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Vienot A, Neuzillet C. Cholangiocarcinoma: the quest for a second-line systemic treatment. Transl Cancer Res 2019; 8:S275-S288. [PMID: 35117107 PMCID: PMC8797902 DOI: 10.21037/tcr.2018.10.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022]
Abstract
Biliary tract cancers (BTC) are a heterogeneous group of epithelial neoplasms, with a poor prognosis. Advanced BTC remains a challenging, non-curable disease. Gemcitabine plus platinum chemotherapy is the standard of care as first-line (L1) therapy in this setting. Beyond failure of L1, available evidence to guide therapeutic decisions is scarce. Data from phase III studies are lacking and there is no validated strategy to date. In this review, we provide an overview of the systemic therapeutic options that can be proposed and unsolved questions in the management of patients with advanced BTC in the second-line (L2) setting. Criteria to select which patients should receive L2 therapy are ill defined and reliable prognostic tools and models to help estimate individual patient survival at the beginning of L2 are needed. Chemotherapy, mainly fluoropyrimidine-based yields modest survival results. There is insufficient evidence level to recommend a specific L2 chemotherapy regimen, and anti-epidermal growth factor receptor and antiangiogenic agents failed to demonstrate any survival improvement in a non-selected patient population. In recent years, knowledge about BTC molecular heterogeneity has considerably increased with the advent of high-throughput genomic and transcriptomic analyses, opening new avenues for targeted therapies. Patients with BTC may be particularly good candidates for biomarker-driven therapy in clinical practice. Among the ongoing developments, targeting of FGFR and IDH mutations and immune therapies hold many promises for the next future. In future L2 clinical trials, patients should be carefully characterized and stratified according to prognostic factors, disease subtype, and genetic drivers.
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Affiliation(s)
- Angélique Vienot
- Department of Medical Oncology, Besançon University Hospital, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University, 35 Rue Dailly, 92210 Saint-Cloud, France
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302
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Ahn KS, Kang KJ, Kim YH, Kim TS, Song BI, Kim HW, O'Brien D, Roberts LR, Lee JW, Won KS. Genetic features associated with 18F-FDG uptake in intrahepatic cholangiocarcinoma. Ann Surg Treat Res 2019; 96:153-161. [PMID: 30941318 PMCID: PMC6444048 DOI: 10.4174/astr.2019.96.4.153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose In intrahepatic cholangiocarcinoma (iCCA), genetic characteristics on 18F-fluorodeoxyglucose (18F-FDG)-PET scans are not yet clarified. If specific genetic characteristics were found to be related to FDG uptake in iCCA, we can predict molecular features based on the FDG uptake patterns and to distinguish different types of treatments. In this purpose, we analyzed RNA sequencing in iCCA patients to evaluate gene expression signatures associated with FDG uptake patterns. Methods We performed RNA sequencing of 22 cases iCCA who underwent preoperative 18F-FDG-PET, and analyzed the clinical and molecular features according to the maximum standard uptake value (SUVmax). Genes and biological pathway which are associated with SUVmax were analyzed. Results Patients with SUVmax higher than 9.0 (n = 9) had poorer disease-free survival than those with lower SUVmax (n = 13, P = 0.035). Genes related to glycolysis and gluconeogenesis, phosphorylation and cell cycle were significantly correlated with SUVmax (r ≥ 0.5). RRM2, which is related to the toxicity of Gemcitabine was positively correlated with SUVmax, and SLC27A2 which is associated with Cisplastin response was negatively correlated with SUVmax. According to the pathway analysis, cell cycle, cell division, hypoxia, inflammatory, and metabolism-related pathways were enriched in high SUVmax patients. Conclusion The genomic features of gene expression and pathways can be predicted by FDG uptake features in iCCA. Patients with high FDG uptake have enriched cell cycle, metabolism and hypoxic pathways, which may lead to a more rational targeted treatment approach.
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Affiliation(s)
- Keun Soo Ahn
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.,Institute for Cancer Research, Keimyung University, Daegu, Korea
| | - Koo Jeong Kang
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Hoon Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-Seok Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Daniel O'Brien
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jeong Woo Lee
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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303
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Akirin2 is modulated by miR-490-3p and facilitates angiogenesis in cholangiocarcinoma through the IL-6/STAT3/VEGFA signaling pathway. Cell Death Dis 2019; 10:262. [PMID: 30886152 PMCID: PMC6423123 DOI: 10.1038/s41419-019-1506-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 02/08/2023]
Abstract
Akirin2 is a key regulator of embryonic development and the innate immunity response. However, this regulator’s role in tumorigenesis especially in cholangiocarcinoma (CCA) development has not been thoroughly elucidated to date. In the current work, we used RT-qPCR, western blot analysis, and immunohistochemistry (IHC) to explore the expression level of Akirin2, and the relationship between Akirin2 levels and clinicopathological characteristics was evaluated. The biological functions of Akirin2 were examined in vitro and in vivo by using a lentiviral vector system. Luciferase reporter assays were applied to detect the direct binding relationship between the 3′-UTR of Akirin2 mRNA and miR-490-3p. The results showed that Akirin2 was overexpressed in CCA and this upregulation was associated with a shorter overall survival. Silencing or overexpressing Akirin2 by lentiviral approaches significantly influenced CCA cell proliferation, migration, invasion, and angiogenesis. An in vivo tumor model further validated the oncogenic effect of Akirin2 on CCA cell growth, metastasis, and angiogenesis. Mechanistic studies demonstrated that Akirin2 induced angiogenesis by increasing the expression of VEGFA by activating the IL-6/STAT3 signaling pathway. Akirin2 promoted cell migratory and invasive potential by affecting the epithelial–mesenchymal transition (EMT) process. In addition, Akirin2 expression was negatively controlled by miR-490-3p in CCA cells, and miR-490-3p attenuated cell migration and angiogenesis in CCA cells by silencing Akirin2. Taken together, the data indicated that Akirin2 could be regulated by miR-490-3p at the posttranscriptional level and facilitate CCA cell progression via the IL-6/STAT3/VEGFA signaling pathway. The present study may expedite the development of novel therapeutic strategies for CCA.
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304
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Peng T, Li Z, Li D, Wang S. MACC1 promotes angiogenesis in cholangiocarcinoma by upregulating VEGFA. Onco Targets Ther 2019; 12:1893-1903. [PMID: 30881041 PMCID: PMC6415730 DOI: 10.2147/ott.s197319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Angiogenesis actively contributes to tumor growth and metastasis. MACC1 was reported to be associated with tumor progression. In the present study, we aimed to investigate the expression and role of MACC1 in cholangiocarcinoma (CCA) and its correlation with angiogenesis. Patients and methods We investigated the expression and correlation of MACC1 and VEGFA in The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets and in 7 paired frozen CCA and matched paracarcinoma tissues. Immunohistochemistry (IHC) was used to examine MACC1 and VEGFA expression as well as microvessel density (MVD) in 122 paraffin-embedded CCA samples. Western blotting, real-time qPCR and ELISA were performed to investigate the effect of MACC1 knockdown on VEGFA expression and secretion in CCA cells. Subsequently, we collected conditioned medium from cells with MACC1 knockdown and used it in angiogenesis assays. Results The expression levels of both MACC1 and VEGFA were significantly upregulated in the TCGA and GEO datasets and in the 7 paired frozen CCA tissues compared to the matched paracarcinoma tissues, and MACC1 was significantly correlated with VEGFA. IHC showed that high expression of MACC1 and VEGFA was significantly correlated with lymph node metastasis (P<0.05 and P<0.01) and worse survival (P<0.01, P<0.05) in patients with CCA. We further verified that MACC1 was significantly correlated with VEGFA (P<0.01) and MVD (P<0.01) in clinical samples. Western blotting, real-time qPCR and ELISA results showed that MACC1 knockdown in CCA cells significantly decreased the protein and mRNA expression of VEGFA and reduced the VEGFA concentration in conditioned medium. Moreover, angiogenesis assays showed that conditioned medium from CCA cells with MACC1 knockdown decreased the number of tubes formed. Conclusion Our results indicate that MACC1 and VEGFA expression are upregulated in CCA. Moreover, MACC1 is an independent predictor of overall survival and facilitates angiogenesis in CCA by upregulating of VEGFA.
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Affiliation(s)
- Tao Peng
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China, ; .,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Zhonghu Li
- Department of General Surgery, General Hospital of Wuhan, People's Liberation Army, Wuhan, China
| | - Dajiang Li
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China, ;
| | - Shuguang Wang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China, ;
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305
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Ruiz-Bañobre J, Goel A. DNA Mismatch Repair Deficiency and Immune Checkpoint Inhibitors in Gastrointestinal Cancers. Gastroenterology 2019; 156:890-903. [PMID: 30578781 PMCID: PMC6409193 DOI: 10.1053/j.gastro.2018.11.071] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/04/2018] [Accepted: 11/20/2018] [Indexed: 12/13/2022]
Abstract
In the recent few years, significant efforts have been undertaken for the development of different immunotherapeutic approaches against cancer. In this context, immune checkpoint inhibitors (ICIs), a novel class of immunotherapeutic drugs with the potential to unleash the immune system, have emerged as authentic game-changers for managing patients with various cancers, including gastrointestinal malignancies. Although the majority of gastrointestinal cancers are generally considered poorly immunogenic, basic research findings and data from clinical trials have proven that subset(s) of patients with various digestive tract cancers are highly responsive to ICI-based therapy. In this context, a better understanding on the role of various DNA repair pathway alterations, especially the evidence supporting the significant importance of DNA mismatch repair deficiencies and the efficacy of the anti-programmed cell death 1 drugs, have led to US Food and Drug Administration approval of 2 anti-programmed cell death 1 antibodies (pembrolizumab and nivolumab) for the treatment of patients with microsatellite instability. This review aims to provide a comprehensive and up-to-date summary for the role of DNA mismatch repair deficiency in cancer, and its importance in the development of ICI therapy. In addition, we provide insights into the spectrum of various genetic alterations underlying ICI resistance, together with the important influence that the tumor microenvironment plays in mediating the therapeutic response to this new class of drugs. Finally, we provide a comprehensive yet succinct glimpse into the most exciting preclinical discoveries and ongoing clinical trials in the field, highlighting bench-to-beside translational impact of this exciting area of research.
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Affiliation(s)
- Juan Ruiz-Bañobre
- Center for Gastrointestinal Research, Center for Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas; Medical Oncology Department, Arquitecto Marcide University Hospital, Ferrol, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago, University Clinical Hospital of Santiago de Compostela, Centro de Investigación Biomédica en Red de Cáncer, Santiago de Compostela, Spain
| | - Ajay Goel
- Center for Gastrointestinal Research, Center for Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas.
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306
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Ding X, Zhang Y, Huang T, Xu G, Peng C, Chen G, Kong B, Friess H, Shen S, Lv Y, Roberts LR, Wang L, Zou X. Targeting sphingosine kinase 2 suppresses cell growth and synergizes with BCL2/BCL-XL inhibitors through NOXA-mediated MCL1 degradation in cholangiocarcinoma. Am J Cancer Res 2019; 9:546-561. [PMID: 30949409 PMCID: PMC6448062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/11/2019] [Indexed: 06/09/2023] Open
Abstract
Sphingosine kinase 2 (SPHK2) is a key factor within sphingolipid metabolism, responsible for the conversion of pro-apoptotic sphingosine to the pro-survival sphingosine-1-phosphate. We have previously shown that ABC294640, a first-in-class SPHK2 inhibitor, inhibits growth of cholangiocarcinoma cells. In a Phase I study of ABC294640 in tumors, the best response was achieved in a cholangiocarcinoma patient. These data suggest SPHK2 as a novel therapeutic target of cholangiocarcinoma. However, the antitumor mechanism of ABC294640 in cholangiocarcinoma remains not clear. In the current study, we found that ABC294640 upregulated expression of pro-apoptotic NOXA. In cholangiocarcinoma patients, high NOXA mRNA expression was associated with better overall survival. Also, SPHK2 mRNA expression was negatively correlated with NOXA mRNA expression. NOXA is known to degrade MCL1, an anti-apoptotic BCL2 protein. We showed that ABC294640 directed MCL1 for proteasome degradation. Knockdown of NOXA prevented ABC294640-induced MCL1 degradation and apoptosis. In addition, ABC294640 had a synergistic effect with BCL2/BCL-XL inhibitors ABT-263 and Obatoclax in inhibiting cell growth. Combined treatment with ABC294640 and BCL2/BCL-XL inhibitors induced potent apoptosis. Silencing of MCL1 also potentiated ABT-263-induced cytotoxicity. Furthermore, we found that both SPHK2 and MCL1 protein expression were significantly higher in cholangiocarcinoma than that in nontumoral bile ducts. SPHK2 expression correlated significantly with MCL1 expression. Our study reveals that ABC294640 inhibits cholangiocarcinoma cell growth and sensitizes the antitumor effect of BCL2/BCL-XL inhibitors through NOXA-mediated MCL1 degradation. Combinations of ABC294640 with BCL2/BCL-XL inhibitors may provide novel strategies for the treatment of cholangiocarcinoma.
