1
|
Soliman O, Wilde DC, Kemnade JO, Sabichi AL, Chen G, Chen A, Little SN, Huang AT, Hernandez DJ, Sandulache VC. Deployment of cisplatin in Veterans with oropharyngeal cancer: toxicity and impact on oncologic outcomes. Laryngoscope Investig Otolaryngol 2023; 8:895-902. [PMID: 37621289 PMCID: PMC10446265 DOI: 10.1002/lio2.1115] [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: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Cisplatin forms the backbone of systemic chemotherapy treatment for oropharyngeal squamous cell carcinoma (OPSCC). The ideal cisplatin dosing regimen remains yet to be fully defined for achieving optimal efficacy and toxicity profiles in patients with comorbidity. Methods We retrospectively reviewed oncologic and toxicity data for patients with OPSCC treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2020 who initiated curative intent, definitive chemo-radiation with one of three single agent regimens: high dose (HD) cisplatin, low dose (LD) cisplatin or cetuximab. Results Patients with HPV-associated tumors and nonsmokers demonstrated improved overall and disease-free survival along with locoregional and distant metastatic control regardless of chemotherapy regimen. Regardless of regimen selection, patients which received a cumulative cisplatin dose ≥200 mg/m2 had a lower rate of distant metastasis. The HD regimen resulted in a greater fraction (75% vs. 50%) of patients receiving a cumulative cisplatin dose ≥200 mg/m2 and a comparable measured toxicity burden compared to the LD regimen. Conclusions Both HD and LD cisplatin regimens can be safely delivered to a Veteran OPSCC patient population which should allow for straightforward application of conclusions drawn from completed and active clinical trials testing cisplatin regimens. Level of Evidence 4.
Collapse
Affiliation(s)
- Ola Soliman
- Bobby R. Alford Department of Otolaryngology Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - David C. Wilde
- Bobby R. Alford Department of Otolaryngology Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Jan O. Kemnade
- Hematology Oncology Section, Medical Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- Department of Internal Medicine, Section of Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - Anita L. Sabichi
- Hematology Oncology Section, Medical Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- Department of Internal Medicine, Section of Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - George Chen
- Department of Radiation OncologyBaylor College of MedicineHoustonTexasUSA
- Radiation Oncology Section, Diagnostic and Therapeutic Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Albert Chen
- Department of Radiation OncologyBaylor College of MedicineHoustonTexasUSA
- Radiation Oncology Section, Diagnostic and Therapeutic Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Samantha N. Little
- ENT Section, Operative Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Andrew T. Huang
- Bobby R. Alford Department of Otolaryngology Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- ENT Section, Operative Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - David J. Hernandez
- Bobby R. Alford Department of Otolaryngology Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- ENT Section, Operative Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- ENT Section, Operative Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- Center for Translational Research on Inflammatory DiseasesMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| |
Collapse
|
2
|
Koyuncu CF, Frederick MJ, Thompson LDR, Corredor G, Khalighi S, Zhang Z, Song B, Lu C, Nag R, Sankar Viswanathan V, Gilkey M, Yang K, Koyfman SA, Chute DJ, Castro P, Lewis JS, Madabhushi A, Sandulache VC. Machine learning driven index of tumor multinucleation correlates with survival and suppressed anti-tumor immunity in head and neck squamous cell carcinoma patients. Oral Oncol 2023; 143:106459. [PMID: 37307602 PMCID: PMC10330801 DOI: 10.1016/j.oraloncology.2023.106459] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Matching treatment intensity to tumor biology is critical to precision oncology for head and neck squamous cell carcinoma (HNSCC) patients. We sought to identify biological features of tumor cell multinucleation, previously shown by us to correlate with survival in oropharyngeal (OP) SCC using a machine learning approach. MATERIALS AND METHODS Hematoxylin and eosin images from an institutional OPSCC cohort formed the training set (DTr). TCGA HNSCC patients (oral cavity, oropharynx and larynx/hypopharynx) formed the validation set (DV). Deep learning models were trained in DTr to calculate a multinucleation index (MuNI) score. Gene set enrichment analysis (GSEA) was then used to explore correlations between MuNI and tumor biology. RESULTS MuNI correlated with overall survival. A multivariable nomogram that included MuNI, age, race, sex, T/N stage, and smoking status yielded a C-index of 0.65, and MuNI was prognostic of overall survival (2.25, 1.07-4.71, 0.03), independent of the other variables. High MuNI scores correlated with depletion of effector immunocyte subsets across all HNSCC sites independent of HPV and TP53 mutational status although the correlations were strongest in wild-type TP53 tumors potentially due to aberrant mitotic events and activation of DNA-repair mechanisms. CONCLUSION MuNI is associated with survival in HNSCC across subsites. This may be driven by an association between high levels of multinucleation and a suppressive (potentially exhausted) tumor immune microenvironment. Mechanistic studies examining the link between multinucleation and tumor immunity will be required to characterize biological drivers of multinucleation and their impact on treatment response and outcomes.
Collapse
Affiliation(s)
- Can F Koyuncu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Mitchell J Frederick
- Bobby R. Alford Department of Otolaryngology- Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Germán Corredor
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Sirvan Khalighi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Zelin Zhang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Bolin Song
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Cheng Lu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Reetoja Nag
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Vidya Sankar Viswanathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Michael Gilkey
- Atlanta Veterans Administration Medical Center, Atlanta, GA, United States
| | - Kailin Yang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland OH, United States
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland OH, United States
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Patricia Castro
- Department of Pathology, Baylor College of Medicine, Houston, TX, United States
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Atlanta Veterans Administration Medical Center, Atlanta, GA, United States.
| | - Vlad C Sandulache
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.
