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Lindahl G, Fjellander S, Selvaraj K, Vildeval M, Ali Z, Almter R, Erkstam A, Rodriguez GV, Abrahamsson A, Kersley ÅR, Fahlgren A, Kjølhede P, Linder S, Dabrosin C, Jensen L. Zebrafish tumour xenograft models: a prognostic approach to epithelial ovarian cancer. NPJ Precis Oncol 2024; 8:53. [PMID: 38413842 PMCID: PMC10899227 DOI: 10.1038/s41698-024-00550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024] Open
Abstract
Epithelial ovarian cancer (EOC) is the gynaecological malignancy with highest mortality. Although adjuvant treatment with carboplatin and paclitaxel leads to an objective response in ~80% of these patients, a majority will relapse within two years. Better methods for assessing long-term treatment outcomes are needed. To address this, we established safe and efficacious doses of carboplatin and paclitaxel using IGROV-1 zebrafish-CDX models. Then fluorescently-labelled cell suspensions from 83 tumour biopsies collected at exploratory laparotomy of women with suspected EOC were generated and 37 (45%) were successfully implanted in zebrafish larvae. Among these 19 of 27 pathology-confirmed EOC samples (70%) engrafted. These zebrafish patient-derived tumour xenograft (ZTX) models were treated with carboplatin or paclitaxel and tumour growth/regression and metastatic dissemination were recorded. In a subgroup of nine patients, four ZTX models regressed during carboplatin treatment. All four corresponding patients had >24 months PFS. Furthermore, both ZTX models established from two patients having <24 months PFS failed to regress during carboplatin treatment. Seven of eight models seeding <6 metastatic cells were established from patients having >24 months PFS. In eleven of fourteen patients, FIGO stage I + II or III tumours gave rise to ZTX models seeding <4 or >4 metastatic cells, respectively. In conclusion, ZTX models predicted patients having >24 or <24 months PFS, based on response/no response to carboplatin. Furthermore, high metastatic dissemination in ZTX models correlated to shorter PFS and more advanced disease at diagnosis. These preliminary results suggest that ZTX models could become a useful prognostic tool in EOC treatment planning.
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Affiliation(s)
- Gabriel Lindahl
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sebastian Fjellander
- BioReperia AB, Linköping, Sweden
- Linköping University, Department of Health, Medicine and Care, Division of Diagnostics and Specialist Medicine, Linköping, Sweden
| | - Karthik Selvaraj
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | | | | | | | | | | | - Annelie Abrahamsson
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Åsa Rydmark Kersley
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna Fahlgren
- BioReperia AB, Linköping, Sweden
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Stig Linder
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Charlotta Dabrosin
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lasse Jensen
- BioReperia AB, Linköping, Sweden.
- Linköping University, Department of Health, Medicine and Care, Division of Diagnostics and Specialist Medicine, Linköping, Sweden.
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2
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Tadić V, Zhang W, Brozovic A. The high-grade serous ovarian cancer metastasis and chemoresistance in 3D models. Biochim Biophys Acta Rev Cancer 2024; 1879:189052. [PMID: 38097143 DOI: 10.1016/j.bbcan.2023.189052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
High-grade serous ovarian cancer (HGSOC) is the most frequent and aggressive type of epithelial ovarian cancer, with high recurrence rate and chemoresistance being the main issues in its clinical management. HGSOC is specifically challenging due to the metastatic dissemination via spheroids in the ascitic fluid. The HGSOC spheroids represent the invasive and chemoresistant cellular fraction, which is impossible to investigate in conventional two-dimensional (2D) monolayer cell cultures lacking critical cell-to-cell and cell-extracellular matrix interactions. Three-dimensional (3D) HGSOC cultures, where cells aggregate and exhibit relevant interactions, offer a promising in vitro model of peritoneal metastasis and multicellular drug resistance. This review summarizes recent studies of HGSOC in 3D culture conditions and highlights the role of multicellular HGSOC spheroids and ascitic environment in HGSOC metastasis and chemoresistance.
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Affiliation(s)
- Vanja Tadić
- Division of Molecular Biology, Ruđer Bošković Institute, Bijenička Str. 54, Zagreb HR-10000, Croatia
| | - Wei Zhang
- Department of Engineering Mechanics, Dalian University of Technology, Linggong Road 2, Dalian CN-116024, China
| | - Anamaria Brozovic
- Division of Molecular Biology, Ruđer Bošković Institute, Bijenička Str. 54, Zagreb HR-10000, Croatia.
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3
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Ex vivo chemosensitivity assay using primary ovarian cancer organoids for predicting clinical response and screening effective drugs. Hum Cell 2023; 36:752-761. [PMID: 36474106 DOI: 10.1007/s13577-022-00827-w] [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: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
Selecting the best treatment for individual patients with cancer has attracted attention for improving clinical outcomes. Recent progress in organoid culture may lead to the development of personalized medicine. Unlike molecular-targeting drugs, there are no predictive methods for patient response to standard chemotherapies for ovarian cancer. We prepared organoids using the cancer tissue-originated spheroid (CTOS) method from 61 patients with ovarian cancer with 100% success rate. Chemosensitivity assays for paclitaxel and carboplatin were performed with 84% success rate using the primary organoids from 50 patients who received the chemotherapy. A wide range of sensitivities was observed among organoids for both drugs. All four clinically resistant organoids were resistant to both drugs in 18 cases in which clinical response information was available. Five out of 18 cases (28%) were double-resistant, the response rate of which was compatible with the clinical remission rate. Carboplatin was significantly more sensitive in serous than in clear cell subtypes (P = 0.025). We generated two lines of organoids, screened 1135 drugs, and found several drugs with better combinatory effects with carboplatin than with paclitaxel. Some drugs, including afatinib, have shown an additive effect with carboplatin. The organoid sensitivity assay did not predict the clinical outcomes, both progression free and overall survival.