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Affiliation(s)
- Xiwei Ding
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Yiyang Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjing 210008, Jiangsu, China
| | - Tianlu Huang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Chunyan Peng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Gang Chen
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, Zhejiang, China
| | - Bo Kong
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
- Department of Surgery, Technical University of MunichMunich 80333, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of MunichMunich 80333, Germany
| | - Shanshan Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Ying Lv
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer CenterRochester 55905, MN, US
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008, Jiangsu, China
| | - Xiaoping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjing 210008, Jiangsu, China
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307
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MEK inhibition suppresses K-Ras wild-type cholangiocarcinoma in vitro and in vivo via inhibiting cell proliferation and modulating tumor microenvironment. Cell Death Dis 2019; 10:120. [PMID: 30741922 PMCID: PMC6370758 DOI: 10.1038/s41419-019-1389-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/05/2019] [Accepted: 01/21/2019] [Indexed: 12/31/2022]
Abstract
PD901, a MEK inhibitor, has been demonstrated of therapeutic efficacy against cholangiocarcinoma (CCA) harboring K-Ras oncogenic mutations. However, most CCA exhibit no K-Ras mutations. In the current study, we investigated the therapeutic potential of PD901, either alone or in combination with the pan-mTOR inhibitor MLN0128, for the treatment of K-Ras wild-type CCA in vitro using human CCA cell lines, and in vivo using AKT/YapS127A CCA mouse model. We discovered that in vitro, PD901 treatment strongly inhibited CCA cell proliferation, and combined PD901 and MLN0128 therapy further increased growth inhibition. In vivo, treatment of PD901 alone triggered tumor regression, which was not further increased when the two drugs were administered simultaneously. Mechanistically, PD901 efficiently hampered ERK activation in vitro and in vivo, leading to strong inhibition of CCA tumor cell cycle progression. Intriguingly, we discovered that PD901, but not MLN0128 treatment resulted in changes affecting the vasculature and cancer-associated fibroblasts in AKT/YapS127A mouse lesions. It led to the decreased hypoxia within tumor lesions, which may further enhance the anti-cell proliferation activities of PD901. Altogether, our study demonstrates that MEK inhibitors could be effective for the treatment of K-Ras wild-type CCA via inhibiting cell proliferation and modulating tumor microenvironment.
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308
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Li L, Knutsdottir H, Hui K, Weiss MJ, He J, Philosophe B, Cameron AM, Wolfgang CL, Pawlik TM, Ghiaur G, Ewald AJ, Mezey E, Bader JS, Selaru FM. Human primary liver cancer organoids reveal intratumor and interpatient drug response heterogeneity. JCI Insight 2019; 4:121490. [PMID: 30674722 DOI: 10.1172/jci.insight.121490] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/05/2018] [Indexed: 12/28/2022] Open
Abstract
Liver cancer is the fourth leading cause of cancer-related mortality and is distinguished by a relative paucity of chemotherapy options. It has been hypothesized that intratumor genetic heterogeneity may contribute to the high failure rate of chemotherapy. Here, we evaluated functional heterogeneity in a cohort of primary human liver cancer organoid lines. Each primary human liver cancer surgical specimen was used to generate multiple cancer organoid lines, obtained from distinct regions of the tumor. A total of 27 liver cancer lines were established and tested with 129 cancer drugs, generating 3,483 cell survival data points. We found a rich intratumor, functional (drug response) heterogeneity in our liver cancer patients. Furthermore, we established that the majority of drugs were either ineffective, or effective only in select organoid lines. In contrast, we found that a subset of drugs appeared pan-effective, displaying at least moderate activity in the majority of these cancer organoid lines. These drugs, which are FDA approved for indications other than liver cancers, deserve further consideration as either systemic or local therapeutics. Of note, molecular profiles, obtained for a reduced sample set, did not correlate with the drug response heterogeneity of liver cancer organoid lines. Taken together, these findings lay the foundation for in-depth studies of pan-effective drugs, as well as for functional personalized oncology approaches. Lastly, these functional studies demonstrate the utility of cancer organoid drug testing as part of a drug discovery pipeline.
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Affiliation(s)
- Ling Li
- Division of Gastroenterology and Hepatology
| | | | - Ken Hui
- Division of Gastroenterology and Hepatology
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Benjamin Philosophe
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher L Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, Health Services Management and Policy, The Ohio State University Ohio, USA
| | | | - Andrew J Ewald
- Departments of Cell Biology and Oncology, Center for Cell Dynamics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Joel S Bader
- Department of Biomedical Engineering and High-Throughput Biology Center
| | - Florin M Selaru
- Division of Gastroenterology and Hepatology.,Department of Oncology, Sidney Kimmel Cancer Center
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309
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Lamberti D, Cristinziano G, Porru M, Leonetti C, Egan JB, Shi CX, Buglioni S, Amoreo CA, Castellani L, Borad MJ, Alemà S, Anastasi S, Segatto O. HSP90 Inhibition Drives Degradation of FGFR2 Fusion Proteins: Implications for Treatment of Cholangiocarcinoma. Hepatology 2019; 69:131-142. [PMID: 30067876 DOI: 10.1002/hep.30127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022]
Abstract
About 15% of intrahepatic cholangiocarcinomas (ICCs) express constitutively active fibroblast growth factor receptor 2 (FGFR2) fusion proteins (FFs) generated by chromosomal translocations. FFs have been nominated as oncogenic drivers because administration of FGFR tyrosine kinase inhibitors (F-TKIs) can elicit meaningful objective clinical responses in patients carrying FF-positive ICC. Thus, optimization of FF targeting is a pressing clinical need. Herein, we report that three different FFs, previously isolated from ICC samples, are heat shock protein 90 (HSP90) clients and undergo rapid degradation upon HSP90 pharmacological blockade by the clinically advanced HSP90 inhibitor ganetespib. Combining catalytic suppression by the F-TKI BGJ398 with HSP90 blockade by ganetespib suppressed FGFR2-TACC3 (transforming acidic coiled-coil containing protein 3) signaling in cultured cells more effectively than either BGJ398 or ganetespib in isolation. The BGJ398 + ganetespib combo was also superior to single agents when tested in mice carrying subcutaneous tumors generated by transplantation of FGFR2-TACC3 NIH3T3 transformants. Of note, FF mutants known to enforce clinical resistance to BGJ398 in ICC patients retained full sensitivity to ganetespib in cultured cells. Conclusion: Our data provide a proof of principle that upfront treatment with the BGJ398 + ganetespib combo improves therapeutic targeting of FGFR2 fusions in an experimental setting, which may be relevant to precision medicine approaches to FF-driven ICC.
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Affiliation(s)
- Dante Lamberti
- Unit of Oncogenomics and Epigenetics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Cristinziano
- Unit of Oncogenomics and Epigenetics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Manuela Porru
- Animal Facility (SAFU), IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Carlo Leonetti
- Animal Facility (SAFU), IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jan B Egan
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Chang-Xin Shi
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Carla A Amoreo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Loriana Castellani
- Dipartimento di Scienze Umane, Sociali e della Salute, Università di Cassino, Cassino, Italy.,Institute of Cell Biology and Neurobiology, National Research Council (CNR), Monterotondo, Italy
| | - Mitesh J Borad
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Stefano Alemà
- Institute of Cell Biology and Neurobiology, National Research Council (CNR), Monterotondo, Italy
| | - Sergio Anastasi
- Unit of Oncogenomics and Epigenetics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Oreste Segatto
- Unit of Oncogenomics and Epigenetics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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310
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Crona J, Backman S, Welin S, Taïeb D, Hellman P, Stålberg P, Skogseid B, Pacak K. RNA-Sequencing Analysis of Adrenocortical Carcinoma, Pheochromocytoma and Paraganglioma from a Pan-Cancer Perspective. Cancers (Basel) 2018; 10:E518. [PMID: 30558313 PMCID: PMC6315481 DOI: 10.3390/cancers10120518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
Adrenocortical carcinoma (ACC) and pheochromocytoma and paraganglioma (PPGL) are defined by clinicopathological criteria and can be further sub-divided based on different molecular features. Whether differences between these molecular subgroups are significant enough to re-challenge their current clinicopathological classification is currently unknown. It is also not fully understood to which other cancers ACC and PPGL show similarity to. To address these questions, we included recent RNA-Seq data from the Cancer Genome Atlas (TCGA) and Therapeutically Applicable Research to Generate Effective Treatments (TARGET) datasets. Two bioinformatics pipelines were used for unsupervised clustering and principal components analysis. Results were validated using consensus clustering model and interpreted according to previous pan-cancer experiments. Two datasets consisting of 3319 tumors from 35 disease categories were studied. Consistent with the current classification, ACCs clustered as a homogenous group in a pan-cancer context. It also clustered close to neural crest derived tumors, including gliomas, neuroblastomas, pancreatic neuroendocrine tumors, and PPGLs. Contrary, some PPGLs mixed with pancreatic neuroendocrine tumors or neuroblastomas. Thus, our unbiased gene-expression analysis of PPGL did not overlap with their current clinicopathological classification. These results emphasize some importances of the shared embryological origin of these tumors, all either related or close to neural crest tumors, and opens for investigation of a complementary categorization based on gene-expression features.
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Affiliation(s)
- Joakim Crona
- Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset ing 78, 75185 Uppsala, Sweden.
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Building 10, Room 1E-3140, Bethesda, MD 20892, USA.
| | - Samuel Backman
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset ing 70, 75185 Uppsala, Sweden.
| | - Staffan Welin
- Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset ing 78, 75185 Uppsala, Sweden.
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix Marseille Université, 13385 Marseille, France.
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset ing 70, 75185 Uppsala, Sweden.
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset ing 70, 75185 Uppsala, Sweden.
| | - Britt Skogseid
- Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset ing 78, 75185 Uppsala, Sweden.
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Building 10, Room 1E-3140, Bethesda, MD 20892, USA.
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Lendvai G, Szekerczés T, Illyés I, Dóra R, Kontsek E, Gógl A, Kiss A, Werling K, Kovalszky I, Schaff Z, Borka K. Cholangiocarcinoma: Classification, Histopathology and Molecular Carcinogenesis. Pathol Oncol Res 2018; 26:3-15. [PMID: 30448973 DOI: 10.1007/s12253-018-0491-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
Cholangiocarcinoma (CC) is the second most common tumor of the liver, originating from the biliary system with increasing incidence and mortality worldwide. Several new classifications review the significance of tumor localization, site of origin, proliferation and biomarkers in the intrahepatic, perihilar and distal forms of the lesion. Based on growth pattern mass-forming, periductal-infiltrating, intraductal, undefined and mixed types are differentiated. There are further subclassifications which are applied for the histological features, in particular for intrahepatic CC. Recognition of the precursors and early lesions of CC including biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of the bile ducts (IPNB), biliary mucinous cystic neoplasm (MCNB) and the candidate precursors, such as bile duct adenoma and von Meyenburg complex is of increasing significance. In addition to the previously used biliary markers detected by immunohistochemistry, several new markers have been added to the differentiation of both the benign and malignant lesions, which can be used to aid in the subclassification in association with the outcome of CC. Major aspects of biliary carcinogenesis have been revealed, yet, the exact way of this diverse process is still unclear. The factors contributing to molecular cholangiocarcinogenesis include various risk factors, different anatomical localizations, multiple cellular origins, genetic and epigenetic alterations, tumor microenvironment, heterogeneity and clonal evolution. Driver mutations have been identified, implying that they are optimal candidates for targeted therapy. The most promising therapeutic candidates have entered clinical trials.
