating transcriptional programs that regulate proliferation, angiogenesis, mitochondrial biogenesis, and differentiation and can be therapeutically targeted to improve treatment.
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MESH Headings
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/metabolism
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Sarcoma, Alveolar Soft Part/genetics
- Sarcoma, Alveolar Soft Part/pathology
- Sarcoma, Alveolar Soft Part/metabolism
- Humans
- Animals
- Mice
- Cell Proliferation/genetics
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Gene Expression Regulation, Neoplastic
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Cell Line, Tumor
- Xenograft Model Antitumor Assays
- Cyclin-Dependent Kinase 4/genetics
- Cyclin-Dependent Kinase 4/metabolism
- Cyclin-Dependent Kinase 4/antagonists & inhibitors
- Female
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/metabolism
- Intracellular Signaling Peptides and Proteins
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Affiliation(s)
- Ewa Sicinska
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Vijaya S R Kola
- Division of Hematology and Oncology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Joseph A Kerfoot
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Madeleine L Taddei
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yi-Hsuan Hsieh
- Division of Hematology and Oncology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Esther Landesman-Bollag
- Department of Medicine, Section of Hematology and Oncology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Yosef Landesman
- Cure Alveolar Soft Part Sarcoma International, Brookline, Massachusetts
| | - Matthew L Hemming
- Division of Hematology and Oncology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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3
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Martin-Broto J, Hindi N, Moura DS. Combination treatment with PD1/PDL-1 inhibitors for sarcomas: state of the art, next questions. Curr Opin Oncol 2024; 36:269-275. [PMID: 38726845 DOI: 10.1097/cco.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Only a small fraction of sarcomas exhibit recognized parameters of immune sensitivity, such as tumor mutational burden, PDL-1 expression, or microsatellite instability. Combined strategies aimed to modulate tumor microenvironment to increase the efficacy of PD1/PDL-1 inhibitors in sarcoma. Most explored prospective studies were based on combinations of PD1/PDL-1 inhibitors with antiangiogenics, other immune checkpoints, or chemotherapy. RECENT FINDINGS Results on 6-month PFS rate, median PFS, and ORR in trials using PD1/PDL-1 inhibitors plus antiangiogenics ranged respectively as 46.9-55%, 4.7-7.8 months and 21-36.7%. In combination with other immune checkpoint inhibitors, the results of median PFS and ORR ranged from 2.8-4.1 months and 10-16%, respectively. In combination with chemotherapy, the best results were obtained with doxorubicin-based regimens compared to other agents. Duplet-based chemotherapy plus anti-PD1/PDL-1 obtained the highest ORR (56.2%) compared with doxorubicin (19-36.7%). Currently, the most robust predictive biomarker for anti-PD1/PDL-1 efficacy is the presence of tertiary lymphoid structures (TLS) with mature dendritic cells. SUMMARY Even when direct comparisons between PD1/PDL-1 inhibitor-based combinations and single agents have not been performed yet in sarcoma, some combinations appear promising. Studies controlling heterogeneity by biomarker or histotype selection contribute to an increase in efficacy or knowledge crucial for future comparative trials.
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Affiliation(s)
- Javier Martin-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital
- University Hospital General de Villalba
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Nadia Hindi
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital
- University Hospital General de Villalba
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - David S Moura
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
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Nguyen A, Nguyen A, Fleeting C, Patel A, Bazett N, Hey G, Mandavali A, Brown NJ, Woolridge M, Foreman M, Lucke-Wold B. An Evaluation of Risk Factors for Intracranial Metastases of Sarcomas: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:e683-e699. [PMID: 38704144 DOI: 10.1016/j.wneu.2024.04.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Sarcomas, a group of neoplasms comprising both tissue and bone soft tissue tumors, has an increasing prevalence in recent years. Prognosis significantly hinges on early detection, and if not detected early, may consequently metastasize. This review will be the first systematic review and meta-analysis characterizing the presentation and progression of brain metastases from bone and soft tissue cancers. METHODS The PubMed, Scopus, and Web of Science databases were queried to identify studies reporting the incidence of intracranial brain metastases from primary sarcoma to the present. Abstract and full-text screening of 1822 initial articles returned by preliminary search yielded 28 studies for inclusion and data extraction. Qualitative assessment of the studies was conducted in accordance with the Newcastle-Ottawa Scale criteria. Meta-analyses were applied to assess risk factors on outcomes. RESULTS The average age within the cohort was 27.9 years with a male and female prevalence of 59.1% and 40.9%, respectively. The odds ratio for living status (dead/alive) was calculated for several risk factors - male/female [OR 1.14, 95% CI 0.62, 2.07], single/multiple metastases [OR 0.67, 95% CI 0.35, 1.28], lung metastases/not [OR 1.63, 95% CI 0.85, 3.13], surgery/no surgery [OR 0.49, 95% CI 0.20, 1.21]. The standardized mean differences for duration from diagnoses to metastases were likewise analyzed - male/female [SMD 0.13, 95% CI -0.15, 0.42], single/multiple metastases [SMD 0.11, 95% CI -0.20, 0.42], lung metastases/not [SMD -0.03, 95% CI -0.38, 0.32], surgery/no surgery [SMD 0.45, 95% CI -0.18, 1.09]. The standardized mean differences for duration from metastases to death were analyzed - lung metastases/not [SMD 0.43, 95% CI -0.08, 0.95]. CONCLUSIONS Our study observed no statistically significant differences in mortality rate among several patient risk factors. Consequentially, there lacks a clear answer as to whether or not an association between mortality rates exists with these patient factors. As such, it is important to continue research in brain-metastasizing sarcomas despite their relative rarity.
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Affiliation(s)
| | - Andrew Nguyen
- College of Medicine, University of Florida, Gainesville, Florida, USA.
| | - Chance Fleeting
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aashay Patel
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicholas Bazett
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Grace Hey
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akhil Mandavali
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California-Irvine, Orange, California, USA
| | - Maxwell Woolridge
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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5
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Zhao S, Sun L, Zhou J, Li R, Sun Q, Wang W, Wang D. Advancements in Diagnosis and Multimodal Treatment Strategies for Retroperitoneal Tumors: A Comprehensive Review. Am J Clin Oncol 2024; 47:350-356. [PMID: 38476111 DOI: 10.1097/coc.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Retroperitoneal tumors (RPTs) encompass both benign and malignant entities, constituting ~0.1% to 0.2% of all malignant tumors, of which 70% to 80% manifest malignancy. Predominantly, retroperitoneal sarcomas (RPS) represent the most prevalent subtype among RPT. With over 70 histologic forms identified, liposarcomas and leiomyosarcomas emerge as the primary constituents of RPS. Accurate diagnosis of RPTs necessitates preoperative core-needle biopsy and comprehensive imaging assessment. The current staging protocol for RPS relies on the eighth edition of the American Joint Committee on Cancer/TNM classification. Surgical excision remains the established gold standard for treating RPS. Therapeutic approaches vary according to the underlying pathophysiology. Although chemotherapy and radiotherapy exhibit efficacy in managing metastatic and recurrent unresectable RPS, their role in primary RPS remains unresolved, necessitating further clinical trials for validation. Concurrently, ongoing research explores the potential of targeted therapies and immunotherapy. This literature review aims to provide a comprehensive overview of existing research, delineating diagnostic pathways and optimal therapeutic strategies for RPT.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Longhe Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Qiannan Sun
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Taizhou Fourth People's Hospital
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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6
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Yang Q, Madueke-Laveaux OS, Cun H, Wlodarczyk M, Garcia N, Carvalho KC, Al-Hendy A. Comprehensive Review of Uterine Leiomyosarcoma: Pathogenesis, Diagnosis, Prognosis, and Targeted Therapy. Cells 2024; 13:1106. [PMID: 38994959 PMCID: PMC11240800 DOI: 10.3390/cells13131106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
Uterine leiomyosarcoma (uLMS) is the most common subtype of uterine sarcomas. They have a poor prognosis with high rates of recurrence and metastasis. The five-year survival for uLMS patients is between 25 and 76%, with survival rates approaching 10-15% for patients with metastatic disease at the initial diagnosis. Accumulating evidence suggests that several biological pathways are involved in uLMS pathogenesis. Notably, drugs that block abnormal functions of these pathways remarkably improve survival in uLMS patients. However, due to chemotherapy resistance, there remains a need for novel drugs that can target these pathways effectively. In this review article, we provide an overview of the recent progress in ascertaining the biological functions and regulatory mechanisms in uLMS from the perspective of aberrant biological pathways, including DNA repair, immune checkpoint blockade, protein kinase and intracellular signaling pathways, and the hedgehog pathway. We review the emerging role of epigenetics and epitranscriptome in the pathogenesis of uLMS. In addition, we discuss serum markers, artificial intelligence (AI) combined with machine learning, shear wave elastography, current management and medical treatment options, and ongoing clinical trials for patients with uLMS. Comprehensive, integrated, and deeper insights into the pathobiology and underlying molecular mechanisms of uLMS will help develop novel strategies to treat patients with this aggressive tumor.
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Affiliation(s)
- Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | | | - Han Cun
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Marta Wlodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Natalia Garcia
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Department of Cell Systems and Anatomy, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento deObstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
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7
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Genevois AL, Carton M, Jean-Denis M, Cyrta J, Corradini N, Metayer L, Chemin-Airiau C, Karanian M, Dufresne A, Pannier S, El Zein S, Defachelles AS, Bompas E, Gantzer J, Honoré C, Noal S, Héritier S, Guillemet C, Serre J, Le Loarer F, Pierron G, Merlin MS, Anract P, Gomez-Mascard A, Llacer C, Ducimetière F, Toulmonde M, Blay JY, Orbach D. Alveolar soft part sarcomas in young patients: The French national NETSARC+ network experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108483. [PMID: 38897095 DOI: 10.1016/j.ejso.2024.108483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIMS Alveolar soft part sarcoma (ASPS) is an ultra-rare chemo-resistant sarcoma in children, occurring preferentially in young adults. We aimed to describe and compare its clinical presentation and behaviour in children and young adults to determine whether the same therapeutic strategy should be addressed for both populations. METHODS National retrospective multicentre study of children (0-18 years) vs. young adults (19-30 years) included in the "ConticaBase" sarcoma database, treated for ASPS between 2010 and 2019 with pathology reviewed via the NETSARC + network. RESULTS Overall, 45 patients were identified, 19 children (42%) and 26 young adults (58%). All ASPS diagnoses were confirmed with TFE3 rearrangement by immunohistochemistry or FISH. All clinical characteristics were balanced between both populations with frequent metastases at diagnosis (8/19 vs. 10/26). The therapeutic strategy was based on surgery (17/19 vs. 21/26), radiotherapy (8/19 vs. 12/26) ± systemic treatment (8/19 vs. 9/26). In patients with initially localized disease, metastatic relapse occurred only in adults (8/16), whereas metastatic progression was present in both metastatic groups (5/8 vs. 8/10). After a median follow-up of 5.2 years (range, 0.2-12.2), 5-year EFS was 74% [95%CI, 56-96] vs. 47% [30-74] (p = 0.071) respectively, and 5-year OS was 95% [85-100] vs. 85% [70-100] (p = 0.84). For localized tumours, 5-year MFS was 100% [100-100] vs. 60% [39-91] (p = 0.005). The 5-year OS of all patients with metastasis at diagnosis was 80.2% (62.2%-100%). CONCLUSIONS ASPS appears to have the overall same clinical characteristics, but a more aggressive behaviour in young adults than in children. However, despite frequent metastases at diagnosis, long-term survival is high in both groups. Overall, the same therapeutic strategies may be considered for both populations.