| |
Collapse
|
3
|
Tarle M, Raguž M, Muller D, Lukšić I. Nuclear Epidermal Growth Factor Receptor Overexpression as a Survival Predictor in Oral Squamous Cell Carcinoma. Int J Mol Sci 2023; 24:ijms24065816. [PMID: 36982894 PMCID: PMC10056291 DOI: 10.3390/ijms24065816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this study was to determine, by immunohistochemical methods, the expression of nEGFR and markers of cell proliferation (Ki-67), cell cycle (mEGFR, p53, cyclin D1), and tumor stem cells (ABCG2) in 59 pathohistological samples of healthy oral mucosa, 50 oral premalignant changes (leukoplakia and erythroplakia), and 52 oral squamous cell carcinomas (OSCC). An increase in the expression of mEGFR and nEGFR was found with the development of the disease (p < 0.0001). In the group of patients with leukoplakia and erythroplakia, we found a positive correlation between nEGFR and Ki67, p53, cyclin D1, and mEGFR, whereas in the group of patients with OSCC, we found a positive correlation between nEGFR and Ki67, mEGFR (p < 0.05). Tumors without perineural (PNI) invasion had a higher expression of p53 protein than tumors with PNI (p = 0.02). Patients with OSCC and overexpression of nEGFR had shorter overall survival (p = 0.004). The results of this study suggest a potentially important independent role of nEGFR in oral carcinogenesis.
Collapse
Affiliation(s)
- Marko Tarle
- Department of Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Danko Muller
- Department of Pathology and Cytology, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivica Lukšić
- Department of Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
4
|
Otsuru M, Yanamoto S, Yamada SI, Nakashiro K, Harazono Y, Kohgo T, Nakamura M, Nomura T, Kasamatsu A, Tanaka S, Kirita T, Kioi M, Ogawa M, Sasaki M, Ota Y, Umeda M. Radiotherapy Plus Cetuximab for Squamous Cell Carcinoma of the Oral Cavity: A Multicenter Retrospective Study of 79 Patients in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4545. [PMID: 36901553 PMCID: PMC10002461 DOI: 10.3390/ijerph20054545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
There are a few reports that focus on radiotherapy (RT) and cetuximab (CET) therapy exclusively for oral cancer. This retrospective study aimed to investigate the efficacy and safety of RT and CET therapy for locally advanced (LA) or recurrent/metastatic (R/M) oral squamous cell carcinoma (OSCC). Seventy-nine patients from 13 hospitals who underwent RT and CET therapy for LA or R/M OSCC between January 2013 and May 2015 were enrolled in the study. Response, overall survival (OS), disease-specific survival (DSS), and adverse events were investigated. The completion rate was 62/79 (78.5%). The response rates in patients with LA and R/M OSCC were 69% and 37.8%, respectively. When only completed cases were examined, the response rates were 72.2% and 62.9%, respectively. The 1- and 2-year OS were 51.5% and 27.8%, respectively (median, 14 months), for patients with LA OSCC, and 41.5% and 11.9% (median, 10 months) for patients with R/M OSCC. The 1- and 2-year DSS were 61.8% and 33.4%, respectively (median, 17 months), for patients with LA OSCC, and 76.6% and 20.4% (median, 12 months) for patients with R/M OSCC. The most common adverse event was oral mucositis (60.8%), followed by dermatitis, acneiform rash, and paronychia. The completion rate was 85.7% in LA patients and 70.3% in R/M patients. The most common reason for noncompletion was an inadequate radiation dose due to worsening general conditions in R/M patients. Although the standard treatment for LA or R/M oral cancer is concomitant RT with high-dose cisplatin (CCRT) and the efficacy of RT and CET therapy for oral cancer is not considered to be as high as that for other head and neck cancers, it was thought that RT and CET therapy could be possible treatments for patients who cannot use high-dose cisplatin.
Collapse
Affiliation(s)
- Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Souichi Yanamoto
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Shin-ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Toyama, Toyama 930-8555, Japan
| | - Kohichi Nakashiro
- Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Yosuke Harazono
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Tomoyuki Kohgo
- Department of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital, Sapporo 003-0026, Japan
| | - Moriyoshi Nakamura
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Takeshi Nomura
- Oral Cancer Center, Tokyo Dental College, Chiba 272-8513, Japan
| | - Atsushi Kasamatsu
- Department of Oral Science, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Susumu Tanaka
- The 1st Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara 634-8521, Japan
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Masaru Ogawa
- Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Masashi Sasaki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| |
Collapse
|
5
|
Hitt R, Mesía R, Lozano A, Iglesias Docampo L, Grau JJ, Taberna M, Rubió-Casadevall J, Martínez-Trufero J, Morillo EDB, García Girón C, Vázquez Estévez S, Cirauqui B, Cruz-Hernández JJ. Randomized phase 3 noninferiority trial of radiotherapy and cisplatin vs radiotherapy and cetuximab after docetaxel-cisplatin-fluorouracil induction chemotherapy in patients with locally advanced unresectable head and neck cancer. Oral Oncol 2022; 134:106087. [PMID: 36126605 DOI: 10.1016/j.oraloncology.2022.106087] [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: 07/22/2021] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Concurrent chemoradiotherapy is the standard treatment for patients with unresectable, locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN); induction chemotherapy (ICT) may provide survival benefits in some patients. This study aimed to demonstrate the noninferiority of concomitant cetuximab plus radiotherapy (cet+RT) vs cisplatin plus radiotherapy (cis+RT) in patients with unresectable LA-SCCHN who were responsive to ICT. MATERIALS AND METHODS This randomized, open-label, phase 3 trial studied patients with unresectable LA-SCCHN who received 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil; TPF) followed by cis+RT (standard arm) or cet+RT (experimental arm). The primary endpoint was noninferiority of the experimental arm vs the standard arm in terms of overall survival (OS), based on a hazard ratio (HR) of < 1.3. Secondary endpoints included progression-free survival, overall response, safety, and quality of life (QOL). RESULTS Between July 15, 2008, and July 5, 2013, 519 patients were recruited and started ICT; 407 patients received post-ICT treatment (cis+RT, n = 205; cet+RT, n = 202). At a median follow-up of 43.9 (cis+RT) and 41.1 (cet+RT) months, median OS was 63.6 and 42.9 months with cis+RT and cet+RT, respectively (HR [90% CI] = 1.106 [0.888-1.378], P =.4492). There were no differences in progression-free survival, overall response rates, or adverse event rates between groups. There was greater late neurotoxicity with cis+RT than cet+RT (P =.0058). Several QOL dimensions improved with cet+RT vs cis+RT (physical functioning, P =.0287; appetite loss, P =.0248; social contact, P =.0153). CONCLUSION Noninferiority of cet+RT over cis+RT was not demonstrated.
