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Schuhmacher J, Heidu S, Balchen T, Richardson JR, Schmeltz C, Sonne J, Schweiker J, Rammensee HG, Thor Straten P, Røder MA, Brasso K, Gouttefangeas C. Vaccination against RhoC induces long-lasting immune responses in patients with prostate cancer: results from a phase I/II clinical trial. J Immunother Cancer 2021; 8:jitc-2020-001157. [PMID: 33184050 PMCID: PMC7662471 DOI: 10.1136/jitc-2020-001157] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Peptide-based vaccination is a rational option for immunotherapy of prostate cancer. In this first-in-man phase I/II study, we assessed the safety, tolerability and immunological impact of a synthetic long peptide vaccine targeting Ras homolog gene family member C (RhoC) in patients with prostate cancer. RhoC is a small GTPase overexpressed in advanced solid cancers, metastases and cancer stem cells. Methods Twenty-two patients who had previously undergone radical prostatectomy received subcutaneous injections of 0.1 mg of a single RhoC-derived 20mer peptide emulsified in Montanide ISA-51 every 2 weeks for the first six times, then five times every 4 weeks for a total treatment time of 30 weeks. The drug safety and vaccine-specific immune responses were assessed during treatment and thereafter within a 13-month follow-up period. Serum level of prostate-specific antigen was measured up to 26 months postvaccination. Results Most patients (18 of 21 evaluable) developed a strong CD4 T cell response against the vaccine, which lasted at least 10 months following the last vaccination. Three promiscuouslypresented HLA-class II epitopes were identified. Vaccine-specific CD4 T cells were polyfunctional and effector memory T cells that stably expressed PD-1 (CD279) and OX-40 (CD134), but not LAG-3 (CD223). One CD8 T cell response was detected in addition. The vaccine was well tolerated and no treatment-related adverse events of grade ≥3 were observed. Conclusion Targeting of RhoC induced a potent and long-lasting T cell immunity in the majority of the patients. The study demonstrates an excellent safety and tolerability profile. Vaccination against RhoC could potentially delay or prevent tumor recurrence and metastasis formation. Trial registration number NCT03199872.
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Affiliation(s)
- Juliane Schuhmacher
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Sonja Heidu
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | | | - Jennifer Rebecca Richardson
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | | | - Jesper Sonne
- Zelo Phase I Unit, DanTrials ApS, Copenhagen, Denmark
| | - Jonas Schweiker
- Department of Oncology, Haematology, Immunology, Rheumatology and Pulmonology, University Hospital of Tübingen, Tübingen, Germany
| | - Hans-Georg Rammensee
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Per Thor Straten
- Department of Oncology, Center for Cancer Immune Therapy (CCIT), University Hospital Herlev & Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cécile Gouttefangeas
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany .,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
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Stroomberg HV, Friberg AS, Helgstrand JT, Brasso K, Røder MA. The impact of positive surgical margins on salvage radiation or androgen deprivation therapy following radical prostatectomy - a nationwide study. Acta Oncol 2021; 60:620-626. [PMID: 33734927 DOI: 10.1080/0284186x.2021.1898047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The extent to which positive surgical margins (PSM) affect the risk of subsequent salvage radiation therapy (sRT) or androgen depletion therapy (ADT) following radical prostatectomy (RP) is not well described. Initiation of additional therapies after RP depend on patient preference, individual factors, local guidelines, and life expectancy. The aim of this study was to analyze differences between margin status in risk of subsequent treatment for PCa following RP in a retrospective population-based cohort from Denmark. METHODS Patients who underwent RP were identified in The Danish Prostate Cancer Registry (DaPCaR). Subsequent sRT and ADT were assessed in uni- and multivariate settings and validated with receiver operating characteristic (ROC). RESULTS PSM was associated with an increased risk of sRT (HR = 1.85, p < .001) and receiving ADT (HR:1.39, p = .007). Margin status only had a minor impact on the predictive ability for sRT (area under the curve (AUC): p < .001) and no significant impact for subsequent ADT (AUC: p = 1). Significant inter-institutional difference in the association between PSM with sRT or ADT was observed. CONCLUSION PSM is associated with the risk of sRT and initiation of ADT, however this association is weak. Our results underline that factors beyond tumor characteristics play a major role for initiation of sRT and ADT.
