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Azin M, Ngo KH, Hojanazarova J, Demehri S. Topical Calcipotriol Plus Imiquimod Immunotherapy for Nonkeratinocyte Skin Cancers. JID INNOVATIONS 2023; 3:100221. [PMID: 37731472 PMCID: PMC10507651 DOI: 10.1016/j.xjidi.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
Nonkeratinocyte cutaneous malignancies, including breast cancer cutaneous metastasis and melanoma in situ, are often poor surgical candidates. Imiquimod (IMQ), a toll-like receptor 7 agonist that activates innate immunity in the skin, is used to treat these cutaneous malignancies. However, IMQ's modest effect on the activation of adaptive immunity limits its efficacy as a monotherapy. In this study, we demonstrate that topical TSLP cytokine inducers-calcipotriol and retinoic acid-synergize with IMQ to activate CD4+ T-cell immunity against nonkeratinocyte cutaneous malignancies. Topical calcipotriol plus IMQ treatment reduced breast tumor growth compared with calcipotriol or IMQ alone (P < 0.0001). Calcipotriol plus IMQ-mediated tumor suppression was associated with significant infiltration of CD4+ effector T cells in the tumor microenvironment. Notably, topical calcipotriol plus IMQ immunotherapy enabled immune checkpoint blockade therapy to effectively control immunologically cold breast tumors, which was associated with induction of CD4+ T-cell immunity. Topical treatment with calcipotriol plus IMQ and retinoic acid plus IMQ also blocked subcutaneous melanoma growth. These findings highlight the synergistic effect of topical TSLP induction in combination with innate immune cell activation as an effective immunotherapy for malignancies affecting the skin.
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Affiliation(s)
- Marjan Azin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth H. Ngo
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennet Hojanazarova
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shadmehr Demehri
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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2
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Conlin A, Chun B, Borges V, Moxon N, Parris H, Walker L, Murthy R. Cutaneous responses in HER2+ metastatic breast cancer: A retrospective case series of a Phase 1b study of Tucatinib, an Oral HER2-specific inhibitor in combination with Capecitabine and/or Trastuzumab in third-line or later treatment. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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3
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Huang S, Parekh V, Waisman J, Jones V, Yuan Y, Vora N, Li R, Jung J, Kruper L, Abdulla F, Fong Y, Li W. Cutaneous metastasectomy: Is there a role in breast cancer? A systematic review and overview of current treatment modalities. J Surg Oncol 2022; 126:217-238. [PMID: 35389520 PMCID: PMC9545220 DOI: 10.1002/jso.26870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 12/21/2022]
Abstract
Cutaneous metastases (CM) are neoplastic lesions involving the dermis or subcutaneous tissues, originating from another primary tumor. Breast cancer is commonest primary solid tumor, representing 24%-50% of CM patients. There is no "standard of care" on management. In particular, the role of surgery in the treatment of cutaneous metastases from breast carcinoma (CMBC) remains controversial. This systematic review evaluates the role of cutaneous metastasectomy in breast cancer and provides an overview of existing treatment types.
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Affiliation(s)
- Samantha Huang
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - James Waisman
- Department of Medical Oncology & Therapeutics ResearchCity of HopeDuarteCaliforniaUSA
| | - Veronica Jones
- Division of Breast SurgeryCity of HopeDuarteCaliforniaUSA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics ResearchCity of HopeDuarteCaliforniaUSA
| | - Nayana Vora
- Department of Radiation OncologyCity of HopeDuarteCaliforniaUSA
| | - Richard Li
- Department of Radiation OncologyCity of HopeDuarteCaliforniaUSA
| | - Jae Jung
- Division of Derm‐oncologyNorton Cancer InstituteLouisvilleKentuckyUSA
| | - Laura Kruper
- Division of Breast SurgeryCity of HopeDuarteCaliforniaUSA
| | - Farah Abdulla
- Division of DermatologyCity of HopeDuarteCaliforniaUSA
| | - Yuman Fong
- Department of SurgeryCity of HopeDuarteCaliforniaUSA
| | - Wai‐Yee Li
- Division of Plastic SurgeryCity of HopeDuarteCaliforniaUSA
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4
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Drohan A, Vidovic D, Barnes PJ, Giacomantonio CA, Helyer LK. Cutaneous Breast Cancer Metastasis Is Effectively Treated With Intralesional Interleukin-2 and Imiquimod: A Case Report and Brief Literature Review. Front Oncol 2022; 12:877014. [PMID: 35712509 PMCID: PMC9192334 DOI: 10.3389/fonc.2022.877014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is the most common non-cutaneous cancer affecting women worldwide and is a major cause of cancer-related morbidity and mortality in females. While many women are diagnosed with early-stage disease, a subset of women may present with isolated cutaneous metastases or recurrent locoregional cutaneous metastatic disease. There is a paucity of evidence for effective treatments for cutaneous breast cancer metastases. Herein, we present a case of hormone receptor negative, HER2 positive cutaneous breast cancer metastasis treated with intralesional IL-2 and topical imiquimod, which was well tolerated with only minor low grade side effects. We also present a brief literature review of immunotherapy for cutaneous breast cancer metastasis to frame the discussion around using minimally invasive local therapies for this disease. Together, this limited data suggests that intralesional IL-2 and imiquimod may be considered as a safe option when treating a patient with cutaneous breast cancer metastases.