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Affiliation(s)
- Anne-Laure Genevois
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris-Saclay University (PSL), Paris, France.
| | - Matthieu Carton
- Unit of Biometry, Institut Curie, DRCI, PSL Research University, Paris, France
| | | | - Joanna Cyrta
- Department of Pathology, Institut Curie, Paris, France
| | - Nadège Corradini
- Department of Paediatric Oncology, Paediatric Haematology and Oncology Institute, Léon Bérard Centre, Lyon, France
| | - Lucy Metayer
- Department of Paediatric and Adolescent Oncology, Gustave Roussy Cancer Centre, Paris-Saclay University, Villejuif, France
| | | | - Marie Karanian
- Department of Biopathology, Léon Bérard Centre, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Léon Bérard Centre, Lyon, France
| | | | | | | | | | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Charles Honoré
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | - Sabine Noal
- Department of Medical Oncology, François Baclesse Centre, Caen, France
| | - Sébastien Héritier
- Department of Paediatric Haematology and Oncology, Trousseau Hospital, Paris, France
| | - Cécile Guillemet
- Department of Medical Oncology, Henry Becquerel Centre, Rouen, France
| | - Jill Serre
- Department of Paediatric Haematology and Oncology, Trousseau Hospital, Tours, France
| | | | | | - Marie-Sophie Merlin
- Department of Paediatric Haematology and Oncology, Brabois Hospital, Nancy, France
| | - Philippe Anract
- Department of Orthopedic and Traumatology, Cochin Hospital, Paris, France
| | | | - Carmen Llacer
- Department of Radiotherapy, Montpellier Cancer Institute, Montpellier, France
| | | | - Maud Toulmonde
- Department of Medical Oncology, Bergonié Institute, Bordeaux, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Centre, Lyon, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris-Saclay University (PSL), Paris, France
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8
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Wood GE, Meyer C, Petitprez F, D'Angelo SP. Immunotherapy in Sarcoma: Current Data and Promising Strategies. Am Soc Clin Oncol Educ Book 2024; 44:e432234. [PMID: 38781557 DOI: 10.1200/edbk_432234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Traditionally sarcomas have been considered immunologically quiet tumours, with low tumour mutational burden (TMB) and an immunosuppressive tumour microenvironment (TME), consisting of decreased T-cell infiltration and elevated levels of H1F1α, macrophages and neutrophils.1,2 However, research has shown that a subset of sarcomas are immunologically 'hot' with either high TMB, PDL-1 expression, CD8+ T cells or presence of tertiary lymphoid structures (TLS) demonstrating sensitivity to immunotherapy.3,4 Here, we review the current evidence for immunotherapy use in bone sarcomas (BS) and soft tissue sarcomas (STS), with immune checkpoint inhibitors (ICI) and adoptive cellular therapies including engineered T-cell therapies, chimeric antigen receptor (CAR) T-cell therapies, tumour infiltrating lymphocytes (TILs) and cancer vaccines and biomarkers of response.
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Affiliation(s)
- Georgina E Wood
- University College Hospital of London, London, United Kingdom
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9
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Hayes AJ, Nixon IF, Strauss DC, Seddon BM, Desai A, Benson C, Judson IR, Dangoor A. UK guidelines for the management of soft tissue sarcomas. Br J Cancer 2024:10.1038/s41416-024-02674-y. [PMID: 38734790 DOI: 10.1038/s41416-024-02674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location, means that developing evidence-based guidelines is complicated by the limitations of the data available. This makes it more important that STS are managed by expert multidisciplinary teams, to ensure consistent and optimal treatment, recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous versions published in 2010 and 2016 [1, 2]. The original guidelines were drawn up by a panel of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This iteration of the guidance, as well as updating the general multidisciplinary management of soft tissue sarcoma, includes specific sections relating to the management of sarcomas at defined anatomical sites: gynaecological sarcomas, retroperitoneal sarcomas, breast sarcomas, and skin sarcomas. These are generally managed collaboratively by site specific multidisciplinary teams linked to the regional sarcoma specialist team, as stipulated in the recently published sarcoma service specification [3]. In the UK, any patient with a suspected soft tissue sarcoma should be referred to a specialist regional soft tissues sarcoma service, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging and a tissue biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon, combined with pre- or post-operative radiotherapy for tumours at higher risk for local recurrence. Systemic anti-cancer therapy (SACT) may be utilised in cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late effects of treatment.
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Affiliation(s)
- Andrew J Hayes
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Ioanna F Nixon
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Center, Glasgow, G12 0YN, UK
| | - Dirk C Strauss
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Beatrice M Seddon
- Department of Medical Oncology, University College London Hospital NHS Foundation Trust, London, NW1 2BU, UK
| | - Anant Desai
- The Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Charlotte Benson
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Ian R Judson
- The Institute of Cancer Research, London, SM2 5NG, UK
| | - Adam Dangoor
- Department of Medical Oncology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, BS1 3NU, UK
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10
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Stacchiotti S, Bouche G, Herold R, Pantziarka P, Schuster K, Wilson R, Pignatti F, Kasper B. How to develop new systemic treatments in ultra-rare cancers with high unmet needs? The case of alveolar soft-part sarcoma. Eur J Cancer 2024; 202:114003. [PMID: 38479120 DOI: 10.1016/j.ejca.2024.114003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/21/2024]
Abstract
Developing new drugs or generating evidence for existing drugs in new indications for ultra-rare cancers is complex and carries a high-risk of failure. This gets even harder in ultra-rare tumours, which have an annual incidence of 1 per 1,000,000 population or less. Here, we illustrate the problem of adequate evidence generation in ultra-rare tumours, using Alveolar Soft-Part Sarcomas (ASPS) - an ultra-rare sarcoma newly diagnosed in approximately 60 persons a year in the European Union - as an exemplar case showing challenges in development despite being potentially relevant for classes of agents. We discuss some possible approaches for addressing such challenges, especially focussing on constructive collaboration between academic groups, patients and advocates, drug manufacturers, and regulators to optimise drug development in ultra-rare cancers. This article, written by various European stakeholders, proposes a way forward to ultimately get better options for patients with ultra-rare cancers.
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Affiliation(s)
- Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | | | | - Roger Wilson
- Sarcoma Patient Advocacy Global Network, Wölfersheim, Germany
| | | | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
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11
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Knoedler L, Huelsboemer L, Hollmann K, Alfertshofer M, Herfeld K, Hosseini H, Boroumand S, Stoegner VA, Safi AF, Perl M, Knoedler S, Pomahac B, Kauke-Navarro M. From standard therapies to monoclonal antibodies and immune checkpoint inhibitors - an update for reconstructive surgeons on common oncological cases. Front Immunol 2024; 15:1276306. [PMID: 38715609 PMCID: PMC11074450 DOI: 10.3389/fimmu.2024.1276306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/05/2024] [Indexed: 05/23/2024] Open
Abstract
Malignancies represent a persisting worldwide health burden. Tumor treatment is commonly based on surgical and/or non-surgical therapies. In the recent decade, novel non-surgical treatment strategies involving monoclonal antibodies (mAB) and immune checkpoint inhibitors (ICI) have been successfully incorporated into standard treatment algorithms. Such emerging therapy concepts have demonstrated improved complete remission rates and prolonged progression-free survival compared to conventional chemotherapies. However, the in-toto surgical tumor resection followed by reconstructive surgery oftentimes remains the only curative therapy. Breast cancer (BC), skin cancer (SC), head and neck cancer (HNC), and sarcoma amongst other cancer entities commonly require reconstructive surgery to restore form, aesthetics, and functionality. Understanding the basic principles, strengths, and limitations of mAB and ICI as (neo-) adjuvant therapies and treatment alternatives for resectable or unresectable tumors is paramount for optimized surgical therapy planning. Yet, there is a scarcity of studies that condense the current body of literature on mAB and ICI for BC, SC, HNC, and sarcoma. This knowledge gap may result in suboptimal treatment planning, ultimately impairing patient outcomes. Herein, we aim to summarize the current translational endeavors focusing on mAB and ICI. This line of research may serve as an evidence-based fundament to guide targeted therapy and optimize interdisciplinary anti-cancer strategies.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Lioba Huelsboemer
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Katharina Hollmann
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Faculty of Medicine, University of Wuerzbuerg, Wuerzburg, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians University Munich, Munich, Germany
| | - Konstantin Herfeld
- Department of Internal Medicine III (Oncology and Haematology), University Hospital Regensburg, Regensburg, Germany
- Leibniz Institute for Immunotherapy, Regensburg, Germany
| | - Helia Hosseini
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Sam Boroumand
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Viola A. Stoegner
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Ali-Farid Safi
- Craniologicum, Center for Cranio-Maxillo-Facial Surgery, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Markus Perl
- Department of Internal Medicine III (Oncology and Haematology), University Hospital Regensburg, Regensburg, Germany
- Leibniz Institute for Immunotherapy, Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
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12
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Guérin R, Menard AL, Angot E, Piton N, Vera P, Schwarz L, Sabourin JC, Laé M, Thiébaut PA. An unusual case of primary splenic soft part alveolar sarcoma: case report and review of the literature with emphasis on the spectrum of TFE3-associated neoplasms. Diagn Pathol 2024; 19:62. [PMID: 38643139 PMCID: PMC11031972 DOI: 10.1186/s13000-024-01483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/02/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Alveolar soft part sarcoma is a rare tumour of soft tissues, mostly localized in muscles or deep soft tissues of the extremities. In rare occasions, this tumour develops in deep tissues of the abdomen or pelvis. CASE PRESENTATION In this case report, we described the case of a 46 year old man who developed a primary splenic alveolar soft part sarcoma. The tumour displayed typical morphological alveolar aspect, as well as immunohistochemical profile notably TFE3 nuclear staining. Detection of ASPSCR1 Exon 7::TFE3 Exon 6 fusion transcript in molecular biology and TFE3 rearrangement in FISH confirmed the diagnosis. CONCLUSION We described the first case of primary splenic alveolar soft part sarcoma, which questions once again the cell of origin of this rare tumour.
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Affiliation(s)
- René Guérin
- Department of Pathology, Rouen University Hospital, Rouen, France
| | | | - Emilie Angot
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Nicolas Piton
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medecine, Centre Henri Becquerel, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | - Marick Laé
- Department of Pathology, Centre Henri Becquerel, Rouen, France
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13
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Starzer AM, Wolff L, Popov P, Kiesewetter B, Preusser M, Berghoff AS. The more the merrier? Evidence and efficacy of immune checkpoint- and tyrosine kinase inhibitor combinations in advanced solid cancers. Cancer Treat Rev 2024; 125:102718. [PMID: 38521009 DOI: 10.1016/j.ctrv.2024.102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
Immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI) have gained therapeutical significance in cancer therapy over the last years. Due to the high efficacy of each substance group, additive or complementary effects are considered, and combinations are the subject of multiple prospective trials in different tumor entities. The majority of available data results from clinical phase I and II trials. Although regarded as well-tolerated therapies ICI-TKI combinations have higher toxicities compared to monotherapies of one of the substance classes and some combinations were shown to be excessively toxic leading to discontinuation of trials. So far, ICI-TKI combinations with nivolumab + cabozantinib, pembrolizumab + axitinib, avelumab + axitinib, pembrolizumab + lenvatinib have been approved in advanced renal cell (RCC), with pembrolizumab + lenvatinib in endometrial carcinoma and with camrelizumab + rivoceranib in hepatocellular carcinoma (HCC). Several ICI-TKI combinations are currently investigated in phase I to III trials in various other cancer entities. Further, the optimal sequence of ICI-TKI combinations is an important subject of investigation, as cross-resistances between the substance classes were observed. This review reports on clinical trials with ICI-TKI combinations in different cancer entities, their efficacy and toxicity.
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Affiliation(s)
- Angelika M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ladislaia Wolff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Petar Popov
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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14
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Kyriazoglou A, Pagkali A, Kotsantis I, Economopoulou P, Kyrkasiadou M, Moutafi M, Gavrielatou N, Anastasiou M, Boulouta A, Pantazopoulos A, Giannakakou M, Digklia A, Psyrri A. Well-differentiated liposarcomas and dedifferentiated liposarcomas: Systemic treatment options for two sibling neoplasms. Cancer Treat Rev 2024; 125:102716. [PMID: 38492514 DOI: 10.1016/j.ctrv.2024.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
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.
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Affiliation(s)
- A Kyriazoglou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - A Pagkali
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - I Kotsantis
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - P Economopoulou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Kyrkasiadou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Moutafi
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - N Gavrielatou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Anastasiou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Boulouta
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Pantazopoulos
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Giannakakou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Digklia
- Sarcoma Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - A Psyrri
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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15
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Bergsma EJ, Elgawly M, Mancuso D, Orr R, Vuskovich T, Seligson ND. Atezolizumab as the First Systemic Therapy Approved for Alveolar Soft Part Sarcoma. Ann Pharmacother 2024; 58:407-415. [PMID: 37466080 DOI: 10.1177/10600280231187421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The objective was to review the pharmacology, efficacy, and safety of atezolizumab (Tecentriq) for the treatment of adult and pediatric patients aged 2 years and older with unresectable or metastatic alveolar soft part sarcoma (ASPS). DATA SOURCES A literature search was conducted using PubMed and MEDLINE databases, published abstracts, and ongoing studies from ClinicalTrials.gov between January 1, 1981, and May 31, 2023. Keywords included atezolizumab, Tecentriq, MPDL3280, immunotherapy, PD-L1, PD-1, pediatrics, sarcoma, and ASPS. STUDY SELECTION AND DATA EXTRACTION All English-language studies involving atezolizumab for ASPS were included and discussed. DATA SYNTHESIS Atezolizumab is an anti-programmed death-ligand 1 (PD-L1) monoclonal antibody designed to block the interaction between PD-L1 and the programmed cell death protein 1 (PD-1) receptor. Atezolizumab was granted approval by the FDA specifically for ASPS based on a phase II clinical trial in adult and pediatric patients (n = 49), which reported an overall response rate of 24% and a durable response rate at 6 and 12 months of 67% and 42%, respectively. Common grade 3/4 adverse reactions include musculoskeletal pain (8%), followed by hypertension (6%), weight gain (6%), headache (4%), and dizziness (4%). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS Advanced ASPS is a high-risk disease with limited treatment options. Atezolizumab appears to be a viable treatment option in ASPS demonstrating clinical efficacy and a manageable toxicity profile. CONCLUSIONS With no other treatments that are FDA approved specifically for ASPS, and few demonstrating efficacy in the advanced setting, the approval of atezolizumab, including the first approval for pediatric patients, represents a landmark improvement to the therapeutic arsenal against this rare disease.