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Howard CM, Bush S, Zgheib NB, Lirette ST, Cortese A, Mollo A, Valluri J, Claudio PP. Cancer Stem Cell Assay for the Treatment of Platinum-Resistant Recurrent Ovarian Cancer. HSOA JOURNAL OF STEM CELLS RESEARCH, DEVELOPMENT & THERAPY 2021; 7:076. [PMID: 34796266 PMCID: PMC8597976 DOI: 10.24966/srdt-2060/100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disease recurrence and progression of ovarian cancer is a common event, which is accompanied by the development of platinum-resistant or refractory disease. The presence of chemo-resistant Cancer Stem Cells (CSCs) contribute to tumor propagation, maintenance, and treatment resistance of this difficult to treat disease. We have developed ChemoID, a cytotoxic synergy assay against CSCs that identifies the most effective chemotherapy treatment from a panel of FDA-approved chemotherapies using fresh cancer biopsies. PATIENTS AND METHODS Ascites or interventional radiology biopsies were collected under physician order from 78 consecutive patients affected by 3rd relapsed ovarian cancer. Test results from the assay were used when possible to treat patients with the highest cell kill drugs, taking into consideration their health status and using dose reductions, if needed. A chart analysis and review of CT and PET scans were performed to determine patients' outcomes for tumor response, Progression-Free Survival (PFS), and Overall Survival (OS). RESULTS We observed that recurrent ovarian cancer patients treated with high-cell kill chemotherapy agents guided by the CSCs drug response assay had an improvement in their median PFS and OS when compared to historical median PFS and OS and/or when compared to patients who could not receive high cell kill chemotherapies (PFS low cell kill 3.5 months vs. high cell kill 12.0 months; OS low cell kill 6.0 months vs. high cell kill 15.0 months). CONCLUSION This data indicates that the drug cytotoxicity assay aimed at targeting CSCs may be a useful tool for optimizing treatment selection when first-line therapy fails, and when there are multiple clinically-acceptable and -equivalent treatments available.
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Affiliation(s)
- Candace M Howard
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephen Bush
- Gynecologic Oncology, Charleston Area Medical Center Hospital, Charleston, WV, USA
| | - Nadim Bou Zgheib
- Gynecologic Oncology, Edwards Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Antonio Cortese
- Department of Medicine and Surgery, University of Salerno, Italy
| | - Antonio Mollo
- Obstetric and Gynecologic Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Jagan Valluri
- Translational Genomics Research Institute, Department of Biological Sciences, Marshall University, Huntington, WV, USA
| | - Pier Paolo Claudio
- Department of BioMolecular Sciences, National Center for Natural Products Research, University of Mississippi, University, MS, USA
- Cancer Center & Research Institute, Departments of Radiation Oncology and Maxillofacial Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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5
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Soto JA, Rodríguez-Antolín C, Vera O, Pernía O, Esteban-Rodríguez I, Dolores Diestro M, Benitez J, Sánchez-Cabo F, Alvarez R, De Castro J, Ibanez de Cáceres I. Transcriptional epigenetic regulation of Fkbp1/Pax9 genes is associated with impaired sensitivity to platinum treatment in ovarian cancer. Clin Epigenetics 2021; 13:167. [PMID: 34454589 PMCID: PMC8401184 DOI: 10.1186/s13148-021-01149-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background In an effort to contribute to overcoming the platinum resistance exhibited by most solid tumors, we performed an array of epigenetic approaches, integrating next-generation methodologies and public clinical data to identify new potential epi-biomarkers in ovarian cancer, which is considered the most devastating of gynecological malignancies.
Methods We cross-analyzed data from methylome assessments and restoration of gene expression through microarray expression in a panel of four paired cisplatin-sensitive/cisplatin-resistant ovarian cancer cell lines, along with publicly available clinical data from selected individuals representing the state of chemoresistance. We validated the methylation state and expression levels of candidate genes in each cellular phenotype through Sanger sequencing and reverse transcription polymerase chain reaction, respectively. We tested the biological role of selected targets using an ectopic expression plasmid assay in the sensitive/resistant tumor cell lines, assessing the cell viability in the transfected groups. Epigenetic features were also assessed in 189 primary samples obtained from ovarian tumors and controls. Results We identified PAX9 and FKBP1B as potential candidate genes, which exhibited epigenetic patterns of expression regulation in the experimental approach. Re-establishment of FKBP1B expression in the resistant OVCAR3 phenotype in which this gene is hypermethylated and inhibited allowed it to achieve a degree of platinum sensitivity similar to the sensitive phenotype. The evaluation of these genes at a translational level revealed that PAX9 hypermethylation leads to a poorer prognosis in terms of overall survival. We also set a precedent for establishing a common epigenetic signature in which the validation of a single candidate, MEST, proved the accuracy of our computational pipelines. Conclusions Epigenetic regulation of PAX9 and FKBP1B genes shows that methylation in non-promoter areas has the potential to control gene expression and thus biological consequences, such as the loss of platinum sensitivity. At the translational level, PAX9 behaves as a predictor of chemotherapy response to platinum in patients with ovarian cancer. This study revealed the importance of the transcript-specific study of each gene under potential epigenetic regulation, which would favor the identification of new markers capable of predicting each patient’s progression and therapeutic response. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01149-8.