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Affiliation(s)
- Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Sofie Friberg
- Copenhagen Prostate Cancer Center, Department of Urology, Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Department of Urology, Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Faculty of Health and Medical Sciences, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Faria LF, Reis ST, Leite KR, da Cruz JAS, Pimenta R, Viana NI, Amaral GQ, Santos GAGD, Ilias D, Fakhouri F, Xavier G, Srougi M, Passerotti CC. Digital application developed to evaluate functional results following robot-assisted radical prostatectomy: App for prostate cancer. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105683. [PMID: 32777664 DOI: 10.1016/j.cmpb.2020.105683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Mobile applications ("apps") developed for smartphones and tablets are increasingly used in healthcare, allowing remote patient support or promoting self-health care. Prostate cancer (PC) screening allows for early-stage PC diagnosis, resulting in high rates of curative procedures such as radical prostatectomy. The main complications following surgery are urinary incontinence and erectile dysfunction. However, the exact numbers related to these morbidities are often missing due to brief interviews during consultations in the medical office. Therefore, the aim of this study was to create an app to determine whether response rates to pre- and post-surgical PC questionnaires will increase. METHODS The app was built using the IONIC framework system and provided to patients through a prospective randomized study. We included 100 patients divided into two groups: 1. first group used the app (n = 50); and 2. second group responded via validated printed questionnaires (control group) (n = 50). All patients received discharge counseling to respond to the questionnaires 1, 3, 6 and 12 months after the procedure. The app group received verbal guidance on how monitoring would occur, received an SMS containing a username and password providing access to the system and received reminder alerts to respond to the questionnaires. RESULTS The new app is called UroHealth and is available for download in the Apple App Store or at www.urohealth.com.br. When we evaluated the response rates, we found that 42.9% of the patients answered the preoperative questionnaire in the app group, while 16% responded in the control group (p = 0.003). By the end of the follow-up, we found that 24.5% of the patients answered the questionnaire in the app group, while 4% responded in the control group (p = 0.003). CONCLUSION This app enabled almost 6 times more patients to answer long-term follow-up questions after surgical procedures, providing high-quality information regarding morbidity related to treatment. Although our initial results indicate that this app may become a useful tool in obtaining more frequent and realistic answers, thus helping to improve surgical techniques, other ways of reaching the patient should be tested to achieve higher response rates.
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Affiliation(s)
- Leandro F Faria
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Sabrina T Reis
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil; Faculdade Atenas - Campus Passos, Minas Gerais, 37900-380, Brazil.
| | - Katia R Leite
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | | | - Ruan Pimenta
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Nayara I Viana
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Gabriela Q Amaral
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Gabriel A G D Santos
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Daniel Ilias
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Felipe Fakhouri
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Geraldo Xavier
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Miguel Srougi
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Carlo Camargo Passerotti
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil; Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
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Do prostate cancer-related mobile phone apps have a role in contemporary prostate cancer management? A systematic review by EAU young academic urologists (YAU) urotechnology group. World J Urol 2020; 38:2411-2431. [PMID: 32322996 PMCID: PMC7508932 DOI: 10.1007/s00345-020-03197-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 10/31/2022] Open
Abstract
AIMS AND OBJECTIVES To review the available literature regarding the use of prostate cancer-related mobile phone applications (PCA). MATERIALS AND METHODS The search was for English language articles between inceptions of databases to June 2019. Medline, EMBASE, Cochrane Library, CINAHL and Web of Science were searched. Full-text articles were reviewed, and the following data were extracted to aid with app analysis: name of application, developer, platform (Apple App Store or Google Play Store) and factors assessed by the article. RESULTS The search yielded 1825 results of which 13 studies were included in the final review. 44 PCAs were identified from the data collected of which 59% of the PCAs had an educational focus. 11 apps were inactive and 5 weren't updated within the last year. Five studies focused on the development and testing of apps (MyHealthAvatar, CPC, Rotterdam, Interaktor, NED). Two studies evaluated the readability of PCAs. Most PCAs had a reading level greater than that of the average patient. Two studies evaluated the quality and accuracy of apps. Majority of PCAs were accurate with a wide range of information. The study reported most PCAs to have deficient or insufficient scores for data protection. Two studies evaluated the accuracy of Rotterdam, CORAL and CPC risk calculators. Rotterdam was the best performer. CONCLUSIONS PCAs are currently in its infancy and do require further development before widespread integration into existing clinical practise. There are concerns with data protection, high readability standards and lack of information update in current PCAs. If developed appropriately with responsible governance, they do have the potential to play important roles in modern-day prostate cancer management.
