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Hintermair S, Iser S, Varga A, Biesinger M, Bohanes T, Celik A, Sayan M, Kankoç A, Akyurek N, Öğüt B, Stubenberger E, Ghanim B. Ki67 Tumor Expression Predicts Treatment Benefit Achieved by Macroscopic Radical Lung-Preserving Surgery in Pleural Mesothelioma-A Retrospective Multicenter Analysis. Cancers (Basel) 2024; 16:1817. [PMID: 38791896 PMCID: PMC11119444 DOI: 10.3390/cancers16101817] [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: 03/24/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Pleural mesothelioma (PM), linked to asbestos-induced inflammation, carries a poor prognosis. Therapy ranges from therapy limitation to aggressive multimodality treatment. Given the uncertainty about treatment benefits for patients, this study aimed to assess the role of Ki67 as a prognostic and predictive parameter in PM. Ki67 was measured in the specimens of 70 PM patients (17 female, 53 male) from two centers and correlated to overall survival (OS) and therapy outcome. The median OS was 16.1 months. The level of Ki67 expression was divided into low (≤15%) and high (>15%). A low value of Ki67 expression was associated with a longer OS (Ki67 ≤ 15%: 31.2 (95% CI 6.5-55.8) months vs. Ki67 > 15%: 11.1 (95% CI 7.7-14.6) months, p = 0.012). The 5-year survival represents 22% in the low Ki67 expression group, in contrast to 5% in the high Ki67 expression group. We found a significant interaction term of Ki67 with multimodality treatment (p = 0.031) translating to an OS of 48.1 months in the low expression Ki67 group compared to 24.3 months in the high Ki67 expression group when receiving surgery within multimodality therapy. Therefore, Ki67 stands out as a validated prognostic and, most importantly, novel predictive biomarker for treatment benefits, particularly regarding surgery within multimodality therapy.
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Affiliation(s)
- Sarah Hintermair
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
| | - Stephanie Iser
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
| | - Alexander Varga
- Department of Pathology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria;
| | - Melanie Biesinger
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
| | - Tomas Bohanes
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
| | - Ali Celik
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, Ankara 06500, Turkey; (A.C.); (M.S.); (A.K.)
| | - Muhammet Sayan
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, Ankara 06500, Turkey; (A.C.); (M.S.); (A.K.)
| | - Aykut Kankoç
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, Ankara 06500, Turkey; (A.C.); (M.S.); (A.K.)
| | - Nalan Akyurek
- Department of Pathology, School of Medicine, Gazi University, Besevler, Ankara 06500, Turkey; (N.A.); (B.Ö.)
| | - Betul Öğüt
- Department of Pathology, School of Medicine, Gazi University, Besevler, Ankara 06500, Turkey; (N.A.); (B.Ö.)
| | - Elisabeth Stubenberger
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
| | - Bahil Ghanim
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria; (S.H.); (S.I.); (M.B.); (T.B.); (E.S.)
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
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Expression of phosphorylated ribosomal protein S6 in mesothelioma patients - correlation with clinico-pathological characteristics and outcome: results from the European Thoracic Oncology Platform (ETOP) Mesoscape project. Mod Pathol 2022; 35:1888-1899. [PMID: 36115922 PMCID: PMC9708564 DOI: 10.1038/s41379-022-01145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
Pleural mesothelioma (PM) is an aggressive malignancy with poor prognosis. Although histology and pathologic stage are important prognostic factors, better prognostic biomarkers are needed. The ribosomal protein S6 is a downstream target of the phosphatidylinositol 3-kinase (PI3K) pathway involved in protein synthesis and cell proliferation. In previous studies, low phosphorylated S6 (pS6) immunoreactivity was significantly correlated with longer progression-free survival (PFS) and overall survival (OS) in PM patients. We aimed to correlate pS6 expression to clinical data in a large multi-centre PM cohort as part of the European Thoracic Oncology Platform (ETOP) Mesoscape project. Tissue Micro Arrays (TMAs) of PM were constructed and expression of pS6 was evaluated by a semi-quantitatively aggregate H-score. Expression results were correlated to patient characteristics as well as OS/PFS. pS6 IHC results of 364 patients from 9 centres, diagnosed between 1999 and 2017 were available. The primary histology of included tumours was epithelioid (70.3%), followed by biphasic (24.2%) and sarcomatoid (5.5%). TMAs included both treatment-naïve and tumour tissue taken after induction chemotherapy. High pS6 expression (181 patients with H-score>1.41) was significantly associated with less complete resection. In the overall cohort, OS/PFS were not significantly different between pS6-low and pS6-high patients. In a subgroup analysis non-epithelioid (biphasic and sarcomatoid) patients with high pS6 expression showed a significantly shorter OS (p < 0.001, 10.7 versus 16.9 months) and PFS (p < 0.001, 6.2 versus 10.8 months). In subgroup analysis, in non-epithelioid PM patients high pS6 expression was associated with significantly shorter OS and PFS. These exploratory findings suggest a clinically relevant PI3K pathway activation in non-epithelioid PM which might lay the foundation for future targeted treatment strategies.
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Bulloni M, Pattini L, Pelosi G. Intratumor Distribution of Ki-67 Antigen Beyond Labeling Index for Clinical Decision-Making: A New Way of Counting. JTO Clin Res Rep 2021; 2:100207. [PMID: 34734194 PMCID: PMC8486920 DOI: 10.1016/j.jtocrr.2021.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matteo Bulloni
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Linda Pattini
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
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4
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Belderbos RA, Maat APWM, Baart SJ, Madsen EVE, Bogers AJJC, Cornelissen R, Aerts JGJV, Mahtab EAF, von der Thüsen JH. Ki67 (MIB-1) as a Prognostic Marker for Clinical Decision Making Before Extended Pleurectomy Decortication in Malignant Pleural Mesothelioma. JTO Clin Res Rep 2021; 2:100155. [PMID: 34590009 PMCID: PMC8474452 DOI: 10.1016/j.jtocrr.2021.100155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction The role of surgery for early stage malignant pleural mesothelioma (MPM) remains controversial. Current expert opinion is only to treat patients surgically as part of multimodality therapy. It is still challenging to identify patients who will not benefit from surgery. We specifically evaluated tumor-related parameters in combination with clinical parameters to identify prognostic markers for survival. Methods Clinical data of 27 consecutive patients with MPM treated with extended pleurectomy and decortication within a multimodality approach were collected and analyzed. Several tumor (immuno-)histopathologic characteristics were determined on resected tumor material, among which MTAP and Ki67 (MIB-1). Univariable and multivariable analyses served to correlate clinical and tumor-related parameters to overall survival (OS) and progression-free survival (PFS). Results The median PFS (mPFS) was 15.3, and the median OS (mOS) was 26.5 months. Patients with a Ki67 score greater than 10% had a significantly shorter PFS (mPFS = 8.81 versus 25.35 mo, p = 0.001) and OS (mOS 19.7 versus 44.5 mo, p = 0.002) than those with a Ki67 score less than or equal to 10. Receiver operating characteristic curve analysis for Ki67 revealed an area under the curve of 0.756 with a sensitivity of 90% and specificity of 71% for a cutoff of 10% for Ki67. Patients with loss of MTAP had a significantly shorter mPFS (9 versus 21.1 mo, p = 0.014) and mOS (19.7 versus 42.6 mo, p = 0.047) than those without MTAP loss. Conclusions In our study, Ki67 was prognostic for OS and PFS in patients with MPM treated with extended pleurectomy/decortication in a multimodality approach. Determination of Ki67 before surgery combined with specific clinical parameters could assist in clinical decision making by identifying patients, with high Ki67, who are unlikely to benefit from surgery.