Collapse
Affiliation(s)
- Ricardo Hitt
- Medical Oncology Service, University Hospital Severo Ochoa, Leganés, Madrid, Spain.
| | - Ricard Mesía
- Medical Oncology Department, Institut Català d́Oncologia (ICO), Hospitalet, Barcelona, Spain
| | - Alicia Lozano
- Radiotherapy Oncology Department, Institut Català d́Oncologia (ICO), Hospitalet, Barcelona, Spain
| | | | - Juan J Grau
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Miren Taberna
- Medical Oncology Department, Institut Català d́Oncologia (ICO), ONCOBELL, IDIBELL, Hospitalet, Barcelona, Spain
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, University Hospital Josep Trueta, Institut Català d'Oncologia (ICO), Girona, Spain
| | | | - Edel Del Barco Morillo
- Medical Oncology Service, University Hospital of Salamanca- IBSAL (Biomedical Research Institute of Salamanca), Salamanca, Spain
| | | | | | - Beatriz Cirauqui
- Medical Oncology Department, Institut Català d'Oncologia (ICO), Badalona Applied Research Group in Oncology (B-ARGO), Badalona, Spain
| | - Juan Jesús Cruz-Hernández
- Medical Oncology Service, University Hospital of Salamanca- IBSAL (Biomedical Research Institute of Salamanca), Salamanca, Spain
| |
Collapse
|
6
|
Imai C, Saeki H, Yamamoto K, Ichikawa A, Arai M, Tawada A, Suzuki T, Takiguchi Y, Hanazawa T, Ishii I. Radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer in patients with cisplatin‑ineligible renal dysfunction: A retrospective study. Oncol Lett 2022; 23:152. [PMID: 35836484 PMCID: PMC9258593 DOI: 10.3892/ol.2022.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Clinical trials have not fully demonstrated the efficacy and safety of radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer (LA-SCCHN) in patients with cisplatin-ineligible renal dysfunction. Patients who received radiotherapy plus cetuximab for LA-SCCHN at Chiba University Hospital (Chiba, Japan) between July 2013 and October 2018 were retrospectively reviewed. Background characteristics and locoregional control and overall survival rates were compared between patients with and without renal dysfunction. Survival was examined using Kaplan-Meier analysis and an adjusted Cox proportional hazards model. Kaplan-Meier analysis demonstrated that overall survival was shorter in patients with creatinine clearance of <45 ml/min (P=0.041; log-rank test). However, there was no difference in the locoregional control rate (P=0.477; log-rank test). Adjusted Cox analysis revealed that the risk of death was increased by 2.52-fold (hazard ratio, 2.52; 95% confidence interval, 1.01-6.30; P=0.048) if creatinine clearance was <45 ml/min. Moderate to severe renal dysfunction did not affect the locoregional control rate in patients with LA-SCCHN treated with radiotherapy plus cetuximab but was an adverse prognostic factor.
Collapse
Affiliation(s)
- Chiaki Imai
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Hiromi Saeki
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Kohei Yamamoto
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Ayano Ichikawa
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo, Chiba 276‑8524, Japan
| | - Akinobu Tawada
- Department of Nursing, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Chiba 261‑0014, Japan
| | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Chiba 260‑8670, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba 260‑8670, Japan
| | - Itsuko Ishii
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| |
Collapse
|
7
|
Routila J, Qiao X, Weltner J, Rantala JK, Carpén T, Hagström J, Mäkitie A, Leivo I, Ruuskanen M, Söderlund J, Rintala M, Hietanen S, Irjala H, Minn H, Westermarck J, Ventelä S. Cisplatin overcomes radiotherapy resistance in OCT4-expressing head and neck squamous cell carcinoma. Oral Oncol 2022; 127:105772. [PMID: 35245886 DOI: 10.1016/j.oraloncology.2022.105772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cisplatin is combined with radiotherapy for advanced head and neck squamous cell carcinoma (HNSCC). While providing a beneficial effect on survival, it also causes side effects and thus is an important target when considering treatment de-escalation. Currently, there are no biomarkers to predict its patient-selective therapeutic utility. In this study, we examined the role of the stem cell factor OCT4 as a potential biomarker to help clinicians stratify HNSCC patients between radiotherapy and chemoradiotherapy. MATERIALS AND METHODS OCT4 immunohistochemical staining of a population-validated tissue microarray (PV-TMA) (n = 166) representative of a standard HNSCC patients was carried out, and 5-year survival was analyzed. The results were validated using ex vivo drug sensitivity analysis of HNSCC tumor samples, and further cross-validated in independent oropharyngeal (n = 118), nasopharyngeal (n = 170), and vulvar carcinoma (n = 95) clinical datasets. In vitro, genetically modified, patient-derived HNSCC cells were used. RESULTS OCT4 expression in HNSCC tumors was associated with radioresistance. However, combination therapy with cisplatin was found to overcome thisradioresistance in OCT4-expressing HNSCC tumors. The results were validated by using several independent patient cohorts. Furthermore, CRISPRa-based OCT4 overexpression in the HNSCC cell line resulted in apoptosis resistance, and cisplatin was found to downregulate OCT4 protein expression in vitro. Ex vivo drug sensitivity analysis of HNSCC tumors confirmed the association between OCT4 expression and cisplatin sensitivity. CONCLUSION This study introduces OCT4 immunohistochemistry as a simple and cost-effective diagnostic approach for clinical practice to identify HNSCC patients benefitting from radiosensitization by cisplatin using either full or reduced dosing.
