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Wei W, Gong C, Wei R, Luo X, Liu Y, Chen G, Ran R, Liu F. Metastatic prostate cancer presenting as generalized lymphadenopathy and progressing with inferior vena cava syndrome: A case report and literature review. Oncol Lett 2024; 28:557. [PMID: 39355785 PMCID: PMC11443306 DOI: 10.3892/ol.2024.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/18/2024] [Indexed: 10/03/2024] Open
Abstract
The present study describes the case of a 71-year-old male patient that presented with generalized lymphadenopathy and a pelvic mass, but no signs of bone and visceral metastasis. Their total prostate-specific antigen level was >100 ng/ml. A biopsy of the pelvic mass, situated near the left iliac vessels, confirmed the existence of an adenocarcinoma originating from the prostate and a subsequent prostate biopsy indicated a Gleason score of 4+5. Endocrine treatment with bicalutamide and goserelin (androgen deprivation therapy) resulted in only a partial response of the left iliac metastatic lesions to the treatment. The subsequent treatment plan of androgen deprivation therapy and abiraterone plus docetaxel did not change the progression of the disease. The patient finally developed inferior vena cava syndrome. Subsequently, the patient declined both a re-biopsy of the prostate and enlarged cervical lymph nodes, and interventions by a vascular surgeon. To the best of our knowledge, the present study is the first documented case of a natural progression of metastatic prostate cancer with inferior vena cava syndrome.
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Affiliation(s)
- Wen Wei
- Department of Urology, West China Tianfu Hospital of Sichuan University, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Chunyu Gong
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Renjie Wei
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Xu Luo
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Yuhao Liu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Guo Chen
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Ruitu Ran
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Fudong Liu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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Ullah A, Yasinzai AQK, Lee KT, Chaudhury T, Chaudhury H, Chandasir A, Wali A, Waheed A, Tareen B, Khan M, Goyal A, Iqbal A, Sohail AH, Maan S, Sheikh AB, Ghafouri SAR, Khan I, Del Rivero J, Karki NR. Prognostic Nomogram Predicting Survival and Propensity Score Matching with Demographics and Comparative Analysis of Prostate Small Cell and Large Cell Neuroendocrine Carcinoma. J Clin Med 2024; 13:4874. [PMID: 39201018 PMCID: PMC11355222 DOI: 10.3390/jcm13164874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: This retrospective study aims to examine the patient demographics, survival rates, and treatment methods for small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC) of prostate origin while also identifying the main differences between common types of prostate cancer with comparative analysis for survival. Methods: Our analysis utilized the Surveillance, Epidemiology, and End Results database (SEER), and data was collected from 2000-2020. Cox proportional hazards and chi-squared analysis were used for statistical analysis. Results: A total of 718 cases of prostate small and large neuroendocrine carcinoma were identified. The median age was 71.5 years, and the median follow-up was 11.0 years (95% confidence interval (95% CI) = 9.2-12.8). Most patients were over the age of 80 years (33.8%) and Caucasian (74.4%). The overall 5-year survival was 8.0% (95% CI = 6.8-9.2). The 5-year OS for Caucasians was 7.3% (95% C.I. 6.0-8.3). For Black Americans, the 5-year OS was 11.9% (95% C.I. 7.3-16.5). For Hispanics, the 5-year OS was 12.2% (95% C.I. 7.7-16.7). The 5-year cause-specific survival (CSS) was 16.2% (95% CI = 14.3-18.1). For treatment modality, the five-year survival for each were as follows: chemotherapy, 3.5% (95% CI = 2.1-4.9); surgery, 18.2% (95% CI = 13.6-22.8); multimodality therapy (surgery and chemotherapy), 4.8% (95% CI = 1.7-7.9); and combination (chemoradiation with surgery), 5.0% (95% CI = 1.0-9.0). The prognostic nomogram created to predict patient survivability matched the findings from the statistical analysis with a statistical difference found in race, income, housing, stage, and nodal status. The nomogram also indicated a slight increase in mortality with tumors of greater size. This analysis showed a slight increase in mortality for patients of Asian race. In addition, there was a significant increase in death for patients with stage 3 tumors, as well as patients who underwent surgery and radiation. Furthermore, we performed propensity score matching for survival differences, and no survival difference was found between SCNEC and LCNEC. Conclusions: Asian patients, larger tumor size, and distant disease were associated with worse long-term clinical outcomes. By leveraging insights from registry-based studies, clinicians can better strategize treatment options, improving patient outcomes in this challenging oncology arena.
