1
|
Unsal M, Kilic C, Cakir C, Kilic F, Ersak B, Karakas S, Tokgozoglu N, Varli B, Oktar O, Kimyon Comert G, Ozdemir IA, Boran N, Toptas T, Ureyen I, Korkmaz V, Taskin S, Moraloglu Tekin O, Ustun Y, Tasci T, Ortac F, Turan T. Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study. J OBSTET GYNAECOL 2023; 43:2151355. [PMID: 36503383 DOI: 10.1080/01443615.2022.2151355] [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: 12/14/2022]
Abstract
The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p < 0.001, p = 0.026 and p = 0.044, respectively). Adnexal metastasis (positive vs. negative) and type of cytoreductive surgery (maximal vs. optimal and suboptimal) had statistical significance for DSS (p = 0.041 and p = 0.015, respectively). Receiving NACT did not affect DFS and DSS in stage IVB uterine serous carcinoma patients. As our sample size was small, precise conclusions could not be made for suggesting the use of NACT in advanced stage uterine serous carcinoma. For more accurate results, more randomized controlled studies are needed in this patient group.IMPACT STATEMENTWhat is already known on this subject? Endometrial carcinoma is the most common type of gynecologic tract malignancies and usually it is diagnosed at early stages. Although the favorable prognosis, uterine serous carcinoma (USC), one of the rarest subtypes, has a poorer prognosis when compared to other histological subtypes. USC has a propensity to spread beyond pelvis. Due to this aggressive behavior, surgical intervention could not be feasible in advanced stage disease.What do the results of this study add? Our study evaluated the prognostic factors that affect survival in advanced stage USC patients. Also we investigated that neoadjuvant chemotherapy (NACT) could improve oncologic outcomes. Performing lymphadenectomy, presence of paraaortic lymph node and adnexal metastasis, number of metastatic lymph nodes and type of cytoreductive surgery improved survival in advanced stage USC patients. However, NACT did not have a statistical significance as a predictor for disease-specific survival (DSS) and disease-free survival (DFS).What are the implications of these findings for clinical practice and/or further research? Maximal surgical effort should be performed in advanced stage USC according to our results. On the other hand, NACT had no impact on DSS and DFS rates. For this reason, we could not be able to suggest the routine use of NACT in advanced stage USC. But more randomized controlled trials are warranted for confirmation of our results.
Collapse
Affiliation(s)
- Mehmet Unsal
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cigdem Kilic
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Caner Cakir
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Sema Karakas
- Department of Gynecologic Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Nedim Tokgozoglu
- Department of Gynecologic Oncology, Okmeydani Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Bulut Varli
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Okan Oktar
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Isa Aykut Ozdemir
- Department of Gynecologic Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Nurettin Boran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Salih Taskin
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yaprak Ustun
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Tolga Tasci
- Department of Gynecologic Oncology, Okmeydani Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Firat Ortac
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
2
|
Rao Q, Liao J, Li Y, Zhang X, Xu G, Zhu C, Tian S, Chen Q, Zhou H, Zhang B. Application of NGS molecular classification in the diagnosis of endometrial carcinoma: A supplement to traditional pathological diagnosis. Cancer Med 2023; 12:5409-5419. [PMID: 36341543 PMCID: PMC10028062 DOI: 10.1002/cam4.5363] [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: 06/10/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aims to demonstrate the advantages of NGS molecular classification in EC diagnosis and to assess whether molecular classification could be performed on curettage specimens and its concordance with subsequent hysterectomy specimens. METHODS 80 patients with hysterectomy specimens and 35/80 patients with paired curettage specimens were stratified as POLE mut, MSI-H, TP53 wt, or TP53 abn group by NGS panel. Histotype, tumor grade, IHC results, and other pathological details were taken from original pathological reports. RESULTS The correlation analysis of 80 patients with hysterectomy specimens between NGS molecular classification and clinicopathological characters displayed that the POLE mut group was associated with EEC (87.5%) and TP53 abn subtype was correlated to a later stage (Stage II-IV, 47.6%), G3 (76.2%), serous histology (61.9%) and myometrial invasion ≥50% (47.6%). A favorable concordance (31/32, 96.9%) was shown in MSI analysis and MMR IHC results, and the agreement rate of p53 IHC and TP53 mutation was 81.5% (53/65). Compared with the p53 IHC abnormal group, the TP53 mutation group had a higher correlation with high-risk factors. A high level of concordance (31/35, 88.0%) of NGS molecular classification was achieved between curettage specimens and hysterectomy specimens while grade and histotype (including unclassified group) from curettage specimens and hysterectomy specimens showed only moderate levels of agreement, 54.3% (19/35) and 68.6% (24/35), respectively. CONCLUSION NGS molecular classification achieved on curettage samples showed high concordance with the final hysterectomy specimens, demonstrating superior to the conventional pathological assessment of grade and histotype and potential utilization in clinical practice.
Collapse
Affiliation(s)
- Qunxian Rao
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianwei Liao
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangyang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Zhang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guocai Xu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Changbin Zhu
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Shengya Tian
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Qiuhong Chen
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Hui Zhou
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bingzhong Zhang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| |
Collapse
|
3
|
Nolin AC, Tian C, Hamilton CA, Casablanca Y, Bateman NW, Chan JK, Cote ML, Shriver CD, Powell MA, Phippen NT, Conrads TP, Maxwell GL, Darcy KM. Conditional estimates for uterine serous cancer: Tools for survivorship counseling and planning. Gynecol Oncol 2022; 166:90-99. [PMID: 35624045 DOI: 10.1016/j.ygyno.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Develop conditional survival and risk-assessment estimates for uterine serous carcinoma (USC) overall and stratified by stage as tools for annual survivorship counseling and care planning. METHODS Patients in the National Cancer Data Base diagnosed between 2004 and 2014 with stage I-IV USC were eligible. Individuals missing stage or survival data or with multiple malignancies were excluded. Five-year conditional survival was estimated using the stage-stratified Kaplan-Meier method annually during follow-up. A standardized mortality ratio (SMR) estimated the proportion of observed to expected deaths in the U.S. adjusted for year, age, and race. The relationships between prognostic factors and survival were studied using multivariate Cox modeling at diagnosis and conditioned on surviving 5-years. RESULTS There were 14,575 participants, including 43% with stage I, 8% with stage II, 29% with stage III, and 20% with stage IV USC. Five-year survival at diagnosis vs. after surviving 5-years was 52% vs. 75% overall, 77% vs. 81% for stage I, 57% vs. 72% for stage II, 40% vs. 66% for stage III, and 17% vs. 60% for stage IV USC, respectively (P < 0.0001). Incremental improvements in 5-year conditional survival and reductions in SMR tracked with annual follow-up and higher stage. The adjusted risk of death at diagnosis vs. after surviving 5-years was 1.15 vs. 1.40 per 5-year increase of age, 1.26 vs. 1.68 for Medicaid insurance, 3.92 vs. 2.48 for stage III disease, and 6.65 vs. 2.79 for stage IV disease, respectively (P < 0.0001). CONCLUSION In USC, the evolution of conditional survival permits annual reassessments of prognosis to tailor survivorship counseling and care planning.