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Affiliation(s)
- Javier Andrés Soto
- Universidad de Santander, School of Medical and Health Sciences, Masira Research Institute, Bucaramanga, Colombia. .,Cancer Epigenetics Laboratory, INGEMM, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Carlos Rodríguez-Antolín
- Cancer Epigenetics Laboratory, INGEMM, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.,Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain
| | - Olga Vera
- Cancer Epigenetics Laboratory, INGEMM, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.,Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain
| | - Olga Pernía
- Cancer Epigenetics Laboratory, INGEMM, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.,Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain
| | - Isabel Esteban-Rodríguez
- Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain.,Department of Pathology, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Maria Dolores Diestro
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier Benitez
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain.,Spanish Network On Rare Diseases (CIBERER), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029, Madrid, Spain
| | - Fátima Sánchez-Cabo
- Spanish National Center for Cardiovascular Research Center (CNIC), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Rafael Alvarez
- Hospital Universitario HM Sanchinarro, Calle de Oña, 10, 28050, Sanchinarro, Madrid, Spain
| | - Javier De Castro
- Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain
| | - Inmaculada Ibanez de Cáceres
- Cancer Epigenetics Laboratory, INGEMM, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Biomarkers and Experimental Therapeutics in Cancer, Calle de Pedro Rico, 6, 28029, IdiPAZMadrid, Spain.
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6
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Howard CM, Zgheib NB, Bush S, DeEulis T, Cortese A, Mollo A, Lirette ST, Denning K, Valluri J, Claudio PP. Clinical relevance of cancer stem cell chemotherapeutic assay for recurrent ovarian cancer. Transl Oncol 2020; 13:100860. [PMID: 32862103 PMCID: PMC7475270 DOI: 10.1016/j.tranon.2020.100860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/18/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Disease recurrence and progression of ovarian cancer is common with the development of platinum-resistant or refractory disease. This is due in large part to the presence of chemo-resistant cancer stem cells (CSCs) that contribute to tumor propagation, maintenance, and treatment resistance. We developed a CSCs drug cytotoxicity assay (ChemoID) to identify the most effective chemotherapy treatment from a panel of FDA approved chemotherapies. Methods Ascites and pleural fluid samples were collected under physician order from 45 consecutive patients affected by 3rd-5th relapsed ovarian cancer. Test results from the assay were used to treat patients with the highest cell kill drugs, taking into consideration their health status and using dose reductions, as needed. A retrospective chart review of CT and PET scans was used to determine patients' outcomes for tumor response, time to recurrence, progression-free survival (PFS), and overall survival (OS). Results We observed that recurrent ovarian cancer patients treated with high-cell kill chemotherapy agents guided by the CSCs drug response assay had an improvement in the median PFS corresponding to 5.4 months (3rd relapse), 3.6 months (4th relapse), and 3.9 months (5th relapse) when compared to historical data. Additionally, we observed that ovarian cancer patients identified as non-responders by the CSC drug response assay had 30 times the hazard of death compared to those women that were identified as responders with respective median survivals of 6 months vs. 13 months. We also found that ChemoID treated patients on average had an incremental cost-effectiveness ratio (ICER) between -$18,421 and $7,241 per life-year saved (LYS). Conclusions This study demonstrated improved PFS and OS for recurrent ovarian cancer patients treated with assay-guided chemotherapies while decreasing the cost of treatment. Ovarian cancer progression and recurrence is mostly attributed to the presence of cancer stem cells (CSCs), which are chemo-resistant. Eliminating CSCs is a strategy that could improve patients' outcome. We developed a CSC drug cytotoxicity assay to identify the most effective chemotherapy treatment from a panel of FDA approved chemotherapies. Recurrent ovarian cancer patients treated with high-cell kill chemotherapy agents guided by the CSCs drug response assay had an improvement in the median PFS when compared to historical data.
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Affiliation(s)
- Candace M Howard
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Nadim Bou Zgheib
- Gynecologic Oncology, Edwards Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Stephen Bush
- Gynecologic Oncology, Charleston Area Medical Center Hospital, Charleston, WV, USA
| | - Timothy DeEulis
- Gynecologic Oncology, Women's Oncologic Palliative Medicine, St. Mary's Hospital, Huntington, WV, USA
| | - Antonio Cortese
- Department of Medicine and Surgery, University of Salerno, Italy
| | - Antonio Mollo
- Obstetric and Gynecologic Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Krista Denning
- Department of Anatomy and Pathology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Jagan Valluri
- Department of Biological Sciences, Marshall University, Huntington, WV, USA
| | - Pier Paolo Claudio
- Department of BioMolecular Sciences, National Center for Natural Products Research, and Department of Radiation Oncology, University of Mississippi Medical Center Cancer Institute, Jackson, MS, USA.
