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Jones JM, Bhatt J, Avery J, Laupacis A, Cowan K, Basappa NS, Basiuk J, Canil C, Al-Asaaed S, Heng DY, Wood L, Stacey D, Kollmannsberger C, Jewett MA. Setting Research Priorities for Kidney Cancer. Eur Urol 2017; 72:861-864. [DOI: 10.1016/j.eururo.2017.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 12/14/2022]
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Jones J, Bhatt J, Avery J, Laupacis A, Cowan K, Basappa N, Basiuk J, Canil C, Al-Asaaed S, Heng D, Wood L, Stacey D, Kollmannsberger C, Jewett MAS. The kidney cancer research priority-setting partnership: Identifying the top 10 research priorities as defined by patients, caregivers, and expert clinicians. Can Urol Assoc J 2017; 11:379-387. [PMID: 29106364 DOI: 10.5489/cuaj.4590] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is critically important to define disease-specific research priorities to better allocate limited resources. There is growing recognition of the value of involving patients and caregivers, as well as expert clinicians in this process. To our knowledge, this has not been done this way for kidney cancer. Using the transparent and inclusive process established by the James Lind Alliance, the Kidney Cancer Research Network of Canada (KCRNC) sponsored a collaborative consensus-based priority-setting partnership (PSP) to identify research priorities in the management of kidney cancer. The final result was identification of 10 research priorities for kidney cancer, which are discussed in the context of current initiatives and gaps in knowledge. This process provided a systematic and effective way to collaboratively establish research priorities with patients, caregivers, and clinicians, and provides a valuable resource for researchers and funding agencies.
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Affiliation(s)
- Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jaimin Bhatt
- Departments of Surgery and Surgical Oncology (Division of Urology), Princess Margaret Cancer Centre, University Health Network, and the University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- School of Rehabilitation Sciences, University of Ottawa, ON, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | - Naveen Basappa
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, University of Ottawa, Ottawa, ON, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Sohaib Al-Asaaed
- Department of Medical Oncology, Dr. H. Bliss Murphy Cancer Centre, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Daniel Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary AB, Canada
| | - Lori Wood
- Division of Medical Oncology, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christian Kollmannsberger
- Medical Oncology, University of British Columbia and Medical Oncology BC Cancer Agency, Vancouver, BC, Canada
| | - Michael A S Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology), Princess Margaret Cancer Centre, University Health Network, and the University of Toronto, Toronto, ON, Canada
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Molecular Markers and Targeted Therapeutics in Metastatic Tumors of the Spine: Changing the Treatment Paradigms. Spine (Phila Pa 1976) 2016; 41 Suppl 20:S218-S223. [PMID: 27488299 DOI: 10.1097/brs.0000000000001833] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY TYPE A review of the literature. OBJECTIVE The aim of this study was to discuss the evolution of molecular signatures and the history and development of targeted therapeutics in metastatic tumor types affecting the spinal column. SUMMARY OF BACKGROUND DATA Molecular characterization of metastatic spine tumors is expected to usher in a revolution in diagnostic and treatment paradigms. Molecular characterization will provide critical information that can be used for initial diagnosis, prognosticating the ideal treatment strategy, assessment of treatment efficacy, surveillance and monitoring recurrence, and predicting complications, clinical outcome, and overall survival in patients diagnosed with metastatic cancers to the spinal column. METHODS A review of the literature was performed focusing on illustrative examples of the role that molecular-based therapeutics have played in clinical outcomes for patients diagnosed with metastatic tumor types affecting the spinal column. RESULTS The impact of molecular therapeutics including receptor tyrosine kinases and immune checkpoint inhibitors and the ability of molecular signatures to provide prognostic information are discussed in metastatic breast cancer, lung cancer, prostate cancer, melanoma, and renal cell cancer affecting the spinal column. CONCLUSION For the providers who will ultimately counsel patients diagnosed with metastases to the spinal column, molecular advancements will radically alter the management/surgical paradigms utilized. Ultimately, the translation of these molecular advancements into routine clinical care will greatly improve the quality and quantity of life for patients diagnosed with spinal malignancies and provide better overall outcomes and counseling for treating physicians. LEVEL OF EVIDENCE N/A.
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Albiges L, Fay AP, McKay RR, Kaymakcalan MD, Choueiri TK. Diagnosis of Renal Cell Carcinoma: A Clinician's Perspective. Surg Pathol Clin 2015; 8:657-662. [PMID: 26612219 DOI: 10.1016/j.path.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Renal cell carcinoma (RCC) is a heterogeneous disease. A rigorous diagnostic assessment by a pathologist with close communication with the clinician provides more accurate prognostication and informed treatment decisions. In the localized setting, an accurate prognostic assessment directs patients to potential adjuvant clinical trials. For patients with advanced disease, the pathologic assessment may have a direct impact on the systemic therapy algorithm. Additionally, it provides the basis for continuous efforts in biomarker development. In rare histologic subtypes, the interaction between clinicians and pathologists provides an opportunity to offer patients specific clinical trials. Molecular characterization platforms may identify targets for therapeutic intervention.