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Affiliation(s)
- Robert A Belderbos
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva V E Madsen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Prall OW. Malignant Pleural Mesothelioma-Does Ki67 Make the Grade? JTO Clin Res Rep 2021; 2:100170. [PMID: 34590021 PMCID: PMC8474261 DOI: 10.1016/j.jtocrr.2021.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Owen W.J. Prall
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Identification of Redox-Sensitive Transcription Factors as Markers of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13051138. [PMID: 33799965 PMCID: PMC7961847 DOI: 10.3390/cancers13051138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Malignant pleural mesothelioma is a lung tumor associated with asbestos exposure, with a poor prognosis, and a difficult pharmacological approach. Asbestos exposure is very toxic for the lungs, which counteract this toxic effect by activating some antioxidant defense proteins. When these proteins are more active that in normal conditions, as in several cancers, these tumors become able to survive and resist to stress or chemotherapy. In our laboratory, we collected cellular samples of mesothelioma and non-transformed mesothelium from Hospital’s Biobank and we evaluated these proteins. Our results demonstrated these proteins are upregulated in mesothelioma cells and not in non-transformed mesothelium. This event could be associated to toxic effects evoked by asbestos exposure, highlighting the need in the future to monitor asbestos-exposed people by measuring biomarkers identified, in the attempt to identify them as possible predictive markers and potential pharmacological targets addressed to improve mesothelioma prognosis. Abstract Although asbestos has been banned in most countries around the world, malignant pleural mesothelioma (MPM) is a current problem. MPM is an aggressive tumor with a poor prognosis, so it is crucial to identify new markers in the preventive field. Asbestos exposure induces oxidative stress and its carcinogenesis has been linked to a strong oxidative damage, event counteracted by antioxidant systems at the pulmonary level. The present study has been focused on some redox-sensitive transcription factors that regulate cellular antioxidant defense and are overexpressed in many tumors, such as Nrf2 (Nuclear factor erythroid 2-related factor 2), Ref-1 (Redox effector factor 1), and FOXM1 (Forkhead box protein M1). The research was performed in human mesothelial and MPM cells. Our results have clearly demonstrated an overexpression of Nrf2, Ref-1, and FOXM1 in mesothelioma towards mesothelium, and a consequent activation of downstream genes controlled by these factors, which in turn regulates antioxidant defense. This event is mediated by oxidative free radicals produced when mesothelial cells are exposed to asbestos fibers. We observed an increased expression of Nrf2, Ref-1, and FOXM1 towards untreated cells, confirming asbestos as the mediator of oxidative stress evoked at the mesothelium level. These factors can therefore be considered predictive biomarkers of MPM and potential pharmacological targets in the treatment of this aggressive cancer.
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Opitz I, Furrer K. Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma. Thorac Surg Clin 2021; 30:435-449. [PMID: 33012431 DOI: 10.1016/j.thorsurg.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the absence of standardized treatment algorithms for patients with malignant pleural mesothelioma, one of the main difficulties remains patient allocation to therapies with potential benefit. This article discusses clinical, radiologic, pathologic, and molecular prognostic factors as well as genetic background leading to preoperative identification of benefit from surgery, which have been investigated over the past years to simplify and at the same time specify patient selection for surgical treatment.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
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Abbott DM, Bortolotto C, Benvenuti S, Lancia A, Filippi AR, Stella GM. Malignant Pleural Mesothelioma: Genetic and Microenviromental Heterogeneity as an Unexpected Reading Frame and Therapeutic Challenge. Cancers (Basel) 2020; 12:cancers12051186. [PMID: 32392897 PMCID: PMC7281319 DOI: 10.3390/cancers12051186] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Mesothelioma is a malignancy of serosal membranes including the peritoneum, pleura, pericardium and the tunica vaginalis of the testes. Malignant mesothelioma (MM) is a rare disease with a global incidence in countries like Italy of about 1.15 per 100,000 inhabitants. Malignant Pleural Mesothelioma (MPM) is the most common form of mesothelioma, accounting for approximately 80% of disease. Although rare in the global population, mesothelioma is linked to industrial pollutants and mineral fiber exposure, with approximately 80% of cases linked to asbestos. Due to the persistent asbestos exposure in many countries, a worldwide progressive increase in MPM incidence is expected for the current and coming years. The tumor grows in a loco-regional pattern, spreading from the parietal to the visceral pleura and invading the surrounding structures that induce the clinical picture of pleural effusion, pain and dyspnea. Distant spreading and metastasis are rarely observed, and most patients die from the burden of the primary tumor. Currently, there are no effective treatments for MPM, and the prognosis is invariably poor. Some studies average the prognosis to be roughly one-year after diagnosis. The uniquely poor mutational landscape which characterizes MPM appears to derive from a selective pressure operated by the environment; thus, inflammation and immune response emerge as key players in driving MPM progression and represent promising therapeutic targets. Here we recapitulate current knowledge on MPM with focus on the emerging network between genetic asset and inflammatory microenvironment which characterize the disease as amenable target for novel therapeutic approaches.