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7
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Shuford S, Wilhelm C, Rayner M, Elrod A, Millard M, Mattingly C, Lotstein A, Smith AM, Guo QJ, O'Donnell L, Elder J, Puls L, Weroha SJ, Hou X, Zanfagnin V, Nick A, Stany MP, Maxwell GL, Conrads T, Sood AK, Orr D, Holmes LM, Gevaert M, Crosswell HE, DesRochers TM. Prospective Validation of an Ex Vivo, Patient-Derived 3D Spheroid Model for Response Predictions in Newly Diagnosed Ovarian Cancer. Sci Rep 2019; 9:11153. [PMID: 31371750 PMCID: PMC6671958 DOI: 10.1038/s41598-019-47578-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022] Open
Abstract
Although 70–80% of newly diagnosed ovarian cancer patients respond to first-line therapy, almost all relapse and five-year survival remains below 50%. One strategy to increase five-year survival is prolonging time to relapse by improving first-line therapy response. However, no biomarker today can accurately predict individual response to therapy. In this study, we present analytical and prospective clinical validation of a new test that utilizes primary patient tissue in 3D cell culture to make patient-specific response predictions prior to initiation of treatment in the clinic. Test results were generated within seven days of tissue receipt from newly diagnosed ovarian cancer patients obtained at standard surgical debulking or laparoscopic biopsy. Patients were followed for clinical response to chemotherapy. In a study population of 44, the 32 test-predicted Responders had a clinical response rate of 100% across both adjuvant and neoadjuvant treated populations with an overall prediction accuracy of 89% (39 of 44, p < 0.0001). The test also functioned as a prognostic readout with test-predicted Responders having a significantly increased progression-free survival compared to test-predicted Non-Responders, p = 0.01. This correlative accuracy establishes the test’s potential to benefit ovarian cancer patients through accurate prediction of patient-specific response before treatment.
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Affiliation(s)
| | | | | | | | | | - Christina Mattingly
- KIYATEC, Inc., Greenville, South Carolina, USA.,USC School of Medicine, Greenville, South Carolina, USA
| | - Alina Lotstein
- KIYATEC, Inc., Greenville, South Carolina, USA.,ECPI University, Greenville, South Carolina, USA
| | | | - Qi Jin Guo
- KIYATEC, Inc., Greenville, South Carolina, USA.,MUSC College of Medicine, Charleston, South Carolina, USA
| | - Lauren O'Donnell
- KIYATEC, Inc., Greenville, South Carolina, USA.,SYNNEX Corporation, Greenville, South Carolina, USA
| | | | - Larry Puls
- Prisma Health, Greenville, South Carolina, USA
| | - S John Weroha
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Xiaonan Hou
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alpa Nick
- Saint Thomas Health/Ascension, Nashville, Tennessee, USA.,Tennessee Oncology, Nashville, Tennessee, USA
| | | | - G Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Thomas Conrads
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Anil K Sood
- Departments of Gynecologic Oncology and Cancer Biology, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Orr
- KIYATEC, Inc., Greenville, South Carolina, USA.,MacuLogix, Inc, Middletown, Pennsylvania, USA
| | | | | | - Howland E Crosswell
- KIYATEC, Inc., Greenville, South Carolina, USA.,Bon Secours St. Francis, Greenville, South Carolina, USA
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8
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Developing a Prognostic Gene Panel of Epithelial Ovarian Cancer Patients by a Machine Learning Model. Cancers (Basel) 2019; 11:cancers11020270. [PMID: 30823599 PMCID: PMC6406249 DOI: 10.3390/cancers11020270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
Epithelial ovarian cancer patients usually relapse after primary management. We utilized the support vector machine algorithm to develop a model for the chemo-response using the Cancer Cell Line Encyclopedia (CCLE) and validated the model in The Cancer Genome Atlas (TCGA) and the GSE9891 dataset. Finally, we evaluated the feasibility of the model using ovarian cancer patients from our institute. The 10-gene predictive model demonstrated that the high response group had a longer recurrence-free survival (RFS) (log-rank test, p = 0.015 for TCGA, p = 0.013 for GSE9891 and p = 0.039 for NTUH) and overall survival (OS) (log-rank test, p = 0.002 for TCGA and p = 0.016 for NTUH). In a multivariate Cox hazard regression model, the predictive model (HR: 0.644, 95% CI: 0.436⁻0.952, p = 0.027) and residual tumor size < 1 cm (HR: 0.312, 95% CI: 0.170⁻0.573, p < 0.001) were significant factors for recurrence. The predictive model (HR: 0.511, 95% CI: 0.334⁻0.783, p = 0.002) and residual tumor size < 1 cm (HR: 0.252, 95% CI: 0.128⁻0.496, p < 0.001) were still significant factors for death. In conclusion, the patients of high response group stratified by the model had good response and favourable prognosis, whereas for the patients of medium to low response groups, introduction of other drugs or clinical trials might be beneficial.
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9
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Di Lorenzo G, Ricci G, Severini GM, Romano F, Biffi S. Imaging and therapy of ovarian cancer: clinical application of nanoparticles and future perspectives. Theranostics 2018; 8:4279-4294. [PMID: 30214620 PMCID: PMC6134923 DOI: 10.7150/thno.26345] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022] Open
Abstract
Despite significant advances in cancer diagnostics and treatment, ovarian cancers (OC) continue to kill more than 150,000 women every year worldwide. Due to the relatively asymptomatic nature and the advanced stage of the disease at the time of diagnosis, OC is the most lethal gynecologic malignancy. The current treatment for advanced OC relies on the synergistic effect of combining surgical cytoreduction and chemotherapy; however, beside the fact that chemotherapy resistance is a major challenge in OC management, new imaging strategies are needed to target microscopic lesions and improve both cytoreductive surgery and patient outcomes. In this context, nanostructured probes are emerging as a new class of medical tool that can simultaneously provide imaging contrast, target tumor cells, and carry a wide range of medicines resulting in better diagnosis and therapeutic precision. Herein we summarize several exemplary efforts in nanomedicine for addressing unmet clinical needs.