Collapse
Affiliation(s)
- Angela C Nolin
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michele L Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies, and Disparities Research Program, Detroit, MI, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - G Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA, USA; Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| |
Collapse
|
4
|
Toboni MD, Lomonosova E, Bruce SF, Tankou JI, Mullen MM, Schab A, Oplt A, Noia H, Wilke D, Kuroki LM, Hagemann AR, McCourt CK, Thaker PH, Powell MA, Khabele D, Mutch DG, Fuh KC. Inhibition of AXL and VEGF-A Has Improved Therapeutic Efficacy in Uterine Serous Cancer. Cancers (Basel) 2021; 13:5877. [PMID: 34884986 PMCID: PMC8656641 DOI: 10.3390/cancers13235877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Endometrial cancer remains the most prevalent gynecologic cancer with continued rising incidence. A less common form of this cancer is uterine serous cancer, which represents 10% of endometrial cancer cases. However, this is the most aggressive cancer. The objective was to assess whether inhibiting the receptor tyrosine kinase AXL with AVB-500 in combination with bevacizumab would improve response in uterine serous cancer. To prove this, we conducted multiple angiogenesis assays including tube formation assays and angiogenesis invasion assays. In addition, we utilized mouse models with multiple cells lines and subsequently analyzed harvested tissue through immunohistochemistry CD31 staining to assess microvessel density. The combination treatment arms demonstrated decreased angiogenic potential in each assay. In addition, intraperitoneal mouse models demonstrated a significant decrease in tumor burden in two cell lines. The combination of AVB-500 and bevacizumab reduced tumor burden in vivo and reduced morphogenesis and migration in vitro which are vital to the process of angiogenesis.
Collapse
Affiliation(s)
- Michael D. Toboni
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Elena Lomonosova
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Shaina F. Bruce
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Jo’an I. Tankou
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Mary M. Mullen
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Angela Schab
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Alyssa Oplt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Hollie Noia
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Danny Wilke
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Lindsay M. Kuroki
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Andrea R. Hagemann
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Carolyn K. McCourt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Premal H. Thaker
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Matthew A. Powell
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Dineo Khabele
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - David G. Mutch
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Katherine C. Fuh
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| |
Collapse
|
5
|
Ditto A, Leone Roberti Maggiore U, Lopez S, Martinelli F, Bogani G, Lo Vullo S, Brusadelli C, Paolini B, Ducceschi M, Mantiero M, Chiappa V, Signorelli M, Evangelista M, Mariani L, Raspagliesi F. Uterine serous carcinoma: role of surgery, risk factors and oncologic outcomes. Experience of a tertiary center. Eur J Surg Oncol 2021; 48:268-274. [PMID: 34753617 DOI: 10.1016/j.ejso.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate factors impacting survival outcomes in patients with uterine serous carcinoma (USC). METHODS Data of consecutive patients diagnosed with USC undergoing surgery between 2000 and 2020 at Fondazione IRCCS Istituto Nazionale Tumori of Milan (Italy) were reviewed. Progression-free (PFS) and overall survival (OS) outcomes were evaluated using Kaplan-Meier and Cox proportional hazard models. RESULTS Records of 147 consecutive patients meeting the inclusion criteria were analyzed. Stage distribution was: 67 (45.6%) patients with early-stage with uterine confined disease and 80 (54.4%) with advanced stages disease. Minimally invasive surgery was performed in 43 patients (29.5%). The median follow-up period was 78.6 months (IQ range = 35.7-117.3 months). The overall recurrence rate was 41% (60 patients): 19/67 patients (28.4%) with early-stage disease and 41/80 patients (51.3%) with advanced stage. The 5-year PFS rate was 35.0% (95% confidence interval [CI]: 27.5-44.7%). In multivariate analysis, age, BMI, depth of myometrial invasion, cytology, and optimal cytoreduction with postoperative residual tumor absent significantly impacted on PFS. The 5-year OS rates were 46.5% (95% CI: 38.1-56.8). The result of multivariate analysis showed that there was significant difference in OS based only on optimal cytoreduction and accuracy of retroperitoneal surgery. CONCLUSIONS In apparent early-stage USC, peritoneal and retroperitoneal staging allows to identify patients with disease harboring outside the uterus. Optimal cytoreduction is the most significant prognostic factor. Further collaborative studies are warranted in order to improve outcomes of USC patients.
Collapse
Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Salvatore Lopez
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Claudia Brusadelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Biagio Paolini
- Department of Pathology, IRCCS National Cancer Institute, Milan, Italy
| | - Monika Ducceschi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mara Mantiero
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | | |
Collapse
|
6
|
Yahya JB, Zhu S, Burmeister C, Hijaz MY, Elshaikh MA. Matched-pair Analysis for Survival Endpoints Between Women With Early-stage Uterine Carcinosarcoma and Uterine Serous Carcinoma. Am J Clin Oncol 2021; 44:463-468. [PMID: 34265785 DOI: 10.1097/coc.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare survival endpoints between women with uterine carcinosarcoma and those with uterine serous carcinoma utilizing matching analysis. METHODS Patients with stages I to II who underwent hysterectomy at our institution were included in this analysis. Patients with carcinosarcoma were then matched to patients with serous carcinoma based on stage, and adjuvant management received (observation, radiation treatment alone, chemotherapy alone, or combined modality with radiotherapy and chemotherapy. Recurrence-free survival, disease-specific survival, and overall survival were calculated for the 2 groups. RESULTS A total of 134 women were included (67 women with carcinosarcoma and 67 with serous carcinoma, matched 1:1). There was no statistically significant difference between the 2 groups regarding 5-year recurrence-free survival (59% vs. 62%), disease-specific survival (66% vs. 67%), or overall survival (53% vs. 57%), respectively. The only independent predictor of shorter recurrence-free survival for the entire cohort was the lack of adjuvant combined modality therapy, while lower uterine segment involvement was the only independent predictor for shorter disease-specific survival. Lack of lymph node dissection and lack of adjuvant combined modality therapy were independent predictors of shorter overall survival. DISCUSSION When matched based on stage and adjuvant treatment, our study suggests that there is no statistically significant difference in survival endpoints between women with early-stage carcinosarcoma and serous carcinoma. Adjuvant combined modality treatment is an independent predictor of longer recurrence-free survival and overall survival.
Collapse
Affiliation(s)
| | | | | | - Miriana Y Hijaz
- Division of Gynecologic Oncology, Henry Ford Cancer Institute
| | | |
Collapse
|
7
|
Larish A, Mariani A, Langstraat C. Controversies in the Management of Early-stage Serous Endometrial Cancer. In Vivo 2021; 35:671-680. [PMID: 33622859 DOI: 10.21873/invivo.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Early-stage uterine serous carcinoma (USC) has one of the highest recurrence rates and mortality among early-stage uterine epithelial cancers. Research into the clinical management of USC has begun to progress, guided by surgical and pathological advances. This article summarizes the available literature regarding diagnosis, management, and possible future uses of molecular analysis of women with early-stage USC. MATERIALS AND METHODS PubMed was searched for all pertinent English language research articles published from January 1, 2006 through March 1, 2020 which included a study population of women diagnosed with stage 1 USC. Due to the scarcity of prospective or large-scale data, studies were not limited by design or numbers of patients. Studies performed at earlier dates were incorporated to provide context. RESULTS A total of 86 studies were included in the review. Multiple well-designed studies have confirmed the safety of a minimally invasive surgical approach for surgical management of USC. The role of sentinel node biopsy has been validated with both prospective and retrospective multi-center data. Stage I USC is associated with a highly variable risk of recurrence, even following completion of adjuvant chemoradiation. This aggressive phenotype has been linked to high numbers of somatic copy number alterations, tumor protein 53, and phosphatidylinositol 3 kinase mutations, which have been shown to be predictive of prognosis. CONCLUSION Early-stage USC demonstrates a lack of predictable recurrence patterns, with reports noting distant recurrence in patients with disease confined to polyps. Unless no residual tumor is found on hysterectomy, chemotherapy and radiotherapy should be discussed and individualized by stage and treatment goals.