Collapse
Affiliation(s)
- Johannes Routila
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Department for Otorhinolaryngology - Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Xi Qiao
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Jere Weltner
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-14186 Stockholm, Sweden and Division of Obstetrics and Gynecology, Karolinska Universitetssjukhuset, SE-14186 Stockholm, Sweden
| | - Juha K Rantala
- MISVIK Biology Ltd, Karjakatu 35 B, 20520 Turku, Finland
| | - Timo Carpén
- Department for Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O.Box 263, FI-00029 HUS Helsinki, Finland
| | - Jaana Hagström
- Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Antti Mäkitie
- Department for Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O.Box 263, FI-00029 HUS Helsinki, Finland
| | - Ilmo Leivo
- Department of Oral Pathology and Radiology, University of Turku, Turku, Finland; Institute of Biomedicine, Pathology, University of Turku, Kiinamyllynkatu 10 D, 20520 Turku, Finland
| | - Miia Ruuskanen
- Department for Otorhinolaryngology - Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Jenni Söderlund
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Marjut Rintala
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; FICAN West Cancer Centre, Turku, Finland
| | - Heikki Irjala
- Department for Otorhinolaryngology - Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Heikki Minn
- FICAN West Cancer Centre, Turku, Finland; Department of Oncology and Radiotherapy, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Westermarck
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Biomedical Institute, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland; FICAN West Cancer Centre, Turku, Finland
| | - Sami Ventelä
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Department for Otorhinolaryngology - Head and Neck Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland; FICAN West Cancer Centre, Turku, Finland.
| |
Collapse
|
8
|
Molecular and Cellular Mechanisms of Perineural Invasion in Oral Squamous Cell Carcinoma: Potential Targets for Therapeutic Intervention. Cancers (Basel) 2021; 13:cancers13236011. [PMID: 34885121 PMCID: PMC8656475 DOI: 10.3390/cancers13236011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Squamous cell carcinoma is the most common type of oral cavity cancer. It can spread along and invade nerves in a process called perineural invasion. Perineural invasion can increase the chances of tumor recurrence and reduce survival in patients with oral cancer. Understanding how oral cancer interacts with nerves to facilitate perineural invasion is an important area of research. Targeting key events that contribute to perineural invasion in oral cavity cancer may reduce tumor recurrence and improve survival. In this review, we describe the impact of perineural invasion in oral cancer and the mechanisms that contribute to perineural invasion. Highlighting the key events of perineural invasion is important for the identification and testing of novel therapies for oral cancer with perineural invasion. Abstract The most common oral cavity cancer is squamous cell carcinoma (SCC), of which perineural invasion (PNI) is a significant prognostic factor associated with decreased survival and an increased rate of locoregional recurrence. In the classical theory of PNI, cancer was believed to invade nerves directly through the path of least resistance in the perineural space; however, more recent evidence suggests that PNI requires reciprocal signaling interactions between tumor cells and nerve components, particularly Schwann cells. Specifically, head and neck SCC can express neurotrophins and neurotrophin receptors that may contribute to cancer migration towards nerves, PNI, and neuritogenesis towards cancer. Through reciprocal signaling, recent studies also suggest that Schwann cells may play an important role in promoting PNI by migrating toward cancer cells, intercalating, and dispersing cancer, and facilitating cancer migration toward nerves. The interactions of neurotrophins with their high affinity receptors is a new area of interest in the development of pharmaceutical therapies for many types of cancer. In this comprehensive review, we discuss diagnosis and treatment of oral cavity SCC, how PNI affects locoregional recurrence and survival, and the impact of adjuvant therapies on tumors with PNI. We also describe the molecular and cellular mechanisms associated with PNI, including the expression of neurotrophins and their receptors, and highlight potential targets for therapeutic intervention for PNI in oral SCC.
Collapse
|
9
|
Shao J, Zhang Q, Wei J, Yuchi Z, Cao P, Li SQ, Wang S, Xu JY, Yang S, Zhang Y, Wei JX, Tian JL. Synthesis, crystal structures, anticancer activities and molecular docking studies of novel thiazolidinone Cu(II) and Fe(III) complexes targeting lysosomes: special emphasis on their binding to DNA/BSA. Dalton Trans 2021; 50:13387-13398. [PMID: 34473154 DOI: 10.1039/d1dt02180j] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Novel [CuL2Cl]Cl·H2O (1) and [FeL2Cl2]Cl·MeOH·CHCl3·H2O (2) complexes of (Z)-N'-((E)-3-methyl-4-oxothiazolidin-2-ylidene)picolinohydrazonamide (L) as antitumor agents were designed and synthesized in order to explore DNA and serum albumin interaction. X-ray diffraction revealed that both 1 and 2 were a triclinic crystal system with P1̄ space group, which consisted of a positive electric main unit, a negative chloride ion and some solvent molecules. The complexes with DNA and bovine serum albumin (BSA) were studied by fluorescence and electronic absorption spectrometry. The results indicated that there was moderate intercalative binding mode between the complexes and DNA with Kapp values of 2.40 × 105 M-1 (1) and 6.49 × 105 M-1 (2). Agarose gel electrophoresis experiment showed that both 1 and 2 exhibited obvious DNA cleavage activity via an oxidative DNA damage pathway, and the cleavage activities of 1 were stronger than those of 2. Cytotoxicity assay showed that 1 had a more effective antitumor activity than 2. The two complexes were bound to BSA by a high affinity and quenched the fluorescence of BSA through a static mechanism. The thermodynamic parameters suggested that hydrophobic interactions played a key role in the binding process. The binding energy xpscore of 1 and 2 were -10.529 kcal mol-1 and -10.826 kcal mol-1 by docking studies, and this suggested that the binding process was spontaneous. Complex 1 displayed a lysosome-specific targeting behavior with a Pearson coefficient value of 0.82 by confocal laser scanning microscopy (CLSM), and accumulated in the lysosomes, followed by the disruption of lysosomal integrity.