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Affiliation(s)
- David Michael Abbott
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Silvia Benvenuti
- Candiolo Cancer Institute, FPO—IRCCS—Str. Prov.le 142, km. 3,95—10060 Candiolo (TO), Italy;
| | - Andrea Lancia
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Andrea Riccardo Filippi
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Giulia Maria Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
- Correspondence:
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Zhang G, Yang DL, Zheng G, Liang Y. Survivin expression as an independent predictor of overall survival in malignant peritoneal mesothelioma. Oncol Lett 2020; 19:3871-3880. [PMID: 32382335 PMCID: PMC7202285 DOI: 10.3892/ol.2020.11505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Malignant peritoneal mesothelioma (MPeM) is an incurable cancer strongly associated with asbestos exposure and characterised by poor prognosis. The aim of the present study was to elucidate the prognostic and predictive value of CD146 and survivin expression in MPeM. Diagnostic biopsies from 60 patients with MPeM were collected and analysed for CD146, survivin and Ki-67 expression using immunohistochemistry. Complete clinical and follow-up information was obtained from patients' records. CD146 was expressed in 31/60 MPeM specimens and survivin in 34/60 specimens, with both expression levels being significantly associated with the Ki-67 labelling index (Ki-67LI). Kaplan-Meier and univariate Cox regression analyses revealed that a lower peritoneal cancer index (PCI), tumour-directed treatment, stage I, lower Ki-67LI and lower CD146 and survivin expression had a statistically positive effect on overall survival (OS). Cox regression analysis revealed that PCI [hazard ratio (HR)=1.99; 95% CI, 1.04–3.83; P=0.038], survivin (HR=1.47; 95% CI, 1.03–2.10; P=0.034) and treatment protocol including intraperitoneal chemotherapy (HR=0.28; 95% CI, 0.14–0.57; P=0.013) and systemic chemotherapy (HR=0.13; 95% CI, 0.04–0.42; P=0.013) retained independent prognostic significance for OS. All of these were included in the nomogram. Calibration curves showed good agreement between nomogram-predicted and observed survival. The C-index of the nomogram for predicting OS was 0.77. A lower PCI, intraperitoneal chemotherapy, systemic chemotherapy and a lower level of survivin were powerful prognostic markers in patients with MPeM. The proposed nomogram provides individual survival prediction for patients with MPeM.
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Affiliation(s)
- Guozun Zhang
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Dong-Liang Yang
- Department of Medical Statistics, Cangzhou Medical College, Cangzhou, Hebei 061001, P.R. China
| | - Guoqi Zheng
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Yufei Liang
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
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10
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Wo YJ, Gan ASP, Lim X, Tay ISY, Lim S, Lim JCT, Yeong JPS. The Roles of CD38 and CD157 in the Solid Tumor Microenvironment and Cancer Immunotherapy. Cells 2019; 9:cells9010026. [PMID: 31861847 PMCID: PMC7017359 DOI: 10.3390/cells9010026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
The tumor microenvironment (TME) consists of extracellular matrix proteins, immune cells, vascular cells, lymphatics and fibroblasts. Under normal physiological conditions, tissue homeostasis protects against tumor development. However, under pathological conditions, interplay between the tumor and its microenvironment can promote tumor initiation, growth and metastasis. Immune cells within the TME have an important role in the formation, growth and metastasis of tumors, and in the responsiveness of these tumors to immunotherapy. Recent breakthroughs in the field of cancer immunotherapy have further highlighted the potential of targeting TME elements, including these immune cells, to improve the efficacy of cancer prognostics and immunotherapy. CD38 and CD157 are glycoproteins that contribute to the tumorigenic properties of the TME. For example, in the hypoxic TME, the enzymatic functions of CD38 result in an immunosuppressive environment. This leads to increased immune resistance in tumor cells and allows faster growth and proliferation rates. CD157 may also aid the production of an immunosuppressive TME, and confers increased malignancy to tumor cells through the promotion of tumor invasion and metastasis. An improved understanding of CD38 and CD157 in the TME, and how these glycoproteins affect cancer progression, will be useful to develop both cancer prognosis and treatment methods. This review aims to discuss the roles of CD38 and CD157 in the TME and cancer immunotherapy of a range of solid tumor types.
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Affiliation(s)
- Yu Jun Wo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Adelia Shin Ping Gan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore;
| | - Xinru Lim
- Institute of Molecular and Cell Biology (IMCB), Agency of Science, Technology and Research (A*STAR), Singapore 138673, Singapore; (X.L.); (S.L.); (J.C.T.L.)
| | - Isabel Shu Ying Tay
- School of Applied Science, Temasek Polytechnic, Singapore 529765, Singapore;
| | - Sherlly Lim
- Institute of Molecular and Cell Biology (IMCB), Agency of Science, Technology and Research (A*STAR), Singapore 138673, Singapore; (X.L.); (S.L.); (J.C.T.L.)
| | - Jeffrey Chun Tatt Lim
- Institute of Molecular and Cell Biology (IMCB), Agency of Science, Technology and Research (A*STAR), Singapore 138673, Singapore; (X.L.); (S.L.); (J.C.T.L.)
| | - Joe Poh Sheng Yeong
- Institute of Molecular and Cell Biology (IMCB), Agency of Science, Technology and Research (A*STAR), Singapore 138673, Singapore; (X.L.); (S.L.); (J.C.T.L.)
- Division of Pathology, Singapore General Hospital, Singapore 169856, Singapore
- Correspondence: ; Tel.: +65-6586-9527
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11
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Johnson TG, Schelch K, Mehta S, Burgess A, Reid G. Why Be One Protein When You Can Affect Many? The Multiple Roles of YB-1 in Lung Cancer and Mesothelioma. Front Cell Dev Biol 2019; 7:221. [PMID: 31632972 PMCID: PMC6781797 DOI: 10.3389/fcell.2019.00221] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
Lung cancers and malignant pleural mesothelioma (MPM) have some of the worst 5-year survival rates of all cancer types, primarily due to a lack of effective treatment options for most patients. Targeted therapies have shown some promise in thoracic cancers, although efficacy is limited only to patients harboring specific mutations or target expression. Although a number of actionable mutations have now been identified, a large population of thoracic cancer patients have no therapeutic options outside of first-line chemotherapy. It is therefore crucial to identify alternative targets that might lead to the development of new ways of treating patients diagnosed with these diseases. The multifunctional oncoprotein Y-box binding protein-1 (YB-1) could serve as one such target. Recent studies also link this protein to many inherent behaviors of thoracic cancer cells such as proliferation, invasion, metastasis and involvement in cancer stem-like cells. Here, we review the regulation of YB-1 at the transcriptional, translational, post-translational and sub-cellular levels in thoracic cancer and discuss its potential use as a biomarker and therapeutic target.
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Affiliation(s)
- Thomas G Johnson
- Asbestos Diseases Research Institute, Sydney, NSW, Australia.,Cell Division Laboratory, The ANZAC Research Institute, Sydney, NSW, Australia.,School of Medicine, The University of Sydney, Sydney, NSW, Australia.,Sydney Catalyst Translational Cancer Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Karin Schelch
- Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Sunali Mehta
- Department of Pathology, University of Otago, Dunedin, New Zealand.,Maurice Wilkins Centre, University of Otago, Dunedin, New Zealand
| | - Andrew Burgess
- Cell Division Laboratory, The ANZAC Research Institute, Sydney, NSW, Australia.,School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Glen Reid
- Department of Pathology, University of Otago, Dunedin, New Zealand.,Maurice Wilkins Centre, University of Otago, Dunedin, New Zealand
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12
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Oehl K, Vrugt B, Opitz I, Meerang M. Heterogeneity in Malignant Pleural Mesothelioma. Int J Mol Sci 2018; 19:ijms19061603. [PMID: 29848954 PMCID: PMC6032160 DOI: 10.3390/ijms19061603] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/13/2022] Open
Abstract
Despite advances in malignant pleural mesothelioma therapy, life expectancy of affected patients remains short. The limited efficiency of treatment options is mainly caused by inter- and intra-tumor heterogeneity of mesotheliomas. This diversity can be observed at the morphological and molecular levels. Molecular analyses reveal a high heterogeneity (i) between patients; (ii) within different areas of a given tumor in terms of different clonal compositions; and (iii) during treatment over time. The aim of the present review is to highlight this diversity and its therapeutic implications.