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Affiliation(s)
- Emilie J Bergsma
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Mariam Elgawly
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Jacksonville, FL, USA
| | - David Mancuso
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Jacksonville, FL, USA
| | - Roger Orr
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Jacksonville, FL, USA
| | - Theresa Vuskovich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Jacksonville, FL, USA
| | - Nathan D Seligson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Jacksonville, FL, USA
- Precision Medicine, Nemours Children's Health, Jacksonville, FL, USA
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16
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Fontebasso AM, Rytlewski JD, Blay JY, Gladdy RA, Wilky BA. Precision Oncology in Soft Tissue Sarcomas and Gastrointestinal Stromal Tumors. Surg Oncol Clin N Am 2024; 33:387-408. [PMID: 38401916 DOI: 10.1016/j.soc.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Soft tissue sarcomas (STSs), including gastrointestinal stromal tumors (GISTs), are mesenchymal neoplasms with heterogeneous clinical behavior and represent broad categories comprising multiple distinct biologic entities. Multidisciplinary management of these rare tumors is critical. To date, multiple studies have outlined the importance of biological characterization of mesenchymal tumors and have identified key molecular alterations which drive tumor biology. GIST has represented a flagship for targeted therapy in solid tumors with the advent of imatinib which has revolutionized the way we treat this malignancy. Herein, the authors discuss the importance of biological and molecular diagnostics in managing STS and GIST patients.
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Affiliation(s)
- Adam M Fontebasso
- Division of Surgical Oncology, Department of Surgery, University of Toronto, 700 University Avenue, 7th Floor, Ontario Power Generation Building, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Sinai Health Systems, 600 University Avenue Room 6-445.10 Surgery, Toronto, Ontario M5G 1X5, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey D Rytlewski
- University of Colorado School of Medicine, 12801 East 17th Avenue, Mailstop 8117, Aurora, CO 80045, USA
| | - Jean-Yves Blay
- Centre Léon Bérard, 28, rue Laennec, 69373 cedex 08. Lyon, France
| | - Rebecca A Gladdy
- Division of Surgical Oncology, Department of Surgery, University of Toronto, 700 University Avenue, 7th Floor, Ontario Power Generation Building, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Sinai Health Systems, 600 University Avenue Room 6-445.10 Surgery, Toronto, Ontario M5G 1X5, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breelyn A Wilky
- University of Colorado School of Medicine, 12801 East 17th Avenue, Mailstop 8117, Aurora, CO 80045, USA.
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17
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Zhang QS, Hayes JP, Gondi V, Pollack SM. Immunotherapy and Radiotherapy Combinations for Sarcoma. Semin Radiat Oncol 2024; 34:229-242. [PMID: 38508787 DOI: 10.1016/j.semradonc.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Sarcomas are a heterogeneous group of bone and soft tissue tumors. Survival outcomes for advanced (unresectable or metastatic) disease remain poor, so therapeutic improvements are needed. Radiotherapy plays an integral role in the neoadjuvant and adjuvant treatment of localized disease as well as in the treatment of metastatic disease. Combining radiotherapy with immunotherapy to potentiate immunotherapy has been used in a variety of cancers other than sarcoma, and there is opportunity to further investigate combining immunotherapy with radiotherapy to try to improve outcomes in sarcoma. In this review, we describe the diversity of the tumor immune microenvironments for sarcomas and describe the immunomodulatory effects of radiotherapy. We discuss studies on the timing of radiotherapy relative to immunotherapy and studies on the radiotherapy dose and fractionation regimen to be used in combination with immunotherapy. We describe the impact of radiotherapy on the tumor immune microenvironment. We review completed and ongoing clinical trials combining radiotherapy with immunotherapy for sarcoma and propose future directions for studies combining immunotherapy with radiotherapy in the treatment of sarcoma.
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Affiliation(s)
- Qian S Zhang
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John P Hayes
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vinai Gondi
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Seth M Pollack
- Division of Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL..
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18
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Liao Z, Teng J, Li T, Liu H, Li T, Zhang C, Xing R, Teng S, Yang Y, Zhao J, Xiao W, Zhang G, Li MJ, Yao W, Yang J. Evaluation of the efficacy and safety of immunotherapy in sarcoma: a two-center study. Front Immunol 2024; 15:1292325. [PMID: 38585276 PMCID: PMC10995229 DOI: 10.3389/fimmu.2024.1292325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/21/2024] [Indexed: 04/09/2024] Open
Abstract
Background Sarcoma is a highly heterogeneous malignancy with a poor prognosis. Although chemotherapy and targeted therapy have improved the prognosis to some extent, the efficacy remains unsatisfactory in some patients. The efficacy and safety of immunotherapy in sarcoma need further evaluation. Methods We conducted a two-center study of sarcoma patients receiving PD-1 immunotherapy at Tianjin Medical University Cancer Institute and Hospital and Henan Provincial Cancer Hospital. The treatment regimens included PD-1 inhibitor monotherapy and combination therapy based on PD-1 inhibitors. The observed primary endpoints were median progression-free survival (mPFS) and median overall survival (mOS). Survival curves were compared using the Kaplan-Meier method. Results A total of 43 patients were included from the two centers. The median follow-up time for all patients was 13 months (range, 1-48 months). In the group of 37 patients with advanced or unresectable sarcoma, the mPFS was 6 months (95%CI: 5-12 months), and the mOS was 16 months (95%CI: 10-28 months). The ORR was 10.8% (4/37), and the DCR was 18.9% (7/37). Subgroup analysis showed no significant differences in mPFS (p=0.11) and mOS (p=0.88) between patients with PD-L1 negative/positive expression. There were also no significant differences in mPFS (p=0.13) or mOS (p=0.72) between PD-1 inhibitor monotherapy and combination therapy. Additionally, there were no significant differences in mPFS (p=0.52) or mOS (p=0.49) between osteogenic sarcoma and soft tissue sarcoma. Furthermore, the results showed no significant differences in mPFS (p=0.66) or mOS (p=0.96) between PD-1 inhibitors combined with targeted therapy and PD-1 inhibitors combined with AI chemotherapy. Among the 6 patients receiving adjuvant therapy after surgery, the mPFS was 15 months (95%CI: 6-NA months), and the mOS was not reached. In terms of safety, most adverse events were mild (grade 1-2) and manageable. The most severe grade 4 adverse events were bone marrow suppression, which occurred in 4 patients but resolved after treatment. There was also one case of a grade 4 adverse event related to hypertension. Conclusion Immunotherapy is an effective treatment modality for sarcoma with manageable safety. Further inclusion of more patients or prospective clinical trials is needed to validate these findings.
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Affiliation(s)
- Zhichao Liao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jianjin Teng
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Tao Li
- Department of Bone and Soft-Tissue Tumor, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Haotian Liu
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ting Li
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ruwei Xing
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Sheng Teng
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yun Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jun Zhao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wanyi Xiao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Gengpu Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Mulin Jun Li
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Weitao Yao
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Li W, Liu L, Liang Z, Lai H, Wu J, Zhang H, Fang C. Efficacy of tyrosine kinase inhibitors in patients with advanced or metastatic sarcomas after prior chemotherapy: A meta-analysis. Medicine (Baltimore) 2024; 103:e37423. [PMID: 38489731 PMCID: PMC10939701 DOI: 10.1097/md.0000000000037423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/07/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Sarcoma is a heterogeneous malignancy arising from interstitial tissue. Anthracycline-based therapy is the first-line treatment recommended by guidelines for patients with locally advanced or metastatic unresectable sarcoma. Recently, targeted therapies, in particular tyrosine kinase inhibitors (TKIs), have made significant progress in the treatment of sarcoma, and their efficacy has been investigated in randomized controlled trials. The aim of this meta-analysis is to evaluate the efficacy of TKIs in patients with advanced or metastatic sarcoma who have previously received chemotherapy. METHODS We completed a meta-analysis after conducting literature searches in PubMed, Embase, and Cochrane. The single-drug, placebo-controlled, randomized controlled clinical trials of TKIs in patients with advanced or progressive sarcoma who have previously received chemotherapy are available for inclusion in the study. The observation results were objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). The subgroup analysis was performed according to histological subtypes of sarcoma. RESULTS This study included 6 studies, including 1033 patients. The ORR (OR: 7.99, 95% CI: 3.62-19.61, P < .00001), DCR (OR: 2.54, 95% CI: 1.27-5.08, P = .009), PFS (HR: 0.46, 95% CI: 0.34-0.62, P < .00001), and OS (HR: 0.80, 95% CI: 0.67-0.96, P = .02) of patients treated with TKIs were better than those in the placebo group. CONCLUSIONS In patients with advanced sarcoma, TKIs have been shown to have advantages in terms of ORR, DCR and PFS and OS. Multi-targeted TKIs may be considered as one of the second-line treatment options for sarcoma patients who have received prior chemotherapy.
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Affiliation(s)
- Wenxia Li
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Liwen Liu
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Zhanpeng Liang
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Huiqin Lai
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Jiaming Wu
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Huatang Zhang
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Cantu Fang
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
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20
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Duan XP, Qin BD, Jiao XD, Liu K, Wang Z, Zang YS. New clinical trial design in precision medicine: discovery, development and direction. Signal Transduct Target Ther 2024; 9:57. [PMID: 38438349 PMCID: PMC10912713 DOI: 10.1038/s41392-024-01760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
In the era of precision medicine, it has been increasingly recognized that individuals with a certain disease are complex and different from each other. Due to the underestimation of the significant heterogeneity across participants in traditional "one-size-fits-all" trials, patient-centered trials that could provide optimal therapy customization to individuals with specific biomarkers were developed including the basket, umbrella, and platform trial designs under the master protocol framework. In recent years, the successive FDA approval of indications based on biomarker-guided master protocol designs has demonstrated that these new clinical trials are ushering in tremendous opportunities. Despite the rapid increase in the number of basket, umbrella, and platform trials, the current clinical and research understanding of these new trial designs, as compared with traditional trial designs, remains limited. The majority of the research focuses on methodologies, and there is a lack of in-depth insight concerning the underlying biological logic of these new clinical trial designs. Therefore, we provide this comprehensive review of the discovery and development of basket, umbrella, and platform trials and their underlying logic from the perspective of precision medicine. Meanwhile, we discuss future directions on the potential development of these new clinical design in view of the "Precision Pro", "Dynamic Precision", and "Intelligent Precision". This review would assist trial-related researchers to enhance the innovation and feasibility of clinical trial designs by expounding the underlying logic, which be essential to accelerate the progression of precision medicine.
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Affiliation(s)
- Xiao-Peng Duan
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bao-Dong Qin
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiao-Dong Jiao
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ke Liu
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhan Wang
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yuan-Sheng Zang
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China.
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21
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Denu RA, Dann AM, Keung EZ, Nakazawa MS, Nassif Haddad EF. The Future of Targeted Therapy for Leiomyosarcoma. Cancers (Basel) 2024; 16:938. [PMID: 38473300 PMCID: PMC10930698 DOI: 10.3390/cancers16050938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Leiomyosarcoma (LMS) is an aggressive subtype of soft tissue sarcoma that arises from smooth muscle cells, most commonly in the uterus and retroperitoneum. LMS is a heterogeneous disease with diverse clinical and molecular characteristics that have yet to be fully understood. Molecular profiling has uncovered possible targets amenable to treatment, though this has yet to translate into approved targeted therapies in LMS. This review will explore historic and recent findings from molecular profiling, highlight promising avenues of current investigation, and suggest possible future strategies to move toward the goal of molecularly matched treatment of LMS. We focus on targeting the DNA damage response, the macrophage-rich micro-environment, the PI3K/mTOR pathway, epigenetic regulators, and telomere biology.