Collapse
Affiliation(s)
- Jia Shao
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin 300192, P. R. China.
| | - Qiang Zhang
- College of Chemistry, Nankai University, Tianjin 300071, P. R. China.
| | - Jing Wei
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, P. R. China
| | - Zhiguang Yuchi
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, P. R. China
| | - Peng Cao
- Key Laboratory of Drug Targets and Drug Leads for Degenerative Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
| | - Shao-Qing Li
- College of Chemistry, Nankai University, Tianjin 300071, P. R. China.
| | - Shan Wang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin 300192, P. R. China.
| | - Jing-Yuan Xu
- School of Pharmacy, Tianjin Medical University, Tianjin 300070, P. R. China
| | - Shuang Yang
- Medical College of Nankai University, Tianjin 300071, P. R.China
| | - Yi Zhang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin 300192, P. R. China.
| | - Jin-Xia Wei
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China.
| | - Jin-Lei Tian
- College of Chemistry, Nankai University, Tianjin 300071, P. R. China.
| |
Collapse
|
10
|
Suzuki YU, Jingu K, Ishida E, Murata T, Kubozono M. Recurrence of Lymph Node Micrometastases After Radiotherapy for Head and Neck Carcinoma: A Propensity Score-matched Study. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:165-172. [PMID: 35399304 PMCID: PMC8962797 DOI: 10.21873/cdp.10022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The standard irradiation dose to the elective lymph node area (ELNA) in locally patients with advanced head and neck squamous cell carcinoma (LA-HNSCC) to control lymph node micrometastases (LN-MM) has not changed since it was empirically determined in the 1950s. We investigated the optimal irradiation dose for controlling LN-MM in ELNAs. PATIENTS AND METHODS The pattern of recurrence of LA-HNSCC was retrospectively evaluated in patients who underwent concurrent chemoradiotherapy with cisplatin or radiation therapy alone. RESULTS In total, 162 patients were enrolled. The median observation period was 34 months. No recurrence was found in ELNAs. After propensity score matching, a cisplatin dose of ≥200 mg/m 2 yielded a significantly higher overall survival rate (p≤0.001) and locoregional control rate (p=0.034) than did a dose of <100 mg/m 2 . CONCLUSION CCRT with a cisplatin dose of ≥200 mg/m 2 can reduce the irradiation dose to 40-44 Gy at 2 Gy per fraction to control LN-MM.
Collapse
Affiliation(s)
- Y U Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Eiichi Ishida
- Department of Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaki Murata
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Kubozono
- Department of Radiation Oncology, Miyagi Prefectural Cancer Center, Natori, Japan
| |
Collapse
|
11
|
Hoffmann TK. Total Laryngectomy-Still Cutting-Edge? Cancers (Basel) 2021; 13:1405. [PMID: 33808695 PMCID: PMC8003522 DOI: 10.3390/cancers13061405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 02/05/2023] Open
Abstract
Surgical removal of the larynx (total laryngectomy) offers a curative approach to patients with advanced laryngeal and hypopharyngeal (squamous cell) cancer without distant metastases. Particularly in T4a carcinoma, laryngectomy seems prognostically superior to primary radio(chemo)therapy. Further relevant indications for laryngectomy include massive laryngeal dysfunction associated with aspiration and recurrence after radio(chemo)therapy, resulting in salvage surgery. The surgical procedure including neck dissection is highly standardised and safe. The resulting aphonia can be compensated by functional rehabilitation (e.g., voice prosthesis) associated with a significant quality of life improvement. This article presents an overview of indications, preoperative diagnostics, surgical procedures, including new developments (robotics), possible complications, the choice of adjuvant treatment, alternative therapeutic approaches, rehabilitation and prognosis. In summary, total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.
Collapse
Affiliation(s)
- Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, 89070 Ulm, Germany
| |
Collapse
|
12
|
Yang ES, Deutsch E, Mehmet A, Fayette J, Tao Y, Nabell L, Spencer SA, Wang XA, Spoljoric EA, Zhang W, Hynes SM, Decker RL, Lin AKB, William WN. A Phase 1b trial of prexasertib in combination with chemoradiation in patients with locally advanced head and neck squamous cell carcinoma. Radiother Oncol 2021; 157:203-209. [PMID: 33577866 DOI: 10.1016/j.radonc.2021.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE This study explored the feasibility of safely combining prexasertib, with cisplatin-radiotherapy (Part A) or cetuximab-radiotherapy (Part B) in patients with previously untreated, locoregionally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Escalating doses of prexasertib were administered in each combination using a modified Time-to-Event Continual Reassessment Method. Pharmacokinetic (PK) analysis was performed using standard non-compartmental methods of analysis. Antitumor activity was evaluated using RECIST version 1.1. RESULTS In Part A, 7 patients received 20 mg/m2 prexasertib and cisplatin-radiotherapy. This dose exceeded the maximum tolerated dose (MTD); no other prexasertib dose was assessed. In Part B, 18 patients received prexasertib (20-40 mg/m2) and cetuximab-radiotherapy. The 30 mg/m2 dose of prexasertib was determined as the MTD. Febrile neutropenia was the dose-limiting toxicity in each arm. Most common treatment-emergent adverse events with both combinations were neutropenia, thrombocytopenia, dysphagia, stomatitis, dry mouth, anemia, radiation skin injury [reported term radiation dermatitis], and nausea. PK of prexasertib was consistent with previously published data following prexasertib monotherapy. Overall response rate in Parts A and B was 71.4% and 83.3%, respectively. The small number of patients and follow-up limits the interpretation of efficacy data. CONCLUSION This study did not establish a safe dose of cisplatin-radiotherapy. However, it demonstrates the proof-of-principle that prexasertib could be safely combined with cetuximab-radiotherapy. These data will provide the basis to leverage the potential radio-sensitization properties of a CHK1 inhibitor in combination with radiation or other targeted agents in a variety of therapeutic settings.