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Affiliation(s)
- Ashley Drohan
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dejan Vidovic
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
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González-Martínez S, Pizarro D, Pérez-Mies B, Caniego-Casas T, Curigliano G, Cortés J, Palacios J. Clinical, Pathological, and Molecular Features of Breast Carcinoma Cutaneous Metastasis. Cancers (Basel) 2021; 13:5416. [PMID: 34771579 PMCID: PMC8582578 DOI: 10.3390/cancers13215416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Cutaneous metastases (CMs) account for 2% of all skin malignancies, and nearly 70% of CMs in women originate from breast cancer (BC). CMs are usually associated with poor prognosis, are difficult to treat, and can pose diagnostic problems, such as in histopathological diagnosis when occurring long after development of the primary tumor. In addition, the molecular differences between the primary tumors and their CMs, and between CMs and metastases in other organs, are not well defined. Here, we review the main clinical, pathological, and molecular characteristics of breast cancer CMs. Identifying molecular markers in primary BC that predict CM and can be used to determine the molecular differences between primary tumors and their metastases is of great interest for the design of new therapeutic approaches.
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Affiliation(s)
- Silvia González-Martínez
- Clinical Researcher, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Fundación Contigo contra el Cáncer de la Mujer, 28010 Madrid, Spain
| | - David Pizarro
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
| | - Belén Pérez-Mies
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
| | - Tamara Caniego-Casas
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, 20141 Milan, Italy;
- Departament of Oncology and Hematology, University of Milan, 20122 Milan, Italy
| | - Javier Cortés
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- International Breast Cancer Center (IBCC), Quironsalud Group, 08017 Barcelona, Spain
- Medica Scientia Innovation Research, 08007 Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, NJ 07450, USA
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - José Palacios
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
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Huth HW, Castro-Gomes T, de Goes AM, Ropert C. Translocation of intracellular CD24 constitutes a triggering event for drug resistance in breast cancer. Sci Rep 2021; 11:17077. [PMID: 34426608 PMCID: PMC8382710 DOI: 10.1038/s41598-021-96449-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/03/2021] [Indexed: 01/06/2023] Open
Abstract
The capacity of tumor cells to shift dynamically between different states could be responsible for chemoresistance and has been commonly linked to the acquisition of stem cell properties. Here, we have evaluated the phenotype switching associated with drug resistance in breast cancer cell lines and cell lineage obtained from Brazilian patients. We have highlighted the role of the cancer stem cell marker CD24 in the dynamics of cell plasticity and the acquirement of drug resistance. We showed that the translocation of CD24 from cytosol to cell membrane is a triggering event for the phenotype change of breast tumor cells exposed to drug stress. Here, we provide evidence that the phenotype switching is due to the presence of a cytosolic pool of CD24. Importantly, the cellular localization of CD24 was correlated with the changes in the dynamics of p38 MAPK activation. A strong and continuous phosphorylation of the p38 MAPK led to the overexpression of Bcl-2 after treatment in persistent cells presenting high density of CD24 on cell membrane. This phenotype enabled the cells to enter in slow-down of cell cycle, after which several weeks later, the dormant cells proliferated again. Importantly, the use of a p38 activity inhibitor sensitized cells to drug treatment and avoided chemoresistance.
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Affiliation(s)
- Hugo Werner Huth
- Departamento de Biologia Celular, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
| | - Thiago Castro-Gomes
- Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
| | - Alfredo Miranda de Goes
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
| | - Catherine Ropert
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil.