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Affiliation(s)
- Asad Ullah
- Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.C.); (H.C.)
| | | | - Kue Tylor Lee
- Medical College of Georgia, Augusta, GA 30912, USA; (K.T.L.); (A.C.)
| | - Tristin Chaudhury
- Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.C.); (H.C.)
| | - Hannah Chaudhury
- Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.C.); (H.C.)
| | | | - Agha Wali
- Bolan Medical College, Quetta 83700, Pakistan; (A.W.); (B.T.)
| | - Abdul Waheed
- Department of Surgery, Baycare Health System, Clearwater, FL 33759, USA;
| | - Bisma Tareen
- Bolan Medical College, Quetta 83700, Pakistan; (A.W.); (B.T.)
| | - Marjan Khan
- Marshfield Clinics, Marshfield, WI 54449, USA;
| | - Aman Goyal
- Seth GS Medical College and KEM Hospital, Mumbai 400012, India;
| | | | - Amir Humza Sohail
- Department of Surgery, University of New Mexico, Albuquerque, NM 87106, USA;
| | - Soban Maan
- Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Sayed Ab Reshad Ghafouri
- Department of Hematology-Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Israr Khan
- Department of Medicine, Insight Hospital and Medical Center, Chicago, IL 60616, USA;
| | - Jaydira Del Rivero
- Division of Medical Oncology, National Institute of Health (NIH), Bethesda, MD 20814, USA;
| | - Nabin R. Karki
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
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Shitara K, Bang YJ, Iwasa S, Sugimoto N, Ryu MH, Sakai D, Chung HC, Kawakami H, Yabusaki H, Sakamoto Y, Nishina T, Inaki K, Kuwahara Y, Wada N, Suto F, Arita T, Sugihara M, Tsuchihashi Z, Saito K, Kojima A, Yamaguchi K. Trastuzumab deruxtecan in HER2-positive advanced gastric cancer: exploratory biomarker analysis of the randomized, phase 2 DESTINY-Gastric01 trial. Nat Med 2024; 30:1933-1942. [PMID: 38745009 PMCID: PMC11271396 DOI: 10.1038/s41591-024-02992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
Trastuzumab deruxtecan (T-DXd) showed statistically significant clinical improvement in patients with human epidermal growth factor receptor 2-positive (HER2+) gastric cancer in the DESTINY-Gastric01 trial. Exploratory results from DESTINY-Gastric01 suggested a potential benefit in patients with HER2-low gastric cancer. Spatial and temporal heterogeneity in HER2 expression or gene alteration, an inherent characteristic of gastric cancer tumors, presents a challenge in identifying patients who may respond to T-DXd. Specific biomarkers related to therapeutic response have not been explored extensively. Exploratory analyses were conducted to assess baseline HER2-associated biomarkers in circulating tumor DNA and tissue samples, and to investigate mechanisms of resistance to T-DXd. Baseline HER2-associated biomarkers were correlated with objective response rate (ORR) in the primary cohort of patients with HER2+ gastric cancer. The primary cohort had 64% concordance between HER2 positivity and HER2 (ERBB2) plasma gene amplification. Other key driver gene amplifications, specifically MET, EGFR and FGFR2, in circulating tumor DNA were associated with numerically lower ORR. Among 12 patients with HER2 gain-of-function mutations, ORR was 58.3% (7 of 12). ORR was consistent regardless of timing of immunohistochemistry sample collection. Further investigations are required in larger studies.
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Affiliation(s)
- Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan.