Collapse
Affiliation(s)
- Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham, USA.
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy, INSERM1030 radiothérapie moléculaire, Université Paris-Saclay, Villejuif, France
| | - Altan Mehmet
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Yungan Tao
- Department of Radiotherapy, Gustave Roussy, INSERM1030 radiothérapie moléculaire, Université Paris-Saclay, Villejuif, France
| | - Lisle Nabell
- Department of Radiation Oncology, University of Alabama at Birmingham, USA
| | - Sharon A Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, USA
| | | | | | - Wei Zhang
- Eli Lilly and Company, Indianapolis, USA
| | | | | | | | - William N William
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
13
|
Chen O, Manig F, Lehmann L, Sorour N, Löck S, Yu Z, Dubrovska A, Baumann M, Kessler BM, Stasyk O, Kunz-Schughart LA. Dual role of ER stress in response to metabolic co-targeting and radiosensitivity in head and neck cancer cells. Cell Mol Life Sci 2020; 78:3021-3044. [PMID: 33230565 PMCID: PMC8004506 DOI: 10.1007/s00018-020-03704-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
Arginine deprivation therapy (ADT) is a new metabolic targeting approach with high therapeutic potential for various solid cancers. Combination of ADT with low doses of the natural arginine analog canavanine effectively sensitizes malignant cells to irradiation. However, the molecular mechanisms determining the sensitivity of intrinsically non-auxotrophic cancers to arginine deficiency are still poorly understood. We here show for the first time that arginine deficiency is accompanied by global metabolic changes and protein/membrane breakdown, and results in the induction of specific, more or less pronounced (severe vs. mild) ER stress responses in head and neck squamous cell carcinoma (HNSCC) cells that differ in their intrinsic ADT sensitivity. Combination of ADT with canavanine triggered catastrophic ER stress via the eIF2α-ATF4(GADD34)-CHOP pathway, thereby inducing apoptosis; the same signaling arm was irrelevant in ADT-related radiosensitization. The particular strong supra-additive effect of ADT, canavanine and irradiation in both intrinsically more and less sensitive cancer cells supports the rational of ER stress pathways as novel target for improving multi-modal metabolic anti-cancer therapy.
Collapse
Affiliation(s)
- Oleg Chen
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Cell Signaling, Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - Friederike Manig
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany.,Chair of Food Chemistry, TU Dresden, Dresden, Germany
| | - Loreen Lehmann
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany
| | - Nagwa Sorour
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany
| | - Steffen Löck
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Zhanru Yu
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anna Dubrovska
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Michael Baumann
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt M Kessler
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Oleh Stasyk
- Department of Cell Signaling, Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - Leoni A Kunz-Schughart
- OncoRay, National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307, Dresden, Germany. .,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany.
| |
Collapse
|
14
|
Rühle A, Nicolay NH. [De-escalation concepts for chemoradiotherapy of HPV-positive oropharyngeal carcinomas: pros and cons]. HNO 2020; 69:278-284. [PMID: 33048200 DOI: 10.1007/s00106-020-00955-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In contrast to alcohol- and nicotine-induced head and neck tumors, human papillomavirus (HPV)-positive oropharyngeal carcinoma rather affects younger patients, and the incidence of this entity is continuously increasing. Due to the significantly better prognosis of HPV-positive oropharyngeal carcinoma, various treatment de-escalation strategies are currently being investigated, with the aim of reducing toxicity without affecting the good survival rates of these patients. OBJECTIVE This study aims to evaluate the evidence for treatment de-escalation in HPV-positive oropharyngeal carcinoma. MATERIALS AND METHODS A literature search was performed and relevant studies are critically discussed. RESULTS De-escalation strategies for HPV-associated oropharyngeal carcinoma using induction chemotherapy or radiation dose reduction have demonstrated good oncological results in phase II trials, with lower toxicity rates compared to historical controls. However, both of the first published phase III trials investigating de-escalation of concomitant chemotherapy regimens demonstrated inferior outcomes for the deescalated treatment strategies without improvements in treatment-associated toxicities. Additional phase-III trials investigating other de-escalation strategies have not yet been published. CONCLUSION Treatment de-escalation should be performed exclusively in prospective studies and can currently not be recommended in clinical routine.
Collapse
Affiliation(s)
- A Rühle
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Deutschland.,Deutsches Krebsforschungszentrum (dkfz), Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partnerstandort Freiburg, Freiburg, Deutschland
| | - N H Nicolay
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Deutschland. .,Deutsches Krebsforschungszentrum (dkfz), Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partnerstandort Freiburg, Freiburg, Deutschland.
| |
Collapse
|
15
|
Fung AS, Afzal AR, Banerjee R, Debenham B, Hao D. A real-world comparison of cisplatin vs cetuximab used concurrently with radiation in the treatment of locally advanced oropharyngeal carcinoma. Head Neck 2020; 43:153-163. [PMID: 32949087 DOI: 10.1002/hed.26469] [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: 02/25/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This population-based retrospective study compares the efficacy of cisplatin (cis-RT) vs cetuximab (cetux-RT) with concurrent radiation as definitive treatment in patients with oropharyngeal carcinoma (OPC). METHODS Patients with OPC treated in Alberta with cis-RT or cetux-RT between 2006 and 2016 were evaluated. Median disease-free survival (DFS) and overall survival (OS) were assessed using the Kaplan-Meier method. Multivariable analysis (MVA) was completed with a Cox proportional hazards model. RESULTS Among 546 patients with OPC, 431 (78.9%) received cis-RT and 115 (21.1%) cetux-RT. Patients treated with cetux-RT were more likely to develop a recurrence after treatment compared to cis-RT (25% vs 15%, P = .01). On MVA, current smoking, human papillomavirus (HPV)-negative status, higher Charlson comorbidity index (CCI), T-stage, and cetux-RT predicted for worse DFS and OS. Outcomes in older patients with a higher CCI still favored cis-RT. CONCLUSIONS Our data reaffirm results from randomized studies showing better survival outcomes with cis-RT compared to cetux-RT even among those who are >65 with CCI ≥3.