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Affiliation(s)
- Laurence Albiges
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue (DANA 1230), Boston, MA 02215, USA
| | - André P Fay
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue (DANA 1230), Boston, MA 02215, USA
| | - Rana R McKay
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue (DANA 1230), Boston, MA 02215, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marina D Kaymakcalan
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue (DANA 1230), Boston, MA 02215, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue (DANA 1230), Boston, MA 02215, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Albiges L, Gizzi M, Carton E, Escudier B. Axitinib in metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2015; 15:499-507. [DOI: 10.1586/14737140.2015.1033408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hawryluk GWJ, Manley GT. Classification of traumatic brain injury: past, present, and future. HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:15-21. [PMID: 25702207 DOI: 10.1016/b978-0-444-52892-6.00002-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Disease classification is central to the practice of medicine; it systematizes clinical knowledge and experience. Classification is essential for diagnosis and effective treatment of human disease. Progress in classifying traumatic brain injury (TBI) for targeted treatment has lagged behind other diseases such as cancer, and has contributed to a lack of progress in the field. Today TBI is most frequently classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS). However, the GCS is symptoms-based and does not allow for targeting of specific pathology. Here we review general schemas for disease classification and how they have evolved over time. We discuss the characteristics of an ideal classification system and the unique challenges inherent to achieving such a system for TBI. Current means of classifying TBI are reviewed, as are the strengths and limitations of these approaches. Generating the data required to modernize TBI classification and to perhaps facilitate a targeted, precision medicine approach to its management will require a highly collaborative international effort. Fortunately these efforts are underway and will benefit from the lessons and tools that have come from other areas of medicine that have already found success with this approach.
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Affiliation(s)
| | - Geoffrey T Manley
- Department of Neurological Surgery and Brain and Spinal Injury Center, University of California, San Francisco, CA, USA.
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Harshman LC, Drake CG, Choueiri TK. PD-1 blockade in renal cell carcinoma: to equilibrium and beyond. Cancer Immunol Res 2014; 2:1132-41. [PMID: 25480555 PMCID: PMC4695990 DOI: 10.1158/2326-6066.cir-14-0193] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past several years have witnessed a resurgence of interest in cancer immunotherapy. The development of blocking antibodies against the inhibitory programmed death-1 (PD-1) pathway represents a clinical breakthrough in the treatment of solid tumors such as melanoma, and these agents show great promise in renal cell carcinoma (RCC). The early data have been surprising in that they demonstrate that blockade of a single immune checkpoint can elicit objective responses in patients with RCC, despite the recognized complexity of the immunosuppressive tumor microenvironment. Reinvigorating the patient's own immune cells to reactivate and to target the tumor has the potential advantages of more selective killing and thus decreased toxicity. In addition, checkpoint blockade immunotherapy has the advantage of inducing a memory response that is unattainable with our current cytotoxic and targeted therapies. This Crossroads overview will highlight the emerging investigation of PD-1 blockade in RCC and how this T cell-targeted strategy may thwart the tumor's escape mechanisms and shift the immune system/tumor balance back to a state of equilibrium and even to tumor elimination.
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Affiliation(s)
- Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Charles G Drake
- Department of Oncology and the Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Huber J, Ihrig A, Winkler E, Brechtel A, Friederich HC, Herzog W, Frank M, Grüllich C, Hallscheidt P, Zeier M, Pahernik S, Hohenfellner M. Interdisciplinary counseling service for renal malignancies: a patient-centered approach to raise guideline adherence. Urol Oncol 2014; 33:23.e1-23.e7. [PMID: 25465195 DOI: 10.1016/j.urolonc.2014.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Tumor boards have become an integral part of high-quality cancer care, but in general, patients are not directly involved. To overcome this weakness, we established an interdisciplinary counseling service for renal malignancies where 4 specialists talked to the patient at once. We evaluated this approach from the patients' and physicians' perspective. MATERIALS AND METHODS For 3 months, we assessed organizational and clinical data. Within a standardized telephone interview lasting for 14 ± 8 minutes, we explored the patients' view 1 week after counseling. A focus group contributed the physicians' perspective. Costs and revenues were calculated from the hospital's perspective. RESULTS We included 52 consecutive patients aged 62 ± 10 years. Patients' initiative for a "second opinion" triggered 37% of all appointments. Patients had localized (52%) and systemic (48%) disease presenting with primary diagnosis (48%), relapse (27%), or under continuous therapy (25%). The treatment strategy was changed significantly in 16 of 30 (53%) patients reporting a specific external opinion. The most frequent changes in recommendation were nephron-sparing surgery instead of radical nephrectomy in 8 cases and divergent judgments on restaging causing changes in systemic treatment in 6 cases. We successfully interviewed 43 of 52 patients. Overall, patients rated the consultation as very positive and only 1 patient (2%) was dissatisfied. Patients rated the quality of interpersonal interaction as very positive and said they would recommend the consultation service to others. Disease state was not associated with ratings. Physicians expressed a very positive opinion, highlighting the patients' benefit and very constructive case discussions. Nevertheless, they report remarkable efforts concerning time investment and effective coordination of medical experts. We estimated a deficit of 39 Euro per patient given the German health care system. There might be relevant secondary positive economic effects for the hospital such as recommendations from one patient to another leading to acquisition of additional patients. CONCLUSIONS Patient involvement in multidisciplinary tumor boards is feasible and well regarded by patients and physicians likewise. By stimulating interdisciplinary collaboration, the interdisciplinary counseling service improves patient satisfaction and clinical decision making. The interdisciplinary counseling service corrected half of the external treatment plans for better guideline adherence. These positive effects come at the price of higher resource utilization. (www.germanctr.de, number DRKS00003279).