Collapse
Affiliation(s)
- Alyssa Larish
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A.
| | - Andrea Mariani
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
| |
Collapse
|
8
|
Cook A, Khalil R, Burmeister C, Dimitrova I, Elshaikh MA. The Impact of Adjuvant Management Strategies on Outcomes in Women With Early Stage Uterine Serous Carcinoma. Cureus 2021; 13:e13505. [PMID: 33786214 PMCID: PMC7992918 DOI: 10.7759/cureus.13505] [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: 11/05/2022] Open
Abstract
Objective To determine the impact of different adjuvant strategies on outcomes in women with early-stage uterine serous carcinoma (USC). Methods Our retrospective database for women with endometrial carcinoma was queried for women with 2009 International Federation of Gynecology and Obstetrics (FIGO) stages I-II USC who underwent surgical staging between January 1991 and April 2019 followed by adjuvant management (observation, radiation therapy (RT), chemotherapy (CT), or combined modality treatment (CRT)). Chi-square tests were performed to compare differences in outcome by type of adjuvant management. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were assessed by Kaplan-Meier and log-rank tests. Univariate and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints. Results We identified 171 women who met our inclusion criteria. The median follow-up time was 70.5 months. Seventy-five percent of the study cohort was FIGO stage IA, 13% were stage IB, and 12% were stage II. All women underwent pelvic lymph node dissection with a median number of dissected lymph nodes of 14. Omentectomy was performed in 64% of patients. Adjuvant RT was utilized in 56% of women (65 patients received vaginal brachytherapy alone, 10 patients received pelvic RT, and 21 patients received a combination of both). The most commonly used chemotherapy regimen was carboplatin and paclitaxel with a median number of cycles of six. A total of 44% of the cohort received CRT, 12% received RT alone, 19% received chemo alone, and 25% were observed. Five-year RFS was 73% for those who received CRT, 84% for those who received RT alone, 68% for those who received CT alone, and 55% for those who were observed (p=0.13). Five-year DSS was 81%, 94%, 71%, and 60%, respectively (p=0.02). Five-year OS was 76%, 70%, 60%, and 56%, respectively (p=0.11). On MVA of OS and DSS, a higher percentage of myometrial invasion, the presence of lower uterine segment involvement, positive peritoneal cytology, and receipt of chemotherapy alone/observation were independent predictors of worse outcomes. The sole independent predictor of worse RFS on MVA was the presence of positive peritoneal cytology. Conclusion In this cohort of women with early-stage USC who underwent surgical staging, adjuvant radiation treatment with or without chemotherapy was associated with improved survival endpoints and trended toward improved recurrence rates.
Collapse
Affiliation(s)
- Andrew Cook
- Radiation Oncology, Henry Ford Health System, Detroit, USA
| | | | | | - Irina Dimitrova
- Gynecologic Oncology, Henry Ford Health System, Detroit, USA
| | | |
Collapse
|
9
|
Chen H, Li L, Qin P, Xiong H, Chen R, Zhang M, Jiang Q. A 4-gene signature predicts prognosis of uterine serous carcinoma. BMC Cancer 2021; 21:154. [PMID: 33579221 PMCID: PMC7881619 DOI: 10.1186/s12885-021-07834-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022] Open
Abstract
Background Uterine serous carcinoma (USC) is an aggressive type of endometrial cancer that accounts for up to 40% of endometrial cancer deaths, creating an urgent need for prognostic biomarkers. Methods USC RNA-Seq data and corresponding patients’ clinical records were obtained from The Cancer Genome Atlas and Genotype-Tissue Expression datasets. Univariate cox, Lasso, and Multivariate cox regression analyses were conducted to forge a prognostic signature. Multivariable and univariable cox regression analysis and ROC curve evaluated the prediction efficiency both in the training and testing sets. Results We uncovered 1385 genes dysregulated in 110 cases of USC tissue relative to 113 cases of normal uterine tissue. Functional enrichment analysis of these genes revealed the involvement of various cancer-related pathways in USC. A novel 4-gene signature (KRT23, CXCL1, SOX9 and ABCA10) of USC prognosis was finally forged by serial regression analyses. Overall patient survival (OS) and recurrence-free survival (RFS) were significantly lower in the high-risk group relative to the low-risk group in both the training and testing sets. The area under the ROC curve of the 4-gene signature was highest among clinicopathological features in predicting OS and RFS. The 4-gene signature was found to be an independent prognostic indicator in USC and was a superior predictor of OS in early stage of USC. Conclusions Our findings highlight the potential of the 4-gene signature as a guide for personalized USC treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07834-4.
Collapse
Affiliation(s)
- Hui Chen
- Department of Pathology, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China.,Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingjun Li
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ping Qin
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hanzhen Xiong
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ruichao Chen
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Minfen Zhang
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qingping Jiang
- Department of Pathology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
10
|
Zhang Y, Huang Y, Yin Y, Fan Y, Sun W, Zhao X, Tucker K, Staley A, Paraghamian S, Hawkins G, Prabhu V, Allen JE, Zhou C, Bae-Jump V. ONC206, an Imipridone Derivative, Induces Cell Death Through Activation of the Integrated Stress Response in Serous Endometrial Cancer In Vitro. Front Oncol 2020; 10:577141. [PMID: 33194693 PMCID: PMC7641618 DOI: 10.3389/fonc.2020.577141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022] Open
Abstract
ONC206 (Oncoceutics) is an imipiridone with nanomolar potency and analogue of ONC201, a selective dopamine receptor D2 (DRD2) antagonist currently being investigated in phase II clinical trials for serous endometrial cancer (SEC). This study investigated the anti-proliferative efficacy of ONC206 in SEC cell lines as well as its impact on cellular stress and adhesion/invasion. ONC206 inhibited cellular proliferation in a dose-dependent manner and was more potent than ONC201 in the ARK1 (IC50 = 0.33µM vs. IC50 = 1.59uM) and SPEC-2 (IC50 = 0.24uM vs. IC50 = 0.81uM) cell lines. Treatment with ONC206 resulted in induction of ROS production and reduction of mitochondrial membrane potential, accompanied by an increase in cleaved caspase-3 and caspase-9 activity (p < 0.01). ONC206 also significantly inhibited cellular adhesion and migration in both cell lines (p < 0.01). Pretreatment with the stress inhibitor N-acetylcysteine (NAC) significantly attenuated the efficacy of ONC206 on cell proliferation, ROS production and cellular invasion. ONC206 demonstrates nanomolar potency for the inhibition of proliferation in SEC cells. Specifically, ONC206 utilizes ISR activation as a significant pathway in the propagation of its anti-proliferative and anti-metastatic effects. Thus, ONC206 may be a promising agent in future SEC clinical trials as was its predecessor ONC201.