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Affiliation(s)
- Ryan A. Denu
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Amanda M. Dann
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Michael S. Nakazawa
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elise F. Nassif Haddad
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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22
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Cho HJ, Yun KH, Shin SJ, Lee YH, Kim SH, Baek W, Han YD, Kim SK, Ryu HJ, Lee J, Cho I, Go H, Ko J, Jung I, Jeon MK, Rha SY, Kim HS. Durvalumab plus pazopanib combination in patients with advanced soft tissue sarcomas: a phase II trial. Nat Commun 2024; 15:685. [PMID: 38263321 PMCID: PMC10806253 DOI: 10.1038/s41467-024-44875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
We aimed to determine the activity of the anti-VEGF receptor tyrosine-kinase inhibitor, pazopanib, combined with the anti-PD-L1 inhibitor, durvalumab, in metastatic and/or recurrent soft tissue sarcoma (STS). In this single-arm phase 2 trial (NCT03798106), treatment consisted of pazopanib 800 mg orally once a day and durvalumab 1500 mg once every 3 weeks. Primary outcome was overall response rate (ORR) and secondary outcomes included progression-free survival (PFS), overall survival, disease control rate, immune-related response criteria, and safety. The ORR was 30.4% and the trial met the pre-specified endpoint. The median PFS was 7.7 months (95% confidence interval: 5.7-10.4). The common treatment-related adverse events of grades 3-4 included neutropenia (9 [19.1%]), elevated aspartate aminotransferase (7 [14.9%]), alanine aminotransferase (5 [10.6%]), and thrombocytopenia (4 [8.5%]). In a prespecified transcriptomic analysis, the B lineage signature was a significant key determinant of overall response (P = 0.014). In situ analysis also showed that tumours with high CD20+ B cell infiltration and vessel density had a longer PFS (P = 6.5 × 10-4) than those with low B cell infiltration and vessel density, as well as better response (50% vs 12%, P = 0.019). CD20+ B cell infiltration was identified as the only independent predictor of PFS via multivariate analysis. Durvalumab combined with pazopanib demonstrated promising efficacy in an unselected STS cohort, with a manageable toxicity profile.
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Affiliation(s)
- Hee Jin Cho
- Department of Biomedical Convergence Science and Technology, CMRI, Kyungpook National University, Daegu, Republic of Korea
| | - Kum-Hee Yun
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Shin
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wooyeol Baek
- Department of Plastic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyum Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyang Joo Ryu
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joohee Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Ko
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Jeon
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Dalal S, Shan KS, Thaw Dar NN, Hussein A, Ergle A. Role of Immunotherapy in Sarcomas. Int J Mol Sci 2024; 25:1266. [PMID: 38279265 PMCID: PMC10816403 DOI: 10.3390/ijms25021266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Sarcomas are a group of malignancies of mesenchymal origin with a plethora of subtypes. Given the sheer heterogeneity of various subtypes and the rarity of the disease, the management of sarcomas has been challenging, with poor patient outcomes. Surgery, radiation therapy and chemotherapy have remained the backbone of treatment in patients with sarcoma. The introduction of immunotherapy has revolutionized the treatment of various solid and hematological malignancies. In this review, we discuss the basics of immunotherapy and the immune microenvironment in sarcomas; various modalities of immunotherapy, like immune checkpoint blockade, oncolytic viruses, cancer-targeted antibodies, vaccine therapy; and adoptive cell therapies like CAR T-cell therapy, T-cell therapy, and TCR therapy.
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Affiliation(s)
- Shivani Dalal
- Memorial Healthcare, Division of Hematology and Oncology, Pembroke Pines, FL 33028, USA; (K.S.S.); (N.N.T.D.); (A.H.); (A.E.)
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24
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Pan M, Zhou MY, Jiang C, Zhang Z, Bui NQ, Bien J, Siy A, Achacoso N, Solorzano AV, Tse P, Chung E, Thomas S, Habel LA, Ganjoo KN. Sex-dependent Prognosis of Patients with Advanced Soft Tissue Sarcoma. Clin Cancer Res 2024; 30:413-419. [PMID: 37831066 PMCID: PMC10792361 DOI: 10.1158/1078-0432.ccr-23-1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/25/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To examine whether overall survival (OS) differs for male and female patients with advanced soft-tissue sarcoma (STS). EXPERIMENTAL DESIGN The study included patients from Kaiser Permanente Northern California and Stanford Cancer Center with grade 2 and 3 locally advanced or metastatic STS whose tumor underwent next-generation sequencing. We used Cox regression modeling to examine association of sex and OS adjusting for other important factors. RESULTS Among 388 eligible patients, 174 had leiomyosarcoma (LMS), 136 had undifferentiated pleomorphic sarcoma (UPS), and 78 had liposarcoma. OS for male versus female patients appeared to be slightly better among the full cohort [HR = 0.89; 95% confidence interval (CI), 0.66-1.20]; this association appeared to be stronger among the subsets of patients with LMS (HR = 0.76; 95% CI, 0.39-1.49) or liposarcoma (HR = 0.74; 95% CI, 0.32-1.70). Better OS for male versus female patients was also observed among all molecular subgroups except mutRB1 and mutATRX, especially among patients whose tumor retained wtTP53 (HR = 0.73; 95% CI, 0.44-1.18), wtCDKN2A (HR = 0.85; 95% CI, 0.59-1.23), wtRB1 (HR = 0.73; 95% CI, 0.51-1.04), and among patients whose tumor had mutPTEN (HR = 0.37; 95% CI, 0.09-1.62). OS also appeared to be better for males in the MSK-IMPACT and TCGA datasets. CONCLUSIONS A fairly consistent pattern of apparent better OS for males across histologic and molecular subgroups of STS was observed. If confirmed, our results could have implications for clinical practice for prognostic stratification and possibly treatment tailoring as well as for future clinical trials design.
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Affiliation(s)
- Minggui Pan
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
- Division of Research, Kaiser Permanente, Oakland, California
| | - Maggie Yuxi Zhou
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Chen Jiang
- Division of Research, Kaiser Permanente, Oakland, California
| | - Zheyang Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Faculty of Medicine and Life Sciences, Xiamen University; and National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China
| | - Nam Q. Bui
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Jeffrey Bien
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Amanda Siy
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente, Oakland, California
| | | | - Pamela Tse
- Division of Research, Kaiser Permanente, Oakland, California
| | - Elaine Chung
- Division of Research, Kaiser Permanente, Oakland, California
| | - Sachdev Thomas
- Department of Oncology and Hematology, Kaiser Permanente, Vallejo, California
| | - Laurel A. Habel
- Division of Research, Kaiser Permanente, Oakland, California
| | - Kristen N. Ganjoo
- Sarcoma Program, Division of Oncology, Stanford University School of Medicine, Stanford, California
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25
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Wang Z, He A, Lu Z, Xu W, Wu G, Peng T. Predicting prognosis and immune status in sarcomas by identifying necroptosis-related lncRNAs. Aging (Albany NY) 2024; 16:493-517. [PMID: 38194709 PMCID: PMC10817413 DOI: 10.18632/aging.205383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sarcomas are a type of highly heterogeneous malignant tumors originating from mesenchymal tissues. Necroptosis is intricately connected to the oncogenesis and progression of tumors. The main goal of this research is to assess the prognostic value of necroptosis-related lncRNAs (NRlncRNAs) in sarcomas and to develop a risk model based on NRlncRNAs to evaluate prognostic and immune status of the sarcomas. METHODS We screened NRlncRNAs using the gene co-expression network, developed a prognostic risk model of sarcomas, and then verified the model. Following that, various bioinformatics analysis algorithms were employed to analyze the distinct characteristics of patients of the risk model. Furthermore, the function and regulatory mechanism of NRlncRNA SNHG6 in sarcomas were investigated through osteosarcoma cell experiments, such as qRT-PCR, Western blot, CCK-8, clone formation, and transwell assay. RESULTS We successfully developed a NRlncRNAs-related prognostic risk model and screened 5 prognosis-related NRlncRNAs, with SNGH6 being the most significant for prognosis of patients. According to results, the significant differences exist in prognosis, clinical characteristics, and tumor immune status among patients of the risk model. The experiments of osteosarcoma cells demonstrated that NRlncRNA SNHG6 knockdown significantly attenuated the cells' proliferation, migration, and invasion. qRT-PCR and WB results showed that SNHG6 regulated AXL and AKT signaling. CONCLUSIONS We have developed an innovative investigation on NRlncRNAs, which can serve as a reference for diagnosis, therapy, and prognosis of sarcomas. Additionally, we demonstrated that NRlncRNA SNHG6 regulated AXL and AKT signaling in osteosarcoma cells and the proliferation, migration, and invasion of tumor cells.
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Affiliation(s)
- Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
| | - Anfang He
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
| | - Zhengyu Lu
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
| | - Wenli Xu
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
| | - Gang Wu
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
| | - Tingsheng Peng
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
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Wu RT, Zhang JC, Fang CN, Qi XY, Qiao JF, Li P, Su L. Anlotinib in combination with pembrolizumab for low-grade myofibroblastic sarcoma of the pancreas: A case report. World J Clin Cases 2023; 11:8385-8391. [PMID: 38130609 PMCID: PMC10731194 DOI: 10.12998/wjcc.v11.i35.8385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Low-grade myofibroblastic sarcoma (LGMS) is a rare spindle cell sarcoma especially in the pancreas, with myofibroblastic differentiation. Hitherto, only a few cases have been reported. CASE SUMMARY Herein, we report a case involving the discovery of a pancreatic mass detected during a routine physical examination. Subsequent imaging and pathological tests of the patient led to the diagnosis of LGMS of the pancreas. Following surgical intervention, the patient experienced recurrence and metastasis. Conventional treatment is not effective for postoperative recurrent pancreatic LGMS with multiple metastases. After communicating with the patients and their families, informed consent was obtained for the treatment of anlotinib combined with pembrolizumab. Evaluation of imaging and clinical symptoms post-treatment revealed a relatively favorable response to the combination of anlotinib and pembrolizumab. CONCLUSION Based on the comprehensive literature review, our report aimed to provide evidence for a better understanding of the disease characteristics, diagnostic criteria, imaging findings, and identification of LGMS. And explore novel treatment strategies for this disease.
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Affiliation(s)
- Rong-Ting Wu
- Graduate School of Anhui University of Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230022, Anhui Province, China
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ji-Cheng Zhang
- Oncology and General Practice, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 234000, Anhui Province, China
| | - Cheng-Nan Fang
- The First Clinical College of Anhui Medical University, Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xiao-Yu Qi
- Graduate School of Anhui University of Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230022, Anhui Province, China
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jin-Fei Qiao
- Graduate School of Anhui University of Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230022, Anhui Province, China
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ping Li
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Li Su
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Jumaniyazova E, Lokhonina A, Dzhalilova D, Kosyreva A, Fatkhudinov T. Immune Cells in the Tumor Microenvironment of Soft Tissue Sarcomas. Cancers (Basel) 2023; 15:5760. [PMID: 38136307 PMCID: PMC10741982 DOI: 10.3390/cancers15245760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Soft tissue sarcomas (STSs) are a rare heterogeneous group of malignant neoplasms characterized by their aggressive course and poor response to treatment. This determines the relevance of research aimed at studying the pathogenesis of STSs. By now, it is known that STSs is characterized by complex relationships between the tumor cells and immune cells of the microenvironment. Dynamic interactions between tumor cells and components of the microenvironment enhance adaptation to changing environmental conditions, which provides the high aggressive potential of STSs and resistance to antitumor therapy. Today, active research is being conducted to find effective antitumor drugs and to evaluate the possibility of using therapy with immune cells of STS. The difficulty in assessing the efficacy of new antitumor options is primarily due to the high heterogeneity of this group of malignant neoplasms. Studying the role of immune cells in the microenvironment in the progression STSs and resistance to antitumor therapies will provide the discovery of new biomarkers of the disease and the prediction of response to immunotherapy. In addition, it will help to initially divide patients into subgroups of good and poor response to immunotherapy, thus avoiding wasting precious time in selecting the appropriate antitumor agent.
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Affiliation(s)
- Enar Jumaniyazova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
| | - Anastasiya Lokhonina
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997 Moscow, Russia
| | - Dzhuliia Dzhalilova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Anna Kosyreva
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Timur Fatkhudinov
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
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Anastasiou M, Kyriazoglou A, Kotsantis I, Economopoulou P, Kyrkasiadou M, Giannopoulou A, Kosmidou A, Smerdi D, Moutafi M, Gavrielatou N, Psyrri A. Immune checkpoint inhibitors in sarcomas: a systematic review. IMMUNO-ONCOLOGY TECHNOLOGY 2023; 20:100407. [PMID: 38192615 PMCID: PMC10772240 DOI: 10.1016/j.iotech.2023.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
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.
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Affiliation(s)
- M. Anastasiou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A. Kyriazoglou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - I. Kotsantis
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - P. Economopoulou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M. Kyrkasiadou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A. Giannopoulou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A. Kosmidou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - D. Smerdi
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M. Moutafi
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - N. Gavrielatou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A. Psyrri
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Jędrys W, Leśniak A, Borkowska A, Rutkowski P, Sobczuk P. Brain metastases of sarcoma: a rare phenomenon in rare tumours. J Cancer Res Clin Oncol 2023; 149:18271-18281. [PMID: 37994983 PMCID: PMC10725339 DOI: 10.1007/s00432-023-05451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023]
Abstract
The usual site for distant metastases of sarcoma is lungs, while brain metastasis (BM) occurs much less frequently and usually late in the disease progression. Despite the advancement in cancer treatment, the outcome for patients with brain metastasis is poor, and their lifespan is short. The frequency of BM in sarcoma seems to be affected by the location and histology of the primary tumour. Sarcoma subtypes with a high propensity for brain metastasis are ASPS, leiomyosarcoma and osteosarcoma. There are no clear guidelines for the treatment of sarcoma brain metastasis. However, therapeutic options include surgery, radiotherapy and chemotherapy, and are often combined. Targeted therapies are a promising treatment option for sarcoma but require investigation in patients with BM. The following review presents the data on sarcoma brain metastasis incidence, treatment and prognosis.