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Affiliation(s)
- Kathrin Oehl
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, 8091 Zürich, Switzerland.
| | - Bart Vrugt
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, 8091 Zürich, Switzerland.
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Mayura Meerang
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
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13
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Shimazu K, Tada Y, Morinaga T, Shingyoji M, Sekine I, Shimada H, Hiroshima K, Namiki T, Tatsumi K, Tagawa M. Metformin produces growth inhibitory effects in combination with nutlin-3a on malignant mesothelioma through a cross-talk between mTOR and p53 pathways. BMC Cancer 2017; 17:309. [PMID: 28464864 PMCID: PMC5414226 DOI: 10.1186/s12885-017-3300-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/25/2017] [Indexed: 12/29/2022] Open
Abstract
Background Mesothelioma is resistant to conventional treatments and is often defective in p53 pathways. We then examined anti-tumor effects of metformin, an agent for type 2 diabetes, and combinatory effects of metformin and nutlin-3a, an inhibitor for ubiquitin-mediated p53 degradation, on human mesothelioma. Methods We examined the effects with a colorimetric assay and cell cycle analyses, and investigated molecular events in cells treated with metformin and/or nutlin-3a with Western blot analyses. An involvement of p53 was tested with siRNA for p53. Results Metformin suppressed cell growth of 9 kinds of mesothelioma including immortalized cells of mesothelium origin irrespective of the p53 functional status, whereas susceptibility to nutlin-3a was partly dependent on the p53 genotype. We investigated combinatory effects of metformin and nutlin-3a on, nutlin-3a sensitive MSTO-211H and NCI-H28 cells and insensitive EHMES-10 cells, all of which had the wild-type p53 gene. Knockdown of p53 expression with the siRNA demonstrated that susceptibility of MSTO-211H and NCI-H28 cells to nutlin-3a was p53-dependent, whereas that of EHMES-10 cells was not. Nevertheless, all the cells treated with both agents produced additive or synergistic growth inhibitory effects. Cell cycle analyses also showed that the combination increased sub-G1 fractions greater than metformin or nutlin-3a alone in MSTO-211H and EHMES-10 cells. Western blot analyses showed that metformin inhibited downstream pathways of the mammalian target of rapamycin (mTOR) but did not activate the p53 pathways, whereas nutlin-3a phosphorylated p53 and suppressed mTOR pathways. Cleaved caspase-3 and conversion of LC3A/B were also detected but it was dependent on cells and treatments. The combination of both agents in MSTO-211H cells rather suppressed the p53 pathways that were activated by nutrin-3a treatments, whereas the combination rather augmented the p53 actions in NCI-H28 and EHMES-10 cells. Conclusion These data collectively indicated a possible interactions between mTOR and p53 pathways, and the combinatory effects were attributable to differential mechanisms induced by a cross-talk between the pathways. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3300-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kengo Shimazu
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, 666-2 Nitona, Chuo-ku, Chiba, 260-8717, Japan.,Department of Japanese-Oriental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takao Morinaga
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, 666-2 Nitona, Chuo-ku, Chiba, 260-8717, Japan
| | - Masato Shingyoji
- Division of Respirology, Chiba Cancer Center, 666-2 Nitona, Chuo-ku, Chiba, Chiba, 260-8717, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Ibaragi, Tsukuba, 305-8575, Japan
| | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Oomori-nishi, Oota-ku, Tokyo, 143-8541, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Takao Namiki
- Department of Japanese-Oriental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masatoshi Tagawa
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, 666-2 Nitona, Chuo-ku, Chiba, 260-8717, Japan. .,Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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14
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Walter RFH, Vollbrecht C, Werner R, Wohlschlaeger J, Christoph DC, Schmid KW, Mairinger FD. microRNAs are differentially regulated between MDM2-positive and negative malignant pleural mesothelioma. Oncotarget 2017; 7:18713-21. [PMID: 26918730 PMCID: PMC4951323 DOI: 10.18632/oncotarget.7666] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a highly aggressive tumour first-line treated with a combination of cisplatin and pemetrexed. MDM2 and P14/ARF (CDKN2A) are upstream regulators of TP53 and may contribute to its inactivation. In the present study, we now aimed to define the impact of miRNA expression on this mechanism. Material and Methods 24 formalin-fixed paraffin-embedded (FFPE) tumour specimens were used for miRNA expression analysis of the 800 most important miRNAs using the nCounter technique (NanoString). Significantly deregulated miRNAs were identified before a KEGG-pathway analysis was performed. Results 17 miRNAs regulating TP53, 18 miRNAs regulating MDM2, and 11 miRNAs directly regulating CDKN2A are significantly downregulated in MDM2-expressing mesotheliomas. TP53 is downregulated in MDM2-negative tumours through miRNAs with a miSVR prediction score of 11.67, RB1 with a prediction score of 8.02, MDM2 with a prediction score of 4.50 and CDKN2A with a prediction score of 1.27. Conclusion MDM2 expression seems to impact miRNA expression levels in MPM. Especially, miRNAs involved in TP53-signaling are strongly decreased in MDM2-positive mesotheliomas. A better understanding of its tumour biology may open the chance for new therapeutic approaches and thereby augment patients' outcome.