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Affiliation(s)
| | | | | | | | - Stefania Biffi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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10
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Abstract
Therapeutics that block kinases, transcriptional modifiers, immune checkpoints and other biological vulnerabilities are transforming cancer treatment. As a result, many patients achieve dramatic responses, including complete radiographical or pathological remission, yet retain minimal residual disease (MRD), which results in relapse. New functional approaches can characterize clonal heterogeneity and predict therapeutic sensitivity of MRD at a single-cell level. Preliminary evidence suggests that iterative detection, profiling and targeting of MRD would meaningfully improve outcomes and may even lead to cure.
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Affiliation(s)
- Marlise R. Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Mark A. Murakami
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Scott R. Manalis
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Corresponding authors: (S. R. M.) and (D. M. W.)
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, 02142, USA
- Corresponding authors: (S. R. M.) and (D. M. W.)
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11
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Monk BJ, Herzog TJ, Tewari KS. Evolution of Chemosensitivity and Resistance Assays as Predictors of Clinical Outcomes in Epithelial Ovarian Cancer Patients. Curr Pharm Des 2017; 22:4717-4728. [PMID: 27145761 DOI: 10.2174/1381612822666160505114326] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023]
Abstract
Epithelial ovarian cancer (EOC) is responsible for more cancer-related deaths than any other malignancy of the female reproductive system. The standard of care for advanced EOC involves a combination of cytoreductive surgery and platinum-based chemotherapy. Although a majority of patients respond to a platinum-containing regimen, many fail to respond to first-line treatment (platinum-refractory disease) or experience disease progression within 6 months of completing treatment (platinum-resistant disease). Even in patients who initially respond to platinum-based therapy, secondary development of platinum resistance is common. Many chemotherapeutic regimens with comparable efficacy and toxicities are available, leaving the determination of optimal therapy to the physician's discretion. There have been many efforts over the years to develop accurate predictors of outcomes in patients treated with chemotherapy to help inform treatment decisions. Predictive treatment markers are particularly relevant in a disease such as EOC, where a large number of similarly efficacious chemotherapy regimens are available. Chemosensitivity and resistance assays (CSRAs) are attractive approaches to interrogate the efficacy and complex biology of EOC. Some early predictive cellular tests, such as the early clonogenic assays, were limited by technical and logistical issues. Over time, changes in these assays have improved their prognostic and predictive value, but there is still a lack of widespread adoption due to methodological difficulties or limited clinical validation. Herein, we provide an overview of the evolution of CSRAs used to predict outcomes in patients treated with chemotherapy that have been evaluated for use in EOC, with a focus on the latest generation chemoresponse assay.
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Affiliation(s)
- Bradley J Monk
- Dignity Health St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 600, Phoenix, AZ 85013.
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12
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The Prognostic 97 Chemoresponse Gene Signature in Ovarian Cancer. Sci Rep 2017; 7:9689. [PMID: 28851888 PMCID: PMC5575202 DOI: 10.1038/s41598-017-08766-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/12/2017] [Indexed: 12/25/2022] Open
Abstract
Patient diagnosis and care would be significantly improved by understanding the mechanisms underlying platinum and taxane resistance in ovarian cancer. Here, we aim to establish a gene signature that can identify molecular pathways/transcription factors involved in ovarian cancer progression, poor clinical outcome, and chemotherapy resistance. To validate the robustness of the gene signature, a meta-analysis approach was applied to 1,020 patients from 7 datasets. A 97-gene signature was identified as an independent predictor of patient survival in association with other clinicopathological factors in univariate [hazard ratio (HR): 3.0, 95% Confidence Interval (CI) 1.66–5.44, p = 2.7E-4] and multivariate [HR: 2.88, 95% CI 1.57–5.2, p = 0.001] analyses. Subset analyses demonstrated that the signature could predict patients who would attain complete or partial remission or no-response to first-line chemotherapy. Pathway analyses revealed that the signature was regulated by HIF1α and TP53 and included nine HIF1α-regulated genes, which were highly expressed in non-responders and partial remission patients than in complete remission patients. We present the 97-gene signature as an accurate prognostic predictor of overall survival and chemoresponse. Our signature also provides information on potential candidate target genes for future treatment efforts in ovarian cancer.