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Friberg AS, Dalton SO, Larsen SB, Andersen EW, Krøyer A, Helgstrand JT, Røder MA, Johansen C, Brasso K. Risk of Depression After Radical Prostatectomy-A Nationwide Registry-based Study. Eur Urol Oncol 2019; 4:601-608. [PMID: 31345731 DOI: 10.1016/j.euo.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Development of depression in prostate cancer patients depends on multiple disease- and patient-related factors. OBJECTIVE To investigate the risk of depression following radical prostatectomy focussing on the impact of surgery and subsequent treatment with salvage radiation or androgen deprivation therapy. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study of 5570 men who underwent radical prostatectomy in Denmark from 1998 to 2011 was identified in the Danish Prostate Cancer Registry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Data on covariates and primary outcome defined as a hospital contact for depression or a redeemed antidepressant prescription were obtained from nationwide Danish registries. The risk of depression was evaluated using cumulative incidence functions and Cox models with time since surgery as an underlying time scale. Exposure to salvage procedures was included as time-varying covariates, and analyses were adjusted for confounders. RESULTS AND LIMITATIONS The cumulative incidence of depression was increased in men who had undergone surgery compared with cancer-free men throughout follow-up of up to 18yr, particularly among men on androgen deprivation therapy. Compared with no subsequent treatment, the risk of depression was increased with subsequent androgen deprivation therapy (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.4-2.3), salvage radiation (HR 1.3, 95% CI 1.0-1.6), and the treatments combined (HR 2.2, 95% CI 1.8-2.8) after adjustments for age, year of surgery, income, and cohabitation status. Further adjustment for comorbidity hardly changed the estimates. CONCLUSIONS Radical prostatectomy and subsequent salvage procedures increase the risk of depression, and men with subsequent androgen deprivation therapy are mainly at risk. Clinicians should thus be aware of depressive symptoms in patients receiving treatment for postsurgical relapse. PATIENT SUMMARY In a population-based study, we found that radical prostatectomy and subsequent treatments with either radiation or endocrine manipulation significantly increased the risk of developing clinical depression.
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Affiliation(s)
- Anne Sofie Friberg
- Department of Oncology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark; Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.
| | - Susanne Oksbjerg Dalton
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Oncology, University Hospital of Zealand Næstved, Næstved, Denmark
| | - Signe Benzon Larsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth W Andersen
- Statistics and Pharmaco-epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John Thomas Helgstrand
- Copenhagen Prostate Cancer Center, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
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‘Prostate Cancer Risk Calculator’ mobile applications (Apps): a systematic review and scoring using the validated user version of the Mobile Application Rating Scale (uMARS). World J Urol 2017; 36:565-573. [DOI: 10.1007/s00345-017-2150-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
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Kurbegovic S, Berg KD, Thomsen FB, Gruschy L, Iversen P, Brasso K, Røder MA. The risk of biochemical recurrence for intermediate-risk prostate cancer after radical prostatectomy. Scand J Urol 2017; 51:450-456. [DOI: 10.1080/21681805.2017.1356369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sorel Kurbegovic
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Kasper Drimer Berg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Frederik Birkebæk Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Lisa Gruschy
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet Copenhagen University Hospital, Copenhagen N, Denmark
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