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Affiliation(s)
- Gábor Lendvai
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Tímea Szekerczés
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Idikó Illyés
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Réka Dóra
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Endre Kontsek
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Alíz Gógl
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - András Kiss
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Klára Werling
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, 1085, Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, 1085, Hungary
| | - Zsuzsa Schaff
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary.
| | - Katalin Borka
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
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312
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Lamarca A, Barriuso J, McNamara MG, Valle JW. Biliary Tract Cancer: State of the Art and potential role of DNA Damage Repair. Cancer Treat Rev 2018; 70:168-177. [PMID: 30218788 DOI: 10.1016/j.ctrv.2018.09.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
Biliary tract cancers (BTCs), including cholangiocarcinoma, gallbladder cancer and ampullary cancers, are poor-prognosis malignancies. Most patients are diagnosed with advanced disease, when treatment is limited to palliative chemotherapy. First line chemotherapy is usually administered in the form of cisplatin and gemcitabine. Benefit from second line chemotherapy is still to be confirmed. Even though new systemic treatment targets have been recognised, especially in patients with intrahepatic cholangiocarcinoma (e.g. IDH and FGFR), there is an urgent need for novel treatment strategies. Genomic profiling of BTC is progressively becoming a reality which allows a better understanding of their biology and potential new targets. This review provides an insight into DNA Damage Repair (DDR) mechanisms, prevalence of DDR-deficient tumours in BTC, and the potential role of DDR in cancer development. Some form of DDR deficiency is expected to be present in around 25% of patients with BTC, and this knowledge could be exploited to potentially increase response to currently-available treatment strategies (chemotherapy, radiotherapy or immunotherapy). For patients with DDR-proficient tumours, drug inhibition of DDR could be instituted.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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313
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The role of next-generation sequencing in the differential diagnosis of composite neoplasms. Hum Pathol 2018; 81:78-88. [DOI: 10.1016/j.humpath.2018.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/28/2023]
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314
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Jain A, Borad MJ, Kelley RK, Wang Y, Abdel-Wahab R, Meric-Bernstam F, Baggerly KA, Kaseb AO, Al-shamsi HO, Ahn DH, DeLeon T, Bocobo AG, Bekaii-Saab T, Shroff RT, Javle M. Cholangiocarcinoma With FGFR Genetic Aberrations: A Unique Clinical Phenotype. JCO Precis Oncol 2018; 2:1-12. [DOI: 10.1200/po.17.00080] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose FGFR genetic aberrations (GAs) occur in an estimated 10% to 16% of intrahepatic cholangiocarcinomas (CCAs). The natural history of CCA with FGFR GAs, the prognostic role of coexisting GAs, and the outcome with FGFR-targeted inhibitors are unknown. Patients and Methods Patients with CCA with FGFR GAs were identified using next-generation sequencing or fluorescence in situ hybridization from four tertiary cancer centers and compared with FGFR wild-type counterparts. Data reviewed included demographic, treatment, overall survival (OS), and GA data. Fisher’s exact test, Kaplan-Meier plots, and log-rank tests were used for statistical analysis. Results Three hundred seventy-seven patients with CCA were identified, and 95 had FGFR GAs. FGFR2 GA was most common (n = 74, with 63 fusions) and seen in intrahepatic CCA. In patients with CCA, FGFR GAs occurred more frequently in younger patients (≤ 40 years; 20%) compared with older patients (> 40 years; 6.7%; P < .001), presented at an earlier stage (TNM stage I/II v III/IV: 35.8% v 22%, respectively; P = .001), and were associated with a longer OS compared with patients without FGFR GAs (37 v 20 months, respectively; P < .001). This difference remained significant after excluding 36 patients treated with FGFR inhibitors. There was no OS difference ( P = .60) between CCA with FGFR2 fusions (n = 63) versus other FGFR GAs (n = 29). Patients with FGFR GAs had a better OS with FGFR-targeted therapy compared with standard treatment ( P = .01). BAP1 mutation was the most common coexisting mutation without prognostic impact, whereas TP53 ( P = .04) and CDKN2A/B ( P = .04) were correlated with a shorter OS. Conclusion CCA with FGFR GAs represents a unique subtype occurring in younger patients with an indolent disease course. FGFR-targeted therapy may have a positive impact on OS in this subgroup.
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Affiliation(s)
- Apurva Jain
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Mitesh J. Borad
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Robin Kate Kelley
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Ying Wang
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Reham Abdel-Wahab
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Funda Meric-Bernstam
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Keith A. Baggerly
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Ahmed Omar Kaseb
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Humaid O. Al-shamsi
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Daniel H. Ahn
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Thomas DeLeon
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Andrea Grace Bocobo
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Tanios Bekaii-Saab
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Rachna T. Shroff
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Milind Javle
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
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315
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Harding JJ, Lowery MA, Shih AH, Schvartzman JM, Hou S, Famulare C, Patel M, Roshal M, Do RK, Zehir A, You D, Selcuklu SD, Viale A, Tallman MS, Hyman DM, Reznik E, Finley LWS, Papaemmanuil E, Tosolini A, Frattini MG, MacBeth KJ, Liu G, Fan B, Choe S, Wu B, Janjigian YY, Mellinghoff IK, Diaz LA, Levine RL, Abou-Alfa GK, Stein EM, Intlekofer AM. Isoform Switching as a Mechanism of Acquired Resistance to Mutant Isocitrate Dehydrogenase Inhibition. Cancer Discov 2018; 8:1540-1547. [PMID: 30355724 DOI: 10.1158/2159-8290.cd-18-0877] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023]
Abstract
Somatic mutations in cytosolic or mitochondrial isoforms of isocitrate dehydrogenase (IDH1 or IDH2, respectively) contribute to oncogenesis via production of the metabolite 2-hydroxyglutarate (2HG). Isoform-selective IDH inhibitors suppress 2HG production and induce clinical responses in patients with IDH1- and IDH2-mutant malignancies. Despite the promising activity of IDH inhibitors, the mechanisms that mediate resistance to IDH inhibition are poorly understood. Here, we describe four clinical cases that identify mutant IDH isoform switching, either from mutant IDH1 to mutant IDH2 or vice versa, as a mechanism of acquired clinical resistance to IDH inhibition in solid and liquid tumors. SIGNIFICANCE: IDH-mutant cancers can develop resistance to isoform-selective IDH inhibition by "isoform switching" from mutant IDH1 to mutant IDH2 or vice versa, thereby restoring 2HG production by the tumor. These findings underscore a role for continued 2HG production in tumor progression and suggest therapeutic strategies to prevent or overcome resistance.This article is highlighted in the In This Issue feature, p. 1494.
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Affiliation(s)
- James J Harding
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maeve A Lowery
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan H Shih
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan M Schvartzman
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shengqi Hou
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Famulare
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Minal Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Zehir
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daoqi You
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Duygu Selcuklu
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Agnes Viale
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Early Drug Development Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ed Reznik
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lydia W S Finley
- Cell Biology Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elli Papaemmanuil
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Guowen Liu
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Bin Fan
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Sung Choe
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Bin Wu
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Yelena Y Janjigian
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ingo K Mellinghoff
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ross L Levine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ghassan K Abou-Alfa
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eytan M Stein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew M Intlekofer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York.,Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
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316
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Xi SY, Fang D, Huo JG. Progress in molecular targeted therapy of intrahepatic cholangiocarcinoma. Shijie Huaren Xiaohua Zazhi 2018; 26:1707-1716. [DOI: 10.11569/wcjd.v26.i29.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intrahepatic cholangiocarcinoma is an uncommon malignant tumor with a poor prognosis due to an incomplete understanding of its molecular pathogenesis and a lack of effective treatment. Precision medical planning and cancer genomics can help to understand the molecular pathogenesis of cancer and identify potential therapeutic targets. With the deepening of basic and clinical research, accurate targeted therapy will be able to improve the prognosis and overall survival of patients with intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Song-Yang Xi
- Department of Oncology, Zhenjiang Hospital of Chinese Traditional and Western Medicine, Zhenjiang 212000, Jiangsu Province, China
| | - Dong Fang
- Department of Oncology, Zhenjiang Hospital of Chinese Traditional and Western Medicine, Zhenjiang 212000, Jiangsu Province, China
| | - Jie-Ge Huo
- Department of Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, Jiangsu Province, China
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317
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Pai S, Bader GD. Patient Similarity Networks for Precision Medicine. J Mol Biol 2018; 430:2924-2938. [PMID: 29860027 PMCID: PMC6097926 DOI: 10.1016/j.jmb.2018.05.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 02/08/2023]
Abstract
Clinical research and practice in the 21st century is poised to be transformed by analysis of computable electronic medical records and population-level genome-scale patient profiles. Genomic data capture genetic and environmental state, providing information on heterogeneity in disease and treatment outcome, but genomic-based clinical risk scores are limited. Achieving the goal of routine precision medicine that takes advantage of these rich genomics data will require computational methods that support heterogeneous data, have excellent predictive performance, and ideally, provide biologically interpretable results. Traditional machine-learning approaches excel at performance, but often have limited interpretability. Patient similarity networks are an emerging paradigm for precision medicine, in which patients are clustered or classified based on their similarities in various features, including genomic profiles. This strategy is analogous to standard medical diagnosis, has excellent performance, is interpretable, and can preserve patient privacy. We review new methods based on patient similarity networks, including Similarity Network Fusion for patient clustering and netDx for patient classification. While these methods are already useful, much work is required to improve their scalability for contemporary genetic cohorts, optimize parameters, and incorporate a wide range of genomics and clinical data. The coming 5 years will provide an opportunity to assess the utility of network-based algorithms for precision medicine.
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Affiliation(s)
- Shraddha Pai
- The Donnelly Centre, University of Toronto, Toronto, Canada
| | - Gary D Bader
- The Donnelly Centre, University of Toronto, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada; Department of Computer Science, University of Toronto, Toronto, Canada; The Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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318
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Nepal C, O’Rourke CJ, Oliveira DVNP, Taranta A, Shema S, Gautam P, Calderaro J, Barbour A, Raggi C, Wennerberg K, Wang XW, Lautem A, Roberts LR, Andersen JB. Genomic perturbations reveal distinct regulatory networks in intrahepatic cholangiocarcinoma. Hepatology 2018; 68:949-963. [PMID: 29278425 PMCID: PMC6599967 DOI: 10.1002/hep.29764] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Intrahepatic cholangiocarcinoma remains a highly heterogeneous malignancy that has eluded effective patient stratification to date. The extent to which such heterogeneity can be influenced by individual driver mutations remains to be evaluated. Here, we analyzed genomic (whole-exome sequencing, targeted exome sequencing) and epigenomic data from 496 patients and used the three most recurrently mutated genes to stratify patients (IDH, KRAS, TP53, "undetermined"). Using this molecular dissection approach, each subgroup was determined to possess unique mutational signature preferences, comutation profiles, and enriched pathways. High-throughput drug repositioning in seven patient-matched cell lines, chosen to reflect the genetic alterations specific for each patient group, confirmed in silico predictions of subgroup-specific vulnerabilities linked to enriched pathways. Intriguingly, patients lacking all three mutations ("undetermined") harbored the most extensive structural alterations, while isocitrate dehydrogenase mutant tumors displayed the most extensive DNA methylome dysregulation, consistent with previous findings. CONCLUSION Stratification of intrahepatic cholangiocarcinoma patients based on occurrence of mutations in three classifier genes (IDH, KRAS, TP53) revealed unique oncogenic programs (mutational, structural, epimutational) that influence pharmacologic response in drug repositioning protocols; this genome dissection approach highlights the potential of individual mutations to induce extensive molecular heterogeneity and could facilitate advancement of therapeutic response in this dismal disease. (Hepatology 2018).