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Kischkel FC, Eich J, Meyer CI, Weidemüller P, Krapfl J, Yassin-Kelepir R, Job L, Fraefel M, Braicu I, Kopp-Schneider A, Sehouli J, De Wilde RL. New in vitro system to predict chemotherapeutic efficacy of drug combinations in fresh tumor samples. PeerJ 2017; 5:e3030. [PMID: 28265509 PMCID: PMC5337084 DOI: 10.7717/peerj.3030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Abstract
Background To find the best individual chemotherapy for cancer patients, the efficacy of different chemotherapeutic drugs can be predicted by pretesting tumor samples in vitro via the chemotherapy-resistance (CTR)-Test®. Although drug combinations are widely used among cancer therapy, so far only single drugs are tested by this and other tests. However, several first line chemotherapies are combining two or more chemotherapeutics, leading to the necessity of drug combination testing methods. Methods We established a system to measure and predict the efficacy of chemotherapeutic drug combinations with the help of the Loewe additivity concept in combination with the CTR-test. A combination is measured by using half of the monotherapy’s concentration of both drugs simultaneously. With this method, the efficacy of a combination can also be calculated based on single drug measurements. Results The established system was tested on a data set of ovarian carcinoma samples using the combination carboplatin and paclitaxel and confirmed by using other tumor species and chemotherapeutics. Comparing the measured and the calculated values of the combination testings revealed a high correlation. Additionally, in 70% of the cases the measured and the calculated values lead to the same chemotherapeutic resistance category of the tumor. Conclusion Our data suggest that the best drug combination consists of the most efficient single drugs and the worst drug combination of the least efficient single drugs. Our results showed that single measurements are sufficient to predict combinations in specific cases but there are exceptions in which it is necessary to measure combinations, which is possible with the presented system.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ioana Braicu
- Gynecology Department, Charité Berlin, Virchow Campus Berlin, Germany
| | | | - Jalid Sehouli
- Gynecology Department, Charité Berlin, Virchow Campus Berlin, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Carl von Ossietzky University Oldenburg, Germany
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Bounaix Morand du Puch C, Nouaille M, Giraud S, Labrunie A, Luce S, Preux PM, Labrousse F, Gainant A, Tubiana-Mathieu N, Le Brun-Ly V, Valleix D, Guillaudeau A, Mesturoux L, Coulibaly B, Lautrette C, Mathonnet M. Chemotherapy outcome predictive effectiveness by the Oncogramme: pilot trial on stage-IV colorectal cancer. J Transl Med 2016; 14:10. [PMID: 26791256 PMCID: PMC4721000 DOI: 10.1186/s12967-016-0765-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/28/2015] [Indexed: 12/25/2022] Open
Abstract
Background Colorectal cancer (CRC) remains a major public concern. While conventional chemotherapeutic regimens have proved useful against advanced/metastatic diseases, progresses are to be made to effectively cure the large portion of patients not benefiting from these treatments. One direction to improve response rates is to develop chemosensitivity and resistance assays (CSRAs) efficiently assisting clinicians in treatment selection process, an already long preoccupation of oncologists and researchers. Several methods have been described to this day, none achieving yet sufficient reliability for recommended use in the clinical routine. Methods
We led a pilot study on 19 metastatic CRC patients evaluating capacity of the Oncogramme, a standardized process using tumor ex vivo models, to provide chemosensitivity profiles and predict clinical outcome of patients receiving standard CRC chemotherapeutics. Oncogramme responses were categorized according to the method of percentiles to assess sensitivity, specificity and concordance. Results We report from a primary analysis a success rate of 97.4 %, a very good sensitivity (84.6 %), a below-average specificity (33.3 %), along with a global agreement of 63.6 % and a concordance between Oncogramme results and patients’ responses (Kappa coefficient) of 0.193. A supplementary analysis, focusing on CRC patients with no treatment switch over a longer time course, demonstrated improvement in specificity and concordance. Conclusions Results establish feasibility and usefulness of the Oncogramme, prelude to a larger-scale trial. Advantages and drawbacks of the procedure are discussed, as well as the place of CSRAs within the future arsenal of methods available to clinicians to individualize treatments and improve patient prognosis. Trial registration: ClinicalTrials.gov database, registration number: NCT02305368 Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0765-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Michelle Nouaille
- Centre d'Investigation Clinique, INSERM 1435, Centre hospitalier régional universitaire de Limoges Dupuytren, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Stéphanie Giraud
- Oncomedics SAS, ESTER technopole, 1 avenue d'Ester, 87069, Limoges, France.
| | - Anaïs Labrunie
- Centre d'Épidémiologie, de Biostatistique et de Méthodologie de la Recherche, Centre hospitalier régional universitaire de Limoges Dupuytren, 2 rue du Dr Marcland, 87025, Limoges Cedex, France.
| | - Sandrine Luce
- Centre d'Épidémiologie, de Biostatistique et de Méthodologie de la Recherche, Centre hospitalier régional universitaire de Limoges Dupuytren, 2 rue du Dr Marcland, 87025, Limoges Cedex, France.
| | - Pierre-Marie Preux
- Centre d'Épidémiologie, de Biostatistique et de Méthodologie de la Recherche, Centre hospitalier régional universitaire de Limoges Dupuytren, 2 rue du Dr Marcland, 87025, Limoges Cedex, France.
| | - François Labrousse
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'anatomopathologie, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Alain Gainant
- Centre hospitalier régional universitaire de Limoges Dupuytren, service de chirurgie digestive, 2 rue du Dr Marcland, 87025, Limoges, France.
| | - Nicole Tubiana-Mathieu
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'oncologie médicale, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Valérie Le Brun-Ly
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'oncologie médicale, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Denis Valleix
- Centre hospitalier régional universitaire de Limoges Dupuytren, service de chirurgie viscérale, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Angélique Guillaudeau
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'anatomopathologie, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Laura Mesturoux
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'anatomopathologie, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Béma Coulibaly
- Centre hospitalier régional universitaire de Limoges Dupuytren, service d'anatomopathologie, 2 avenue Martin Luther King, 87042, Limoges Cedex, France.
| | | | - Muriel Mathonnet
- Centre hospitalier régional universitaire de Limoges Dupuytren, service de chirurgie digestive générale et endocrinienne, 2 avenue Martin Luther King, 87042, Limoges Cedex, France. .,Université de Limoges, Institut 145 GEIST, EA 3842 "Homéostasie cellulaire et pathologies", Facultés de médecine et de pharmacie, 2 rue du Dr Marcland, 87025, Limoges Cedex, France.