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yung-Jue Bang
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Min-Hee Ryu
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Tomohiro Nishina
- National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | | | | | - Naoya Wada
- Daiichi Sankyo RD Novare Co. Ltd, Tokyo, Japan
| | | | | | | | | | - Kaku Saito
- Daiichi Sankyo Inc., Basking Ridge, NJ, USA
| | | | - Kensei Yamaguchi
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Di Y, Song J, Song Z, Wang Y, Meng L. Prognostic nomogram to predict cancer-specific survival with small-cell carcinoma of the prostate: a multi-institutional study. Front Oncol 2024; 14:1349888. [PMID: 38800400 PMCID: PMC11116562 DOI: 10.3389/fonc.2024.1349888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Objective The aim of this study is to examine the predictive factors for cancer-specific survival (CSS) in patients diagnosed with Small-Cell Carcinoma of the Prostate (SCCP) and to construct a prognostic model. Methods Cases were selected using the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method was utilized to calculate survival rates, while Lasso and Cox regression were employed to analyze prognostic factors. An independent prognostic factor-based nomogram was created to forecast CSS at 12 and 24 months. The model's predictive efficacy was assessed using the consistency index (C-index), calibration curve, and decision curve analysis (DCA) in separate tests. Results Following the analysis of Cox and Lasso regression, age, race, Summary stage, and chemotherapy were determined to be significant risk factors (P < 0.05). In the group of participants who received training, the rate of 12-month CSS was 44.6%, the rate of 24-month CSS was 25.5%, and the median time for CSS was 10.5 months. The C-index for the training cohort was 0.7688 ± 0.024. As for the validation cohort, it was 0.661 ± 0.041. According to the nomogram, CSS was accurately predicted and demonstrated consistent and satisfactory predictive performance at both 12 months (87.3% compared to 71.2%) and 24 months (80.4% compared to 71.7%). As shown in the external validation calibration plot, the AUC for 12- and 24-month is 64.6% vs. 56.9% and 87.0% vs. 70.7%, respectively. Based on the calibration plot of the CSS nomogram at both the 12-month and 24-month marks, it can be observed that both the actual values and the nomogram predictions indicate a predominantly stable CSS. When compared to the AJCC staging system, DCA demonstrated a higher level of accuracy in predicting CSS through the use of a nomogram. Conclusion Clinical prognostic factors can be utilized with nomograms to forecast CSS in Small-Cell Carcinoma of the Prostate (SCCP).
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Affiliation(s)
- Yupeng Di
- Department of Radiotherapy, Air Force Medical Center, PLA, Beijing, China
| | - Jiazhao Song
- Department of Radiotherapy, Air Force Medical Center, PLA, Beijing, China
| | - Zhuo Song
- Department of Radiotherapy, Air Force Medical Center, PLA, Beijing, China
| | - Yingjie Wang
- Department of Radiotherapy, Air Force Medical Center, PLA, Beijing, China
| | - Lingling Meng
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
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de Kouchkovsky I, Chan E, Schloss C, Poehlein C, Aggarwal R. Diagnosis and management of neuroendocrine prostate cancer. Prostate 2024; 84:426-440. [PMID: 38173302 DOI: 10.1002/pros.24664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Although most patients with prostate cancer (PC) respond to initial androgen deprivation therapy (ADT), castration-resistant disease invariably develops. Progression to treatment-emergent neuroendocrine PC (t-NEPC) represents a unique mechanism of resistance to androgen receptor (AR)-targeted therapy in which lineage plasticity and neuroendocrine differentiation induce a phenotypic switch from an AR-driven adenocarcinoma to an AR-independent NEPC. t-NEPC is characterized by an aggressive clinical course, increased resistance to AR-targeted therapies, and a poor overall prognosis. METHODS This review provides an overview of our current knowledge of NEPC, with a focus on the unmet needs, diagnosis, and clinical management of t-NEPC. RESULTS Evidence extrapolated from the literature on small cell lung cancer or data from metastatic castration-resistant PC (mCRPC) cohorts enriched for t-NEPC suggests an increased sensitivity to platinum-based chemotherapy. However, optimal strategies for managing t-NEPC have not been established, and prospective clinical trial data are limited. Intertumoral heterogeneity within a given patient, as well as the lack of robust molecular or clinical biomarkers for early detection, often lead to delays in diagnosis and prolonged treatment with suboptimal strategies (i.e., conventional chemohormonal therapies for mCRPC), which may further contribute to poor outcomes. CONCLUSIONS Recent advances in genomic and molecular classification of NEPC and the development of novel biomarkers may facilitate an early diagnosis, help to identify promising therapeutic targets, and improve the selection of patients most likely to benefit from NEPC-targeted therapies.