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Affiliation(s)
- Chirag Nepal
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Colm J. O’Rourke
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Douglas VNP Oliveira
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Andrzej Taranta
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Steven Shema
- Center for Cancer Research Genomics Core, National Cancer Institute, NIH Bethesda, Maryland 20892, USA
| | - Prson Gautam
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00290 Helsinki, Finland
| | - Julien Calderaro
- Assistance Publique-Hôpitaux de Paris, Department of Pathology, CHU Henri Mondor, F-94000, Créteil, France,Faculté de Médecine, Université Paris-Est Créteil, Créteil, France,Inserm U955 Equipe 18, Institut Mondor de Recherche Biomédicale, Créteil, France
| | | | - Chiara Raggi
- Center for Autoimmune Liver Diseases, IRCCS Istituto Clinico Humanitas, 20089 Rozzano (MI), Italy
| | - Krister Wennerberg
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00290 Helsinki, Finland
| | - Xin W. Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892, USA
| | - Anja Lautem
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, 55131, Germany
| | - Lewis R. Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jesper B. Andersen
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark,Corresponding author: Jesper B Andersen, Biotech Research and Innovation Centre (BRIC) Department of Health and Medical Sciences University of Copenhagen, Ole Maaløes Vej 5, DK-2200 Copenhagen N Denmark, Phone: +45 35325834,
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319
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Zhang Q, Lou Y, Bai XL, Liang TB. Immunometabolism: A novel perspective of liver cancer microenvironment and its influence on tumor progression. World J Gastroenterol 2018; 24:3500-3512. [PMID: 30131656 PMCID: PMC6102497 DOI: 10.3748/wjg.v24.i31.3500] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/29/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
The initiation and progression of liver cancer, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma, are dependent on its tumor microenvironment. Immune cells are key players in the liver cancer microenvironment and show complicated crosstalk with cancer cells. Emerging evidence has shown that the functions of immune cells are closely related to cell metabolism. However, the effects of metabolic changes of immune cells on liver cancer progression are largely undefined. In this review, we summarize the recent findings of immunometabolism and relate these findings to liver cancer progression. We also explore the translation of the understanding of immunometabolism for clinical use.
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Affiliation(s)
- Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, Zhejiang Province, China
| | - Yu Lou
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, Zhejiang Province, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, Zhejiang Province, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, Zhejiang Province, China
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320
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Pellino A, Loupakis F, Cadamuro M, Dadduzio V, Fassan M, Guido M, Cillo U, Indraccolo S, Fabris L. Precision medicine in cholangiocarcinoma. Transl Gastroenterol Hepatol 2018; 3:40. [PMID: 30148225 DOI: 10.21037/tgh.2018.07.02] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/03/2018] [Indexed: 12/19/2022] Open
Abstract
Cholangiocarcinoma is one of the epithelial cancers with the poorest prognosis and the narrowest therapeutic choice in humans. Compared with other cancer types, cholangiocarcinoma has been often neglected by oncology and liver research studies, thereby leaving many issues unsolved. Apart from the early and marked aggressiveness, one of the main reasons of the still unsatisfying clinical management of cholangiocarcinoma is its wide tumor heterogeneity needing more than other diseases a 'precision medicine' approach. In this regard, in the last few years there has been an awakening of interest aimed at dissecting the complex molecular and genomic profile of cholangiocarcinoma. Thus, a range of molecular players have been recently identified as putative mechanistic determinants of cholangiocarcinoma invasiveness, encompassing tyrosine kinase receptors, metabolic enzymes, transcription factors, small GTPases, ubiquitin ligases, and chromatin-remodelling proteins, whose aberrant expression may derive from stochastic mutations as well as from pro-oncogenic paracrine signals released by the stromal microenvironment, which is particularly exuberant in cholangiocarcinoma. Herein, we sought to overview the most relevant observations unravelling the genomic landscape of cholangiocarcinoma, and the prognostic and predictive biomarkers that consequently have been emerging. Then, we will discuss innovative treatment approaches derived from conventional chemotherapy, targeted therapies, antiangiogenic therapies and immunotherapy, and how they are opening new avenues towards a precision medicine in cholangiocarcinoma.
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Affiliation(s)
- Antonio Pellino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Fotios Loupakis
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Maria Guido
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Luca Fabris
- Department of Molecular Medicine (DMM), University of Padua, Padua, Italy.,Department of Internal Medicine, Yale Liver Center (YLC), School of Medicine, Yale University New Haven, CT, USA
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321
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Mody K, Cleary SP. A Review of Circulating Tumor DNA in Hepatobiliary Malignancies. Front Oncol 2018; 8:212. [PMID: 29942792 PMCID: PMC6004782 DOI: 10.3389/fonc.2018.00212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/24/2018] [Indexed: 12/11/2022] Open
Abstract
Circulating tumor DNA (ctDNA) is released into circulation (blood) specifically from tumor cells undergoing metabolic secretion, apoptosis, or necrosis, carries tumor-specific genetic or epigenetic alterations. Technologies enabling clinical evaluation of ctDNA continue to advance rapidly and allow for the assessment of patient-specific tumoral genetic and epigenetic alterations. This holds great potential for earlier detection of disease, serial monitoring of tumor heterogeneity, identification of therapeutic targets, and evaluation of treatment response and mechanisms of resistance. Hepatobiliary malignancies are often diagnosed late, recur commonly, yield limited available tumor on biopsy, and harbor several genomic alterations with potential therapeutic impacts. Patients suffering from or at risk for these diseases thus stand to benefit immensely from this technology. Herein, we review the limited literature pertaining to the potential for ctDNA technologies in such patients. Patients with these cancers stand to benefit greatly from the application of ctDNA technologies, and concerted efforts at further investigation of such are ongoing and greatly needed.
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Affiliation(s)
- Kabir Mody
- Division of Hematology/Oncology, Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, FL, United States
| | - Sean P Cleary
- Division of Hepatobiliary/Pancreas Surgery, Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, United States
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322
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Abstract
This article focuses on cholangiocarcinoma, both intrahepatic and extrahepatic. The various classification schemes based on anatomic location, macroscopic growth pattern, microscopic features, and cell of origin are outlined. The clinicopathologic, immunohistochemical and molecular differences between intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma, as well as differences in the 2 subtypes of intrahepatic cholangiocarcinoma, are discussed. Finally, precursor lesions, prognosis, treatment, and promising new potential targeted therapies are reviewed.
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Affiliation(s)
- Alyssa M Krasinskas
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road Northeast, Suite H180D, Atlanta, GA 30322, USA.
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323
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Lowery MA, Ptashkin R, Jordan E, Berger MF, Zehir A, Capanu M, Kemeny NE, O'Reilly EM, El-Dika I, Jarnagin WR, Harding JJ, D'Angelica MI, Cercek A, Hechtman JF, Solit DB, Schultz N, Hyman DM, Klimstra DS, Saltz LB, Abou-Alfa GK. Comprehensive Molecular Profiling of Intrahepatic and Extrahepatic Cholangiocarcinomas: Potential Targets for Intervention. Clin Cancer Res 2018; 24:4154-4161. [PMID: 29848569 DOI: 10.1158/1078-0432.ccr-18-0078] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022]
Abstract
Purpose: Various genetic driver aberrations have been identified among distinct anatomic and clinical subtypes of intrahepatic and extrahepatic cholangiocarcinoma, and these molecular alterations may be prognostic biomarkers and/or predictive of drug response.Experimental Design: Tumor samples from patients with cholangiocarcinoma who consented prospectively were analyzed using the MSK-IMPACT platform, a targeted next-generation sequencing assay that analyzes all exons and selected introns of 410 cancer-associated genes. Fisher exact tests were performed to identify associations between clinical characteristics and genetic alterations.Results: A total of 195 patients were studied: 78% intrahepatic and 22% extrahepatic cholangiocarcinoma. The most commonly altered genes in intrahepatic cholangiocarcinoma were IDH1 (30%), ARID1A (23%), BAP1 (20%), TP53 (20%), and FGFR2 gene fusions (14%). A tendency toward mutual exclusivity was seen between multiple genes in intrahepatic cholangiocarcinoma including TP53:IDH1, IDH1:KRAS, TP53:BAP1, and IDH1:FGFR2 Alterations in CDKN2A/B and ERBB2 were associated with reduced survival and time to progression on chemotherapy in patients with locally advanced or metastatic disease. Genetic alterations with potential therapeutic implications were identified in 47% of patients, leading to biomarker-directed therapy or clinical trial enrollment in 16% of patients.Conclusions: Cholangiocarcinoma is a genetically diverse cancer. Alterations in CDKN2A/B and ERBB2 are associated with negative prognostic implications in patients with advanced disease. Somatic alterations with therapeutic implications were identified in almost half of patients. These prospective data provide a contemporary benchmark for guiding the development of targeted therapies in molecularly profiled cholangiocarcinoma, and support to the use of molecular profiling to guide therapy selection in patients with advanced biliary cancers. Clin Cancer Res; 24(17); 4154-61. ©2018 AACR.
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Affiliation(s)
| | - Ryan Ptashkin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emmet Jordan
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Nancy E Kemeny
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Imane El-Dika
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - William R Jarnagin
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - James J Harding
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Michael I D'Angelica
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Andrea Cercek
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | | | - David B Solit
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | | | - David M Hyman
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - David S Klimstra
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Leonard B Saltz
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York. .,Weill Cornell Medical College, New York, New York
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324
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Qian F, Guo J, Jiang Z, Shen B. Translational Bioinformatics for Cholangiocarcinoma: Opportunities and Challenges. Int J Biol Sci 2018; 14:920-929. [PMID: 29989102 PMCID: PMC6036745 DOI: 10.7150/ijbs.24622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
Translational bioinformatics is becoming a driven force and a new scientific paradigm for cancer research in the era of big data. To promote the cross-disciplinary communication and research, we take cholangiocarcinoma as an example to review the present status and the future perspectives of the bioinformatics models applied in cancer study. We first summarize the present application of computational methods to the study of cholangiocarcinoma ranged from pattern recognition of biological data, knowledge based data annotation to systems biological level modeling and clinical translation. Then the future opportunities and challenges about database or knowledge base building, novel model developing and molecular mechanism exploring as well as the intelligent decision supporting system construction for the precision diagnosis, prognosis and treatment of cholangiocarcinoma are discussed.
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Affiliation(s)
- Fuliang Qian
- Center for Systems Biology, Soochow University, Suzhou 215006, China
| | - Junping Guo
- The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214200, China
| | - Zhi Jiang
- Center for Systems Biology, Soochow University, Suzhou 215006, China
| | - Bairong Shen
- Center for Systems Biology, Soochow University, Suzhou 215006, China.,Guizhou University School of Medicine, Guiyang, 550025, China.,Institute for Systems Genetics, West China Hospital, Sichuan University, Chengdu, 610041, China
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325
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Wardell CP, Fujita M, Yamada T, Simbolo M, Fassan M, Karlic R, Polak P, Kim J, Hatanaka Y, Maejima K, Lawlor RT, Nakanishi Y, Mitsuhashi T, Fujimoto A, Furuta M, Ruzzenente A, Conci S, Oosawa A, Sasaki-Oku A, Nakano K, Tanaka H, Yamamoto Y, Michiaki K, Kawakami Y, Aikata H, Ueno M, Hayami S, Gotoh K, Ariizumi SI, Yamamoto M, Yamaue H, Chayama K, Miyano S, Getz G, Scarpa A, Hirano S, Nakamura T, Nakagawa H. Genomic characterization of biliary tract cancers identifies driver genes and predisposing mutations. J Hepatol 2018; 68:959-969. [PMID: 29360550 DOI: 10.1016/j.jhep.2018.01.009] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Biliary tract cancers (BTCs) are clinically and pathologically heterogeneous and respond poorly to treatment. Genomic profiling can offer a clearer understanding of their carcinogenesis, classification and treatment strategy. We performed large-scale genome sequencing analyses on BTCs to investigate their somatic and germline driver events and characterize their genomic landscape. METHODS We analyzed 412 BTC samples from Japanese and Italian populations, 107 by whole-exome sequencing (WES), 39 by whole-genome sequencing (WGS), and a further 266 samples by targeted sequencing. The subtypes were 136 intrahepatic cholangiocarcinomas (ICCs), 101 distal cholangiocarcinomas (DCCs), 109 peri-hilar type cholangiocarcinomas (PHCs), and 66 gallbladder or cystic duct cancers (GBCs/CDCs). We identified somatic alterations and searched for driver genes in BTCs, finding pathogenic germline variants of cancer-predisposing genes. We predicted cell-of-origin for BTCs by combining somatic mutation patterns and epigenetic features. RESULTS We identified 32 significantly and commonly mutated genes including TP53, KRAS, SMAD4, NF1, ARID1A, PBRM1, and ATR, some of which negatively affected patient prognosis. A novel deletion of MUC17 at 7q22.1 affected patient prognosis. Cell-of-origin predictions using WGS and epigenetic features suggest hepatocyte-origin of hepatitis-related ICCs. Deleterious germline mutations of cancer-predisposing genes such as BRCA1, BRCA2, RAD51D, MLH1, or MSH2 were detected in 11% (16/146) of BTC patients. CONCLUSIONS BTCs have distinct genetic features including somatic events and germline predisposition. These findings could be useful to establish treatment and diagnostic strategies for BTCs based on genetic information. LAY SUMMARY We here analyzed genomic features of 412 BTC samples from Japanese and Italian populations. A total of 32 significantly and commonly mutated genes were identified, some of which negatively affected patient prognosis, including a novel deletion of MUC17 at 7q22.1. Cell-of-origin predictions using WGS and epigenetic features suggest hepatocyte-origin of hepatitis-related ICCs. Deleterious germline mutations of cancer-predisposing genes were detected in 11% of patients with BTC. BTCs have distinct genetic features including somatic events and germline predisposition.