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Affiliation(s)
- Robert Fred Henry Walter
- Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Claudia Vollbrecht
- Institute of Pathology, University Hospital Cologne, Germany.,Institute of Pathology, Division of Molecular Pathology, Charité, Berlin, Germany
| | - Robert Werner
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jeremias Wohlschlaeger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Daniel Christian Christoph
- Department of Medical Oncology, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabian Dominik Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Pathology, Division of Molecular Pathology, Charité, Berlin, Germany
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15
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Meerang M, Bérard K, Friess M, Bitanihirwe BKY, Soltermann A, Vrugt B, Felley-Bosco E, Bueno R, Richards WG, Seifert B, Stahel R, Weder W, Opitz I. Low Merlin expression and high Survivin labeling index are indicators for poor prognosis in patients with malignant pleural mesothelioma. Mol Oncol 2016; 10:1255-65. [PMID: 27378628 DOI: 10.1016/j.molonc.2016.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alterations of the tumor suppressor Neurofibromatosis type II (NF2) have been reported in about 40% of Malignant pleural mesothelioma (MPM) patients. NF2 (Merlin) deficiency leads to alterations of the Hippo pathway; resulting in activation of the oncogenic Yes Associated Protein-1 (YAP1). Our aim was to investigate the association between these alterations and clinical outcomes. MATERIAL AND METHODS Tissue microarrays composed of MPM tumors derived from 2 independent MPM cohorts were employed for this study. Immunohistochemical expression of Merlin, YAP1 and its target genes, Survivin and connective tissue growth factor (CTGF) were assessed in nuclear and cytoplasmic fractions. Cohort 1 was comprised of 145 patients intended to be treated with chemotherapy (CTX) followed by extrapleural pneumonectomy (EPP), thus both pre- and post-CTX tissues were available. Cohort 2 was comprised of 59 patients treated with EPP followed by intraoperative hyperthermic cisplatin and/or adjuvant CTX and/or radiotherapy. Marker expression was quantified by means of labeling index (%) for nuclear Survivin and by H-score for the other markers. The dichotomized marker expression was tested for the association with overall survival (OS) and freedom from recurrence (FFR). RESULTS Kaplan-Meier survival curves revealed a significant association between low cytoplasmic Merlin expression in pre-induction CTX tissues of cohort 1 with shorter FFR (p = 0.02) and OS (p = 0.03). The same tendency was observed in the chemotherapy naïve tissues obtained during EPP of cohort 2. Low nuclear Merlin expression in post-CTX tissues (available from cohort 1 only) was associated with shorter FFR (p = 0.04) and OS (p = 0.05). High nuclear Survivin labeling indices in both pre- and post-CTX tissues of cohort 1 was associated with shorter FFR (p = 0.02). In cohort 2, this was associated with both FFR and OS (p = 0.046 and p = 0.002, respectively). In multivariate analysis, low expression of cytoplasmic Merlin remained an independent prognosticator for shorter FFR of cohort 1 [hazard ratio (HR) = 0.5, 95% confidence interval (CI) = 0.3-0.9, p = 0.001] and OS [HR = 0.5, 95% CI = 0.3-1, p = 0.04]. High Survivin labeling index was an independent prognostic factor for shorter FFR in patients from cohort 1 [HR = 3.4, 95% CI = 1.7-6.8, p = 0.006] and shorter OS in patients from cohort 2 [HR = 2.35, 95% CI = 1.27-4.33, p = 0.006]. CONCLUSIONS Our findings uncover the significance of Merlin protein expression and Survivin labeling index as prognosticators for poor clinical outcome in two independent MPM cohorts. If confirmed, these markers may be used to identify subgroups of patients benefitting from additional treatment.
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Affiliation(s)
- Mayura Meerang
- Division of Thoracic Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Karima Bérard
- Division of Thoracic Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Martina Friess
- Division of Thoracic Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | | | - Alex Soltermann
- Institute of Surgical Pathology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Bart Vrugt
- Institute of Surgical Pathology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Raphael Bueno
- Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - William G Richards
- Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute (EBPI), University of Zürich, Zürich 8001, Switzerland
| | - Rolf Stahel
- Laboratory of Molecular Oncology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zürich, Zürich 8091, Switzerland.
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16
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Cedrés S, Ponce-Aix S, Pardo-Aranda N, Navarro-Mendivil A, Martinez-Marti A, Zugazagoitia J, Sansano I, Montoro MA, Enguita A, Felip E. Analysis of expression of PTEN/PI3K pathway and programmed cell death ligand 1 (PD-L1) in malignant pleural mesothelioma (MPM). Lung Cancer 2016; 96:1-6. [PMID: 27133741 DOI: 10.1016/j.lungcan.2016.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) frequently express elevated AKT/mTOR activity. Previous reports in gliomas, colon, breast and prostate cancer suggest that PTEN/PI3K pathway may be important for the induction of PD-L1 expression. This study explored the expression of PTEN/PI3K pathway and PD-L1 in MPM and its relationship with the patient́s prognosis MATERIAL AND METHODS Twenty seven consecutive MPM patients were reviewed. Formalin-fixed, paraffin-embedded tissue biopsies were used for immunohistochemical analysis of PTEN/PI3K pathway and PD-L1 RESULTS: Expression of PTEN, mTOR, pAKT, p4EBP1, peif4E, pS6 and FOXO3a was found in 88.5%, 92.3%, 78.3%, 38.5%, 100%, 52.2% and 100% of tumors and PD-L1 in 23%. We found a significant correlation between pAKT, FOXO3a and PD-L1 expression and longer overall survival (p <0.05). We did not identify significant association between the level of PD-L1 expression and alterations in PI3K pathway CONCLUSIONS This study shows PTEN/PI3K pathway and PD-L1 in MPM are frequently activated. Our results suggests that there is not association between PD-L1 and the involvement of the PI3K pathway in MPM.
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Affiliation(s)
- S Cedrés
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain.
| | - S Ponce-Aix
- Medical Oncology Service, 12 de Octubre University Hospital, Madrid, Spain
| | - N Pardo-Aranda
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - A Navarro-Mendivil
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - A Martinez-Marti
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - J Zugazagoitia
- Medical Oncology Service, 12 de Octubre University Hospital, Madrid, Spain
| | - I Sansano
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M A Montoro
- Pathology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Enguita
- Pathology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - E Felip
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
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Abstract
Malignant mesothelioma is a deadly tumor whose diagnosis and treatment remain very challenging. There is an urgent need to advance our understanding of mesothelioma biology and to identify new molecular markers for improving management of patients. CD157 is a membrane glycoprotein linked to ovarian cancer progression and mesenchymal differentiation. The common embryonic origin of ovarian epithelial cells and mesothelial cells and the evident similarities between ovarian and mesothelial cancer prompted us to investigate the biological role and clinical significance of CD157 in malignant pleural mesothelioma (MPM). CD157 mRNA and protein were detected in four of nine MPM cell lines of diverse histotype and in 85.2% of MPM surgical tissue samples (32/37 epithelioid; 37/44 biphasic). CD157 expression correlated with clinical aggressiveness in biphasic MPM. Indeed, high CD157 was a negative prognostic factor and an independent predictor of poor survival for patients with biphasic MPM by multivariate survival analysis (HR = 2.433, 95% CI 1.120-5.284; p = 0.025). In mesothelioma cell lines, CD157 gain (in CD157-negative cells) or knockdown (in CD157-positive cells) affected cell growth, migration, invasion and tumorigenicity, most notably in biphasic MPM cell lines. In these cells, CD157 expression was associated with increased activation of the mTOR signaling pathway, resulting in decreased platinum sensitivity. Moreover, a trend towards reduced survival was observed in patients with biphasic MPM receiving postoperative platinum-based chemotherapy. These findings indicate that CD157 is implicated in multiple aspects of MPM progression and suggest that CD157 expression could be used to stratify patients into different prognostic groups or to select patients that might benefit from particular chemotherapeutic approach.