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Affiliation(s)
- Ivan de Kouchkovsky
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
| | - Emily Chan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | | | | | - Rahul Aggarwal
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
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6
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Chen E, Yip PY, Tognela A, Gandy G, Earl C, Tran P, Kok PS. A comparison of the outcomes of pulmonary versus extrapulmonary extensive-stage small cell carcinoma. Intern Med J 2024; 54:414-420. [PMID: 38009656 DOI: 10.1111/imj.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Extrapulmonary small cell carcinomas (EPSCCs) are rare cancers, comprising 0.1-0.4% of all cancers. The scarcity of EPSCC studies has led current treatment strategies to be extrapolated from small cell lung cancer (SCLC), justified by analogous histological and clinical features. AIMS We conducted a retrospective cohort study comparing the outcomes of extensive-stage (ES) SCLC and EPSCC. METHODS Patients diagnosed with ES SCLC or EPSCC between 2010 and 2020 from four hospitals in Sydney were identified. Patients who received active treatment and best supportive care were included. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival (PFS) and overall response rates (ORRs). RESULTS Three hundred and eighty-four patients were included (43 EPSCC vs. 340 SCLC). EPSCC were of genitourinary (n = 15), unknown primary (n = 13) and gastrointestinal (n = 12) origin. Treatment modalities for EPSCC compared to SCLC included palliative chemotherapy (56% vs 73%), palliative radiotherapy (47% vs 59%) and consolidation chest radiotherapy (10% of SCLC). Overall, median OS was 6.4 versus 7 months for EPSCC versus SCLC respectively, but highest in prostate EPSCC (25.6 months). Of those who received chemotherapy (22 EPSCC vs 233 SCLC), median OS was 10.4 versus 8.4 months (HR OS 0.81, 95% confidence interval (CI): 0.5-1.31, P = 0.38); PFS was 5.4 versus 5.5 months (HR PFS 0.93, 95% CI: 0.58-1.46, P = 0.74) and ORR were 73% versus 68%. CONCLUSIONS EPSCC and SCLC appeared to have comparable OS and treatment outcomes. However, the wide range of OS in EPSCC highlights the need for an improved understanding of its genomics to explore alternative therapeutics.
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Affiliation(s)
- Emily Chen
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Po Y Yip
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Geovanny Gandy
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Clare Earl
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Patrick Tran
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Peey-Sei Kok
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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7
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Baralo B, Schneider M, Baralo I. Survival analysis of small cell carcinomas of the genitourinary system. Proc AMIA Symp 2022; 36:8-14. [PMID: 36578621 PMCID: PMC9762741 DOI: 10.1080/08998280.2022.2123664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Due to low incidence, there are no large prospective studies or clinical trials for small cell carcinoma (SCC) of the genitourinary system (GU), and most data are extrapolated from SCC of the lung. Using the SEER database, we analyzed incidence trends, overall survival, and cancer-specific survival using the log-rank test. Analysis of variables was performed using the Cox proportional hazards regression model. The analysis showed that SCC of the bladder and prostate were the most common types of GU SCC, with 1836 and 606 cases, respectively. In 2018, the incidence of SCC of the bladder and prostate was twice that of 2010 (P < 0.001). The overall survival and cancer-specific survival of patients with SCC of the bladder were significantly longer than those of patients with SCC of the prostate (P < 0.0001). SCC bladder patients with advanced age, more extensive growth, lymph node involvement, no surgical intervention, and the presence of the metastasis had worse survival outcomes (P < 0.05). The Asian/Pacific Islander race provided some survival benefits for patients with SCC of the bladder (P < 0.05). For patients with SCC of the prostate, only advanced age was a risk factor for poor outcomes (P < 0.05).