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Friedman AA, Letai A, Fisher DE, Flaherty KT. Precision medicine for cancer with next-generation functional diagnostics. Nat Rev Cancer 2015; 15:747-56. [PMID: 26536825 PMCID: PMC4970460 DOI: 10.1038/nrc4015] [Citation(s) in RCA: 398] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Precision medicine is about matching the right drugs to the right patients. Although this approach is technology agnostic, in cancer there is a tendency to make precision medicine synonymous with genomics. However, genome-based cancer therapeutic matching is limited by incomplete biological understanding of the relationship between phenotype and cancer genotype. This limitation can be addressed by functional testing of live patient tumour cells exposed to potential therapies. Recently, several 'next-generation' functional diagnostic technologies have been reported, including novel methods for tumour manipulation, molecularly precise assays of tumour responses and device-based in situ approaches; these address the limitations of the older generation of chemosensitivity tests. The promise of these new technologies suggests a future diagnostic strategy that integrates functional testing with next-generation sequencing and immunoprofiling to precisely match combination therapies to individual cancer patients.
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Affiliation(s)
- Adam A Friedman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Anthony Letai
- Dana-Farber Cancer Institute, Harvard Medical School, 440 Brookline Avenue, Mayer 430, Boston, Massachusetts 02215, USA
| | - David E Fisher
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
- Dermatology and Cutaneous Biology Research Center, Massachusetts General Hospital, 149 East 13th Street, Charlestown, Massachusetts 02129, USA
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
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Lau V, Wong ALA, Ng C, Mok Y, Lakshmanan M, Yan B. Drug sensitivity testing platforms for gastric cancer diagnostics. J Clin Pathol 2015; 69:93-6. [PMID: 26567318 DOI: 10.1136/jclinpath-2015-203426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/20/2015] [Indexed: 01/09/2023]
Abstract
Gastric cancer diagnostics has traditionally been histomorphological and primarily the domain of surgical pathologists. Although there is an increasing usage of molecular and genomic techniques for clinical diagnostics, there is an emerging field of personalised drug sensitivity testing. In this review, we describe the various personalised drug sensitivity testing platforms and discuss the challenges facing clinical adoption of these assays for gastric cancer.
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Affiliation(s)
- Vianne Lau
- Department of Gastroenterology Monash University, Melbourne, Australia
| | - Andrea Li-Ann Wong
- Department of Haematology and Oncology, National University Health System, Singapore, Singapore
| | - Christopher Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Hospital, National University Health System, Singapore, Singapore
| | - Yingting Mok
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Manikandan Lakshmanan
- Mouse Models for Human Cancer Unit, Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Benedict Yan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Hospital, National University Health System, Singapore, Singapore
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Xiang SD, Gao Q, Wilson KL, Heyerick A, Plebanski M. Mapping T and B cell epitopes in sperm protein 17 to support the development of an ovarian cancer vaccine. Vaccine 2015; 33:5950-9. [PMID: 26263201 DOI: 10.1016/j.vaccine.2015.07.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Abstract
Ovarian cancer (OC) is the seventh most common cancer in women worldwide, and the leading cause of death from gynaecological malignancy. Immunotherapeutic strategies including cancer vaccines are considered less toxic and more specific than current treatments. Sperm surface protein (Sp17) is a protein aberrantly expressed in primary as well as in metastatic lesions in >83% of ovarian cancer patients. Vaccines based on the Sp17 protein are immunogenic and protective in animal models. To map the immunogenic regions and support the development of human Sp17 peptide based vaccines, we used 6 overlapping peptides of the human Sp17 sequence adjuvanted with CpG to immunise humanised HLA-A2.1 transgenic C57BL/6 mice, and assessed immunogenicity by ELISPOT and ELISA. No CD8 T cells were found to be induced to a comprehensive panel of 10 HLA-A2.1 or H-2K(b) binding predicted epitopes. However, one of the 6 peptides, hSp17111-142, induced high levels of antibodies and IFN-γ producing T cells (but not IL-17 or IL-4) both in C57BL/6 and in C57BL/6-HLA-A2.1 transgenic mice. C57BL/6 mice immunised with CpG adjuvanted hSp17111-142 significantly prolonged the life-span of the mice bearing the ovarian carcinoma ID8 cell line. We further mapped the immuno-dominant B and T cell epitope regions within hSp17111-142 using ELISPOT and competition ELISA. Herein, we report the identification of a single immuno-dominant B cell (134-142 aa) epitope and 2 T helper 1 (Th1) cell epitopes (111-124 aa and 124-138 aa). These result together support further exploration of hSp17111-142 peptide formulations as vaccines against ovarian cancer.