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Affiliation(s)
- Wiktoria Jędrys
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Leśniak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland.
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Hwang JR, Cho YJ, Ryu JY, Choi JY, Choi JJ, Sa JK, Kim HS, Lee JW. Ulipristal acetate, a selective progesterone receptor modulator, induces cell death via inhibition of STAT3/CCL2 signaling pathway in uterine sarcoma. Biomed Pharmacother 2023; 168:115792. [PMID: 37924789 DOI: 10.1016/j.biopha.2023.115792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
Ulipristal acetate (UPA) is a selective progesterone receptor modulator and is used for the treatment of uterine leiomyoma (a benign tumor). Uterine sarcoma which is highly malignant cancer with a poor prognosis is clinically resembled with uterine leiomyoma. There has been no experimental research on the effect of UPA on uterine sarcoma. In this study, we examined the efficacy of UPA in uterine sarcoma with in vitro and in vivo animal models. Cytotoxicity of UPA was determined in uterine sarcoma cell lines (MES-SA, SK-UT-1, and SK-LMS-1). Apoptotic genes and signaling pathways affected by UPA were analyzed by complementary DNA (cDNA) microarray of uterine sarcoma cell lines and western blot, respectively. An in vivo efficacy of UPA was examined with uterine sarcoma cell line- and patient-derived xenograft (PDX) mice models. UPA inhibited cell growth in uterine sarcoma cell lines and primary culture cells from a PDX mouse (PDX-C). cDNA microarray analysis revealed that CCL2 was highly down-regulated by UPA. Phosphorylation and the total expression of STAT3 were inhibited by UPA. UPA also inhibited CCL2 and STAT3 in PDX-C. The inhibitory effect of UPA had not changed in the overexpression of PR and treatment of progesterone. In vivo efficacy studies with cell line-derived xenografts and a PDX model with leiomyosarcoma, a typical uterine sarcoma, demonstrated that UPA significantly decreased tumor growth. UPA had significant anti-tumor effects in uterine sarcoma through the inhibition of STAT3/CCL2 signaling pathway and might be a potential therapeutic agent to treat this disease.
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Affiliation(s)
- Jae Ryoung Hwang
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Young-Jae Cho
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Ji-Yoon Ryu
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Ju-Yeon Choi
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jung-Joo Choi
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jason K Sa
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Hyun-Soo Kim
- Department of Pathology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jeong-Won Lee
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
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Hindi N, Razak A, Rosenbaum E, Jonczak E, Hamacher R, Rutkowski P, Bhadri VA, Skryd A, Brahmi M, Alshibany A, Jagodzinska-Mucha P, Bauer S, Connolly E, Gelderblom H, Boye K, Henon C, Bae S, Bogefors K, Vincenzi B, Martinez-Trufero J, Lopez-Martin JA, Redondo A, Valverde C, Blay JY, Moura DS, Gutierrez A, Tap W, Martin-Broto J. Efficacy of immune checkpoint inhibitors in alveolar soft-part sarcoma: results from a retrospective worldwide registry. ESMO Open 2023; 8:102045. [PMID: 38016251 PMCID: PMC10698259 DOI: 10.1016/j.esmoop.2023.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Conventional cytotoxic drugs are not effective in alveolar soft-part sarcoma (ASPS). Immune checkpoint (programmed cell death protein 1/programmed death-ligand 1) inhibitors (ICIs) are promising drugs in ASPS. A worldwide registry explored the efficacy of ICI in ASPS. MATERIALS AND METHODS Data from adult patients diagnosed with ASPS and treated with ICI for advanced disease in expert sarcoma centers from Europe, Australia and North America were retrospectively collected, including demographics and data related to treatments and outcome. RESULTS Seventy-six ASPS patients, with a median age at diagnosis of 25 years (range 3-61 years), were registered. All patients received ICI for metastatic disease. Immunotherapy regimens consisted of monotherapy in 38 patients (50%) and combination in 38 (50%) (23 with a tyrosine kinase inhibitor). Among the 68 assessable patients, there were 3 complete responses and 34 partial responses, translating into an overall response rate of 54.4%. After a median follow-up of 36 months [95% confidence interval (CI) 32-40 months] since the start of immunotherapy, 45 (59%) patients have progressed on ICI, with a median progression-free survival (PFS) of 16.3 months (95% CI 8-25 months). Receiving ICI in first line (P = 0.042) and achieving an objective response (P = 0.043) correlated with a better PFS. Median estimated overall survival (OS) from ICI initiation has not been reached. The 12-month and 24-month OS rates were 94% and 81%, respectively. CONCLUSIONS This registry constitutes the largest available series of ASPS treated with ICI. Our results suggest that the ICI treatment provides long-lasting disease control and prolonged OS in patients with advanced ASPS, an ultra-rare entity with limited active therapeutic options.
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Affiliation(s)
- N Hindi
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital and Hospital General de Villalba, Madrid; Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain.
| | - A Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - E Rosenbaum
- Memorial Sloan Kettering Cancer Center, New York
| | - E Jonczak
- Department of Hematology Oncology, Miami University, Miami, USA
| | - R Hamacher
- Medical Oncology Department, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - V A Bhadri
- Medical Oncology Department, Chris O Brien Lifehouse, Sydney, Australia
| | - A Skryd
- Miller School of Medicine, University of Miami, Miami, USA
| | - M Brahmi
- Centre Leon Berard & University Claude Bernard Lyon 1, Lyon, France
| | - A Alshibany
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - P Jagodzinska-Mucha
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - S Bauer
- Medical Oncology Department, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - E Connolly
- Medical Oncology Department, Chris O Brien Lifehouse, Sydney, Australia
| | - H Gelderblom
- Medical Oncology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Institute for Cancer Research, Oslo University Hospital, Oslo; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - C Henon
- Medical Oncology Department, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - S Bae
- Medical Oncology Department, Peter Mac Callum Center, Melbourne, Australia
| | - K Bogefors
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - B Vincenzi
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - J Martinez-Trufero
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza
| | - J A Lopez-Martin
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Translational Oncology Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
| | - A Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Madrid
| | - C Valverde
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona
| | - J-Y Blay
- Centre Leon Berard & University Claude Bernard Lyon 1, Lyon, France
| | - D S Moura
- Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain
| | - A Gutierrez
- Hematology Department, Hospital Universitario Son Espases, Palma, Spain
| | - W Tap
- Memorial Sloan Kettering Cancer Center, New York
| | - J Martin-Broto
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital and Hospital General de Villalba, Madrid; Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain
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Zhou Y, Li M, Zhang B, Yang C, Wang Y, Zheng S, Tang L, Zhou C, Qian G, Huang Y, Yu W, Li H, Wang Y, He A, Shen Z, Zhang J, Li X, Yang Q, Hu H, Yao Y. A pilot study of multi-antigen stimulated cell therapy-I plus camrelizumab and apatinib in patients with advanced bone and soft-tissue sarcomas. BMC Med 2023; 21:470. [PMID: 38031088 PMCID: PMC10687909 DOI: 10.1186/s12916-023-03132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Cell-based immunotherapy shows the therapeutic potential in sarcomas, in addition to angiogenesis-targeted tyrosine kinase inhibitor (TKI) and immune checkpoint inhibitor (ICI). Multi-antigen stimulated cell therapy-I (MASCT-I) technology is a sequential immune cell therapy for cancer, which composes of multiple antigen-loaded dendritic cell (DC) vaccines followed by the adoptive transfer of anti-tumor effector T-cells. METHODS In this phase 1 study, we assessed MASCT-I plus camrelizumab (an ICI against PD-1) and apatinib (a highly selective TKI targeting VEGFR2) in patients with unresectable recurrent or metastatic bone and soft-tissue sarcoma after at least one line of prior systemic therapy. One MASCT-I course consisted of 3 DC subcutaneous injections, followed by 3 active T cell infusions administered 18-27 days after each DC injection. In schedule-I group, 3 DC injections were administered with a 28-day interval in all courses; in schedule-II group, 3 DC injections were administered with a 7-day interval in the first course and with a 28-day interval thereafter. All patients received intravenous camrelizumab 200 mg every 3 weeks and oral apatinib 250 mg daily. RESULTS From October 30, 2019, to August 12, 2021, 19 patients were enrolled and randomly assigned to schedule-I group (n = 9) and schedule-II group (n = 10). Of the 19 patients, 11 (57.9%) experienced grade 3 or 4 treatment-related adverse events. No treatment-related deaths occurred. Patients in schedule-II group showed similar objective response rate (ORR) with those in schedule-I group (30.0% versus 33.3%) but had higher disease control rate (DCR; 90.0% versus 44.4%) and longer median progression-free survival (PFS; 7.7 versus 4.0 months). For the 13 patients with soft-tissue sarcomas, the ORR was 30.8%, DCR was 76.9%, and median PFS was 12.9 months; for the 6 patients with osteosarcomas, the ORR was 33.3%, the DCR was 50.0%, and median PFS was 5.7 months. CONCLUSIONS Overall, MASCT-I plus camrelizumab and apatinib was safe and showed encouraging efficacy in advanced bone and soft-tissue sarcoma, and schedule-II administration method was recommended. TRIAL REGISTRATION ClinicalTrials.gov, NCT04074564.
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Affiliation(s)
- Yan Zhou
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Mei Li
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhang
- Department of Orthopedic Oncology, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Jiangxi, China
| | - Cheng Yang
- Department of Orthopedic Oncology, Changzheng Hospital of Naval Military Medical University, Shanghai, China
| | - Yaling Wang
- Department of Oncology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Shuier Zheng
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Lina Tang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Chenliang Zhou
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Guowei Qian
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yujing Huang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Wenxi Yu
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Hongtao Li
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yonggang Wang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Aina He
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Zan Shen
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jianjun Zhang
- Department of Oncology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | | | - Qingcheng Yang
- Department of Orthopedic, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Haiyan Hu
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Clinical Research Ward (SCRW), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Yang Yao
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Wang B, Han Y, Liu J, Zhang X, Zhuo H, Jiang Y, Deng Y. Case report: the dissociated response and clinical benefit of primary leiomyosarcoma of the bone treated with penpulimab plus lenvatinib after failed multi-line therapy. Front Pharmacol 2023; 14:1239699. [PMID: 38026935 PMCID: PMC10665504 DOI: 10.3389/fphar.2023.1239699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Leiomyosarcoma occurring in the bone as primary tumor localization is extremely scarce with limited cases described in the literature, accounting for less than 0.7% of all primary bone malignancies. Once distant metastasis occurs, patients have limited treatments and often a somber prognosis, which underscore the need for innovative and effective treatment approaches. The emerging evidence suggests that anti-angiogenic therapy could inhibit angiogenesis and normalize vascular permeability in the tumor microenvironment, which, in turn, would increase immune effector cell infiltration into tumors. Immunotherapy depends on the accumulation and activity of immune effector cells within the tumor microenvironment, and immune responses and vascular normalization seem to be reciprocally regulated. Immunotherapy combined with anti-angiogenic therapy has recently made great progress in the treatment of various types of tumors. However, the effectiveness of the combination treatment in metastatic leiomyosarcoma is undetermined. In this study, we presented a rare case of primary leiomyosarcoma of the bone located in the trochanteric region of the femur, accompanied by multiple distant metastases. After the failure of multi-line therapies including AI regiments as the adjuvant chemotherapy, anlotinib as the first-line therapy, GT regiment as the second-line therapy, and eribulin as the third-line therapy, the patient received combinational therapy with penpulimab plus lenvatinib. The best efficacy for this regimen was a partial response, with a progression-free survival of 8.4 months according to the iRECIST criteria. After a dissociated response was detected without severe toxicities, the patient received local radiotherapy and continued treatment on penpulimab plus lenvatinib and eventually achieved long-term survival benefits with a total of over 60 months of overall survival with good quality of life and ongoing treatment. As our previous retrospective study found that one-third of advanced STS patients could still achieve clinical benefits from rechallenge with multi-targeted tyrosine kinase inhibitors (TKIs), after the failure of previous TKI therapy, this case provided the potential clinical activity of immunotherapy combined with anti-angiogenic TKI rechallenge in metastatic leiomyosarcoma.