Collapse
Affiliation(s)
- Yingao Zhang
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Yu Huang
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Gynecologic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yajie Yin
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yali Fan
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Wenchuan Sun
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Xiaoling Zhao
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Katherine Tucker
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison Staley
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah Paraghamian
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabrielle Hawkins
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | - Chunxiao Zhou
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Victoria Bae-Jump
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
11
|
Identifying the worst of the worst: HER2 positive early stage uterine papillary serous carcinoma. Gynecol Oncol 2020; 159:1-2. [DOI: 10.1016/j.ygyno.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Hu W, Zhang L, Ferri-Borgogno S, Kwan SY, Lewis KE, Cun HT, Yeung TL, Soliman PT, Tarapore RS, Allen JE, Guan X, Lu KH, Mok SC, Au-Yeung CL. Targeting Dopamine Receptor D2 by Imipridone Suppresses Uterine Serous Cancer Malignant Phenotype. Cancers (Basel) 2020; 12:cancers12092436. [PMID: 32867127 PMCID: PMC7563948 DOI: 10.3390/cancers12092436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023] Open
Abstract
Uterine serous cancer (USC) is an aggressive subtype of endometrial cancer, with poor survival and high recurrence rates. The development of novel and effective therapies specific to USC would aid in its management. However, few studies have focused solely on this rare subtype. The current study demonstrated that the orally bioavailable, investigational new drug and novel imipridone ONC206 suppressed USC cell proliferation and induced apoptosis both in vitro and in vivo. Disruption of the DRD2-mediated p38MAPK/ERK/PGC-1α network by ONC206 led to metabolic reprogramming and suppression of both glycolysis and oxidative phosphorylation. ONC206 also synergized with paclitaxel in reducing USC cell viability. In addition, DRD2 overexpression correlated with poor overall survival in patients. This study provides the first evidence that ONC206 induced metabolic reprogramming in USC cells and is a promising therapeutic agent for USC treatment. These findings support further development of ONC206 as a promising therapeutic agent and improves survival rates in patients with USC.
Collapse
Affiliation(s)
- Wen Hu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
- State Key Laboratory of Oncology in South China and Collaborative Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China;
| | - Li Zhang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Sammy Ferri-Borgogno
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Suet-Ying Kwan
- Department of Molecular and Cellular Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Kelsey E. Lewis
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA;
| | - Han T. Cun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Tsz-Lun Yeung
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Pamela T. Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | | | - Joshua E. Allen
- Oncoceutics Inc., Philadelphia, PA 19104, USA; (R.S.T.); (J.E.A.)
| | - Xinyuan Guan
- State Key Laboratory of Oncology in South China and Collaborative Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China;
| | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Samuel C. Mok
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
| | - Chi-Lam Au-Yeung
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (W.H.); (L.Z.); (S.F.-B.); (H.T.C.); (T.-L.Y.); (P.T.S.); (K.H.L.); (S.C.M.)
- Correspondence:
| |
Collapse
|
13
|
Abstract
Recent advances in molecular studies, especially genome-wide analyses, have revealed the landscape of genomic alterations present in endometrial carcinomas, and have provided valuable insight into the pathogenesis of this disease. The current challenges are in developing a molecular-morphologic classification system to enhance traditional pathologic diagnosis and in determining the optimal approach to using this new information to guide clinical management. Molecular assays may be particularly beneficial in allowing the earlier detection of endometrial cancer or precursor lesions and in guiding personalized treatment approaches. In this review, we describe the current molecular landscape of endometrial cancers, efforts underway to incorporate molecular alterations into the current classification systems, and the development of diagnostic tools for the early detection of endometrial cancer. Finally, we present opportunities for using these data to tailor therapeutic strategies. A comprehensive understanding of the molecular alterations responsible for the origination, relapse, and resistance patterns of this disease will ultimately improve outcomes for patients with endometrial cancer.
Collapse
|
14
|
Tran LKH, Tran PMH, Mysona DP, Purohit SB, Myers E, Lee WS, Dun B, Xu D, Liu H, Hopkins D, Nechtman J, Scelsi CL, Mittal PK, Kleven D, Wallbillich JJ, Rungruang B, Ghamande S, She JX. A 73-gene proliferative transcriptomic signature predicts uterine serous carcinoma patient survival and response to primary therapy. Gynecol Oncol 2020; 157:340-347. [PMID: 32067813 DOI: 10.1016/j.ygyno.2020.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To develop a transcriptomic signature capable of predicting overall survival (OS) for uterine serous carcinoma (USC). METHODS RNAseq data for 58 USC patients were obtained from TCGA. Expression of 73 candidate genes was measured for 67 Augusta University (AU) samples using NanoString technology. RESULTS Analysis of the TCGA RNAseq data identified 73 genes that individually predict prognosis for USC patients and an elastic net model with all 73 genes (USC73) distinguishes a good OS group with low USC73 score from a poor OS group with high USC73 score (5-year OS = 83.3% and 13.3% respectively, HR = 40.1; p = 3 × 10-8). This finding was validated in the independent AU cohort (HR = 4.3; p = 0.0004). The poor prognosis group with high USC73 score consists of 37.9% and 32.8% of patients in the TCGA and AU cohort respectively. USC73 score and pathologic stage independently contribute to OS and together provide the best prognostic value. Early stage, low USC73 patients have the best prognosis (5-year OS = 85.1% in the combined dataset), while advanced stage, high USC73 patients have the worst prognosis (5-year OS = 6.4%, HR = 30.5, p = 1.2 × 10-12). Consistent with the observed poor survival, primary cell cultures from high USC73 patients had higher proliferation rate and cell cycle progression; and high USC73 patients had lower rates of complete response to standard therapy. CONCLUSIONS The USC73 transcriptomic signature and stage independently predict OS of USC patients and the best prediction is achieved using USC73 and stage. USC73 may also serve as a therapeutic biomarker to guide patient care.
Collapse
Affiliation(s)
- Lynn K H Tran
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Paul M H Tran
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - David P Mysona
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Sharad B Purohit
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Undergraduate Health Professionals, College of Allied Health Sciences, Augusta University, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Emily Myers
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Won Sok Lee
- Department of Pathology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Boying Dun
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Duo Xu
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Haitao Liu
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Diane Hopkins
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - John Nechtman
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Chris L Scelsi
- Department of Radiology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Pardeep K Mittal
- Department of Radiology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Daniel Kleven
- Department of Pathology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - John J Wallbillich
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Bunja Rungruang
- Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Sharad Ghamande
- Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, 1120 15(th) Street, Augusta, GA 30912, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, 1120 15(th) Street, Augusta, GA 30912, USA.
| |
Collapse
|
15
|
Uterine Papillary Serous Carcinoma Arising in a Polyp: A Multicenter Retrospective Analysis on 75 Patients. Am J Clin Oncol 2020; 42:472-480. [PMID: 30973371 DOI: 10.1097/coc.0000000000000541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate whether the international recommendations on the management of uterine papillary serous carcinoma arising in a polyp are uniformly followed in Italian Oncologic Centers and whether the strategy adopted is effective. MATERIALS AND METHODS Patients with uterine papillary serous carcinoma arising in a polyp and who had undergone a hysterectomy were identified in the 2003-2013 database of 7 Italian Gynecologic Oncology Centers. Clinical and pathologic characteristics and outcomes were compared between staging procedure types. Survival curves of the women were plotted using the Kaplan-Meier method and analyzed using Cox regression hazard model and the log-rank test. Associations between clinical parameters and the incidence of recurrence were assessed by generalized linear models and the Fisher test. RESULTS A total of 75 patients met the inclusion criteria. Recurrence-free survival was affected positively by type of surgical staging and negatively by preoperative diagnosis of hypertension. The association between surgical staging and recurrence-free survival resulted significant at univariate survival analysis (P=0.048 and 0.045) and maintained a trend of significance (P=0.070) in multivariate analysis, whereas hypertension was demonstrated to be the principal influencing factor. CONCLUSIONS The international recommendations on the management of uterine papillary serous carcinoma are not uniformly followed in daily practice, although the extension of the surgery seems to be associated with lower recurrence rates also when uterine papillary serous carcinoma is confined to a polyp or endometrial surface.