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Affiliation(s)
- Johannes Huber
- Department of Urology, University of Heidelberg, Heidelberg, Germany.
| | - Andreas Ihrig
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany.
| | - Eva Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Anette Brechtel
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Martin Frank
- Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
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Choueiri TK, Fay AP, Gray KP, Callea M, Ho TH, Albiges L, Bellmunt J, Song J, Carvo I, Lampron M, Stanton ML, Hodi FS, McDermott DF, Atkins MB, Freeman GJ, Hirsch MS, Signoretti S. PD-L1 expression in nonclear-cell renal cell carcinoma. Ann Oncol 2014; 25:2178-2184. [PMID: 25193987 DOI: 10.1093/annonc/mdu445] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression in nonclear-cell RCC (non-ccRCC) and its association with clinical outcomes are unknown. METHODS Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 101 patients with non-ccRCC. PD-L1 expression was evaluated by immunohistochemistry in both tumor cell membrane and tumor-infiltrating mononuclear cells (TIMC). PD-L1 tumor positivity was defined as ≥5% tumor cell membrane staining. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrate and percentage of positive cells was used. Baseline clinico-pathological characteristics and outcome data [time to recurrence (TTR) and overall survival (OS)] were correlated with PD-L1 staining. RESULTS Among 101 patients, 11 (10.9%) were considered PD-L1+ in tumor cells: 2/36 (5.6%) of chromophobe RCC, 5/50 (10%) of papillary RCC, 3/10 (30%) of Xp11.2 translocation RCC and 1/5 (20%) of collecting duct carcinoma. PD-L1 positivity (PD-L1+) in tumor cells was significantly associated with higher stage (P = 0.01) and grade (P = 0.03), as well as shorter OS (P < 0.001). On the other hand, PD-L1 positivity by TIMC was observed in 57 (56.4%) patients: 13/36 (36.1%) of chromophobe RCC, 30/50 (60%) of papillary RCC, 9/10 (90%) of Xp11.2 translocation RCC and 5/5 (100%) of collecting duct carcinoma. A trend toward shorter OS was observed in patients with PD-L1+ in TIMC (P = 0.08). PD-L1+ in both tumor cell membrane and TIMC cells were associated with shorter TTR (P = 0.02 and P = 0.03, respectively). CONCLUSION In non-ccRCC, patients with PD-L1+ tumors appear to have worse clinical outcomes, although only PD-L1 positivity in tumor cells is associated with higher tumor stage and grade.
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Affiliation(s)
- T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston.
| | - A P Fay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K P Gray
- Biostatistics and Computational Biology, Harvard School of Public Health, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - T H Ho
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - L Albiges
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston
| | - J Song
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - I Carvo
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - M Lampron
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - M L Stanton
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - F S Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston
| | - D F McDermott
- Harvard Medical School, Boston; Department of Medical Oncology, Beth-Israel Deaconess Medical Center, Boston
| | - M B Atkins
- Department of Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, USA
| | - G J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston
| | - M S Hirsch
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
| | - S Signoretti
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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Bielecka ZF, Czarnecka AM, Szczylik C. Genomic Analysis as the First Step toward Personalized Treatment in Renal Cell Carcinoma. Front Oncol 2014; 4:194. [PMID: 25120953 PMCID: PMC4110478 DOI: 10.3389/fonc.2014.00194] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/09/2014] [Indexed: 12/13/2022] Open
Abstract
Drug resistance mechanisms in renal cell carcinoma (RCC) still remain elusive. Although most patients initially respond to targeted therapy, acquired resistance can still develop eventually. Most of the patients suffer from intrinsic (genetic) resistance as well, suggesting that there is substantial need to broaden our knowledge in the field of RCC genetics. As molecular abnormalities occur for various reasons, ranging from single nucleotide polymorphisms to large chromosomal defects, conducting whole-genome association studies using high-throughput techniques seems inevitable. In principle, data obtained via genome-wide research should be continued and performed on a large scale for the purposes of drug development and identification of biological pathways underlying cancerogenesis. Genetic alterations are mostly unique for each histological RCC subtype. According to recently published data, RCC is a highly heterogeneous tumor. In this paper, the authors discuss the following: (1) current state-of-the-art knowledge on the potential biomarkers of RCC subtypes; (2) significant obstacles encountered in the translational research on RCC; and (3) recent molecular findings that may have a crucial impact on future therapeutic approaches.