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Affiliation(s)
- Bin Wang
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yin Han
- Department of Pathology, Cancer Prevention and Treatment Institute of Chengdu, Chengdu Fifth People’s Hospital, The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Liu
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyao Zhang
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Zhuo
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jiang
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yaotiao Deng
- Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Fujiwara T, Kunisada T, Nakata E, Nishida K, Yanai H, Nakamura T, Tanaka K, Ozaki T. Advances in treatment of alveolar soft part sarcoma: an updated review. Jpn J Clin Oncol 2023; 53:1009-1018. [PMID: 37626447 PMCID: PMC10632598 DOI: 10.1093/jjco/hyad102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Alveolar soft part sarcoma is a rare neoplasm of uncertain histogenesis that belongs to a newly defined category of ultra-rare sarcomas. The neoplasm is characterized by a specific chromosomal translocation, der (17) t(X; 17)(p11.2;q25), that results in ASPSCR1-TFE3 gene fusion. The natural history of alveolar soft part sarcoma describes indolent behaviour with slow progression in deep soft tissues of the extremities, trunk and head/neck in adolescents and young adults. A high rate of detection of distant metastasis at presentation has been reported, and the most common metastatic sites in decreasing order of frequency are the lung, bone and brain. Complete surgical resection remains the standard treatment strategy, whereas radiotherapy is indicated for patients with inadequate surgical margins or unresectable tumours. Although alveolar soft part sarcoma is refractory to conventional doxorubicin-based chemotherapy, monotherapy or combination therapy using tyrosine kinase inhibitors and immune checkpoint inhibitors have provided antitumor activity and emerged as new treatment strategies. This article provides an overview of the current understanding of this ultra-rare sarcoma and recent advancements in treatments according to the clinical stage of alveolar soft part sarcoma.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Nishida
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University, Tsu, Japan
| | - Kazuhiro Tanaka
- Department of Advanced Medical Sciences, Oita University, Yufu, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Spinnato P, Papalexis N, Colangeli M, Miceli M, Crombé A, Parmeggiani A, Palmerini E, Righi A, Bianchi G. Imaging Features of Alveolar Soft Part Sarcoma: Single Institution Experience and Literature Review. Clin Pract 2023; 13:1369-1382. [PMID: 37987424 PMCID: PMC10660714 DOI: 10.3390/clinpract13060123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Alveolar soft part sarcoma (ASPS) is an extremely rare and aggressive soft-tissue sarcoma (STS) subtype with poor prognosis and limited response to radiation therapy and chemotherapy. Prompt recognition and referral to sarcoma centers for appropriate management are crucial for patients' survival. The purpose of this study was to report ASPS pre-treatment imaging features and to examine the existing literature on this topic. Twelve patients (7 women, 5 men-mean age 27.1 ± 10.7 years) were included from our single-center experience. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) available were reviewed according to an analysis grid incorporating features from the latest research on STS. Clinical, histological, and outcome data were collected. MRI was available in 10 patients (83.3%), US in 7 patients (58.3%), and CT in 3 patients (25%). Mean longest tumor diameter was 7.6 ± 2.9 cm, and all tumors were deeply seated. Large peritumoral feeding vessels were systematically found and identified on ultrasonography (7/7), MRI (10/10), and CT (3/3). US revealed a well-defined heterogeneous hypoechoic pattern, with abundant flow signals in all patients (7/7). In all patients, MRI showed mildly high signal intensity (SI) on T1-WI and high SI on T2-WI and peritumoral edema. Moreover, flow-voids (due to arteriosus high-flow) into the peritumoral/intratumoral feeding vessels were detected in the MRI fluid-sensitive sequences of all patients. At baseline, whole-body contrast-enhanced CT revealed metastases in 8/12 (66.7%) patients. A pre-treatment longest diameter > 5 cm was significantly associated with distant metastases at diagnosis (p = 0.01). A maximum diameter > 5 cm represents a risk of metastatic disease at diagnosis (odds ratio = 45.0000 (95% CI: 1.4908-1358.3585), p = 0.0285). In the comprehensive literature review, we found 14 articles (case series or original research) focusing on ASPS imaging, with a total of 151 patients included. Merging our experience with the data from the existing literature, we conclude that the hallmark of ASPS imaging at presentation are the following characteristics: deep location, a slight hyperintense MRI SI on T1-WI and a hyperintense SI on T2-WI, numerous MRI flow voids, high internal vascularization, and large peritumoral feeding vessels.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, University of Bordeaux, 33000 Bordeaux, France
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Torrado C, Camaño M, Hindi N, Ortega J, Sevillano AR, Civantos G, Moura DS, Dimino A, Martín-Broto J. Antiangiogenics in Malignant Granular Cell Tumors: Review of the Literature. Cancers (Basel) 2023; 15:5187. [PMID: 37958362 PMCID: PMC10650106 DOI: 10.3390/cancers15215187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Granular cell tumors (GCT) represent 0.5% of all soft tissue sarcomas (STS), and when metastatic, they exhibit aggressive behavior and determine limited survival. Metastatic GCTs are relatively chemo-resistant; however, there is growing evidence of the benefit of using pazopanib and other targeted therapies in this histology. This is a review of the role of pazopanib and other targeted therapies in the treatment of GCTs, along with some insights on pathology and molecular biology described in GCTs. From 256 articles found in our search, 10 case-report articles met the inclusion criteria. Pazopanib was the most employed systemic therapy. The median reported time on therapy with pazopanib was seven months. Eight out of ten patients (80%) experienced disease control with pazopanib, while four out of ten (40%) patients achieved an objective RECIST response. Molecular studies suggested that antitumoral effects of pazopanib in GCT might be due to a loss-of-function of ATP6AP1/2 genes which consequently enhance signaling through several molecular pathways, such as SFKs, STAT5a/b, and PDGFR-β. Other reported targeted therapies for malignant GCTs included pazopanib in combination with crizotinib, which showed disease control for four months in one patient, and a PI3K inhibitor which achieved disease control for nine months in another patient. Dasatinib and megestrol were ineffective in two other different patients. Pazopanib has been demonstrated to be active in advanced GCTs and may be considered as a preferable treatment option.
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Affiliation(s)
- Carlos Torrado
- Medical Oncology Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - Melisa Camaño
- Medical Oncology Department, National Cancer Institute, 11600 Montevideo, Uruguay;
| | - Nadia Hindi
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Justo Ortega
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Alberto R. Sevillano
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Gema Civantos
- Pathology Department, Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - David S. Moura
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
| | - Alessandra Dimino
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90127 Palermo, Italy;
| | - Javier Martín-Broto
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
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Martin-Broto J, Martinez-Garcia J, Moura DS, Redondo A, Gutierrez A, Lopez-Pousa A, Martinez-Trufero J, Sevilla I, Diaz-Beveridge R, Solis-Hernandez MP, Carnero A, Perez M, Marcilla D, Garcia-Foncillas J, Romero P, Fernandez-Jara J, Lopez-Lopez D, Arribas I, Hindi N. Phase II trial of CDK4/6 inhibitor palbociclib in advanced sarcoma based on mRNA expression of CDK4/ CDKN2A. Signal Transduct Target Ther 2023; 8:405. [PMID: 37875500 PMCID: PMC10598203 DOI: 10.1038/s41392-023-01661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/16/2023] [Indexed: 10/26/2023] Open
Abstract
Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors demonstrated activity in terms of progression-free survival (PFS) in advanced dedifferentiated liposarcoma (DD-LPS), a sarcoma with CDK4 amplification. CDK4 overexpression is by far more common than amplification in sarcomas and it might be a rational target for CDK inhibitors. Preclinical investigators of this study found that CDK4 overexpression, while not of CDKN2A, was the most consistent predictive factor for palbociclib efficacy in sarcomas. Advanced adult-type soft-tissue sarcoma, excluding DD-LPS, or bone sarcoma patients, progressing after at least one systemic line, whose tumors overexpressed CDK4, but not CDKN2A at baseline biopsy, were accrued in this single-arm phase II trial (EudraCT number: 2016-004039-19). With the main endpoint of a 6-month PFS rate, 40% was considered promising in this population. Palbociclib was administered orally at 125 mg/day for 21 days in 28-day cycles. A total of 214 patients with 236 CDK4/CDKN2A determinations were assessed for prescreening, archival material (141), and screening, baseline biopsy (95). There were 28 (29%) with favorable mRNA profiles from 95 screened patients at baseline. From 23 enrolled patients, 21 evaluable, the 6-month PFS rate was 29% (95% CI 9-48), and there were 6 patients out of 21 with a PFS longer than 6 months. The median PFS and overall survival were 4.2 (95% CI 3.6-4.8) and 12 (95% CI 8.7-15.4) months, respectively. Translational research showed a significant correlation between CDK4 mRNA and protein expression. Palbociclib was active in a variety of sarcoma subtypes, selected by CDK4/CDKN2A, and deserves further investigation in the sarcoma context.
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Affiliation(s)
- Javier Martin-Broto
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain.
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain.
- General de Villalba University Hospital, 28400, Madrid, Spain.
| | | | - David S Moura
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
| | - Andres Redondo
- Department of Medical Oncology, Hospital Universitario La Paz-IdiPAZ, P. Castellana, 261, 28046, Madrid, Spain
| | - Antonio Gutierrez
- Hematology Department, University Hospital Son Espases, 07120, Mallorca, Spain
| | | | | | - Isabel Sevilla
- Investigación Clínica y Traslacional en Cáncer/ Instituto de Investigaciones Biomédicas de Malaga (IBIMA)/ Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Malaga, Spain
| | - Roberto Diaz-Beveridge
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, 46026, Valencia, Spain
| | | | - Amancio Carnero
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
| | - Marco Perez
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
- Pathology Department, Virgen del Rocio University Hospital, 41013, Sevilla, Spain
| | - David Marcilla
- Pathology Department, Virgen del Rocio University Hospital, 41013, Sevilla, Spain
| | - Jesus Garcia-Foncillas
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
| | - Pablo Romero
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
| | - Javier Fernandez-Jara
- Radiology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
| | - Daniel Lopez-Lopez
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
- Computational Medicine Platform, Fundación progreso y salud (FPS), Hospital Virgen del Rocío, 41013, Seville, Spain
- Bioinformatics in Rare Diseases (BiER). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, Sevilla, Spain
| | - Ivan Arribas
- Universitat de València - ERI-CES, 46010, Valencia, Spain
| | - Nadia Hindi
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
- General de Villalba University Hospital, 28400, Madrid, Spain
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Yu P, Wang Y, Yuan D, Sun Y, Qin S, Li T. Vascular normalization: reshaping the tumor microenvironment and augmenting antitumor immunity for ovarian cancer. Front Immunol 2023; 14:1276694. [PMID: 37936692 PMCID: PMC10626545 DOI: 10.3389/fimmu.2023.1276694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Ovarian cancer remains a challenging disease with limited treatment options and poor prognosis. The tumor microenvironment (TME) plays a crucial role in tumor growth, progression, and therapy response. One characteristic feature of the TME is the abnormal tumor vasculature, which is associated with inadequate blood perfusion, hypoxia, and immune evasion. Vascular normalization, a therapeutic strategy aiming to rectify the abnormal tumor vasculature, has emerged as a promising approach to reshape the TME, enhance antitumor immunity, and synergize with immunotherapy in ovarian cancer. This review paper provides a comprehensive overview of vascular normalization and its potential implications in ovarian cancer. In this review, we summarize the intricate interplay between anti-angiogenesis and immune modulation, as well as ICI combined with anti-angiogenesis therapy in ovarian cancer. The compelling evidence discussed in this review contributes to the growing body of knowledge supporting the utilization of combination therapy as a promising treatment paradigm for ovarian cancer, paving the way for further clinical development and optimization of this therapeutic approach.
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Affiliation(s)
- Ping Yu
- Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Yaru Wang
- Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Dahai Yuan
- Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Yunqin Sun
- Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Shuang Qin
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianye Li
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Rosenbaum E, Seier K, Bradic M, Kelly C, Movva S, Nacev BA, Gounder MM, Keohan ML, Avutu V, Chi P, Thornton KA, Chan JE, Dickson MA, Donoghue MT, Tap WD, Qin LX, D'Angelo SP. Immune-related Adverse Events after Immune Checkpoint Blockade-based Therapy Are Associated with Improved Survival in Advanced Sarcomas. CANCER RESEARCH COMMUNICATIONS 2023; 3:2118-2125. [PMID: 37787759 PMCID: PMC10583739 DOI: 10.1158/2767-9764.crc-22-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
The association between immune-related AEs (irAE) and outcome in patients with sarcoma is not known. We retrospectively reviewed a cohort of patients with advanced sarcoma treated with immune checkpoint blockade (ICB)-based therapy. Association of irAEs with survival was assessed using a Cox regression model that incorporated irAE occurrence as a time-dependent covariate. Tumor samples with available RNA sequencing data were stratified by presence of an irAE to identify patterns of differential gene expression. A total of 131 patients were included. Forty-two (32%) had at least one irAE of any grade and 16 (12%) had at least one grade ≥ 3 irAE. The most common irAEs were hypothyroidism (8.3%), arthralgias (5.3%), pneumonitis (4.6%), allergic reaction (3.8%), and elevated transaminases (3.8%). Median progression-free survival (PFS) and overall survival (OS) from the time of study entry were 11.4 [95% confidence interval (CI), 10.7-15.0) and 74.6 weeks (CI, 44.9-89.7), respectively. On Cox analysis adjusting for clinical covariates that were significant in the univariate setting, the HR for an irAE (HR, 0.662; CI, 0.421-1.041) approached, but did not reach statistical significance for PFS (P = 0.074). Patients had a significantly lower HR for OS (HR, 0.443; CI, 0.246-0.798; P = 0.007) compared with those without or before an irAE. Gene expression profiling on baseline tumor samples found that patients who had an irAE had higher numbers of tumor-infiltrating dendritic cells, CD8+ T cells, and regulatory T cells as well as upregulation of immune and inflammatory pathways. SIGNIFICANCE irAE after ICB therapy was associated with an improved OS; it also approached statistical significance for improved PFS. Patients who had an irAE were more likely to have an inflamed tumor microenvironment at baseline.