Collapse
|
16
|
Erickson BK, Zeybek B, Santin AD, Fader AN. Targeting human epidermal growth factor receptor 2 (HER2) in gynecologic malignancies. Curr Opin Obstet Gynecol 2020; 32:57-64. [PMID: 31833974 PMCID: PMC7307693 DOI: 10.1097/gco.0000000000000599] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the role of the human epidermal growth factor receptor 2 (HER2) as a biomarker and potential target in gynecologic malignancies and to describe contemporary updates in the use of anti-HER2 treatments for these cancers. RECENT FINDINGS Approximately 25-30% of all patients with uterine serous carcinoma overexpress tumoral HER2. The anti-HER2 antibody trastuzumab represents an effective, targeted therapy with significant efficacy in the treatment of HER2-positive breast and gastric cancer. Recently, trastuzumab efficacy has also been demonstrated in a randomized controlled trial of women with advanced or recurrent uterine serous carcinoma. Additionally, trastuzumab may be effective in women with HER2-positive uterine carcinosarcoma. The role of anti-HER2 therapy is unclear in women with other gynecologic malignancies but is being evaluated. SUMMARY HER2 amplification/overexpression is an effective therapeutic target in select gynecologic malignancies, and especially in the rare endometrial cancer subtype, uterine serous carcinoma. As anti-HER2-targeted therapies become increasingly available, more treatment options may become available for women with HER2-positive disease.
Collapse
Affiliation(s)
- Britt K. Erickson
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Burak Zeybek
- Division of Gynecologic Oncology, Yale University, New Haven, Connecticut
| | | | - Amanda N. Fader
- Division of Gynecologic Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Mysona DP, Tran LKH, Tran PMH, Gehrig PA, Van Le L, Ghamande S, Rungruang BJ, Java J, Mann AK, Liao J, Kapp DS, Santos BD, She JX, Chan JK. Clinical calculator predictive of chemotherapy benefit in stage 1A uterine papillary serous cancers. Gynecol Oncol 2019; 156:77-84. [PMID: 31796203 DOI: 10.1016/j.ygyno.2019.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Determine the utility of a clinical calculator to predict the benefit of chemotherapy in stage IA uterine papillary serous cancer (UPSC). PATIENTS AND METHODS Data were collected from NCDB from years 2010-2014. Based on demographic and surgical characteristics, a clinical score was developed using the random survival forest machine learning algorithm. RESULTS Of 1,751 patients with stage IA UPSC, 1,012 (58%) received chemotherapy and 739 (42%) did not. Older age (HR 1.06), comorbidities (HR 1.31), larger tumor size (HR 1.27), lymphovascular invasion (HR 1.86), positive peritoneal cytology (HR 2.62), no pelvic lymph node dissection (HR 1.51), and no chemotherapy (HR 2.16) were associated with poorer prognosis. Compared to no chemotherapy, patients who underwent chemotherapy had a 5-year overall survival of 80% vs. 67%. To better delineate those who may derive more benefit from chemotherapy, we designed a clinical calculator capable of dividing patients into low, moderate, and high-risk groups with associated 5-year OS of 86%, 73%, and 53%, respectively. Using the calculator to assess the relative benefit of chemotherapy in each risk group, chemotherapy improved the 5-year OS in the high (42% to 64%; p < 0.001) and moderate risk group (66% to 79%; p < 0.001) but did not benefit the low risk group (84% to 87%; p = 0.29). CONCLUSION Our results suggest a clinical calculator is useful for counseling and personalizing chemotherapy for stage IA UPSC.
Collapse
Affiliation(s)
- D P Mysona
- The University of North Carolina, Chapel Hill, NC, USA; The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - L K H Tran
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - P M H Tran
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - P A Gehrig
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - L Van Le
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - S Ghamande
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - B J Rungruang
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - J Java
- Genomics Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - A K Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - J Liao
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - D S Kapp
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - J X She
- The Medical College of Georgia at Augusta University, Augusta, GA, USA; Jinfinti Precision Medicine, Inc, Augusta, GA, USA.
| | - J K Chan
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA; California Pacific & Palo Alto Medical Foundation/Sutter Health Research Institute, San Francisco, CA, USA.
| |
Collapse
|
18
|
Abstract
BACKGROUND The prognostic factors of uterine serous carcinoma (USC) vary among studies, and there is no report of Chinese USC patients. OBJECTIVE The aim of this study was to investigate the clinicopathological characteristics and prognostic factors in Chinese patients with USC. METHODS Patients with USC from 13 authoritative university hospitals in China and treated between 2004 and 2014 were retrospectively reviewed. Three-year disease-free survival rate (DFSR), cumulative recurrence, and cumulative mortality were estimated by Kaplan-Meier analyses and log-rank tests. Multivariate Cox regression analysis was used to model the association of potential prognostic factors with clinical outcomes. RESULTS Data of a total of 241 patients were reviewed. The median follow-up was 26 months (range, 1-128 months). Median age was 60 years (range, 39-84 years), and 58.0% had stages I-II disease. The 3-year DFSR and cumulative recurrence were 46.8% and 27.7%. Advanced stage (III and IV) (P = 0.004), myometrial invasion (P = 0.001), adnexal involvement (P < 0.001), lymph node metastasis (P = 0.025), and positive peritoneal cytology (P = 0.007) were independently associated with 3-year DFSR. Advanced stage (P = 0.017), myometrial invasion (P = 0.008), adnexal involvement (odds ratio, 2.987; P = 0.001), lymph node metastasis (P = 0.031), and positive peritoneal cytology (P = 0.001) were independently associated with the cumulative recurrence. Myometrial invasion (P = 0.004) and positive peritoneal cytology (P = 0.025) were independently associated with 3-year cumulative mortality. CONCLUSIONS Peritoneal cytology and myometrial invasion could be independent prognostic factors for 3-year DFSR, cumulative recurrence, and cumulative mortality of patients with USC. Prospective studies are needed to confirm these results.
Collapse
|
19
|
Bonazzoli E, Predolini F, Cocco E, Bellone S, Altwerger G, Menderes G, Zammataro L, Bianchi A, Pettinella F, Riccio F, Han C, Yadav G, Lopez S, Manzano A, Manara P, Buza N, Hui P, Wong S, Litkouhi B, Ratner E, Silasi DA, Huang GS, Azodi M, Schwartz PE, Schlessinger J, Santin AD. Inhibition of BET Bromodomain Proteins with GS-5829 and GS-626510 in Uterine Serous Carcinoma, a Biologically Aggressive Variant of Endometrial Cancer. Clin Cancer Res 2018; 24:4845-4853. [PMID: 29941483 PMCID: PMC6168417 DOI: 10.1158/1078-0432.ccr-18-0864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/18/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Uterine serous carcinoma (USC) is a rare and aggressive variant of endometrial cancer. Whole-exome sequencing (WES) studies have recently reported c-Myc gene amplification in a large number of USCs, suggesting c-Myc as a potential therapeutic target. We investigated the activity of novel BET bromodomain inhibitors (GS-5829 and GS-626510, Gilead Sciences Inc.) and JQ1 against primary USC cultures and USC xenografts.Experimental Design: We evaluated c-Myc expression by qRT-PCR in a total of 45 USCs including fresh-frozen tumor tissues and primary USC cell lines. We also performed IHC and Western blot experiments in 8 USC tumors. USC cultures were evaluated for sensitivity to GS-5829, GS-626510, and JQ1 in vitro using proliferation, viability, and apoptosis assays. Finally, the in vivo activity of GS-5829, GS-626510, and JQ1 was studied in USC-ARK1 and USC-ARK2 mouse xenografts.Results: Fresh-frozen USC and primary USC cell lines overexpressed c-Myc when compared with normal tissues (P = 0.0009 and 0.0083, respectively). High c-Myc expression was found in 7 of 8 of primary USC cell lines tested by qRT-PCR and 5 of 8 tested by IHC. In vitro experiments demonstrated high sensitivity of USC cell lines to the exposure to GS-5829, GS-626510, and JQ1 with BET inhibitors causing a dose-dependent decrease in the phosphorylated levels of c-Myc and a dose-dependent increase in caspase activation (apoptosis). In comparative in vivo experiments, GS-5829 and/or GS-626510 were found more effective than JQ1 at the concentrations/doses used in decreasing tumor growth in both USC-ARK1 and USC-ARK2 mouse xenograft models.Conclusions: GS-5829 and GS-626510 may represent novel, highly effective therapeutics agents against recurrent/chemotherapy-resistant USC-overexpressing c-Myc. Clinical studies with GS-5829 in patients with USC harboring chemotherapy-resistant disease are warranted. Clin Cancer Res; 24(19); 4845-53. ©2018 AACR.