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Affiliation(s)
- Christopher P Wardell
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Masashi Fujita
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Toru Yamada
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Michele Simbolo
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Matteo Fassan
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Rosa Karlic
- Bioinformatics Group, Department of Molecular Biology, Division of Biology, Faculty of Science, University of Zagreb, Croatia
| | - Paz Polak
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Jaegil Kim
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Yutaka Hatanaka
- Research Division of Companion Diagnostics, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Kazuhiro Maejima
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Rita T Lawlor
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Akihiro Fujimoto
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Mayuko Furuta
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Andrea Ruzzenente
- Department of Surgery, General and Hepatobiliary Surgery, University Hospital G.B. Rossi, University and Hospital Trust of Verona, Verona, Italy
| | - Simone Conci
- Department of Surgery, General and Hepatobiliary Surgery, University Hospital G.B. Rossi, University and Hospital Trust of Verona, Verona, Italy
| | - Ayako Oosawa
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Aya Sasaki-Oku
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Kaoru Nakano
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan
| | - Hiroko Tanaka
- Laboratory of DNA Information Analysis, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Yujiro Yamamoto
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan; Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Kubo Michiaki
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Yoshiiku Kawakami
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University School of Medicine, Hiroshima 734-8551, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University School of Medicine, Hiroshima 734-8551, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama 641-8510, Japan
| | - Shinya Hayami
- Second Department of Surgery, Wakayama Medical University, Wakayama 641-8510, Japan
| | - Kunihito Gotoh
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Shun-Ichi Ariizumi
- Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama 641-8510, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University School of Medicine, Hiroshima 734-8551, Japan
| | - Satoru Miyano
- Laboratory of DNA Information Analysis, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hidewaki Nakagawa
- Laboratory for Genome Sequencing Analysis, RIKEN Center for Integrative Medical Sciences, Tokyo 108-8639, Japan.
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326
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Schauer SN, Carreira PE, Shukla R, Gerhardt DJ, Gerdes P, Sanchez-Luque FJ, Nicoli P, Kindlova M, Ghisletti S, Santos AD, Rapoud D, Samuel D, Faivre J, Ewing AD, Richardson SR, Faulkner GJ. L1 retrotransposition is a common feature of mammalian hepatocarcinogenesis. Genome Res 2018; 28:639-653. [PMID: 29643204 PMCID: PMC5932605 DOI: 10.1101/gr.226993.117] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
Abstract
The retrotransposon Long Interspersed Element 1 (LINE-1 or L1) is a continuing source of germline and somatic mutagenesis in mammals. Deregulated L1 activity is a hallmark of cancer, and L1 mutagenesis has been described in numerous human malignancies. We previously employed retrotransposon capture sequencing (RC-seq) to analyze hepatocellular carcinoma (HCC) samples from patients infected with hepatitis B or hepatitis C virus and identified L1 variants responsible for activating oncogenic pathways. Here, we have applied RC-seq and whole-genome sequencing (WGS) to an Abcb4 (Mdr2)-/- mouse model of hepatic carcinogenesis and demonstrated for the first time that L1 mobilization occurs in murine tumors. In 12 HCC nodules obtained from 10 animals, we validated four somatic L1 insertions by PCR and capillary sequencing, including TF subfamily elements, and one GF subfamily example. One of the TF insertions carried a 3' transduction, allowing us to identify its donor L1 and to demonstrate that this full-length TF element retained retrotransposition capacity in cultured cancer cells. Using RC-seq, we also identified eight tumor-specific L1 insertions from 25 HCC patients with a history of alcohol abuse. Finally, we used RC-seq and WGS to identify three tumor-specific L1 insertions among 10 intra-hepatic cholangiocarcinoma (ICC) patients, including one insertion traced to a donor L1 on Chromosome 22 known to be highly active in other cancers. This study reveals L1 mobilization as a common feature of hepatocarcinogenesis in mammals, demonstrating that the phenomenon is not restricted to human viral HCC etiologies and is encountered in murine liver tumors.
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Affiliation(s)
- Stephanie N Schauer
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Patricia E Carreira
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Ruchi Shukla
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - Daniel J Gerhardt
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
- Invenra, Incorporated, Madison, Wisconsin 53719, USA
| | - Patricia Gerdes
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Francisco J Sanchez-Luque
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer-University of Granada-Andalusian Regional Government, PTS Granada, 18016 Granada, Spain
| | - Paola Nicoli
- Department of Experimental Oncology, European Institute of Oncology, 20146 Milan, Italy
| | - Michaela Kindlova
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | | | - Alexandre Dos Santos
- INSERM, U1193, Paul-Brousse University Hospital, Hepatobiliary Centre, Villejuif 94800, France
- Université Paris-Sud, Faculté de Médecine, Villejuif 94800, France
| | - Delphine Rapoud
- INSERM, U1193, Paul-Brousse University Hospital, Hepatobiliary Centre, Villejuif 94800, France
- Université Paris-Sud, Faculté de Médecine, Villejuif 94800, France
| | - Didier Samuel
- INSERM, U1193, Paul-Brousse University Hospital, Hepatobiliary Centre, Villejuif 94800, France
- Université Paris-Sud, Faculté de Médecine, Villejuif 94800, France
| | - Jamila Faivre
- INSERM, U1193, Paul-Brousse University Hospital, Hepatobiliary Centre, Villejuif 94800, France
- Université Paris-Sud, Faculté de Médecine, Villejuif 94800, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pôle de Biologie Médicale, Paul-Brousse University Hospital, Villejuif 94800, France
| | - Adam D Ewing
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Sandra R Richardson
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Geoffrey J Faulkner
- Mater Research Institute-University of Queensland, Woolloongabba, QLD 4102, Australia
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD 4072, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD 4072, Australia
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327
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Shibata T, Arai Y, Totoki Y. Molecular genomic landscapes of hepatobiliary cancer. Cancer Sci 2018; 109:1282-1291. [PMID: 29573058 PMCID: PMC5980207 DOI: 10.1111/cas.13582] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/03/2018] [Accepted: 03/11/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and biliary tract cancer are more frequent in East Asia including Japan than in Europe or North America. A compilation of 1340 multi‐ethnic HCC genomes, the largest cohort ever reported, identified a comprehensive landscape of HCC driver genes, comprised of three core drivers (TP53,TERT, and WNT signaling) and combinations of infrequent alterations in various cancer pathways. In contrast, five core driver genes (TP53,ARID1A,KRAS,SMAD4, and BAP1) with characteristic molecular alterations including fusion transcripts involving fibroblast growth factor receptor 2 and the protein kinase A pathway, and IDH1/2 mutation constituted the biliary tract cancer genomes. Consistent with their heterogeneous epidemiological backgrounds, mutational signatures and combinations of non‐core driver genes within these cancer genomes were found to be complex. Integrative analyses of multi‐omics data identified molecular classifications of these tumors that are associated with clinical outcome and enrichments of potential therapeutic targets, including immune checkpoint molecules. Translating comprehensive molecular‐genomic analysis together with further basic research and international collaborations are highly anticipated for developing precise and better treatments, diagnosis, and prevention of these tumor types.
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Affiliation(s)
- Tatsuhiro Shibata
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.,Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasushi Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
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328
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O'Rourke CJ, Munoz-Garrido P, Aguayo EL, Andersen JB. Epigenome dysregulation in cholangiocarcinoma. Biochim Biophys Acta Mol Basis Dis 2018. [DOI: 10.1016/j.bbadis.2017.06.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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329
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Mertens JC, Ilyas SI, Gores GJ. Targeting cholangiocarcinoma. Biochim Biophys Acta Mol Basis Dis 2018; 1864:1454-1460. [PMID: 28844952 PMCID: PMC6013079 DOI: 10.1016/j.bbadis.2017.08.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
Cholangiocarcinoma (CCA) represents a diverse group of epithelial cancers associated with the biliary tract, and can best be stratified anatomically into intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA) subsets. Molecular profiling has identified genetic aberrations associated with these anatomic subsets. For example, IDH catalytic site mutations and constitutively active FGFR2 fusion genes are predominantly identified in iCCA, whereas KRAS mutations and PRKACB fusions genes are identified in pCCA and dCCA. Clinical trials targeting these specific driver mutations are in progress. However, The Tumor Genome Atlas (TCGA) marker analysis of CCA also highlights the tremendous molecular heterogeneity of this cancer rendering comprehensive employment of targeted therapies challenging. CCA also display a rich tumor microenvironment which may be easier to target. For example, targeting cancer associated fibroblasts for apoptosis with BH3-mimetics and/or and reversing T-cell exhaustion with immune check point inhibitors may help aid in the treatment of this otherwise devastating malignancy. Combinatorial therapy attacking the tumor microenvironment plus targeted therapy may help advance treatment for CCA. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
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Affiliation(s)
- Joachim C Mertens
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland.
| | - Sumera I Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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330
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Harris WP, Wong KM, Saha S, Dika IE, Abou-Alfa GK. Biomarker-Driven and Molecular Targeted Therapies for Hepatobiliary Cancers. Semin Oncol 2018; 45:116-123. [PMID: 30348531 DOI: 10.1053/j.seminoncol.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 12/18/2022]
Abstract
The recent accumulation of molecular profiling data for primary hepatobiliary malignancies, including hepatocellular carcinoma and biliary tract cancers, has led to a proliferation of promising therapeutic investigations in recent years. Treatment with pathway-specific targeted inhibitors and immunotherapeutic agents have demonstrated promising early clinical results. Key molecular alterations in common hepatobiliary cancers and ongoing interventional clinical trials of molecularly targeted systemic agents focusing on hepatocellular carcinoma and biliary tract cancer are reviewed.
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Affiliation(s)
- William P Harris
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Kit Man Wong
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Supriya Saha
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Imane El Dika
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Medical College at Cornell University, New York, NY.
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331
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Iida N, Okuda Y, Ogasawara O, Yamashita S, Takeshima H, Ushijima T. MACON: a web tool for computing DNA methylation data obtained by the Illumina Infinium Human DNA methylation BeadArray. Epigenomics 2018; 10:249-258. [DOI: 10.2217/epi-2017-0093] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: Bioinformatics analysis for Illumina Infinium Human DNA methylation BeadArray is essential, but still remains difficult task for many experimental researchers. We here aimed to develop a browser-accessible bioinformatics tool for analyzing the BeadArray data. Materials & methods: The tool was established as an analytical pipeline using R, Perl and Python programming languages. Results: We introduced a method that groups neighboring probes into a genomic block, which facilitated efficient identification of densely methylated/unmethylated regions. The tool, MACON, provided probe filtering, β-mixture quantile normalization, grouping into genomic blocks, annotation and production of a data subset. Conclusion: MACON allows researchers to analyze the BeadArray data using a web browser ( http://epigenome.ncc.go.jp/macon ).