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Affiliation(s)
- Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martina Bradic
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ciara Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Benjamin A. Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mrinal M. Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mary L. Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine A. Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jason E. Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mark T.A. Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra P. D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
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Salawu A, Wang BX, Han M, Geady C, Heirali A, Berman HK, Pfister TD, Hernando-Calvo A, Al-Ezzi EM, Stayner LA, Gupta AA, Ayodele O, Lam B, Hansen AR, Spreafico A, Bedard PL, Butler MO, Avery L, Coburn B, Haibe-Kains B, Siu LL, Abdul Razak AR. Safety, Immunologic, and Clinical Activity of Durvalumab in Combination with Olaparib or Cediranib in Advanced Leiomyosarcoma: Results of the DAPPER Clinical Trial. Clin Cancer Res 2023; 29:4128-4138. [PMID: 37566240 DOI: 10.1158/1078-0432.ccr-23-1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/21/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Non-inflamed (cold) tumors such as leiomyosarcoma do not benefit from immune checkpoint blockade (ICB) monotherapy. Combining ICB with angiogenesis or PARP inhibitors may increase tumor immunogenicity by altering the immune cell composition of the tumor microenvironment (TME). The DAPPER phase II study evaluated the safety, immunologic, and clinical activity of ICB-based combinations in pretreated patients with leiomyosarcoma. PATIENTS AND METHODS Patients were randomized to receive durvalumab 1,500 mg IV every 4 weeks with either olaparib 300 mg twice a day orally (Arm A) or cediranib 20 mg every day orally 5 days/week (Arm B) until unacceptable toxicity or disease progression. Paired tumor biopsies, serial radiologic assessments and stool collections were performed. Primary endpoints were safety and immune cell changes in the TME. Objective responses and survival were correlated with transcriptomic, radiomic, and microbiome parameters. RESULTS Among 30 heavily pretreated patients (15 on each arm), grade ≥ 3 toxicity occurred in 3 (20%) and 2 (13%) on Arms A and B, respectively. On Arm A, 1 patient achieved partial response (PR) with increase in CD8 T cells and macrophages in the TME during treatment, while 4 had stable disease (SD) ≥ 6 months. No patients on Arm B achieved PR or SD ≥ 6 months. Transcriptome analysis showed that baseline M1-macrophage and B-cell activity were associated with overall survival. CONCLUSIONS Durvalumab plus olaparib increased immune cell infiltration of TME with clinical benefit in some patients with leiomyosarcoma. Baseline M1-macrophage and B-cell activity may identify patients with leiomyosarcoma with favorable outcomes on immunotherapy and should be further evaluated.
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Affiliation(s)
- Abdulazeez Salawu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ben X Wang
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ming Han
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Caryn Geady
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Alya Heirali
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Hal K Berman
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas D Pfister
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alberto Hernando-Calvo
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Esmail Mutahar Al-Ezzi
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lee-Anne Stayner
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abha A Gupta
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olubukola Ayodele
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Lam
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcus O Butler
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Avery
- Department of Statistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Benjamin Haibe-Kains
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Albiruni R Abdul Razak
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Anzar I, Malone B, Samarakoon P, Vardaxis I, Simovski B, Fontenelle H, Meza-Zepeda LA, Stratford R, Keung EZ, Burgess M, Tawbi HA, Myklebost O, Clancy T. The interplay between neoantigens and immune cells in sarcomas treated with checkpoint inhibition. Front Immunol 2023; 14:1226445. [PMID: 37799721 PMCID: PMC10548483 DOI: 10.3389/fimmu.2023.1226445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/10/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Sarcomas are comprised of diverse bone and connective tissue tumors with few effective therapeutic options for locally advanced unresectable and/or metastatic disease. Recent advances in immunotherapy, in particular immune checkpoint inhibition (ICI), have shown promising outcomes in several cancer indications. Unfortunately, ICI therapy has provided only modest clinical responses and seems moderately effective in a subset of the diverse subtypes. Methods To explore the immune parameters governing ICI therapy resistance or immune escape, we performed whole exome sequencing (WES) on tumors and their matched normal blood, in addition to RNA-seq from tumors of 31 sarcoma patients treated with pembrolizumab. We used advanced computational methods to investigate key immune properties, such as neoantigens and immune cell composition in the tumor microenvironment (TME). Results A multifactorial analysis suggested that expression of high quality neoantigens in the context of specific immune cells in the TME are key prognostic markers of progression-free survival (PFS). The presence of several types of immune cells, including T cells, B cells and macrophages, in the TME were associated with improved PFS. Importantly, we also found the presence of both CD8+ T cells and neoantigens together was associated with improved survival compared to the presence of CD8+ T cells or neoantigens alone. Interestingly, this trend was not identified with the combined presence of CD8+ T cells and TMB; suggesting that a combined CD8+ T cell and neoantigen effect on PFS was important. Discussion The outcome of this study may inform future trials that may lead to improved outcomes for sarcoma patients treated with ICI.
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Affiliation(s)
- Irantzu Anzar
- Oslo Cancer Cluster, NEC OncoImmunity AS, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Leonardo A. Meza-Zepeda
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Genomics Core Facility, Department of Core Facilities, Oslo University Hospital, Oslo, Norway
| | | | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Melissa Burgess
- Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hussein A. Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ola Myklebost
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trevor Clancy
- Oslo Cancer Cluster, NEC OncoImmunity AS, Oslo, Norway
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Chen AP, Sharon E, O'Sullivan-Coyne G, Moore N, Foster JC, Hu JS, Van Tine BA, Conley AP, Read WL, Riedel RF, Burgess MA, Glod J, Davis EJ, Merriam P, Naqash AR, Fino KK, Miller BL, Wilsker DF, Begum A, Ferry-Galow KV, Deshpande HA, Schwartz GK, Ladle BH, Okuno SH, Beck JC, Chen JL, Takebe N, Fogli LK, Rosenberger CL, Parchment RE, Doroshow JH. Atezolizumab for Advanced Alveolar Soft Part Sarcoma. N Engl J Med 2023; 389:911-921. [PMID: 37672694 PMCID: PMC10729808 DOI: 10.1056/nejmoa2303383] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) is a rare soft-tissue sarcoma with a poor prognosis and no established therapy. Recently, encouraging responses to immune checkpoint inhibitors have been reported. METHODS We conducted an investigator-initiated, multicenter, single-group, phase 2 study of the anti-programmed death ligand 1 (PD-L1) agent atezolizumab in adult and pediatric patients with advanced ASPS. Atezolizumab was administered intravenously at a dose of 1200 mg (in patients ≥18 years of age) or 15 mg per kilogram of body weight with a 1200-mg cap (in patients <18 years of age) once every 21 days. Study end points included objective response, duration of response, and progression-free survival according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, as well as pharmacodynamic biomarkers of multistep drug action. RESULTS A total of 52 patients were evaluated. An objective response was observed in 19 of 52 patients (37%), with 1 complete response and 18 partial responses. The median time to response was 3.6 months (range, 2.1 to 19.1), the median duration of response was 24.7 months (range, 4.1 to 55.8), and the median progression-free survival was 20.8 months. Seven patients took a treatment break after 2 years of treatment, and their responses were maintained through the data-cutoff date. No treatment-related grade 4 or 5 adverse events were recorded. Responses were noted despite variable baseline expression of programmed death 1 and PD-L1. CONCLUSIONS Atezolizumab was effective at inducing sustained responses in approximately one third of patients with advanced ASPS. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT03141684.).
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Affiliation(s)
- Alice P Chen
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Elad Sharon
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Geraldine O'Sullivan-Coyne
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Nancy Moore
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Jared C Foster
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - James S Hu
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Brian A Van Tine
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Anthony P Conley
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - William L Read
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Richard F Riedel
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Melissa A Burgess
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - John Glod
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Elizabeth J Davis
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Priscilla Merriam
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Abdul R Naqash
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Kristin K Fino
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Brandon L Miller
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Deborah F Wilsker
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Asma Begum
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Katherine V Ferry-Galow
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Hari A Deshpande
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Gary K Schwartz
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Brian H Ladle
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Scott H Okuno
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Jill C Beck
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - James L Chen
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Naoko Takebe
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Laura K Fogli
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Christina L Rosenberger
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - Ralph E Parchment
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
| | - James H Doroshow
- From the Division of Cancer Treatment and Diagnosis (A.P. Chen, E.S., G.O.-C., N.M., J.C.F., A.R.N., N.T., L.K.F., C.L.R., J.H.D.) and the Center for Cancer Research (J.G., J.H.D.), National Cancer Institute, Bethesda, the Clinical Pharmacodynamics Biomarker Program, Applied and Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick (K.K.F., B.L.M., D.F.W., A.B., K.V.F.-G., R.E.P.), and the Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore (B.H.L.) - all in Maryland; the Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles (J.S.H.); the Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis (B.A.V.T.); the University of Texas M.D. Anderson Cancer Center, Houston (A.P. Conley); Emory University, Atlanta (W.L.R.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (R.F.R.); University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (M.A.B.); the Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville (E.J.D.); the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.M.); the Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT (H.A.D.); the Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York (G.K.S.); Mayo Clinic, Rochester, MN (S.H.O.); the Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha (J.C.B.); the Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus (J.L.C.); and Stephenson Cancer Center at the University of Oklahoma, Oklahoma City (A.R.N.)
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Blay JY, Chevret S, Le Cesne A, Brahmi M, Penel N, Cousin S, Bertucci F, Bompas E, Ryckewaert T, Soibinet P, Boudou-Rouquette P, Saada Bouzid E, Soulie P, Valentin T, Lotz JP, Tosi D, Neviere Z, Cancel M, Ray-Coquard I, Gambotti L, Legrand F, Lamrani-Ghaouti A, Simon C, Even C, Massard C. Pembrolizumab in patients with rare and ultra-rare sarcomas (AcSé Pembrolizumab): analysis of a subgroup from a non-randomised, open-label, phase 2, basket trial. Lancet Oncol 2023; 24:892-902. [PMID: 37429302 DOI: 10.1016/s1470-2045(23)00282-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Sarcoma is a heterogeneous group of diseases with few treatment options. Immunotherapy has shown little activity in studies including unselected sarcomas, but immune checkpoint blockers have shown activity in specific histotypes. We evaluated the activity of pembrolizumab in rare and ultra-rare sarcomas. METHODS AcSé Pembrolizumab is an ongoing phase 2, basket, multitumour study investigating the activity of pembrolizumab monotherapy in rare cancers. Here, we report the results obtained in patients with selected histotypes of rare sarcomas (incidence of less than one case per 1 000 000 people per year) recruited at 24 French hospitals. Key inclusion criteria were age 15 years or older, Eastern Cooperative Oncology Group performance status of 0-1, and advanced disease that was untreated and resistant to treatment. Patients were given pembrolizumab 200 mg intravenously on day 1 of every 21-day cycle for a maximum of 24 months. The primary endpoint was objective response rate at week 12 using Response Evaluation Criteria in Solid Tumours version 1.1, assessed by local investigators. The primary endpoint and safety were analysed in the intention-to-treat population. The AcSé Pembrolizumab study is registered with ClinicalTrials.gov, NCT03012620. FINDINGS Between Sept 4, 2017, and Dec 29, 2020, 98 patients were enrolled, of whom 97 received treatment and were included in analyses (median age 51 years [IQR 35-65]; 53 [55%] were male; 44 [45%] were female; no data were collected on race or ethnicity). 34 (35%) patients had chordomas, 14 (14%) had alveolar soft part sarcomas, 12 (12%) had SMARCA4-deficient sarcomas or malignant rhabdoid tumours, eight (8%) had desmoplastic small round cell tumours, six (6%) had epithelioid sarcomas, four (4%) had dendritic cell sarcomas, three (3%) each had clear cell sarcomas, solitary fibrous tumours, and myxoid liposarcomas, and ten (10%) had other ultra-rare histotypes. As of data cutoff (April 11, 2022), median follow-up was 13·1 months (range 0·1-52·8; IQR 4·3-19·7). At week 12, objective response rate was 6·2% (95% CI 2·3-13·0), with no complete responses and six partial responses in the 97 patients. The most common grade 3-4 adverse events were anaemia (eight [8%] of 97), alanine aminotransferase and aspartate aminotransferase increase (six [6%]), and dyspnoea (five [5%]). 86 serious adverse events were reported in 37 patients. Five deaths due to adverse events were reported, none of which were determined to be related to treatment (two due to disease progression, two due to cancer, and one due to unknown cause). INTERPRETATION Our data show the activity and manageable toxicity of pembrolizumab in some rare and ultra-rare sarcoma histotypes, and support the PD-1/PD-L1 pathway as a potential therapeutic target in selected histotypes. The completion of the basket study will provide further evidence regarding the activity and toxicity of pembrolizumab in identified rare types of cancer. FUNDING The Ligue contre le cancer, INCa, MSD. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jean-Yves Blay
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France.