Collapse
Affiliation(s)
- Elena Bonazzoli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Emiliano Cocco
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Anna Bianchi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesca Pettinella
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesco Riccio
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Chanhee Han
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Ghanshyam Yadav
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Paola Manara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph Schlessinger
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
20
|
Fader AN, Roque DM, Siegel E, Buza N, Hui P, Abdelghany O, Chambers SK, Secord AA, Havrilesky L, O'Malley DM, Backes F, Nevadunsky N, Edraki B, Pikaart D, Lowery W, ElSahwi KS, Celano P, Bellone S, Azodi M, Litkouhi B, Ratner E, Silasi DA, Schwartz PE, Santin AD. Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu. J Clin Oncol 2018; 36:2044-2051. [PMID: 29584549 DOI: 10.1200/jco.2017.76.5966] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Uterine serous carcinoma is a rare, aggressive variant of endometrial cancer. Trastuzumab is a humanized monoclonal antibody that targets human epidermal growth factor receptor 2 (HER2)/neu, a receptor overexpressed in 30% of uterine serous carcinoma. This multicenter, randomized phase II trial compared carboplatin-paclitaxel with and without trastuzumab in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu. Methods Eligible patients had primary stage III or IV or recurrent HER2/neu-positive disease. Participants were randomly assigned to receive carboplatin-paclitaxel (control arm) for six cycles with or without intravenous trastuzumab (experimental arm) until progression or unacceptable toxicity. The primary end point was progression-free survival, which was assessed for differences between treatment arms via one-sided log-rank tests. Results From August 2011 to March 2017, 61 patients were randomly assigned. Forty progression-free survival-related events occurred among 58 evaluable participants. Among all patients, median progression-free survival was 8.0 months (control) versus 12.6 months (experimental; P = .005; hazard ratio [HR], 0.44; 90% CI, 0.26 to 0.76). Similarly, median progression-free survival was 9.3 (control) versus 17.9 (experimental) months among 41 patients with stage III or IV disease undergoing primary treatment ( P = .013; HR, 0.40; 90% CI, 0.20 to 0.80) and 6.0 (control) versus 9.2 months (experimental), respectively, among 17 patients with recurrent disease ( P = .003; HR, 0.14; 90% CI, 0.04 to 0.53). Toxicity was not different between treatment arms, and no unexpected safety signals emerged. Conclusion Addition of trastuzumab to carboplatin-paclitaxel was well tolerated and increased progression-free survival. These encouraging results deserve further investigation to determine their impact on overall survival in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu.
Collapse
Affiliation(s)
- Amanda N Fader
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dana M Roque
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Eric Siegel
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Natalia Buza
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Pei Hui
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Osama Abdelghany
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Setsuko K Chambers
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Angeles Alvarez Secord
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Laura Havrilesky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - David M O'Malley
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Floor Backes
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Nicole Nevadunsky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Edraki
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dirk Pikaart
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - William Lowery
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Karim S ElSahwi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Paul Celano
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Stefania Bellone
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Masoud Azodi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Litkouhi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Elena Ratner
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dan-Arin Silasi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Peter E Schwartz
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Alessandro D Santin
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| |
Collapse
|
21
|
Improved Outcome of High-Grade, Early 1-Stage Endometrioid Endometrial Carcinoma With Adjuvant Chemotherapy and Radiotherapy: Comparison of 2 Treatment Strategies. Int J Gynecol Cancer 2018; 27:467-472. [PMID: 28129237 DOI: 10.1097/igc.0000000000000900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Patients with high-grade endometrioid endometrial carcinoma have a high risk of recurrence, even in early stage. To determine the benefit of a more aggressive adjuvant treatment approach, different treatment strategies of 2 referral centers were compared. MATERIALS AND METHODS Outcome of all patients with International Federation of Gynecology and Obstetrics IB and II high-grade endometrioid endometrial carcinoma treated between 2008 and 2012, at the Gynecological Oncology Center South (GOCS) were compared with patients treated at the British Columbia Cancer Agency (BCCA). All patients underwent primary surgical treatment. Adjuvant treatment consisted of radiotherapy dependent on final pathology (GOCS), or adjuvant chemotherapy and pelvic radiotherapy (BCCA). RESULTS A total of 116 patients were treated at the GOCS (n = 61) and BCCA (n = 55). Patient cohorts were comparable for clinicopathological factors, except for age at diagnosis and lymphadenectomy. Radiotherapy was applied in 70.5% at the GOCS compared with 100% at the BCCA. All BCCA patients received chemotherapy compared with 3.3% at GOCS. The BCCA treatment strategy resulted in a significant reduced recurrence rate when compared with GOCS, 10.9% and 36.1%, respectively. There was no significant difference in the recurrence rate between patients with (n = 48) and without a lymphadenectomy (n = 68). Yet, numbers are relatively low. Because most recurrences were distant 78.6% (22/28), adjuvant chemotherapy resulted in reduced disease-related mortality. CONCLUSIONS Adjuvant chemotherapy and radiotherapy in early-stage high-grade endometrioid endometrial carcinoma results in improved disease-specific and overall survival compared to radiotherapy alone. Yet, due to the relatively low numbers, validation of these findings is needed in large prospective trials.
Collapse
|
22
|
Clinical Significance of Positive Pelvic Washings in Uterine Papillary Serous Carcinoma Confined to an Endometrial Polyp. Int J Gynecol Pathol 2017; 35:249-55. [PMID: 26535985 DOI: 10.1097/pgp.0000000000000235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Uterine papillary serous carcinoma (UPSC) represents 10% of endometrial carcinomas. Significant number of patients initially present with extrauterine disease. The role of adjuvant treatment in low stage, especially polyp-confined UPSC is controversial. This multi-institutional study evaluated the significance of positive pelvic washing (PW) and adjuvant treatment on disease recurrence in a setting of endometrial polyp-confined UPSC. Surgical pathology files from 3 institutions were searched for cases of endometrial polyp-confined UPSC. Following histologic review, cases were clinically staged as Stage I, without myoinvasion or lymphovascular invasion. Clinicopathologic characteristics, results of PW, and type of adjuvant therapy were recorded. Statistical analysis using the Kaplan-Meier method for survival and Fisher exact test were performed. Thirty-three patients were included in the study. All patients were diagnosed with polyp-confined UPSC. The size of the polyp ranged from 0.3 to 4.3 cm. PW was positive for tumor cells in 8/33 (24%) patients. Twenty-two patients (66.6%) received some type of adjuvant treatment. Six patients (18%) developed recurrent disease. There was no significant difference in disease-free survival in the patients receiving adjuvant treatment versus not (P=0.375). However, there was significant association (P=0.0013) between positive PW and disease recurrence. Data are conflicting whether positive PW affects prognosis in low-stage endometrial carcinomas. Our study showed that in UPSC, malignant cells can be present in PW without lymphovascular invasion or myoinvasion and may have negative prognostic implication. Our data also reflect the controversies in the role of adjuvant treatment in endometrium-confined UPSC.