Collapse
Affiliation(s)
- Andrea S Fung
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Arfan Raheen Afzal
- Surveillance and Reporting, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Robyn Banerjee
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brock Debenham
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Desiree Hao
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
16
|
Tang WH, Sun W, Long GX. Concurrent cisplatin or cetuximab with radiotherapy in patients with locally advanced head and neck squamous cell carcinoma: A meta-analysis. Medicine (Baltimore) 2020; 99:e21785. [PMID: 32899005 PMCID: PMC7478598 DOI: 10.1097/md.0000000000021785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Concurrent cisplatin with radiotherapy (CRT) or concurrent cetuximab with radiotherapy (BRT) improves outcomes in locally advanced head and neck squamous cell carcinoma (HNSCC) compared with radiotherapy alone. Nevertheless, a detailed comparison between CRT and BRT in locally advanced HNSCC is required due to inconclusive results. METHODS A comprehensive literature search was conducted on PubMed, Web of Science, Cochrane databases, and EMBASE. Studies that evaluated CRT vs BRT in locally advanced HNSCC were included. The primary outcome that was overall survival (OS), whereas the secondary outcomes were progression-free survival (PFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Pooled hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were used to evaluate prognosis. All the analyses were performed using Stata Statistical Software 12.0. RESULTS Twenty-three studies, with a total of 8701 patients, were considered eligible and included in this meta-analysis. Our results revealed that patients treated with CRT had longer OS (HR = 0.51, 95%CI, 0.41-0.64, P < .001), PFS (HR = 0.37, 95%CI, 0.23-0.60, P < .001), LRC (HR = 0.46, 95%CI, 0.37-0.57, P < .001), and DMFS (HR = 0.56, 95%CI, 0.40-0.77, P < .001) than those treated with BRT. Furthermore, the results of the subgroup analyses were consistent with the primary analysis. CONCLUSIONS CRT has a better OS, PFS, LRC, and DMFS than BRT in locally advanced HNSCC, and should be the preferred treatment for patients with the disease.
Collapse
Affiliation(s)
- Wen-Hua Tang
- Department of Oncology, Chengdu Seventh People's Hospital, Chengdu, Sichuan, China
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guo-Xian Long
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
17
|
Jeong ISD, Mo H, Nguyen A, Chong EG, Tsai HHC, Moyers J, Kim M, Lacy C, Shah V, Lau E, Xu Y, Cao H. Primary chemoradiation with cisplatin versus cetuximab for locally advanced head and neck cancer: a retrospective cohort study. Exp Hematol Oncol 2020; 9:19. [PMID: 32775042 PMCID: PMC7409407 DOI: 10.1186/s40164-020-00175-1] [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: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To explore the efficacy of primary chemoradiation with cisplatin versus cetuximab with respect to HPV/p16 and smoking statuses. Methods We retrospectively reviewed patients from our center with locally advanced non-nasopharyngeal head and neck squamous cell carcinoma (HNSCC) who received primary chemoradiation with cisplatin or cetuximab between 2006 and 2018. Results The median OS for cisplatin (n = 66) was not reached versus 132 months when treated with cetuximab (n = 55) (p = 0.03). For HPV/p16-positive patients, we found the median OS for cisplatin (n = 34) was not reached versus 60 months with cetuximab (n = 21) (p = 0.036). In the smoking group, the median OS was not reached in the cisplatin group (n = 44) versus 60 months when treated with cetuximab (n = 32) (p = 0.03). Conclusion HPV/p16-positive and smoking cohorts treated with cisplatin-based chemoradiotherapy had a significantly better OS versus cetuximab.
Collapse
Affiliation(s)
| | - Huan Mo
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Anthony Nguyen
- Department of Hematology and Oncology, Loma Linda University Medical Center, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354 USA
| | - Esther G Chong
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | | | - Justin Moyers
- Department of Hematology and Oncology, Loma Linda University Medical Center, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354 USA
| | - Matthew Kim
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Curtis Lacy
- Department of Hematology and Oncology, Loma Linda University Medical Center, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354 USA
| | - Vivek Shah
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Eric Lau
- Department of Hematology and Oncology, Loma Linda University Medical Center, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354 USA
| | - Yi Xu
- Department of Regenerative Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Huynh Cao
- Department of Hematology and Oncology, Loma Linda University Medical Center, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354 USA
| |
Collapse
|
18
|
Weinstein GS, Cohen R, Lin A, O'Malley BW, Lukens J, Swisher‐McClure S, Shanti RM, Newman JG, Parhar HS, Tasche K, Brody RM, Chalian A, Cannady S, Palmer JN, Adappa ND, Kohanski MA, Bauml J, Aggarwal C, Montone K, Livolsi V, Baloch ZW, Jalaly JB, Cooper K, Rajasekaran K, Loevner L, Rassekh C. Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines. Head Neck 2020; 42:1507-1515. [PMID: 32584447 PMCID: PMC7362039 DOI: 10.1002/hed.26318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS Creation of consensus document. RESULTS The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.