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Affiliation(s)
- Zofia Felicja Bielecka
- Department of Oncology with the Laboratory of Molecular Oncology, Military Institute of Medicine , Warsaw , Poland ; Postgraduate School of Molecular Medicine, Medical University of Warsaw , Warsaw , Poland
| | - Anna Małgorzata Czarnecka
- Department of Oncology with the Laboratory of Molecular Oncology, Military Institute of Medicine , Warsaw , Poland
| | - Cezary Szczylik
- Department of Oncology with the Laboratory of Molecular Oncology, Military Institute of Medicine , Warsaw , Poland
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Gnanapragasam VJ. Molecular markers to guide primary radical treatment selection in localized prostate cancer. Expert Rev Mol Diagn 2014; 14:871-81. [DOI: 10.1586/14737159.2014.936851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fay AP, Signoretti S, Choueiri TK. MET as a Target in Papillary Renal Cell Carcinoma. Clin Cancer Res 2014; 20:3361-3. [DOI: 10.1158/1078-0432.ccr-14-0690] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grabiner BC, Nardi V, Birsoy K, Possemato R, Shen K, Sinha S, Jordan A, Beck AH, Sabatini DM. A diverse array of cancer-associated MTOR mutations are hyperactivating and can predict rapamycin sensitivity. Cancer Discov 2014; 4:554-63. [PMID: 24631838 PMCID: PMC4012430 DOI: 10.1158/2159-8290.cd-13-0929] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Genes encoding components of the PI3K-AKT-mTOR signaling axis are frequently mutated in cancer, but few mutations have been characterized in MTOR, the gene encoding the mTOR kinase. Using publicly available tumor genome sequencing data, we generated a comprehensive catalog of mTOR pathway mutations in cancer, identifying 33 MTOR mutations that confer pathway hyperactivation. The mutations cluster in six distinct regions in the C-terminal half of mTOR and occur in multiple cancer types, with one cluster particularly prominent in kidney cancer. The activating mutations do not affect mTOR complex assembly, but a subset reduces binding to the mTOR inhibitor DEPTOR. mTOR complex 1 (mTORC1) signaling in cells expressing various activating mutations remains sensitive to pharmacologic mTOR inhibition, but is partially resistant to nutrient deprivation. Finally, cancer cell lines with hyperactivating MTOR mutations display heightened sensitivity to rapamycin both in culture and in vivo xenografts, suggesting that such mutations confer mTOR pathway dependency.
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Affiliation(s)
- Brian C. Grabiner
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
- Howard Hughes Medical Institute and Department of Biology, MIT, Cambridge, MA 02139
- Broad Institute of Harvard and MIT, Cambridge, MA 02142
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA 02139
| | - Valentina Nardi
- Department of Pathology and Massachusetts General Hospital Cancer Center, Boston, MA 02114
| | - Kivanc Birsoy
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
- Howard Hughes Medical Institute and Department of Biology, MIT, Cambridge, MA 02139
- Broad Institute of Harvard and MIT, Cambridge, MA 02142
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA 02139
| | - Richard Possemato
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
- Howard Hughes Medical Institute and Department of Biology, MIT, Cambridge, MA 02139
- Broad Institute of Harvard and MIT, Cambridge, MA 02142
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA 02139
| | - Kuang Shen
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
- Howard Hughes Medical Institute and Department of Biology, MIT, Cambridge, MA 02139
- Broad Institute of Harvard and MIT, Cambridge, MA 02142
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA 02139
| | - Sumi Sinha
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
| | - Alexander Jordan
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
| | - Andrew H. Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215
| | - David M. Sabatini
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142
- Howard Hughes Medical Institute and Department of Biology, MIT, Cambridge, MA 02139
- Broad Institute of Harvard and MIT, Cambridge, MA 02142
- The David H. Koch Institute for Integrative Cancer Research at MIT, Cambridge, MA 02139
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