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18
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Vazakidou ME, Magkouta S, Moschos C, Psallidas I, Pappas A, Psarra K, Kalomenidis I. Temsirolimus targets multiple hallmarks of cancer to impede mesothelioma growth in vivo. Respirology 2015; 20:1263-71. [PMID: 26245309 DOI: 10.1111/resp.12604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/16/2015] [Accepted: 05/03/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The mechanistic target of rapamycin (mTOR) promotes cancer cell proliferation and survival, transduces pro-angiogenic signals and regulates immune cell differentiation and function. We hypothesized that temsirolimus, an mTOR inhibitor, would curtail experimental mesothelioma progression in vivo by limiting tumour cell growth, abrogating tumour angiogenesis and modulating immune/inflammatory tumour milieu. METHODS We produced flank and pleural syngeneic murine mesotheliomas by delivering AE17 and AB1 murine mesothelioma cells into the right flank or the pleural space of C57BL/6 and BALB/c mice, respectively. Animals were given five times/week intraperitoneal injections of 20 mg/kg temsirolimus or vehicle and were sacrificed on day 26 (flank) or on day 15 (pleural) post-tumour cell propagation. RESULTS Temsirolimus limited mesothelioma growth in vivo by stimulating tumour cell apoptosis, inhibiting tumour angiogenesis, enhancing tumour lymphocyte abundance and blocking pro-tumour myeloid cell recruitment. Pleural fluid accumulation was significantly mitigated in AE17 but not in AB1 mesotheliomas. In vitro, temsirolimus hindered mesothelioma cell growth, NF-kappaB activation and macrophage migration. CONCLUSIONS In conclusion, temsirolimus apart from inducing tumour cell apoptosis, targets tumour angiogenesis and influences inflammatory tumour microenvironment to halt experimental mesothelioma growth in vivo.
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Affiliation(s)
- Maria Eleni Vazakidou
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Sophia Magkouta
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Charalampos Moschos
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Ioannis Psallidas
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Apostolos Pappas
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Katherina Psarra
- Department of Immunology-Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Ioannis Kalomenidis
- 'Marianthi Simou Laboratory', 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
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19
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Felley-Bosco E, Opitz I, Meerang M. Hedgehog Signaling in Malignant Pleural Mesothelioma. Genes (Basel) 2015; 6:500-11. [PMID: 26184317 PMCID: PMC4584313 DOI: 10.3390/genes6030500] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 12/29/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a cancer associated with exposure to asbestos fibers, which accumulate in the pleural space, damage tissue and stimulate regeneration. Hedgehog signaling is a pathway important during embryonic mesothelium development and is inactivated in adult mesothelium. The pathway is reactivated in some MPM patients with poor clinical outcome, mainly mediated by the expression of the ligands. Nevertheless, mutations in components of the pathway have been observed in a few cases. Data from different MPM animal models and primary culture suggest that both autocrine and paracrine Hedgehog signaling are important to maintain tumor growth. Drugs inhibiting the pathway at the level of the smoothened receptor (Smo) or glioma-associated protein transcription factors (Gli) have been used mostly in experimental models. For clinical development, biomarkers are necessary for the selection of patients who can benefit from Hedgehog signaling inhibition.
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Affiliation(s)
- Emanuela Felley-Bosco
- University Hospital Zurich, Laboratory of Molecular Oncology, Clinic of Oncology, Haeldeliweg 4, 8044 Zürich, Switzerland.
| | - Isabelle Opitz
- University Hospital Zurich, Division of Thoracic Surgery, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Mayura Meerang
- University Hospital Zurich, Division of Thoracic Surgery, Raemistrasse 100, 8091 Zurich, Switzerland.
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20
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Davidson B. Prognostic factors in malignant pleural mesothelioma. Hum Pathol 2015; 46:789-804. [DOI: 10.1016/j.humpath.2015.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022]
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21
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Pignochino Y, Dell'Aglio C, Inghilleri S, Zorzetto M, Basiricò M, Capozzi F, Canta M, Piloni D, Cemmi F, Sangiolo D, Gammaitoni L, Soster M, Marchiò S, Pozzi E, Morbini P, Luisetti M, Aglietta M, Grignani G, Stella GM. The combination of sorafenib and everolimus shows antitumor activity in preclinical models of malignant pleural mesothelioma. BMC Cancer 2015; 15:374. [PMID: 25952930 PMCID: PMC4429519 DOI: 10.1186/s12885-015-1363-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/24/2015] [Indexed: 12/21/2022] Open
Abstract
Background Malignant Pleural Mesothelioma (MPM) is an aggressive tumor arising from mesothelial cells lining the pleural cavities characterized by resistance to standard therapies. Most of the molecular steps responsible for pleural transformation remain unclear; however, several growth factor signaling cascades are known to be altered during MPM onset and progression. Transducers of these pathways, such as PIK3CA-mTOR-AKT, MAPK, and ezrin/radixin/moesin (ERM) could therefore be exploited as possible targets for pharmacological intervention. This study aimed to identify ‘druggable’ pathways in MPM and to formulate a targeted approach based on the use of commercially available molecules, such as the multikinase inhibitor sorafenib and the mTOR inhibitor everolimus. Methods We planned a triple approach based on: i) analysis of immunophenotypes and mutational profiles in a cohort of thoracoscopic MPM samples, ii) in vitro pharmacological assays, ii) in vivo therapeutic approaches on MPM xenografts. No mutations were found in ‘hot spot’ regions of the mTOR upstream genes (e.g. EGFR, KRAS and PIK3CA). Results Phosphorylated mTOR and ERM were specifically overexpressed in the analyzed MPM samples. Sorafenib and everolimus combination was effective in mTOR and ERM blockade; exerted synergistic effects on the inhibition of MPM cell proliferation; triggered ROS production and consequent AMPK-p38 mediated-apoptosis. The antitumor activity was displayed when orally administered to MPM-bearing NOD/SCID mice. Conclusions ERM and mTOR pathways are activated in MPM and ‘druggable’ by a combination of sorafenib and everolimus. Combination therapy is a promising therapeutic strategy against MPM. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1363-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ymera Pignochino
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Carmine Dell'Aglio
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Simona Inghilleri
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Michele Zorzetto
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Marco Basiricò
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Federica Capozzi
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Marta Canta
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Davide Piloni
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Francesca Cemmi
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Dario Sangiolo
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Loretta Gammaitoni
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Marco Soster
- Laboratory of Tumor Microenvironment, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Serena Marchiò
- Laboratory of Tumor Microenvironment, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Ernesto Pozzi
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Patrizia Morbini
- Department of Molecular Medicine- Section of Pathology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Maurizio Luisetti
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Massimo Aglietta
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Giovanni Grignani
- Division of Medical Oncology, IRCCS-Institute for Cancer Research and Treatment, Candiolo, (TO), 10060, Italy.