Collapse
|
23
|
Extent of lymphovascular space invasion may predict lymph node metastasis in uterine serous carcinoma. Gynecol Oncol 2017; 147:24-29. [PMID: 28709703 DOI: 10.1016/j.ygyno.2017.07.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Emerging evidence suggests that extent of lymphovascular space invasion (LVSI) predicts for risk of lymph node metastasis in endometrioid uterine cancers. However, this correlation remains unknown in the setting of uterine serous carcinoma (USC). We sought to examine the association between extent of LVSI and other histopathologic characteristics with risk of nodal metastasis for women with USC. MATERIALS/METHODS Pathological data from all cases of uterine serous carcinoma between July 1998 to July 2015 at our institution were reviewed. Descriptive, univariate, and multivariate logistic regression analysis of selected pathologic features were performed. RESULTS 88 patients with USC underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy. Surgical staging revealed the following FIGO stage distributions: I (41%), II (8%), III (32%), IV (19%). LVSI was present in 44 (50%) patients. 36 patients (41%) had LN metastases with median number of total nodes removed of 17 (range, 1-49). On univariate analysis, depth of myometrial invasion, LVSI, tumor size, and cervical stromal involvement were significantly associated with nodal involvement. In a multivariate model, LVSI (OR 6.25, 95% CI 2.2-18.0, p<0.01) and cervical stromal involvement (OR 3.33, 95% CI 1.10-10.0, p=0.03) were the only factors that remained significant. Among patients with LVSI-positive disease, extensive LVSI was associated with increased risk of nodal involvement compared to focal LVSI (90% vs 29%, p=0.04). CONCLUSIONS Presence and extent of LVSI, and cervical stromal invasion are important predictors for lymph node metastasis in uterine serous carcinoma.
Collapse
|
24
|
Bhargava A, Mishra DK, Jain SK, Srivastava RK, Lohiya NK, Mishra PK. Comparative assessment of lipid based nano-carrier systems for dendritic cell based targeting of tumor re-initiating cells in gynecological cancers. Mol Immunol 2016; 79:98-112. [PMID: 27764711 DOI: 10.1016/j.molimm.2016.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Abstract
We aimed to identify an optimum nano-carrier system to deliver tumor antigen to dendritic cells (DCs) for efficient targeting of tumor reinitiating cells (TRICs) in gynecological malignancies. Different lipid based nano-carrier systems i.e. liposomes, ethosomes and solid lipid nanoparticles (SLNPs) were examined for their ability to activate DCs in allogeneic settings. Out of these three, the most optimized formulation was subjected for cationic and mannosylated surface modification and pulsed with DCs for specific targeting of tumor cells. In both allogeneic and autologous trials, SLNPs showed a strong ability to activate DCs and orchestrate specific immune responses for targeting TRICs in gynecological malignancies. Our findings suggest that the mannosylated form of SLNPs is a suitable molecular vector for DC based therapeutics. DCs pulsed with mannosylated SLNPs may be utilized as adjuvant therapy for specific removal of TRICs to benefit patients from tumor recurrence.
Collapse
Affiliation(s)
- Arpit Bhargava
- School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, India
| | | | - Subodh K Jain
- School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, India
| | - Rupesh K Srivastava
- School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, India
| | - Nirmal K Lohiya
- Centre for Advanced Studies in Zoology, University of Rajasthan, Jaipur, India
| | - Pradyumna K Mishra
- School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, India; Department of Molecular Biology, National Institute for Research in Environmental Health, Bhopal, India.
| |
Collapse
|
25
|
Üreyen I, Karalok A, Akdağ Cırık D, Taşçı T, Türkmen O, Kimyon Cömert G, Boran N, Tulunay G, Turan T. A comparison of clinico-pathologic characteristics of patients with serous and clear cell carcinoma of the uterus. Turk J Obstet Gynecol 2016; 13:137-143. [PMID: 28913109 PMCID: PMC5558304 DOI: 10.4274/tjod.14478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/21/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: Serous carcinoma and clear cell carcinomas account for 10% and 3% of endometrial cancers but are responsible for 39% and 8% of cancer deaths, respectively. In this study, we aimed to compare serous carcinoma and clear cell carcinoma regarding the surgico-pathologic and clinical characteristics, and survival, and to detect factors that affected recurrence and survival. Materials and Methods: We retrospectively analyzed patients with clear cell and serous endometrial cancer who underwent surgery between January 1993 and December 2013 in our clinic. We used Kaplan-Meier estimator to analyze survival. Results: The tumor type in 49 patients was clear cell carcinomas and was serous uterine carcinoma in 51 patients. Advanced stage (stage III and IV) disease was present in 42% of the patients in the clear cell group, whereas this rate was 62% in the serous group (p=0.044). Lymph node metastasis was detected in 37% of the patients with clear cell carcinomas and 51% of the patients with serous carcinoma (p=0.17). The adjuvant therapies used did not differ significantly between the groups (p=0.192). The groups had similar recurrence patterns. Five-year progression-free survival and the 5-year overall survival were 60.6% and 85.8%, 45.5% and 67.8% in the patients with clear cell carcinomas and serous tumor, respectively. Conclusion: With the exception that more advanced stages were observed in patients with serous carcinoma endometrial cancers at presentation, the surgico-pathologic features, recurrence rates and patterns, and survival rates did not differ significantly between the groups with clear cell carcinoma and serous carcinoma endometrial cancers.
Collapse
Affiliation(s)
- Işın Üreyen
- Antalya Training and Research Hospital, Clinic of Gynecology and Obstetrics, Divisin of Gynecological Oncology, Antalya, Turkey
| | - Alper Karalok
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Derya Akdağ Cırık
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Tolga Taşçı
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Osman Türkmen
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Günsü Kimyon Cömert
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Nurettin Boran
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Gökhan Tulunay
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Taner Turan
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| |
Collapse
|
26
|
Black J, Menderes G, Bellone S, Schwab CL, Bonazzoli E, Ferrari F, Predolini F, De Haydu C, Cocco E, Buza N, Hui P, Wong S, Lopez S, Ratner E, Silasi DA, Azodi M, Litkouhi B, Schwartz PE, Goedings P, Beusker PH, van der Lee MMC, Timmers CM, Dokter WHA, Santin AD. SYD985, a Novel Duocarmycin-Based HER2-Targeting Antibody-Drug Conjugate, Shows Antitumor Activity in Uterine Serous Carcinoma with HER2/Neu Expression. Mol Cancer Ther 2016; 15:1900-9. [PMID: 27256376 DOI: 10.1158/1535-7163.mct-16-0163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022]
Abstract
Uterine serous carcinoma (USC) is an aggressive form of endometrial cancer. Up to 35% of USC may overexpress the HER2/neu oncogene at strong (i.e., 3+) levels by IHC while an additional 40% to 50% express HER2/neu at moderate (2+) or low (1+) levels. We investigated the efficacy of SYD985, (Synthon Biopharmaceuticals), a novel HER2-targeting antibody-drug conjugate (ADC) composed of the mAb trastuzumab linked to a highly potent DNA-alkylating agent (i.e., duocarmycin) in USC. We also compared the antitumor activity of SYD985 in head-to-head experiments to trastuzumab emtansine (T-DM1), a FDA-approved ADC, against multiple primary USC cell lines expressing different levels of HER2/neu in in vitro and in vivo experiments. Using antibody-dependent cellular cytotoxicity (ADCC), proliferation, viability, and bystander killing assays as well as propidium iodide-based flow cytometry assays and multiple in vivo USC mouse xenograft models, we demonstrate for the first time that SYD985 is a novel ADC with activity against USC with strong (3+) as well as low to moderate (i.e., 1+/2+) HER2/neu expression. SYD985 is 10- to 70-fold more potent than T-DM1 in comparative experiments and, unlike T-DM1, it is active against USC demonstrating moderate/low or heterogeneous HER2/neu expression. Clinical studies with SYD985 in patients harboring chemotherapy-resistant USC with low, moderate, and high HER2 expression are warranted. Mol Cancer Ther; 15(8); 1900-9. ©2016 AACR.