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Affiliation(s)
- Naoko Iida
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | | | | | - Satoshi Yamashita
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Hideyuki Takeshima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Toshikazu Ushijima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
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332
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Lombardi P, Marino D, Fenocchio E, Chilà G, Aglietta M, Leone F. Emerging molecular target antagonists for the treatment of biliary tract cancer. Expert Opin Emerg Drugs 2018; 23:63-75. [PMID: 29468924 DOI: 10.1080/14728214.2018.1444749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Biliary tract cancers (BTCs) are a heterogeneous group of cancers, characterized by low incidence but poor prognosis. Even after complete surgical resection for early stage, relapse is frequent and the lack of effective treatments contributes to the dismal prognosis. To date, the only standard treatment in first-line is cisplatin/gemcitabine combination, whereas no standard in 2nd-line has been defined. Hence, the current goal is to better understand the biology of BTCs, discovering new treatment methods and improving clinical outcomes. Areas covered: The development of next-generation-sequencing has unveiled the picture of the molecular signatures characterizing BTCs, leading to the identification of actionable mutations in biomarker-driven clinical trials. In this review we will cover the genetic landscape of BTC, focusing on the efficacy of existing treatments. Furthermore, we will discuss emerging molecular targets and evaluate the findings of pre-clinical studies. Finally, the encouraging results of clinical trials involving targeted therapies or immunotherapy will be reviewed. Expert opinion: FGFR fusion rearrangements and IDH1 or IDH2 mutations are the most promising targeted treatments under evaluation. In addition, innovative trial design will allow to offer a chance for tailored medicine to infrequent subgroups of BTCs patients based on their molecular features rather than their histology.
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Affiliation(s)
- Pasquale Lombardi
- a Department of Oncology , University of Turin Medical School , Turin , Italy
| | - Donatella Marino
- b Medical Oncology , Candiolo Cancer Institute - FPO- IRCCS , Candiolo , Italy
| | | | - Giovanna Chilà
- a Department of Oncology , University of Turin Medical School , Turin , Italy
| | - Massimo Aglietta
- a Department of Oncology , University of Turin Medical School , Turin , Italy.,b Medical Oncology , Candiolo Cancer Institute - FPO- IRCCS , Candiolo , Italy
| | - Francesco Leone
- a Department of Oncology , University of Turin Medical School , Turin , Italy
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333
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Høgdall D, Lewinska M, Andersen JB. Desmoplastic Tumor Microenvironment and Immunotherapy in Cholangiocarcinoma. Trends Cancer 2018; 4:239-255. [PMID: 29506673 DOI: 10.1016/j.trecan.2018.01.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/15/2018] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma (CCA) is a dismal disease which often is diagnosed at a late stage where the tumor is locally advanced, metastatic, and, as a result, is associated with low resectability. The heterogeneity of this cancer type is a major reason why the majority of patients fail to respond to therapy, and surgery remains their only curative option. Among patients who undergo surgical intervention, such tumors typically recur in 50% of cases within 1year. Thus, CCA is among the most aggressive and chemoresistant malignancies. CCA is characterized by marked tumor reactive stroma, a fibrogenic connective tissue which surrounds and infiltrates the tumor epithelium. This desmoplastic environment presents a clinical challenge, limiting drug delivery and supporting the growth of the tumor mass. In this review we attempt to highlight key pathways involved in cell to cell communication between the tumor epithelium and stroma, the immune components, and opportunities for novel strategies to improve patient outcome.
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Affiliation(s)
- Dan Høgdall
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Ole Maaløes Vej 5, 2200, Copenhagen N, Denmark; Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; These authors contributed equally
| | - Monika Lewinska
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Ole Maaløes Vej 5, 2200, Copenhagen N, Denmark; These authors contributed equally
| | - Jesper B Andersen
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Ole Maaløes Vej 5, 2200, Copenhagen N, Denmark.
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334
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Ilyas SI, Khan SA, Hallemeier CL, Kelley RK, Gores GJ. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 2018; 15:95-111. [PMID: 28994423 PMCID: PMC5819599 DOI: 10.1038/nrclinonc.2017.157] [Citation(s) in RCA: 985] [Impact Index Per Article: 164.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cholangiocarcinoma is a disease entity comprising diverse epithelial tumours with features of cholangiocyte differentiation: cholangiocarcinomas are categorized according to anatomical location as intrahepatic (iCCA), perihilar (pCCA), or distal (dCCA). Each subtype has a distinct epidemiology, biology, prognosis, and strategy for clinical management. The incidence of cholangiocarcinoma, particularly iCCA, has increased globally over the past few decades. Surgical resection remains the mainstay of potentially curative treatment for all three disease subtypes, whereas liver transplantation after neoadjuvant chemoradiation is restricted to a subset of patients with early stage pCCA. For patients with advanced-stage or unresectable disease, locoregional and systemic chemotherapeutics are the primary treatment options. Improvements in external-beam radiation therapy have facilitated the treatment of cholangiocarcinoma. Moreover, advances in comprehensive whole-exome and transcriptome sequencing have defined the genetic landscape of each cholangiocarcinoma subtype. Accordingly, promising molecular targets for precision medicine have been identified, and are being evaluated in clinical trials, including those exploring immunotherapy. Biomarker-driven trials, in which patients are stratified according to anatomical cholangiocarcinoma subtype and genetic aberrations, will be essential in the development of targeted therapies. Targeting the rich tumour stroma of cholangiocarcinoma in conjunction with targeted therapies might also be useful. Herein, we review the evolving developments in the epidemiology, pathogenesis, and management of cholangiocarcinoma.
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Affiliation(s)
- Sumera I Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Shahid A Khan
- Department of Hepatology, St Mary's Hospital, Imperial College London, Praed Street, London W2 1NY, UK
- Department of Hepatology, Hammersmith Hospital, Imperial College London, Ducane Road, London W12 0HS, UK
| | - Christopher L Hallemeier
- Department of Radiation Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Robin K Kelley
- The University of California, San Francisco Medical Center, 505 Parnassus Avenue, San Francisco, California 94143, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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335
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Molenaar RJ, Maciejewski JP, Wilmink JW, van Noorden CJF. Wild-type and mutated IDH1/2 enzymes and therapy responses. Oncogene 2018; 37:1949-1960. [PMID: 29367755 PMCID: PMC5895605 DOI: 10.1038/s41388-017-0077-z] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022]
Abstract
Isocitrate dehydrogenase 1 and 2 (IDH1/2) are key enzymes in cellular metabolism, epigenetic regulation, redox states, and DNA repair. IDH1/2 mutations are causal in the development and/or progression of various types of cancer due to supraphysiological production of d-2-hydroxyglutarate. In various tumor types, IDH1/2-mutated cancers predict for improved responses to treatment with irradiation or chemotherapy. The present review discusses the molecular basis of the sensitivity of IDH1/2-mutated cancers with respect to the function of mutated IDH1/2 in cellular processes and their interactions with novel IDH1/2-mutant inhibitors. Finally, lessons learned from IDH1/2 mutations for future clinical applications in IDH1/2 wild-type cancers are discussed.
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Affiliation(s)
- Remco J Molenaar
- Cancer Center Amsterdam, Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands. .,Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Cornelis J F van Noorden
- Cancer Center Amsterdam, Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands
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336
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Javle M, Lowery M, Shroff RT, Weiss KH, Springfeld C, Borad MJ, Ramanathan RK, Goyal L, Sadeghi S, Macarulla T, El-Khoueiry A, Kelley RK, Borbath I, Choo SP, Oh DY, Philip PA, Chen LT, Reungwetwattana T, Van Cutsem E, Yeh KH, Ciombor K, Finn RS, Patel A, Sen S, Porter D, Isaacs R, Zhu AX, Abou-Alfa GK, Bekaii-Saab T. Phase II Study of BGJ398 in Patients With FGFR-Altered Advanced Cholangiocarcinoma. J Clin Oncol 2018; 36:276-282. [PMID: 29182496 PMCID: PMC6075847 DOI: 10.1200/jco.2017.75.5009] [Citation(s) in RCA: 469] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose No standard treatment exists for patients with cholangiocarcinoma for whom first-line gemcitabine-based therapy fails. Fibroblast growth factor receptor 2 ( FGFR2) fusions/translocations are present in 13% to 17% of intrahepatic cholangiocarcinomas. BGJ398, an orally bioavailable, selective pan-FGFR kinase inhibitor, has shown preliminary clinical activity against tumors with FGFR alterations. Methods A multicenter, open-label, phase II study ( ClinicalTrials.gov identifier: NCT02150967) evaluated BGJ398 antitumor activity in patients age ≥ 18 years with advanced or metastatic cholangiocarcinoma containing FGFR2 fusions or other FGFR alterations whose disease had progressed while receiving prior therapy. Patients received BGJ398 125 mg once daily for 21 days, then 7 days off (28-day cycles). The primary end point was investigator-assessed overall response rate. Results Sixty-one patients (35 women; median age, 57 years) with FGFR2 fusion (n = 48), mutation (n = 8), or amplification (n = 3) participated. At the prespecified data cutoff (June 30, 2016), 50 patients had discontinued treatment. All responsive tumors contained FGFR2 fusions. The overall response rate was 14.8% (18.8% FGFR2 fusions only), disease control rate was 75.4% (83.3% FGFR2 fusions only), and estimated median progression-free survival was 5.8 months (95% CI, 4.3 to 7.6 months). Adverse events included hyperphosphatemia (72.1% all grade), fatigue (36.1%), stomatitis (29.5%), and alopecia (26.2%). Grade 3 or 4 treatment-related adverse events occurred in 25 patients (41%) and included hyperphosphatemia (16.4%), stomatitis (6.6%), and palmar-plantar erythrodysesthesia (4.9%). Conclusion BGJ398 is a first-in-class FGFR kinase inhibitor with manageable toxicities that shows meaningful clinical activity against chemotherapy-refractory cholangiocarcinoma containing FGFR2 fusions. This promising antitumor activity supports continued development of BGJ398 in this highly selected patient population.
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Affiliation(s)
- Milind Javle
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ.,Corresponding author: Milind Javle, MD, Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail:
| | - Maeve Lowery
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Rachna T. Shroff
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Karl Heinz Weiss
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Christoph Springfeld
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Mitesh J. Borad
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ramesh K. Ramanathan
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Lipika Goyal
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Saeed Sadeghi
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Teresa Macarulla
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Anthony El-Khoueiry
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Robin Kate Kelley
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ivan Borbath
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Su Pin Choo
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Do-Youn Oh
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Philip A. Philip
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Li-Tzong Chen
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Thanyanan Reungwetwattana
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Eric Van Cutsem
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kun-Huei Yeh
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kristen Ciombor
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Richard S. Finn
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Anuradha Patel
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Suman Sen
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Dale Porter
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Randi Isaacs
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andrew X. Zhu
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ghassan K. Abou-Alfa
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Tanios Bekaii-Saab
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
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337
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Dong M, Liu X, Evert K, Utpatel K, Peters M, Zhang S, Xu Z, Che L, Cigliano A, Ribback S, Dombrowski F, Cossu A, Gordan J, Calvisi DF, Evert M, Liu Y, Chen X. Efficacy of MEK inhibition in a K-Ras-driven cholangiocarcinoma preclinical model. Cell Death Dis 2018; 9:31. [PMID: 29348467 PMCID: PMC5833851 DOI: 10.1038/s41419-017-0183-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a deadly malignancy with limited treatment options. Gain-of-function mutations in K-Ras is a very frequent alteration, occurring in ~15 to 25% of human iCCA patients. Here, we established a new iCCA model by expressing activated forms of Notch1 (NICD) and K-Ras (K-RasV12D) in the mouse liver (K-Ras/NICD mice). Furthermore, we investigated the therapeutic potential of MEK inhibitors in vitro and in vivo using human CCA cell lines and K-Ras/NICD mice, respectively. Treatment with U0126, PD901, and Selumetinib MEK inhibitors triggered growth restraint in all CCA cell lines tested, with the most pronounced growth suppressive effects being observed in K-Ras mutant cells. Growth inhibition was due to reduction in proliferation and massive apoptosis. Furthermore, treatment of K-Ras/NICD tumor-bearing mice with PD901 resulted in stable disease. At the molecular level, PD901 efficiently inhibited ERK activation in K-Ras/NICD tumor cells, mainly leading to increased apoptosis. Altogether, our study demonstrates that K-Ras/NICD mice represent a novel and useful preclinical model to study K-Ras-driven iCCA development and the effectiveness of MEK inhibitors in counteracting this process. Our data support the usefulness of MEK inhibitors for the treatment of human iCCA.