| | - Giulia M Stella
- Department of Molecular Medicine, - Section of Pneumology, Laboratory of Biochemistry & Genetics, University and Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
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Inhibition of autophagy sensitizes malignant pleural mesothelioma cells to dual PI3K/mTOR inhibitors. Cell Death Dis 2015; 6:e1757. [PMID: 25950487 PMCID: PMC4669703 DOI: 10.1038/cddis.2015.124] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 01/01/2023]
Abstract
Malignant pleural mesothelioma (MPM) originates in most of the cases from chronic inflammation of the mesothelium due to exposure to asbestos fibers. Given the limited effect of chemotherapy, a big effort is being made to find new treatment options. The PI3K/mTOR pathway was reported to be upregulated in MPM. We tested the cell growth inhibition properties of two dual PI3K/mTOR inhibitors NVP-BEZ235 and GDC-0980 on 19 MPM cell lines. We could identify resistant and sensitive lines; however, there was no correlation to the downregulation of PI3K/mTOR activity markers. As a result of mTOR inhibition, both drugs efficiently induced long-term autophagy but not cell death. Autophagy blockade by chloroquine in combination with the dual PI3K/mTOR inhibitors significantly induced caspase-independent cell death involving RIP1 in the sensitive cell line SPC212. Cell death in the resistant cell line Mero-82 was less pronounced, and it was not induced via RIP1-dependent mechanism, suggesting the involvement of RIP1 downstream effectors. Cell death induction was confirmed in 3D systems. Based on these results, we identify autophagy as one of the main mechanisms of cell death resistance against dual PI3K/mTOR inhibitors in MPM. As PI3K/mTOR inhibitors are under investigation in clinical trials, these results may help interpreting their outcome and suggest ways for intervention.
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Kirschner MB, Cheng YY, Armstrong NJ, Lin RCY, Kao SC, Linton A, Klebe S, McCaughan BC, van Zandwijk N, Reid G. MiR-score: a novel 6-microRNA signature that predicts survival outcomes in patients with malignant pleural mesothelioma. Mol Oncol 2015; 9:715-26. [PMID: 25497279 PMCID: PMC5528709 DOI: 10.1016/j.molonc.2014.11.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/05/2014] [Accepted: 11/21/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prognosis of malignant pleural mesothelioma (MPM) is poor, and predicting the outcomes of treatment is difficult. Here we investigate the potential of microRNA expression to estimate prognosis of MPM patients. METHODS Candidate microRNAs from microarray profiling of tumor samples from 8 long (median: 53.7 months) and 8 short (median: 6.4 months) survivors following extrapleural pneumonectomy (EPP) were validated by RT-qPCR in 48 additional EPP samples. Kaplan-Meier log ranking was used to further explore the association between microRNA expression and overall survival (OS). Binary logistic regression was used to construct a microRNA signature (miR-Score) that was able to predict an OS of ≥20 months. Performance of the miR-Score was evaluated by receiver operating characteristic (ROC) curve analysis and validated in a series of 43 tumor samples from patients who underwent palliative surgery [pleurectomy/decortication (P/D)]. RESULTS The miR-Score, using expression data of six microRNAs (miR-21-5p, -23a-3p, -30e-5p, -221-3p, -222-3p, and -31-5p), enabled prediction of long survival with an accuracy of 92.3% for EPP and 71.9% for palliative P/D. Hazard ratios for score-negative patients were 4.12 (95% CI: 2.03-8.37) for EPP and 1.93 (95% CI: 1.01-3.69) for P/D. Importantly, adding the miR-Score to a set of clinical selection criteria (histology, age, gender) increased predictive accuracy in the independent validation set from 76.3% for clinical factors only to 87.3%. CONCLUSIONS This study has identified a novel 6-microRNA signature (miR-Score) that can accurately predict prognosis of MPM patients.
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Affiliation(s)
- Michaela B Kirschner
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Yuen Yee Cheng
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia.
| | - Nicola J Armstrong
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia.
| | - Ruby C Y Lin
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; School of Biotechnology and Biomolecular Sciences, University of New South Wales, NSW, Australia.
| | - Steven C Kao
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
| | - Anthony Linton
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Adelaide, SA, Australia.
| | - Brian C McCaughan
- Sydney Cardiothoracic Surgeons, RPA Medical Centre, Sydney, NSW, Australia.
| | - Nico van Zandwijk
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Glen Reid
- Asbestos Diseases Research Institute (ADRI), Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Frischknecht L, Meerang M, Soltermann A, Stahel R, Moch H, Seifert B, Weder W, Opitz I. Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery. J Thorac Cardiovasc Surg 2015; 149:1539-46.e1. [PMID: 25840756 DOI: 10.1016/j.jtcvs.2015.01.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 12/11/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Survival and response to platinum-based induction chemotherapy are heterogeneous among patients with malignant pleural mesothelioma. The aim of the present study was to assess the prognostic role of DNA repair markers, such as excision repair cross-complementation group 1 and ribonucleotide reductase M1, in multimodally treated patients with malignant pleural mesothelioma. METHODS Tumor tissue of a malignant pleural mesothelioma cohort (n = 107) treated with platinum/gemcitabine (n = 46) or platinum/pemetrexed (n = 61) induction chemotherapy followed by extrapleural pneumonectomy was assembled on a tissue microarray. Immunohistochemical expression of excision repair cross-complementation group 1 (nuclear) and ribonucleotide reductase M1 (nuclear and cytoplasmic) was assessed for its prognostic impact (association with overall survival or freedom from recurrence). RESULTS Patients with high nuclear ribonucleotide reductase M1 expression before chemotherapy showed significantly longer freedom from recurrence (P = .03). When specifically analyzed in the subgroup of patients receiving platinum/gemcitabine followed by extrapleural pneumonectomy, high nuclear ribonucleotide reductase M1 was associated with prolonged freedom from recurrence (P = .03) and overall survival (P = .02). Low excision repair cross-complementation group 1 expression in prechemotherapy tumor tissues was associated with significantly longer freedom from recurrence (P = .04). Nuclear ribonucleotide reductase M1 and excision repair cross-complementation group 1 were independent prognosticators of freedom from recurrence in addition to pT stage in multivariate analysis. CONCLUSIONS In the present study, nuclear ribonucleotide reductase M1 and excision repair cross-complementation group 1 expression were identified as independent prognosticators for freedom from recurrence of malignant pleural mesothelioma in patients undergoing induction chemotherapy followed by extrapleural pneumonectomy.