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Affiliation(s)
- Bohdan Baralo
- Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania,Corresponding author: Bohdan Baralo, MD, Internal Medicine, Mercy Catholic Medical Center, 1500 Lansdowne Ave., Box 40, Darby, PA19026 (e-mail: )
| | - Michael Schneider
- Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ihor Baralo
- Urology, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
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Nada MH, Wang H, Hussein AJ, Tanaka Y, Morita CT. PD-1 checkpoint blockade enhances adoptive immunotherapy by human Vγ2Vδ2 T cells against human prostate cancer. Oncoimmunology 2021; 10:1989789. [PMID: 34712512 PMCID: PMC8547840 DOI: 10.1080/2162402x.2021.1989789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human Vγ2Vδ2 (also termed Vγ9Vδ2) T cells play important roles in microbial and tumor immunity by monitoring foreign- and self-prenyl pyrophosphate metabolites in isoprenoid biosynthesis. Accumulation of isoprenoid metabolites after bisphosphonate treatment allows Vγ2Vδ2 T cells to recognize and kill tumors independently of their MHC expression or burden of non-synonymous mutations. Clinical trials with more than 400 patients show that adoptive immunotherapy with Vγ2Vδ2 T cells has few side effects but has resulted in only a few partial and complete remissions. Here, we have tested Vγ2Vδ2 T cells for expression of inhibitory receptors and determined whether adding PD-1 checkpoint blockade to adoptively transferred Vγ2Vδ2 T cells enhances immunity to human PC-3 prostate tumors in an NSG mouse model. We find that Vγ2Vδ2 T cells express PD-1, CTLA-4, LAG-3, and TIM-3 inhibitory receptors during the 14-day ex vivo expansion period, and PD-1, LAG-3, and TIM-3 upon subsequent stimulation by pamidronate-treated tumor cells. Expression of PD-L1 on PC-3 prostate cancer cells was increased by co-culture with activated Vγ2Vδ2 T cells. Importantly, anti-PD-1 mAb treatment enhanced Vγ2Vδ2 T cell immunity to PC-3 tumors in immunodeficient NSG mice, reducing tumor volume nearly to zero after 5 weeks. These results demonstrate that PD-1 checkpoint blockade can enhance the effectiveness of adoptive immunotherapy with human γδ T cells in treating prostate tumors in a preclinical model.
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Affiliation(s)
- Mohanad H Nada
- Department of Veterans Affairs, Iowa City Veterans Health Care System, Iowa City, IA, USA.,Division of Immunology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Pathology, College of Medicine, Tikrit University, Tikrit, Iraq.,Department of Medical and Health Sciences, The American University of Iraq, Sulaimani, Sulaymaniah, Iraq
| | - Hong Wang
- Department of Veterans Affairs, Iowa City Veterans Health Care System, Iowa City, IA, USA.,Division of Immunology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Auter J Hussein
- Department of Veterans Affairs, Iowa City Veterans Health Care System, Iowa City, IA, USA.,Salah Al-Din Directorate of Health, Ministry of Health, Iraq
| | - Yoshimasa Tanaka
- Center for Medical Innovation, Nagasaki University, Nagasaki Japan
| | - Craig T Morita
- Department of Veterans Affairs, Iowa City Veterans Health Care System, Iowa City, IA, USA.,Division of Immunology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Interdisciplinary Graduate Program in Immunology,University of Iowa Carver College of Medicine, Iowa City, IA, USA
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9
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Wee CE, Costello BA, Orme JJ, Quevedo JF, Pagliaro LC. Chemotherapy with atezolizumab for small cell or neuroendocrine carcinoma of the prostate: A single institution experience. Prostate 2021; 81:938-943. [PMID: 34254332 DOI: 10.1002/pros.24189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chemotherapy in combination with immunotherapy has a proven survival benefit compared to chemotherapy alone in extensive stage small cell lung cancer (SCLC) and is the new standard of care. Since extrapulmonary small cell carcinomas (SCCs) are less common, treatment paradigms are reasonably extrapolated from SCLC regimens. We examined our institution's experience utilizing the combination of chemotherapy and immunotherapy (as used in SCLC) for SCC and neuroendocrine carcinoma of the prostate. METHODS Utilizing an institutional database search tool, we queried the electronic medical record to identify patients with SCC or neuroendocrine carcinoma of the prostate who had been treated with atezolizumab and chemotherapy. We recorded patient characteristics, including age, pathology, and disease extent. Treatment characteristics included number of prior treatments, use of concominant androgen deprivation, number of cycles of immunotherapy, and prior systemic therapies (including those for adenocarcinoma of the prostate). Progression free survival (PFS) and overall survival (OS) were the primary outcomes. RESULTS We identified seven men who received atezolizumab for metastatic prostate cancer with a small cell or neuroendocrine component. In six of the seven patients, the combination of carboplatin, etoposide, and atezolizumab was the first-line of treatment after diagnosis of small cell or neuroendocrine carcinoma. Two of the seven patients had de novo small cell/neuroendocrine pathology, while the other five had transformation from a preexisting adenocarcinoma. In the patients who received chemotherapy plus immunotherapy in the first-line setting, at a median follow-up of 6.5 months (range: 1.5-15.1) the median PFS was 3.4 months and median OS was 8.4 months. CONCLUSION Small cell or neuroendocrine carcinoma of the prostate was associated with poor survival outcomes despite adding immunotherapy (atezolizumab) to chemotherapy (carboplatin and etoposide). To our knowledge, there has been no demonstrable benefit of adding immunotherapy to chemotherapy in this setting.