Collapse
Affiliation(s)
- Jonathan Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Stefania Bellone
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Carlton L Schwab
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesca Ferrari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Federica Predolini
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher De Haydu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Emiliano Cocco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Salvatore Lopez
- Division of Gynecologic Oncology, University Campus Bio-Medico of Roma, Rome, Italy
| | - Elena Ratner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter Goedings
- Synthon Biopharmaceuticals BV., Nijmegen, the Netherlands
| | | | | | | | - Wim H A Dokter
- Synthon Biopharmaceuticals BV., Nijmegen, the Netherlands
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
27
|
Bellone S, Centritto F, Black J, Schwab C, English D, Cocco E, Lopez S, Bonazzoli E, Predolini F, Ferrari F, Silasi DA, Ratner E, Azodi M, Schwartz PE, Santin AD. Polymerase ε (POLE) ultra-mutated tumors induce robust tumor-specific CD4+ T cell responses in endometrial cancer patients. Gynecol Oncol 2015; 138:11-7. [PMID: 25931171 PMCID: PMC4469551 DOI: 10.1016/j.ygyno.2015.04.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Around 7-10% of endometrial carcinomas are characterized by polymerase-ε-(POLE) exonuclease-domain-mutations, an ultra-mutated-phenotype and a favorable prognosis. It is currently unknown whether POLE ultra-mutated-tumors are more immunogenic when compared to the other groups of endometrial cancers. METHODS We used autologous-dendritic-cells (DC) pulsed with whole-tumor-extracts to assess the level of CD8+ and CD4+ T-cell-activation induced by POLE-ultramutated (+) and POLE wild-type (-) endometrial cancer cells in vitro. T-lymphocyte-proliferations were evaluated using CFSE and/or ([3H])thymidine-incorporation-assays while the ability to specifically kill autologous-tumor-cells by cytotoxic-T-lymphocyte (CTL) was tested in standard 4-h-(51)Cr-cytotoxicity-assays. In order to correlate cytotoxic activity and proliferation by CD4+ and CD8+ T-lymphocytes, respectively, with a particular lymphoid subset, two-color-flow-cytometric analysis of intracellular-cytokine-expression (IFN-γ vs IL-4) at the single cell level was also performed. RESULTS DC-pulsed with tumor extracts were able to induce CTL-responses against autologous-tumor-cells in both POLE (+) and POLE (-) cancer patients (P=0.305). These CD8+ T-cell-populations were cytotoxic against tumor-cells but they did not lyse PHA-stimulated-autologous-lymphocytes or autologous-EBV-transformed-lymphoblastoid-control-cell-lines. In contrast, only POLE (+) tumor-lysate-pulsed-DC were able to induce significant proliferation and high IFN-γ expression (i.e., Th1-cytokine-bias) in autologous in vitro DC-stimulated CD4+ T-cells as well as naïve CD4+ and CD8+ T-cells from patients-peripheral-blood (P<0.05). CONCLUSIONS POLE ultra-mutated-tumors are significantly more immunogenic when compared to POLE (-) tumors, in particular to the helper arm of the immune system. These data lend support to the hypothesis that the better prognosis of patients with POLE (+) tumors may at least in part be linked to their enhanced immunogenicity.
Collapse
Affiliation(s)
- Stefania Bellone
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Floriana Centritto
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Jonathan Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Carlton Schwab
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Diana English
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Emiliano Cocco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Salvatore Lopez
- Division of Gynecologic Oncology, University Campus Bio-Medico of Roma, Roma, Italy
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Federica Predolini
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Francesca Ferrari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA.
| |
Collapse
|
28
|
The importance of surgical staging in women with uterine serous carcinoma: experience in a single institution reveals a survival benefit. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:1085-1092. [PMID: 25668044 DOI: 10.1016/s1701-2163(15)30386-8] [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] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the appropriate extent of surgical staging in women with clinically early stage uterine serous carcinoma (USC). METHODS We conducted a single-institution retrospective cohort study of all women with USC between 2007 and 2012. Treatment practices, outcomes, and factors affecting survival were analyzed using univariate and multivariate analysis. RESULTS Eighty-four patients were identified, 76 of whom were included in the analysis. Preoperative pathology correctly identified USC in 73.3% of cases. Surgical stage distribution was 44.7% stage I, 7.9% stage II, 31.6% stage III, and 15.8% stage IV. Women thought to have early stage disease preoperatively encompassed 84.2% (64) of the cohort. Fifty-two (81.3%) of these women with clinically early stage disease had complete surgical staging. Thirty-four (53.1%) were determined to have surgical stage I, and the remaining 30 (46.9%) had occult advanced stage disease. Median follow-up was 43.2 months. Univariate analysis found a significant increase in progression-free survival and overall survival for women with clinically early stage disease with positive lymphovascular space invasion (P < 0.001 and P = 0.002, respectively), positive peritoneal cytology (P = 0.022 and P = 0.04, respectively), early stage (P < 0.001 and P = 0.004, respectively), and elevated serum CA125 at diagnosis (P = 0.003 and P = 0.001, respectively). On multivariate analysis, early stage (hazard ratio [HR] 9.87; 95% CI 2.79 to 34.92, P < 0.001) and complete surgical staging (HR 2.96; 95% CI 1.05 to 8.37, P = 0.040) were associated with prolonged progression-free survival, while overall survival was not affected by complete surgical staging (HR 1.92; 95% CI 0.64 to 5.76, P = 0.79). CONCLUSION Complete surgical staging prolongs the progression-free survival of women with clinical early-stage uterine serous cancer. Although this does not extend to overall survival, this enables patients to have an improved quality of life with a longer interval without the burden of disease.
Collapse
|
29
|
Santin AD, Bellone S, Centritto F, Schlessinger J, Lifton R. Improved survival of patients with hypermutation in uterine serous carcinoma. Gynecol Oncol Rep 2015; 12:3-4. [PMID: 26076146 PMCID: PMC4442647 DOI: 10.1016/j.gore.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/15/2015] [Indexed: 11/05/2022] Open
Abstract
Uterine serous carcinoma (USC) is an aggressive subtype of endometrial cancer. Mutations in DNA polymerase ε gene (POLE) are detected in a subset of USC and confer a strong mutator phenotype. USC patients diagnosed with POLE mutations experience a significantly better prognosis.
Collapse
|
30
|
Demiral S, Beyzadeoglu M, Sager O, Dincoglan F, Uysal B, Gamsiz H, Akin M, Turker T, Dirican B. Evaluation of Treatment Outcomes of Early-Stage Endometrial Cancer Radiotherapy: A Single Center Experience. Asian Pac J Cancer Prev 2014; 15:9599-602. [DOI: 10.7314/apjcp.2014.15.22.9599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
31
|
Targeting HER2 in ovarian and uterine cancers: Challenges and future directions. Gynecol Oncol 2014; 135:364-70. [DOI: 10.1016/j.ygyno.2014.09.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 01/22/2023]
|
32
|
Ricci S, Fader AN. Treatment of uterine papillary serous carcinoma. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.847365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|