| | - Sylvie Chevret
- Service de Biostatistique, Hôpital Saint Louis (AP-HP), Université Paris Cité, Paris, France
| | - Axel Le Cesne
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Mehdi Brahmi
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Emmanuelle Bompas
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes, France
| | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | - Diego Tosi
- Institut Régional du Cancer de Montpellier, Centre Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | | | | | - Caroline Even
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
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Feng X, Tonon L, Li H, Darbo E, Pleasance E, Macagno N, Dufresne A, Brahmi M, Bollard J, Ducimetière F, Karanian M, Meurgey A, Pérot G, Valentin T, Chibon F, Blay JY. Comprehensive Immune Profiling Unveils a Subset of Leiomyosarcoma with "Hot" Tumor Immune Microenvironment. Cancers (Basel) 2023; 15:3705. [PMID: 37509366 PMCID: PMC10378143 DOI: 10.3390/cancers15143705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Purpose: To investigate the immune biomarker in Leiomyosarcoma (LMS), which is rare and recognized as an immune cold cancer showing a poor response rate (<10%) to immune checkpoint inhibitors (ICIs). However, durable response and clinical benefit to ICIs has been observed in a few cases of LMS, including, but not only, LMS with tertiary lymphoid structure (TLS) structures. Patients and methods: We used comprehensive transcriptomic profiling and a deconvolution method extracted from RNA-sequencing gene expression data in two independent LMS cohorts, the International Cancer Genome Consortium (ICGC, N = 146) and The Cancer Genome Atlas (TCGA, N = 75), to explore tumor immune microenvironment (TIME) in LMS. Results: Unsupervised clustering analysis using the previously validated two methods, 90-gene signature and Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT), identified immune hot (I-H) and immune high (I-Hi) LMS, respectively, in the ICGC cohort. Similarly, immune active groups (T-H, T-Hi) were identified in the TCGA cohort using these two methods. These immune active ("hot") clusters were significantly associated, but not completely overlapping, with several validated immune signatures such as sarcoma immune class (SIC) classification and TLS score, T cell inflamed signature (TIS) score, immune infiltration score (IIS), and macrophage score (M1/M2), with more patients identified by our clustering as potentially immune hot. Conclusions: Comprehensive immune profiling revealed a subset of LMS with a distinct active ("hot") TIME, consistently associated with several validated immune signatures in other cancers. This suggests that the methodologies that we used in this study warrant further validation and development, which can potentially help refine our current immune biomarkers to select the right LMS patients for ICIs in clinical trials.
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Affiliation(s)
- Xiaolan Feng
- Tom Baker Cancer Center, Department of Medical Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Laurie Tonon
- Synergie Lyon Cancer, Gille Thomas Bioinformatice Platform, Centre Léon Bérard, 69008 Lyon, France
| | - Haocheng Li
- Department of Mathematics and Statistics, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Elodie Darbo
- BRIC, INSERM U1312, Université de Bordeaux, 33600 Bordeaux, France
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V5Z 4S6, Canada
| | - Nicolas Macagno
- Department of Pathology, Aix Marseille University, INSERM, APHM MMG, UMR1251, Marmara Institute, La Timone Hospital, 13005 Marseille, France
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Leon Bérard, 69008 Lyon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Leon Bérard, 69008 Lyon, France
| | - Julien Bollard
- Department of Medical Oncology, Centre Leon Bérard, 69008 Lyon, France
| | | | - Marie Karanian
- Centre Léon Bérard, Department of Pathology, 69008 Lyon, France
| | | | - Gaëlle Pérot
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Thibaud Valentin
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Frédéric Chibon
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard Lyon, 69008 Lyon, France
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45
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Ahn WK, Hahn SM, Yoon HI, Kim SH, Kim SK, Lyu CJ, Han JW. Sustained deep partial response with axitinib and pembrolizumab in a patient with alveolar soft-part sarcoma: A case report and review of the literature. Pediatr Blood Cancer 2023:e30491. [PMID: 37335266 DOI: 10.1002/pbc.30491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Won Kee Ahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Seung Hyun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang Kyum Kim
- Department of Pathology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
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46
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Kasper B, Baldi GG, Loong HHF, Trent J. EJSO educational Special issue from the TARPSWG - Standard medical treatment and new options in retroperitoneal sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1133-1139. [PMID: 34998634 DOI: 10.1016/j.ejso.2021.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 01/10/2023]
Abstract
Retroperitoneal soft tissue sarcomas mainly consist histologically of liposarcomas and leiomyosarcomas. For the liposarcoma subgroup, the local relapse rate seems to determine patients' overall prognosis. In contrast, leiomyosarcoma patients are challenged by the development of metastatic disease; therefore, effective systemic therapies are the cornerstone to improve patients' outcome. No doubt, the limited number of active regimens currently available makes the treatment of patients with locally advanced and/or metastatic disease challenging and results in the overall poor prognosis of this population. In this European Journal of Surgical Oncology Educational Special Issue from the Transatlantic Australasian RetroPeritoneal Sarcoma Working Group (TARPSWG), we aim to summarize state-of-the-art systemic treatments for patients with retroperitoneal sarcomas with a focus on the locally advanced and metastatic disease setting including conventional standard chemotherapies as well as new innovative treatment approaches in order to identify current unmet medical needs guiding the sarcoma community to initiate appropriate translational research projects and design innovative clinical trials.
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Affiliation(s)
- Bernd Kasper
- University of Heidelberg, Mannheim University Medical Center, Sarcoma Unit, Mannheim, Germany.
| | | | - Herbert Ho-Fung Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jonathan Trent
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, USA
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47
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Meissner M, Napolitano A, Thway K, Huang P, Jones RL. Pharmacotherapeutic strategies for epithelioid sarcoma: are we any closer to a non-surgical cure? Expert Opin Pharmacother 2023; 24:1395-1401. [PMID: 37326105 DOI: 10.1080/14656566.2023.2224500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) is a rare soft tissue sarcoma subtype, predominantly occurring in children and young adults. Despite optimal management of localized disease, approximately 50% of patients develop advanced disease. The management of advanced ES remains challenging due to limited response to conventional chemotherapy and despite novel oral EZH2 inhibitors that have better tolerability but similar efficacy to chemotherapy. AREAS COVERED We performed a literature review using the PubMed (MEDLINE) and Web of Science databases. We have focused on the role of chemotherapy, targeted agents such as EZH2 inhibitors, potential new targets and immune checkpoint inhibitors and combinations of therapies currently undergoing clinical investigation. EXPERT OPINION ES is a soft tissue sarcoma with a heterogeneous pathological, clinical, and molecular presentation. In the current era of precision medicine, more trials with targeted therapies and a combination of chemotherapy or immunotherapy with targeted therapies are required to establish optimal treatment for ES.
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Affiliation(s)
- Magdalena Meissner
- Velindre Cancer Centre, Cardiff, UK
- Department of Cancer and Genetics, Cardiff University, Cardiff, UK
| | | | - Khin Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Paul Huang
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
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Wang S, Ma P, Jiang N, Jiang Y, Yu Y, Fang Y, Miao H, Huang H, Tang Q, Cui D, Fang H, Zhang H, Fan Q, Wang Y, Liu G, Yu Z, Lei Q, Li N. Rare tumors: a blue ocean of investigation. Front Med 2023; 17:220-230. [PMID: 37185946 DOI: 10.1007/s11684-023-0984-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/05/2023] [Indexed: 05/17/2023]
Abstract
Advances in novel drugs, therapies, and genetic techniques have revolutionized the diagnosis and treatment of cancers, substantially improving cancer patients' prognosis. Although rare tumors account for a non-negligible number, the practice of precision medicine and development of novel therapies are largely hampered by many obstacles. Their low incidence and drastic regional disparities result in the difficulty of informative evidence-based diagnosis and subtyping. Sample exhaustion due to difficulty in diagnosis also leads to a lack of recommended therapeutic strategies in clinical guidelines, insufficient biomarkers for prognosis/efficacy, and inability to identify potential novel therapies in clinical trials. Herein, by reviewing the epidemiological data of Chinese solid tumors and publications defining rare tumors in other areas, we proposed a definition of rare tumor in China, including 515 tumor types with incidences of less than 2.5/100 000 per year. We also summarized the current diagnosis process, treatment recommendations, and global developmental progress of targeted drugs and immunotherapy agents on the status quo. Lastly, we pinpointed the current recommendation chance for patients with rare tumors to be involved in a clinical trial by NCCN. With this informative report, we aimed to raise awareness on the importance of rare tumor investigations and guarantee a bright future for rare tumor patients.
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Affiliation(s)
- Shuhang Wang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Peiwen Ma
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Jiang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yale Jiang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue Yu
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Fang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Huilei Miao
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Huiyao Huang
- Phase I Clinical Trial Center, Fujian Medical University Cancer Hospital/Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Qiyu Tang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dandan Cui
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hong Fang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Huishan Zhang
- Phase I Clinical Trial Center, Fujian Medical University Cancer Hospital/Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Qi Fan
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuning Wang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gang Liu
- Key Laboratory of Molecular Epigenetics of the Ministry of Education, Northeast Normal University, Changchun, 130024, China
| | - Zicheng Yu
- GenePlus-Shenzhen, Shenzhen, 518118, China
| | - Qi Lei
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Li
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Albarrán V, Villamayor ML, Pozas J, Chamorro J, Rosero DI, San Román M, Guerrero P, Pérez de Aguado P, Calvo JC, García de Quevedo C, González C, Vaz MÁ. Current Landscape of Immunotherapy for Advanced Sarcoma. Cancers (Basel) 2023; 15:2287. [PMID: 37190214 PMCID: PMC10136499 DOI: 10.3390/cancers15082287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
There is substantial heterogeneity between different subtypes of sarcoma regarding their biological behavior and microenvironment, which impacts their responsiveness to immunotherapy. Alveolar soft-part sarcoma, synovial sarcoma and undifferentiated pleomorphic sarcoma show higher immunogenicity and better responses to checkpoint inhibitors. Combination strategies adding immunotherapy to chemotherapy and/or tyrosine-kinase inhibitors globally seem superior to single-agent schemes. Therapeutic vaccines and different forms of adoptive cell therapy, mainly engineered TCRs, CAR-T cells and TIL therapy, are emerging as new forms of immunotherapy for advanced solid tumors. Tumor lymphocytic infiltration and other prognostic and predictive biomarkers are under research.
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Affiliation(s)
- Víctor Albarrán
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain
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Tanaka M, Chuaychob S, Homme M, Yamazaki Y, Lyu R, Yamashita K, Ae K, Matsumoto S, Kumegawa K, Maruyama R, Qu W, Miyagi Y, Yokokawa R, Nakamura T. ASPSCR1::TFE3 orchestrates the angiogenic program of alveolar soft part sarcoma. Nat Commun 2023; 14:1957. [PMID: 37029109 PMCID: PMC10082046 DOI: 10.1038/s41467-023-37049-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/01/2023] [Indexed: 04/09/2023] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a soft part malignancy affecting adolescents and young adults. ASPS is characterized by a highly integrated vascular network, and its high metastatic potential indicates the importance of ASPS's prominent angiogenic activity. Here, we find that the expression of ASPSCR1::TFE3, the fusion transcription factor causatively associated with ASPS, is dispensable for in vitro tumor maintenance; however, it is required for in vivo tumor development via angiogenesis. ASPSCR1::TFE3 is frequently associated with super-enhancers (SEs) upon its DNA binding, and the loss of its expression induces SE-distribution dynamic modification related to genes belonging to the angiogenesis pathway. Using epigenomic CRISPR/dCas9 screening, we identify Pdgfb, Rab27a, Sytl2, and Vwf as critical targets associated with reduced enhancer activities due to the ASPSCR1::TFE3 loss. Upregulation of Rab27a and Sytl2 promotes angiogenic factor-trafficking to facilitate ASPS vascular network construction. ASPSCR1::TFE3 thus orchestrates higher ordered angiogenesis via modulating the SE activity.
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Affiliation(s)
- Miwa Tanaka
- Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
- Department of Experimental Pathology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.
- Project for Cancer Epigenomics, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Surachada Chuaychob
- Department of Micro Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Mizuki Homme
- Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Cell Biology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukari Yamazaki
- Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Experimental Pathology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Ruyin Lyu
- Department of Micro Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Kyoko Yamashita
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisuke Ae
- Department of Orthopedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichi Matsumoto
- Department of Orthopedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Kumegawa
- Project for Cancer Epigenomics, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Reo Maruyama
- Project for Cancer Epigenomics, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Wei Qu
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Ryuji Yokokawa
- Department of Micro Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Takuro Nakamura
- Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
- Department of Experimental Pathology, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.
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