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Affiliation(s)
- Christopher E Wee
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Costello
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob J Orme
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lance C Pagliaro
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Henriques V, Wenzel M, Demes MC, Köllermann J. [Metastatic castration-resistant prostate cancer]. DER PATHOLOGE 2021; 42:431-441. [PMID: 34170384 DOI: 10.1007/s00292-021-00956-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/01/2022]
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is considered as the final stage of the disease with limited therapeutic options to date. In this article, we review recent histopathologic and molecular pathologic findings that may expand our understanding of the disease and may lay, or have already laid the groundwork for the development of novel and individualized therapies. These include the detection of pathogenic mutations in the DNA repair genes BRCA1/2, androgen receptor splice variant 7 (AR-V7), deletion of the tumor suppressor gene PTEN, and evidence of neuroendocrine prostate cancer (t-NEPC) arising under antiandrogenic therapy. The theoretical and diagnostic basis behind the increasing relevance of pathology for therapeutic guidance in this stage of disease are presented.
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Affiliation(s)
- Vanessa Henriques
- Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland.
| | - Mike Wenzel
- Klinik für Urologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Quebec, Montreal, Kanada
| | - Melanie-Christin Demes
- Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland
| | - Jens Köllermann
- Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland
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Pepe P, Pepe L, Curdman M, Pennisi M, Fraggetta F. Primitive small cell carcinoma of the prostate. Case report and revision of the literature. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348972 DOI: 10.4081/aiua.2020.4.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
A Caucasian man 84 years old was admitted to our Department for acute renal failure secondary to severe bilateral hydronephrosis; moreover, the patient referred chronic fatigue and was anuric from two days. Serum creatinine and PSA values were equal to 9.6 mg/dl and 4.8 ng/ml and digital rectal examination was highly suspicious for prostate cancer. In emergency, the patient underwent bilateral application of percutaneous renal nephrostomies to restore kidney function and, after three days, was submitted to ultrasound-guided extended transperineal biopsy; the histology showed the presence of a prostatic small cell carcinoma (SCC) fulfilling the World Health Organization criteria. The patient underwent clinical staging including chest and abdominal computed tomography evaluation and total body scan that did not demonstrated distant metastases and/or others primitive tumors; in addition, cystoscopy and urinary cytology were negative. The patient underwent multidisciplinary evaluation, but he died 20 days from the diagnosis for progressive clinical worsening (physical and cognitive impairments) before beginning oncological treatment. In conclusion, primitive SCC represents a very rare cancer provided of poor prognosis; only the execution of prostate biopsy combined with an accurate specimen analysis allow to make the correct diagnosis and therapeutic treatment.
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Affiliation(s)
- Pietro Pepe
- Urology Unit - Cannizzaro Hospital, Catania.