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Affiliation(s)
- Mingjie Dong
- Department of Gastroenterology, 307 Hospital of Academy of Military Medical Science, Beijing, China.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Liver Center, University of California, San Francisco, CA, USA
| | - Xianqiong Liu
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Liver Center, University of California, San Francisco, CA, USA.,School of Pharmacy, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Michele Peters
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Shanshan Zhang
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Liver Center, University of California, San Francisco, CA, USA.,Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zhong Xu
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Liver Center, University of California, San Francisco, CA, USA
| | - Li Che
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Liver Center, University of California, San Francisco, CA, USA
| | - Antonio Cigliano
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Silvia Ribback
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Frank Dombrowski
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Antonio Cossu
- Unit of Pathology, Azienda Ospedaliero Universitaria Sassari, Sassari, Italy
| | - John Gordan
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Diego F Calvisi
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany.
| | - Yan Liu
- Department of Gastroenterology, 307 Hospital of Academy of Military Medical Science, Beijing, China.
| | - Xin Chen
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA. .,Liver Center, University of California, San Francisco, CA, USA. .,School of Pharmacy, Hubei University of Chinese Medicine, Wuhan, Hubei, China.
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338
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Shiao MS, Chiablaem K, Charoensawan V, Ngamphaiboon N, Jinawath N. Emergence of Intrahepatic Cholangiocarcinoma: How High-Throughput Technologies Expedite the Solutions for a Rare Cancer Type. Front Genet 2018; 9:309. [PMID: 30158952 PMCID: PMC6104394 DOI: 10.3389/fgene.2018.00309] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 07/23/2018] [Indexed: 12/16/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is the cancer of the intrahepatic bile ducts, and together with hepatocellular carcinoma (HCC), constitute the majority of primary liver cancers. ICC is a rare disorder as its overall incidence is < 1/100,000 in the United States and Europe. However, it shows much higher incidence in particular geographical regions, such as northeastern Thailand, where liver fluke infection is the most common risk factor of ICC. Since the early stages of ICC are often asymptomatic, the patients are usually diagnosed at advanced stages with no effective treatments available, leading to the high mortality rate. In addition, unclear genetic mechanisms, heterogeneous nature, and various etiologies complicate the development of new efficient treatments. Recently, a number of studies have employed high-throughput approaches, including next-generation sequencing and mass spectrometry, in order to understand ICC in different biological aspects. In general, the majority of recurrent genetic alterations identified in ICC are enriched in known tumor suppressor genes and oncogenes, such as mutations in TP53, KRAS, BAP1, ARID1A, IDH1, IDH2, and novel FGFR2 fusion genes. Yet, there are no major driver genes with immediate clinical solutions characterized. Interestingly, recent studies utilized multi-omics data to classify ICC into two main subgroups, one with immune response genes as the main driving factor, while another is enriched with driver mutations in the genes associated with epigenetic regulations, such as IDH1 and IDH2. The two subgroups also show different hypermethylation patterns in the promoter regions. Additionally, the immune response induced by host-pathogen interactions, i.e., liver fluke infection, may further stimulate tumor growth through alterations of the tumor microenvironment. For in-depth functional studies, although many ICC cell lines have been globally established, these homogeneous cell lines may not fully explain the highly heterogeneous genetic contents of this disorder. Therefore, the advent of patient-derived xenograft and 3D patient-derived organoids as new disease models together with the understanding of evolution and genetic alterations of tumor cells at the single-cell resolution will likely become the main focus to fill the current translational research gaps of ICC in the future.
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Affiliation(s)
- Meng-Shin Shiao
- Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Khajeelak Chiablaem
- Program in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Varodom Charoensawan
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Nakhon Pathom, Thailand
- Systems Biology of Diseases Research Unit, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Nuttapong Ngamphaiboon
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natini Jinawath
- Program in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Nakhon Pathom, Thailand
- *Correspondence: Natini Jinawath ;
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339
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Raggi C, Gammella E, Correnti M, Buratti P, Forti E, Andersen JB, Alpini G, Glaser S, Alvaro D, Invernizzi P, Cairo G, Recalcati S. Dysregulation of Iron Metabolism in Cholangiocarcinoma Stem-like Cells. Sci Rep 2017; 7:17667. [PMID: 29247214 PMCID: PMC5732280 DOI: 10.1038/s41598-017-17804-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/26/2017] [Indexed: 12/13/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a devastating liver tumour arising from malignant transformation of bile duct epithelial cells. Cancer stem cells (CSC) are a subset of tumour cells endowed with stem-like properties, which play a role in tumour initiation, recurrence and metastasis. In appropriate conditions, CSC form 3D spheres (SPH), which retain stem-like tumour-initiating features. Here, we found different expression of iron proteins indicating increased iron content, oxidative stress and higher expression of CSC markers in CCA-SPH compared to tumour cells growing as monolayers. Exposure to the iron chelator desferrioxamine decreased SPH forming efficiency and the expression of CSC markers and stem-like genes, whereas iron had an opposite effect. Microarray profiles in CCA samples (n = 104) showed decreased H ferritin, hepcidin and ferroportin expression in tumours respect to surrounding liver, whereas transferrin receptor was up-regulated. Moreover, we found a trend toward poorer outcome in CCA patients with elevated expression of ferritin and hepcidin, two major proteins of iron metabolism. These findings, which represent the first evidence of a role for iron in the stem cell compartment as a novel metabolic factor involved in CCA growth, may have implications for a better therapeutic approach.
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Affiliation(s)
- Chiara Raggi
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano, Italy.,Dipartimento Medicina Sperimentale e Clinica, University of Firence, Firenze, Italy
| | - Elena Gammella
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Margherita Correnti
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Paolo Buratti
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Elisa Forti
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Jesper B Andersen
- Biotech Research and Innovation Centre, Department of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - Gianfranco Alpini
- Research, Central Texas Veterans Health Care System, Baylor Scott & White Digestive Disease Research Center, Scott & White Health, Department of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Shannon Glaser
- Research, Central Texas Veterans Health Care System, Baylor Scott & White Digestive Disease Research Center, Scott & White Health, Department of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Domenico Alvaro
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Program for Autoimmune Liver Diseases, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
| | - Gaetano Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy.
| | - Stefania Recalcati
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
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340
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Ikeda M, Ioka T, Fukutomi A, Morizane C, Kasuga A, Takahashi H, Todaka A, Okusaka T, Creasy CL, Gorman S, Felitsky DJ, Kobayashi M, Zhang F, Furuse J. Efficacy and safety of trametinib in Japanese patients with advanced biliary tract cancers refractory to gemcitabine. Cancer Sci 2017; 109:215-224. [PMID: 29121415 PMCID: PMC5765304 DOI: 10.1111/cas.13438] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 12/13/2022] Open
Abstract
Gemcitabine‐based therapy remains the mainstay of treatment for patients with biliary tract cancers (BTCs) with no second‐line treatment(s) established yet. Aberrant activation of the MAPK pathway in patients with BTC indicates its importance in BTC. Trametinib is a potent, highly selective, allosteric non‐competitive inhibitor of MEK1/MEK2. In this phase IIa open‐label, single‐arm study, we investigated the efficacy and safety of trametinib in Japanese patients with advanced BTC refractory to gemcitabine‐based therapy. All patients received oral trametinib 2 mg once daily until progressive disease (PD), death, or unacceptable toxicity. The primary objective was to determine the 12‐week non‐PD rate. Secondary assessments included safety, progression‐free survival (PFS), overall survival, and overall response rate. Targeted exome sequencing was used to identify biomarkers for sensitivity or resistance to trametinib monotherapy. Twenty patients (median age, 61.5 years) with carcinoma of gall bladder (40%), intrahepatic (25%) or extrahepatic (30%) bile duct, and ampulla of Vater (5%) were enrolled. The non‐PD rate at week 12 was 10% (95% confidence interval, 1.2‐31.7); it did not reach the threshold rate of 25%. Median PFS was 10.6 weeks (95% confidence interval, 4.6‐12.1) and 1‐year overall survival was 20.0%. Stable disease and PD were observed in 13 (65%) and seven (35%) patients, respectively. No new safety signals were reported. Although the primary end‐point was not met, prolonged PFS was observed in one patient having six somatic variants including synonymous NF1 exon 12 splice variant and a loss‐of‐function variant in ARID1A. Efforts to understand responsive mutations and sensitivity to targeted therapies are warranted. This trial was registered with ClinicalTrials.gov: NCT01943864.
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Affiliation(s)
- Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Ioka
- Osaka International Cancer Institute, Osaka, Japan
| | | | | | - Akiyoshi Kasuga
- Department of Medical Oncology, Kyorin University, Tokyo, Japan
| | - Hideaki Takahashi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | | | | | | | - Junji Furuse
- Department of Medical Oncology, Kyorin University, Tokyo, Japan
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341
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Cardinale V, Carpino G. Multilevel heterogeneity of biliary tract cancers may affect the modelling of prognosis. Liver Int 2017; 37:1773-1775. [PMID: 29149490 DOI: 10.1111/liv.13565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome "Foro Italico", Rome, Italy
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342
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Bragazzi MC, Ridola L, Safarikia S, Matteo SD, Costantini D, Nevi L, Cardinale V. New insights into cholangiocarcinoma: multiple stems and related cell lineages of origin. Ann Gastroenterol 2017; 31:42-55. [PMID: 29333066 PMCID: PMC5759612 DOI: 10.20524/aog.2017.0209] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies that may develop at any level of the biliary tree. CCA is currently classified into intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA) on the basis of its anatomical location. Notably, although these three CCA subtypes have common features, they also have important inter- and intra-tumor differences that can affect their pathogenesis and outcome. A unique feature of CCA is that it manifests in the hepatic parenchyma or large intrahepatic and extrahepatic bile ducts, furnished by two distinct stem cell niches: the canals of Hering and the peribiliary glands, respectively. The complexity of CCA pathogenesis highlights the need for a multidisciplinary, translational, and systemic approach to this malignancy. This review focuses on advances in the knowledge of CCA histomorphology, risk factors, molecular pathogenesis, and subsets of CCA.
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Affiliation(s)
- Maria Consiglia Bragazzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Ridola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Samira Safarikia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Sabina Di Matteo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Daniele Costantini
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Nevi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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343
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Xian ZH, Qin C, Cong WM. KRAS mutation and immunohistochemical profile in intraductal papillary neoplasm of the intrahepatic bile ducts. Pathol Res Pract 2017; 214:105-111. [PMID: 29103773 DOI: 10.1016/j.prp.2017.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/16/2022]
Abstract
Intraductal papillary neoplasm of bile duct (IPNB) is characterized by a spectrum of diseases ranging from low-grade intraepithelial neoplasia to invasive carcinoma. In the present study, we aimed to investigate immunophenotypic features and KRAS mutations in relation to pathological subtypes and grades in Chinese patients with IPNBs. A total of 46 patients with IPNBs and 11 invasive adenocarcinomas arising in IPNBs (invasive IPNBs) were enrolled and clinicopathological data were analyzed. It was found that CK7 was expressed in 42 of the 46 neoplastic lesions. HepPar1 was expressed in 11 of the 46 noninvasive IPNBs, but not in invasive IPNBs. Additionally, CK19 was frequently expressed in both noninvasive IPNBs and invasive IPNBs. The intestinal-type IPNBs had a significantly higher percentage of MUC2 expression relative to the pancreaticobiliary (P=0.015) and gastric-type IPNBs (P<0.001). High-grade IPNBs and invasive IPNBs showed increased expression of cyclin D1, Ki-67, p53, mCEA, and CA19-9. The rate of KRAS mutation was significantly higher in high-grade IPNBs (P=0.001) and invasive IPNBs (P=0.006) than that in low- to intermediate-grade IPNBs. Additionally, KRAS mutation was significantly associated with tumor size, and Ki-67 expression. In conclusion, the expression of cyclin D, Ki-67, p53, mCEA and CA19-9 and KRAS mutation status are significantly correlated with histological grades of IPNBs.