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Affiliation(s)
- Sue D Xiang
- Department of Immunology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
| | - Qian Gao
- Department of Immunology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
| | - Kirsty L Wilson
- Department of Immunology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
| | - Arne Heyerick
- PX Biosolutions Pty Ltd, PO Box 290, South Melbourne 3205, VIC, Australia.
| | - Magdalena Plebanski
- Department of Immunology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
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Richard S, Wells A, Connor J, Price F. Use of ChemoFx® for Identification of Effective Treatments in Epithelial Ovarian Cancer. PLOS CURRENTS 2015; 7:ecurrents.eogt.8b0b6fffc7b999b34bc4c8152edbf237. [PMID: 26213638 PMCID: PMC4506277 DOI: 10.1371/currents.eogt.8b0b6fffc7b999b34bc4c8152edbf237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Selection of appropriate chemotherapy, including identification of platinum resistance, is critical to effective management of advanced epithelial ovarian cancer (EOC). ChemoFx®, a multiple treatment marker (chemoresponse assay), has been developed to address this challenge and to improve outcomes in patients with advanced EOC. While much work has been done that has demonstrated the analytical validity of this assay, more recent studies have highlighted the unique clinical benefits offered by the assay. A prospective, multicenter trial has shown an increase in overall survival (OS) of 14 months and an increase in progression-free survival (PFS) by 3 months in patients with recurrent EOS treated by a "sensitive" therapy based on ChemoFx results. Along with other studies showing similar gains in OS and PFS, ChemoFx has been shown to be both a prognostic and predictive marker in patients with recurrent EOC where current treatment options are sorely lacking. In addition to these clinical benefits, economic analyses have shown that ChemoFx is a cost-effective intervention. Current guidelines and technology assessments relating to ChemoFx are largely outdated and refer primarily to metrics of analytical validity. Thus, in addition to analytical validity, the clinical validity, clinical utility and economic impact of ChemoFx are reviewed herein, including published literature, technology assessments by independent parties, and regulatory approvals of this marker.
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Affiliation(s)
- Scott Richard
- Department of Obstetrics and Gynecology, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Alan Wells
- Department of Pathology, University of Pittsburgh; and Pittsburgh VA Health System, Pittsburgh, PA, USA
| | - Joseph Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fredric Price
- Department of Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, PA, USA
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Granato T, Porpora MG, Longo F, Angeloni A, Manganaro L, Anastasi E. HE4 in the differential diagnosis of ovarian masses. Clin Chim Acta 2015; 446:147-55. [PMID: 25892674 DOI: 10.1016/j.cca.2015.03.047] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/25/2015] [Accepted: 03/09/2015] [Indexed: 12/12/2022]
Abstract
Ovarian masses, a common finding among pre- and post-menopausal women, can be benign or malignant. Ovarian cancer is the leading cause of death from gynecologic malignancy among women living in industrialized countries. According to the current guidelines, measurement of CA125 tumor marker remains the gold standard in the management of ovarian cancer. Recently, HE4 has been proposed as emerging biomarker in the differential diagnosis of adnexal masses and in the early diagnosis of ovarian cancer. Discrimination of benign and malignant ovarian tumors is very important for correct patient referral to institutions specialized in care and management of ovarian cancer. Tumor markers CA125 and HE4 are currently incorporated into the "Risk of Ovarian Malignancy Algorithm" (ROMA) with menopausal status for discerning malignant from benign pelvic masses. The availability of a good biomarker such as HE4, closely associated with the differential and early diagnosis of ovarian cancer, could reduce medical costs related to more expensive diagnostic procedures. Finally, it is important to note that HE4 identifies platinum non-responders thus enabling a switch to second line chemotherapy and improved survival.
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Affiliation(s)
- Teresa Granato
- CNR-IBPM, National Research Council, Viale Regina Elena 324, 00161 Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynaecology, Obstetrics and Urology, "Sapienza" University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy
| | - Flavia Longo
- Department of Molecular Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Angeloni
- Department of Molecular Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy
| | - Lucia Manganaro
- Department of Radiology, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy
| | - Emanuela Anastasi
- Department of Molecular Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
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Evaluation of chemoresponse assays as predictive markers. Br J Cancer 2015; 112:621-3. [PMID: 25584494 PMCID: PMC4333499 DOI: 10.1038/bjc.2014.661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/04/2014] [Accepted: 12/18/2014] [Indexed: 12/30/2022] Open
Abstract
Background: A chemoresponse assay that can be used to predict which patients will respond to which drugs would be useful in directing treatment. Two new analytic methods to assess the predictive ability of a chemoresponse assay have been proposed by Tian et al. Methods: Three examples in which a hypothetical assay has no predictive ability are considered to evaluate the properties of the proposed analytic methods. Results: For these specific examples, the proposed methods incorrectly suggest that the assay is predictive. Conclusions: The examples presented here demonstrate that it can be challenging to evaluate the predictive value of a chemoresponse assay.
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A cost-effectiveness analysis of a chemoresponse assay for treatment of patients with recurrent epithelial ovarian cancer. Gynecol Oncol 2014; 136:94-8. [PMID: 25462203 DOI: 10.1016/j.ygyno.2014.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/28/2014] [Accepted: 11/18/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Clinical validation of a chemoresponse assay was recently published, demonstrating a significant increase in overall survival in recurrent ovarian cancer patients treated with therapies to which their tumor was sensitive in the assay. The current study investigates the cost effectiveness of using the assay at the time of ovarian cancer recurrence from the payer's perspective. METHODS Using a Markov state transition model, patient characteristics and survival data from the recent clinical study, the cumulative costs over the study horizon (71 months) for both the baseline (no assay) and intervention (assay consistent, hypothetical) cohorts were evaluated. RESULTS The assay consistent cohort had an incremental cost effectiveness ratio (ICER) of $6206 per life year saved (LYS), as compared to the baseline cohort. Cost-effectiveness was further demonstrated in platinum-sensitive and platinum-resistant populations treated with assay-sensitive therapies, with ICERs of $2773 per LYS and $2736 per LYS, respectively. CONCLUSIONS The use of a chemoresponse assay to inform treatment decisions in recurrent ovarian cancer patients has the potential to be cost-effective in both platinum-sensitive and platinum-resistant patients.
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