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Montironi R, Cimadamore A, Lopez-Beltran A, Scarpelli M, Aurilio G, Santoni M, Massari F, Cheng L. Morphologic, Molecular and Clinical Features of Aggressive Variant Prostate Cancer. Cells 2020; 9:cells9051073. [PMID: 32344931 PMCID: PMC7291250 DOI: 10.3390/cells9051073] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
The term aggressive variant prostate cancer (AVPCa) refers to androgen receptor (AR)-independent anaplastic forms of prostate cancer (PCa), clinically characterized by a rapidly progressive disease course. This involves hormone refractoriness and metastasis in visceral sites. Morphologically, AVPCa is made up of solid sheets of cells devoid of pleomorphism, with round and enlarged nuclei with prominent nucleoli and slightly basophilic cytoplasm. The cells do not show the typical architectural features of prostatic adenocarcinoma and mimic the undifferentiated carcinoma of other organs and locations. The final diagnosis is based on the immunohistochemical expression of markers usually seen in the prostate, such as prostate-specific membrane antigen (PSMA). A subset of AVPCa can also express neuroendocrine (NE) markers such as chromogranin A, synaptophysin and CD56. This letter subset represents an intermediate part of the spectrum of NE tumors which ranges from small cell to large cell carcinoma. All such tumors can develop following potent androgen receptor pathway inhibition. This means that castration-resistant prostate cancer (CRPCa) transdifferentiates and becomes a treatment-related NE PCa in a clonally divergent manner. The tumors that do not show NE differentiation might harbor somatic and/or germline alterations in the DNA repair pathway. The identification of these subtypes has direct clinical relevance with regard to the potential benefit of platinum-based chemotherapy, poly (ADP-ribose) polymerase inhibitors and likely further therapies.
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Affiliation(s)
- Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, 60126 Ancona, Italy; (A.C.); (M.S.)
- Correspondence: ; Tel.: +39-071-5964830
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, 60126 Ancona, Italy; (A.C.); (M.S.)
| | | | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, 60126 Ancona, Italy; (A.C.); (M.S.)
| | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62012 Macerata, Italy;
| | - Francesco Massari
- Division of Oncology, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Wang J, Liu X, Wang Y, Ren G. Current trend of worsening prognosis of prostate small cell carcinoma: A population-based study. Cancer Med 2019; 8:6799-6806. [PMID: 31518071 PMCID: PMC6825972 DOI: 10.1002/cam4.2551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the accurate age-adjusted incidence of prostate small cell carcinoma (SCC), update the clinical and pathological characteristics, as well as survival data of prostate SCC from Surveillance, Epidemiology, and End Results (SEER) datasets. METHODS A total of 260 patients with prostate SCC were selected from the SEER database of the National Cancer Institute between 2004 and 2015. Age-adjusted incidence (AAI) rates, the observed and relative survival rates were evaluated over time by the SEER*Stat Software version 8.3.5. Overall survival (OS) rates that stratified by summary stage and treatment effects were evaluated by Kaplan-Meier method. The significant differences were assessed in a log-rank test. Univariate and multivariate cox hazard regression analysis were performed to determine independent predictors of OS. RESULTS The incidence of prostate SCC has increased over time. The average age of prostate SCC patients was 70.25 years. More than 90% of tumors were poorly differentiated or undifferentiated. The majority of prostate SCC (77.7%) was at stage IV. 49% of patients had lymph node metastases and 68% of patients presented distant metastases (Compared with 60.5% of patients with distant metastases between 1973-2003). Interestingly only 23.5% patients had high level PSA (>10 ng/mL). 58.8% of patients underwent chemotherapy, 25.4% of patients were treated by surgery, and 31.9% of patients were treated by radiotherapy. The observed survival rates of 1-year, 2-year, and 5-year were 42.1%, 22.1%, and 12.5%, respectively (Compared with 47.9%, 27.5%, and 14.3%, respectively, between 1973 and 2003). Chemotherapy prolonged the OS of patients with regional (distant) metastases from 3 months (2 months) to 12 months (9 months). Multivariate cox regression analysis showed age, race, and stage were independent prognostic factors for prostate SCC patients. CONCLUSION Prostate SCC is a highly malignant cancer and our analysis of recent data has shown its incidence is increasing. Incidence rate of metastatic prostate SCC has increased and the survival rates have worsened in recent years. However, chemotherapy shows some survival benefit for prostate SCC patients with regional and distant metastasis over other treatment methods. Further work is needed to understand the reason prognosis of this type prostate cancer is worsening.
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Affiliation(s)
- Jili Wang
- Department of PathologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of Pathology and PathophysiologyZhejiang University School of MedicineHangzhouChina
| | - Xiaoyan Liu
- Department of PathologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yan Wang
- Department of PathologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of Pathology and PathophysiologyZhejiang University School of MedicineHangzhouChina
| | - Guoping Ren
- Department of PathologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of Pathology and PathophysiologyZhejiang University School of MedicineHangzhouChina
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