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Affiliation(s)
- Zhi-Hong Xian
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
| | - Chun Qin
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wen-Ming Cong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
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344
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Castelli G, Pelosi E, Testa U. Liver Cancer: Molecular Characterization, Clonal Evolution and Cancer Stem Cells. Cancers (Basel) 2017; 9:cancers9090127. [PMID: 28930164 PMCID: PMC5615342 DOI: 10.3390/cancers9090127] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 12/15/2022] Open
Abstract
Liver cancer is the second most common cause of cancer-related death. The major forms of primary liver cancer are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). Both these tumors develop against a background of cirrhotic liver, non-alcoholic fatty liver disease, chronic liver damage and fibrosis. HCC is a heterogeneous disease which usually develops within liver cirrhosis related to various etiologies: hepatitis B virus (HBV) infection (frequent in Asia and Africa), hepatitis C virus (HCV), chronic alcohol abuse, or metabolic syndrome (frequent in Western countries). In cirrhosis, hepatocarcinogenesis is a multi-step process where pre-cancerous dysplastic macronodules transform progressively into HCC. The patterns of genomic alterations observed in these tumors were recently identified and were instrumental for the identification of potential targeted therapies that could improve patient care. Liver cancer stem cells are a small subset of undifferentiated liver tumor cells, responsible for cancer initiation, metastasis, relapse and chemoresistance, enriched and isolated according to immunophenotypic and functional properties: cell surface proteins (CD133, CD90, CD44, EpCAM, OV-6, CD13, CD24, DLK1, α2δ1, ICAM-1 and CD47); the functional markers corresponding to side population, high aldehyde dehydrogenase (ALDH) activity and autofluorescence. The identification and definition of liver cancer stem cells requires both immunophenotypic and functional properties.
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Affiliation(s)
- Germana Castelli
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00141, Italy.
| | - Elvira Pelosi
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00141, Italy.
| | - Ugo Testa
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00141, Italy.
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345
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Valle JW, Lamarca A, Goyal L, Barriuso J, Zhu AX, Knittel G, Leeser U, van Oers J, Edelmann W, Heukamp LC, Reinhardt HC. New Horizons for Precision Medicine in Biliary Tract Cancers. Cancer Discov 2017. [PMID: 28818953 DOI: 10.1158/2159-8290] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary tract cancers (BTC), including cholangiocarcinoma and gallbladder cancer, are poor-prognosis and low-incidence cancers, although the incidence of intrahepatic cholangiocarcinoma is rising. A minority of patients present with resectable disease but relapse rates are high; benefit from adjuvant capecitabine chemotherapy has been demonstrated. Cisplatin/gemcitabine combination chemotherapy has emerged as the reference first-line treatment regimen; there is no standard second-line therapy. Selected patients may be suitable for liver-directed therapy (e.g., radioembolization or external beam radiation), pending confirmation of benefit in randomized studies. Initial trials targeting the epithelial growth factor receptor and angiogenesis pathways have failed to deliver new treatments. Emerging data from next-generation sequencing analyses have identified actionable mutations (e.g., FGFR fusion rearrangements and IDH1 and IDH2 mutations), with several targeted drugs entering clinical development with encouraging results. The role of systemic therapies, including targeted therapies and immunotherapy for BTC, is rapidly evolving and is the subject of this review.Significance: The authors address genetic drivers and molecular biology from a translational perspective, in an intent to offer a clear view of the recent past, present, and future of BTC. The review describes a state-of-the-art update of the current status and future directions of research and therapy in advanced BTC. Cancer Discov; 7(9); 943-62. ©2017 AACR.
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Affiliation(s)
- Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK. .,Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, UK
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - Lipika Goyal
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK.,Faculty of Medical, Biological and Human Sciences, University of Manchester, Rumford Street, Manchester, UK
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
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346
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Valle JW, Lamarca A, Goyal L, Barriuso J, Zhu AX. New Horizons for Precision Medicine in Biliary Tract Cancers. Cancer Discov 2017; 7:943-962. [PMID: 28818953 DOI: 10.1158/2159-8290.cd-17-0245] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
Biliary tract cancers (BTC), including cholangiocarcinoma and gallbladder cancer, are poor-prognosis and low-incidence cancers, although the incidence of intrahepatic cholangiocarcinoma is rising. A minority of patients present with resectable disease but relapse rates are high; benefit from adjuvant capecitabine chemotherapy has been demonstrated. Cisplatin/gemcitabine combination chemotherapy has emerged as the reference first-line treatment regimen; there is no standard second-line therapy. Selected patients may be suitable for liver-directed therapy (e.g., radioembolization or external beam radiation), pending confirmation of benefit in randomized studies. Initial trials targeting the epithelial growth factor receptor and angiogenesis pathways have failed to deliver new treatments. Emerging data from next-generation sequencing analyses have identified actionable mutations (e.g., FGFR fusion rearrangements and IDH1 and IDH2 mutations), with several targeted drugs entering clinical development with encouraging results. The role of systemic therapies, including targeted therapies and immunotherapy for BTC, is rapidly evolving and is the subject of this review.Significance: The authors address genetic drivers and molecular biology from a translational perspective, in an intent to offer a clear view of the recent past, present, and future of BTC. The review describes a state-of-the-art update of the current status and future directions of research and therapy in advanced BTC. Cancer Discov; 7(9); 943-62. ©2017 AACR.
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Affiliation(s)
- Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK. .,Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, UK
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - Lipika Goyal
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK.,Faculty of Medical, Biological and Human Sciences, University of Manchester, Rumford Street, Manchester, UK
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
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347
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Verlingue L, Hollebecque A, Boige V, Ducreux M, Malka D, Ferté C. Matching genomic molecular aberrations with molecular targeted agents: Are biliary tract cancers an ideal playground? Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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348
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Jusakul A, Cutcutache I, Yong CH, Lim JQ, Huang MN, Padmanabhan N, Nellore V, Kongpetch S, Ng AWT, Ng LM, Choo SP, Myint SS, Thanan R, Nagarajan S, Lim WK, Ng CCY, Boot A, Liu M, Ong CK, Rajasegaran V, Lie S, Lim AST, Lim TH, Tan J, Loh JL, McPherson JR, Khuntikeo N, Bhudhisawasdi V, Yongvanit P, Wongkham S, Totoki Y, Nakamura H, Arai Y, Yamasaki S, Chow PKH, Chung AYF, Ooi LLPJ, Lim KH, Dima S, Duda DG, Popescu I, Broet P, Hsieh SY, Yu MC, Scarpa A, Lai J, Luo DX, Carvalho AL, Vettore AL, Rhee H, Park YN, Alexandrov LB, Gordân R, Rozen SG, Shibata T, Pairojkul C, Teh BT, Tan P. Whole-Genome and Epigenomic Landscapes of Etiologically Distinct Subtypes of Cholangiocarcinoma. Cancer Discov 2017; 7:1116-1135. [PMID: 28667006 DOI: 10.1158/2159-8290.cd-17-0368] [Citation(s) in RCA: 572] [Impact Index Per Article: 81.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/07/2017] [Accepted: 06/28/2017] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma (CCA) is a hepatobiliary malignancy exhibiting high incidence in countries with endemic liver-fluke infection. We analyzed 489 CCAs from 10 countries, combining whole-genome (71 cases), targeted/exome, copy-number, gene expression, and DNA methylation information. Integrative clustering defined 4 CCA clusters-fluke-positive CCAs (clusters 1/2) are enriched in ERBB2 amplifications and TP53 mutations; conversely, fluke-negative CCAs (clusters 3/4) exhibit high copy-number alterations and PD-1/PD-L2 expression, or epigenetic mutations (IDH1/2, BAP1) and FGFR/PRKA-related gene rearrangements. Whole-genome analysis highlighted FGFR2 3' untranslated region deletion as a mechanism of FGFR2 upregulation. Integration of noncoding promoter mutations with protein-DNA binding profiles demonstrates pervasive modulation of H3K27me3-associated sites in CCA. Clusters 1 and 4 exhibit distinct DNA hypermethylation patterns targeting either CpG islands or shores-mutation signature and subclonality analysis suggests that these reflect different mutational pathways. Our results exemplify how genetics, epigenetics, and environmental carcinogens can interplay across different geographies to generate distinct molecular subtypes of cancer.Significance: Integrated whole-genome and epigenomic analysis of CCA on an international scale identifies new CCA driver genes, noncoding promoter mutations, and structural variants. CCA molecular landscapes differ radically by etiology, underscoring how distinct cancer subtypes in the same organ may arise through different extrinsic and intrinsic carcinogenic processes. Cancer Discov; 7(10); 1116-35. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 1047.
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Affiliation(s)
- Apinya Jusakul
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,The Centre for Research and Development of Medical Diagnostic Laboratories and Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Ioana Cutcutache
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Chern Han Yong
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Jing Quan Lim
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Division of Medical Oncology, Singapore
| | - Mi Ni Huang
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Nisha Padmanabhan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
| | - Vishwa Nellore
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
| | - Sarinya Kongpetch
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Alvin Wei Tian Ng
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - Ley Moy Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Swe Swe Myint
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Raynoo Thanan
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sanjanaa Nagarajan
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Weng Khong Lim
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Arnoud Boot
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Mo Liu
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Division of Medical Oncology, Singapore
| | - Vikneswari Rajasegaran
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Stefanus Lie
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Alvin Soon Tiong Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Tse Hui Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Jing Tan
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Jia Liang Loh
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - John R McPherson
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Narong Khuntikeo
- Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Puangrat Yongvanit
- Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sopit Wongkham
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yasushi Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Hiromi Nakamura
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Satoshi Yamasaki
- Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Japan
| | - Pierce Kah-Hoe Chow
- Division of Surgical Oncology, National Cancer Center Singapore and Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary/Transplant Surgery, Singapore General Hospital, Singapore
| | | | - Kiat Hon Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Simona Dima
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Dan G Duda
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irinel Popescu
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Philippe Broet
- DHU Hepatinov, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Aldo Scarpa
- Applied Research on Cancer Centre (ARC-Net), University and Hospital Trust of Verona, Verona, Italy
| | - Jiaming Lai
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China
| | - Di-Xian Luo
- National and Local Joint Engineering Laboratory of High-through Molecular Diagnostic Technology, the First People's Hospital of Chenzhou, Southern Medical University, Chenzhou, P. R. China
| | | | - André Luiz Vettore
- Laboratory of Cancer Molecular Biology, Department of Biological Sciences, Federal University of São Paulo, Rua Pedro de Toledo, São Paulo, Brazil
| | - Hyungjin Rhee
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea
| | - Ludmil B Alexandrov
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, and Center for Nonlinear Studies, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - Raluca Gordân
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina. .,Department of Computer Science, Duke University, Durham, North Carolina
| | - Steven G Rozen
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Centre for Computational Biology, Duke-NUS Medical School, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan. .,Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Japan
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Bin Tean Teh
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore.,Institute of Molecular and Cell Biology, Singapore
| | - Patrick Tan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore.,Genome Institute of Singapore, Singapore
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349
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Xue R, Li J, Bai F, Wang X, Ji J, Lu Y. A race to uncover a panoramic view of primary liver cancer. Cancer Biol Med 2017; 14:335-340. [PMID: 29372099 PMCID: PMC5785169 DOI: 10.20892/j.issn.2095-3941.2017.0112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ruidong Xue
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China.,Translational Cancer Research Center, Peking University First Hospital, Beijing 100034, China.,Biodynamic Optical Imaging Center (BIOPIC), School of Life Sciences, Peking University, Beijing 100871, China
| | - Jing Li
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China.,Translational Cancer Research Center, Peking University First Hospital, Beijing 100034, China
| | - Fan Bai
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China
| | - Xinwei Wang
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China
| | - Junfang Ji
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China
| | - Yinying Lu
- Comprehensive Liver Cancer Center, Beijing 302 Hospital of PLA, Beijing 100039, China
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