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Affiliation(s)
- Lukas Frischknecht
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mayura Meerang
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alex Soltermann
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Laboratory of Molecular Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, ISPM, University Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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Ignatius Ou SH, Moon J, Garland LL, Mack PC, Testa JR, Tsao AS, Wozniak AJ, Gandara DR. SWOG S0722: phase II study of mTOR inhibitor everolimus (RAD001) in advanced malignant pleural mesothelioma (MPM). J Thorac Oncol 2015; 10:387-91. [PMID: 25611229 PMCID: PMC4304604 DOI: 10.1097/jto.0000000000000360] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The PI3K/Akt/mammalian target of rapamycin pathway is activated in a majority of malignant pleural mesotheliomas (MPM). We evaluated the activity of everolimus, an oral mammalian target of rapamycin inhibitor, in patients with unresectable MPM. METHODS MPM patients who had received at least one but no more than two prior chemotherapy regimens, which must have been platinum-based, were treated with 10 mg of everolimus daily. The primary endpoint was 4-month progression-free survival (PFS) by RECIST 1.1. RESULTS A total of 59 evaluable patients were included in the analysis. The median duration of treatment was 2 cycles (56 days). Overall response rate was 2% [95% confidence interval (CI): 0-12%] by RECIST 1.1 and 0% (0-10%) by modified RECIST for MPM. The 4-month PFS rate was 29% (95% CI: 17-41%) by RECIST 1.1, and 27% (95% CI: 16-39%) by modified RECIST. The median PFS was 2.8 months (95% CI: 1.8-3.4) by RECIST 1.1. The median overall survival was 6.3 months (95% CI: 4.0-8.0). There was no difference in PFS among patients who received one or two prior chemotherapy regimens (p = 0.74). There was no difference in overall survival between patients with epithelioid histology versus other types (p = 0.47). The most common toxicities were fatigue (59%), hypertriglyceridemia (44%), anemia (42%), oral mucositis (34%), nausea (32%), and anorexia (32%). The most common grade 3 to 4 toxicities were fatigue (10.2%), anemia (6.8%), and lung infection (6.8%). CONCLUSION Everolimus has limited clinical activity in advanced MPM patients. Additional studies of single-agent everolimus in advanced MPM are not warranted.
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Affiliation(s)
- Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA 92868
| | - James Moon
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, 98101
| | - Linda L. Garland
- Arizona Cancer Center, University of Arizona Tucson School of Medicine, Tucson, AZ 85719
| | - Philip C. Mack
- University of California Davis Comprehensive Cancer Center, Sacramento, CA 95817
| | | | | | - Antoniette J. Wozniak
- Karmanos Cancer Institute, Wayne state University School of Medicine, Detroit, MI 48201
| | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA 95817
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Ki67 index is an independent prognostic factor in epithelioid but not in non-epithelioid malignant pleural mesothelioma: a multicenter study. Br J Cancer 2015; 112:783-92. [PMID: 25633038 PMCID: PMC4453963 DOI: 10.1038/bjc.2015.9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/19/2014] [Accepted: 12/25/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Estimating the prognosis in malignant pleural mesothelioma (MPM) remains challenging. Thus, the prognostic relevance of Ki67 was studied in MPM. Methods: Ki67 index was determined in a test cohort of 187 cases from three centres. The percentage of Ki67-positive tumour cells was correlated with clinical variables and overall survival (OS). The prognostic power of Ki67 index was compared with other prognostic factors and re-evaluated in an independent cohort (n=98). Results: Patients with Ki67 higher than median (>15%) had significantly (P<0.001) shorter median OS (7.5 months) than those with low Ki67 (19.1 months). After multivariate survival analyses, Ki67 proved to be—beside histology and treatment—an independent prognostic marker in MPM (hazard ratio (HR): 2.1, P<0.001). Interestingly, Ki67 was prognostic exclusively in epithelioid (P<0.001) but not in non-epithelioid subtype. Furthermore, Ki67 index was significantly lower in post-chemotherapy samples when compared with chemo-naive cases. The prognostic power was comparable to other recently published prognostic factors (CRP, fibrinogen, neutrophil-to-leukocyte ratio (NLR) and nuclear grading score) and was recapitulated in the validation cohort (P=0.048). Conclusion: This multicentre study demonstrates that Ki67 is an independent and reproducible prognostic factor in epithelioid but not in non-epithelioid MPM and suggests that induction chemotherapy decreases the proliferative capacity of MPM.
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Meerang M, Boss A, Kenkel D, Broggini-Tenzer A, Bérard K, Lauk O, Arni S, Weder W, Opitz I. Evaluation of imaging techniques for the assessment of tumour progression in an orthotopic rat model of malignant pleural mesothelioma†. Eur J Cardiothorac Surg 2014; 47:e34-41. [PMID: 25344922 DOI: 10.1093/ejcts/ezu393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES An orthotopic rat tumour recurrence model for malignant pleural mesothelioma (MPM) provides clinical similarity to patients and is useful for drug testing combined with surgical intervention. Importantly, a reliable imaging method is required allowing for noninvasive and repetitive evaluation of the tumour load. We compared the tumour load assessed by bioluminescence and magnetic resonance imaging (MRI) to the macroscopic tumour volume as a reference standard. METHODS A total of 500,000 syngeneic rat MPM cells transfected with luciferase were implanted underneath the parietal pleura of immunocompetent rats (n=13). From the second day after implantation, bioluminescence measurements of the tumour load expressed as the maximum bioluminescent intensity (photon/second) were performed daily after intraperitoneal injection of the luciferase substrate, d-luciferin, to observe the first occurrence of tumour. Six days after the first detection of tumour, bioluminescence, MRI and macroscopic tumour volume measurement were conducted. For MRI, a 4.7-Tesla small animal imager equipped with a 1H whole-body rat coil was employed using T2-weighted fast spin-echo sequences. Tumour burden (mm3) was quantified from magnetic resonance transverse images by two independent readers by manual segmentation. Finally, the tumour burden assessed by bioluminescence and MRI was correlated (Pearson's correlation) with the macroscopic measurement of tumour (ellipsoid) volume. RESULTS In all rats, a single tumour nodule was found at the inoculation site with a median macroscopic volume of 46 mm3 (18-377 mm3). For tumour burden quantification of MRIs, we observed good interobserver correlation (R2=0.81, P<0.0001) as well as significant association with the macroscopic tumour volume (R2=0.59, P=0.002). However, the signal intensity of bioluminescence did not correspond to the macroscopic tumour volume (R2=0.01, P=0.76). CONCLUSIONS MRI is a reliable and reproducible noninvasive in vivo imaging method for MPM tumour burden assessment for the present MPM model.
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Affiliation(s)
- Mayura Meerang
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Boss
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - David Kenkel
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Karima Bérard
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Arni
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Opitz I. Management of malignant pleural mesothelioma-The European experience. J Thorac Dis 2014; 6 Suppl 2:S238-52. [PMID: 24868442 DOI: 10.3978/j.issn.2072-1439.2014.05.03] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 12/29/2022]
Abstract
Management of malignant pleural mesothelioma (MPM) remains a clinical challenge and the incidence of the disease will continue to increase worldwide. Several aspects of mesothelioma treatment are discussed controversially, in particular, regarding extent and best type of surgery, radiotherapy, and the role of neoadjuvant or adjuvant treatment. However, best survival data is reported from groups using multimodality treatment including macroscopic complete resection (MCR) achieved by either extrapleural pneumonectomy (EPP) or (extended) pleurectomy/decortication for patients qualifying from the tumor biology, stage, and patient's performance status and comorbidities. Several aspects have to be considered during surgery but morbidity and mortality have been reduced at experienced centres. The final analysis of extended selection algorithms is pending.
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Affiliation(s)
- Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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