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Nguyen AL, Chong EG, Lee J, Mirshahidi S, Mirshahidi H. A case report of imiquimod topical therapy as treatment for cutaneous metastasis of breast cancer. Rare Tumors 2021; 13:2036361320975748. [PMID: 34249290 PMCID: PMC8239964 DOI: 10.1177/2036361320975748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Cutaneous metastasis of breast cancer carries a poor prognosis, invokes a poor quality of life, and increases mortality by raising one’s risk of bleeding and infection. Currently, options for treatment are systemic chemotherapy, surgical resection and radiation. These treatments are invasive and can have toxic side effects. A 50-year-old African-American woman with stage IV breast cancer with cutaneous metastasis to the left anterior chest and left supraclavicular area was successfully treated with topical imiquimod. She experienced improvement in appearance and symptoms within several months of starting treatment, resulting in near resolution of her cutaneous metastasis. Imiquimod is currently approved for several cutaneous conditions and has the potential to treat cutaneous metastasis of breast cancer.
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Affiliation(s)
- Anthony L Nguyen
- Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Esther G Chong
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Joanne Lee
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Saied Mirshahidi
- Loma Linda University Cancer Center Biospecimen Laboratory, Department of Microbiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Hamid Mirshahidi
- Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Sittenfeld SMC, Murray E, Guo B, Tendulkar R, Xia P, Shah C. Treatment of diffuse cutaneous metastases from breast cancer. Breast J 2020; 26:2444-2446. [PMID: 32918340 DOI: 10.1111/tbj.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah M C Sittenfeld
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric Murray
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bingqi Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Tendulkar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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First Case of Topical 5-FU Therapy for Cutaneous Metastasis in a Patient with Colon Cancer. EURASIAN JOURNAL OF MEDICINE AND ONCOLOGY 2020; 4:89-93. [PMID: 32964198 PMCID: PMC7504877 DOI: 10.14744/ejmo.2020.81980] [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] [Indexed: 12/02/2022]
Abstract
Cutaneous metastasis from colon cancer is rare, occurs in less than 6% of patients and its associated with poor prognosis. Most often it presents in the abdomen, inguinal or perineal regions, supraclavicular area, and less commonly on the face, neck, scalp, and prior surgical sites. We present a case of a 41-year-old female with colon cancer who developed cutaneous metastases to the scalp, and was treated with topical 5-FU and radiation therapy. Treatment options for cutaneous metastases usually include systemic therapy, topical chemotherapy, surgical excision, or radiation. Our case is probably the first report who was treated with topical 5-FU in addition to radiation therapy. This treatment modality is easy to use and we would recommend clinical trials to be conducted to further study the use of topical 5-FU.
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Jouret G, Gonne E, Quatresooz P, Reginster MA, Collins P, Lebas E, Jerusalem G, Nikkels AF. Cutaneous Breast Cancer Metastases Successfully Treated Using an Oxygen Flow Assisted Topical Administration of Methotrexate (OFAMTX). Dermatol Ther (Heidelb) 2020; 10:855-861. [PMID: 32415574 PMCID: PMC7367989 DOI: 10.1007/s13555-020-00393-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Cutaneous metastases of breast cancer remain a therapeutic challenge. Oxygen flow-assisted topical administration of methotrexate 5% (OFAMTX, 5% methotrexate in a carrier solution) has recently been proven to be an efficacious alternative treatment for extramammary Paget’s disease, which is considered to be an in situ mammary adenocarcinoma of the epidermis. Case Report A 51-year-old patient with triple negative breast cancer presenting with biopsy-proven skin metastases on the chest agreed to a treatment with OFAMTX5%. The treatment duration was 2 weeks and consisted of twice-weekly sessions with OFAMTX5% applied to an area of skin of approximately 40 cm2. Skin biopsies were performed before and 2 months after procedure. The tolerance to the treatment was excellent, and no pain sensations were experienced. Two months post-procedure the treated area presented a post-inflammatory hyperpigmentation. No residual metastatic lesions were detectable on the control skin biopsy. Six months post-procedure the patient is still in clinical remission. Discussion OFAMTX5% represents an alternative skin-directed, painless, patient-friendly and efficacious adjuvant treatment for superficial metastatic lesions of breast cancer. Larger series are required to evaluate the potential of OFAMTX5% for the treatment of superficial metastatic lesions of breast cancer.
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Affiliation(s)
- Gaëlle Jouret
- Department of Dermatology (Skin Cancer Center), Centre Hospitalier Universitaire (CHU) du Sart Tilman, University of Liège, Liège, Belgium
| | - Elodie Gonne
- Department of Medical Oncology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Pascale Quatresooz
- Department of Dermatopathology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | | | - Patrick Collins
- Department of Dermatopathology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Eve Lebas
- Department of Dermatology (Skin Cancer Center), Centre Hospitalier Universitaire (CHU) du Sart Tilman, University of Liège, Liège, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Arjen F Nikkels
- Department of Dermatology (Skin Cancer Center), Centre Hospitalier Universitaire (CHU) du Sart Tilman, University of Liège, Liège, Belgium.
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