Collapse
Affiliation(s)
- Gregory S. Weinstein
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Roger Cohen
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alexander Lin
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Bert W. O'Malley
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Lukens
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Rabie M. Shanti
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Oral and Maxillofacial SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason G. Newman
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Harman S. Parhar
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kendall Tasche
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ara Chalian
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Steven Cannady
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joshua Bauml
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Charu Aggarwal
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathleen Montone
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia Livolsi
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Zubair W. Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jalal B. Jalaly
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kumarasen Cooper
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Christopher Rassekh
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
19
|
Rehmani HS, Issaeva N. EGFR in head and neck squamous cell carcinoma: exploring possibilities of novel drug combinations. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:813. [PMID: 32793658 PMCID: PMC7396252 DOI: 10.21037/atm.2020.04.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Hina S Rehmani
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalia Issaeva
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
20
|
Abstract
Total laryngectomy provides a curative approach for patients with advanced laryngeal and hypopharyngeal cancer without distant metastasis. Especially in stage cT4a disease, laryngectomy is superior to primary radio(chemo)therapy in retrospective studies. Further relevant indications for the procedure are tumor-related laryngeal dysfunction such as dysphagia and aspiration, as well as cancer recurrence after primary radio(chemo)therapy. The surgical procedure is highly standardized, with an appropriate safety profile. The subsequent loss of voice must be compensated by voice rehabilitation (voice prosthesis, ructus). The current overview provides information about indications for laryngectomy, preoperative clinical diagnostics, the surgical procedure, complications, alternative treatment, rehabilitation, and prognosis. Total laryngectomy remains a standard procedure in modern head and neck oncology.
Collapse
|
21
|
|
22
|
Nagatsuka M, Hughes RT, Shenker RF, Frizzell BA, Greven KM. Omitting Elective Irradiation of the Contralateral Retropharyngeal Nodes in Oropharyngeal Squamous Cell Carcinoma Treated with Intensity-modulated Radiotherapy. Cureus 2019; 11:e3825. [PMID: 30868038 PMCID: PMC6402860 DOI: 10.7759/cureus.3825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: The use of intensity-modulated radiation therapy (IMRT) in head and neck cancers has allowed for selective sparing of low-risk or uninvolved lymph nodes. In oropharyngeal cancers, the benefits and risks of omitting contralateral retropharyngeal lymph nodes (RPLN) remain uncertain. This study examines the outcomes of elective coverage of contralateral RPLN in oropharyngeal cancer treated with definitive IMRT. Methods: We analyzed 54 patients with newly diagnosed unilateral tonsil or base of tongue squamous cell carcinoma with at most unilateral neck involvement (cN0-N2b) and no RPLN involvement. These patients had no prior head and neck irradiation and were treated with definitive radiotherapy or chemoradiotherapy between 2012 and 2017. Cumulative incidences of local/regional/distant failure were estimated using competing risks methodology, and overall survival (OS) was estimated using the Kaplan-Meier method. Results: All patients received elective nodal coverage to the ipsilateral RPLN, and 38 (62%) patients did not receive elective treatment of the contralateral RPLN. There were no significant differences in baseline characteristics. There were no contralateral RPLN failures observed. When comparing patients who received contralateral RP treatment with those who did not, there were no significant differences in two-year local failure (23% vs. 9%, p = 0.09), regional failure (18% vs. 4%, p = 0.12), or distant failure (15% vs. 9%, p = 0.62). Two-year OS was 89%. Mean parotid dose was not significantly lower after sparing vs. treating the contralateral RPLN (median 25.6 vs. 32.7 Gy, p = 0.15). Conclusions: The omission of contralateral RPLN irradiation in tonsil or tongue base carcinomas with unilateral neck involvement is safe without compromising disease control.
Collapse
Affiliation(s)
- Moeko Nagatsuka
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Ryan T Hughes
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Rachel F Shenker
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Bart A Frizzell
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Kathryn M Greven
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| |
Collapse
|
23
|
Cui J, Zheng X, Yang D, Hu Y, An C, Bo Y, Li H, Zhang Y, Niu M, Xue X, Lu Y, Tang Y, Yin H, Li Z, Gao W, Wu Y. Astragali radix total flavonoid synergizes cisplatin to inhibit proliferation and enhances the chemosensitivity of laryngeal squamous cell carcinoma. RSC Adv 2019; 9:24471-24482. [PMID: 35527911 PMCID: PMC9069756 DOI: 10.1039/c9ra04701h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023] Open
Abstract
Laryngeal squamous cell carcinoma (LSCC) is the most common head and neck cancer. Astragali radix extracts play crucial roles in the regulation of cancer progression. However, the role of Astragali radix extracts in LSCC and the related mechanisms remains unclear. Here, we evaluated the inhibitory effects of the combined use of Astragali radix total flavonoid (TFA) and cisplatin (CDDP) on an LSCC mouse model by pharmacodynamics. Ultra-high-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was employed to define the prototype of TFA in vivo. The potential drug targets were identified through the integrative analysis of LSCC microarrays, RNA sequencing data and the main bioactive component of TFA. Furthermore, a protein–protein interaction network, compound–target network and target–pathway network were constructed based on the prototype and potential drug targets to identify the main targets and pathways. Animal experiments showed that TFA has significant synergistic antitumor activity with cisplatin and attenuates the nephrotoxicity caused by CDDP chemotherapy, improving the survival of LSCC-bearing mice. Using UPLC-MS/MS, we identified 8 constituents of TFA in experimental mice serum: formononetin, ononin, calycosin, calycosin-7-O-β-D-glucoside, 7,2′-dihydroxy-3′,4′-dimethoxyisoflavan, 7,2′-dihydroxy-3′,4′-dimethoxyisoflavaneglucoside, 3-hydroxy-9,10-dimethoxypterocarpan and 9,10-dimethoxyptercarpan-3-O-β-d-glucoside. Integrative analysis predicted 19 target genes for TFA constituents, and the target genes were mainly involved in the EGFR-related cancer signaling, metabolism and oxidative stress. Collectively, these findings highlight the role of TFA in the regulation of LSCC and provide potential targets for a high-efficiency and low-toxicity therapeutic strategy of LSCC. Astragali radix total flavonoid synergizes with cisplatin to inhibit tumorigenesis of laryngeal squamous cell carcinoma.![]()
Collapse
|