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Jirovec A, Flaman A, Godbout E, Serrano D, Werier J, Purgina B, Diallo JS. Immune profiling of dedifferentiated liposarcoma and identification of novel antigens for targeted immunotherapy. Sci Rep 2024; 14:11254. [PMID: 38755218 PMCID: PMC11099179 DOI: 10.1038/s41598-024-61860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Dedifferentiated liposarcoma (DDLS) is an aggressive, recurring sarcoma with limited treatments. T-cell immunotherapies selectively target malignant cells, holding promise against DDLS. The development of successful immunotherapy for DDLS requires a thorough evaluation of the tumor immune microenvironment and the identification and characterization of targetable immunogenic tumor antigens. To assess the complexity of the human DDLS tumor immune microenvironment and to identify target antigens, we used the nCounter NanoString platform, analyzing gene expression profiles across 29 DDLS and 10 healthy adipose tissue samples. Hierarchical clustering of tumors based on expression of tumor inflammation signature genes revealed two distinct groups, consisting of 15 inflamed tumors and 14 non-inflamed tumors, demonstrating tumor heterogeneity within this sarcoma subtype. Among the identified antigens, PBK and TTK exhibited substantial upregulation in mRNA expression compared to healthy adipose tissue controls, further corroborated by positive protein expression by IHC. This data shows considerable inter-tumoral heterogeneity of inflammation, which should be taken into consideration when designing an immunotherapy for DDLS, and provides a novel targetable antigen in DDLS. The results of this study lay the groundwork for the development of a novel immunotherapy for this highly aggressive sarcoma.
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Affiliation(s)
- Anna Jirovec
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada.
- Centre for Innovative Cancer Research, Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, 501 Smyth Road, Box 926, Ottawa, ON, K1H 8L6, Canada.
| | - Ashley Flaman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Elena Godbout
- Centre for Innovative Cancer Research, Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, 501 Smyth Road, Box 926, Ottawa, ON, K1H 8L6, Canada
| | - Daniel Serrano
- Centre for Innovative Cancer Research, Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, 501 Smyth Road, Box 926, Ottawa, ON, K1H 8L6, Canada
| | - Joel Werier
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Orthopedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jean-Simon Diallo
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- Centre for Innovative Cancer Research, Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, 501 Smyth Road, Box 926, Ottawa, ON, K1H 8L6, Canada
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2
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Kyriazoglou A, Pagkali A, Kotsantis I, Economopoulou P, Kyrkasiadou M, Moutafi M, Gavrielatou N, Anastasiou M, Boulouta A, Pantazopoulos A, Giannakakou M, Digklia A, Psyrri A. Well-differentiated liposarcomas and dedifferentiated liposarcomas: Systemic treatment options for two sibling neoplasms. Cancer Treat Rev 2024; 125:102716. [PMID: 38492514 DOI: 10.1016/j.ctrv.2024.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
Well-differentiated liposarcomas (WDLPS) and dedifferentiated liposarcomas (DDLPS) account for 60 % of all liposarcomas, reflecting the heterogeneity of this type of sarcoma. Genetically, both types of liposarcomas are characterized by the amplification of MDM2 and CDK4 genes, which indicates an important molecular event with diagnostic and therapeutic relevance. In both localized WDLPS and DDLPS of the retroperitoneum and the extremities, between 25 % and 30 % of patients have local or distant recurrence, even when perioperatively treated, with clear margins present. The systemic treatment of WDLPS and DDLPS remains a challenge, with anthracyclines as the gold standard for first-line treatment. Several regimens have been tested with modest results regarding their efficacy. Herein we discuss the systemic treatment options for WDLPS and DDLPS and review their reported clinical efficacy results.
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Affiliation(s)
- A Kyriazoglou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - A Pagkali
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - I Kotsantis
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - P Economopoulou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Kyrkasiadou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Moutafi
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - N Gavrielatou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Anastasiou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Boulouta
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Pantazopoulos
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Giannakakou
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Digklia
- Sarcoma Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - A Psyrri
- Section of Medical Oncology, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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3
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Wang S, Wang H, Li C, Liu B, He S, Tu C. Tertiary lymphoid structures in cancer: immune mechanisms and clinical implications. MedComm (Beijing) 2024; 5:e489. [PMID: 38469550 PMCID: PMC10925885 DOI: 10.1002/mco2.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
Cancer is a major cause of death globally, and traditional treatments often have limited efficacy and adverse effects. Immunotherapy has shown promise in various malignancies but is less effective in tumors with low immunogenicity or immunosuppressive microenvironment, especially sarcomas. Tertiary lymphoid structures (TLSs) have been associated with a favorable response to immunotherapy and improved survival in cancer patients. However, the immunological mechanisms and clinical significance of TLS in malignant tumors are not fully understood. In this review, we elucidate the composition, neogenesis, and immune characteristics of TLS in tumors, as well as the inflammatory response in cancer development. An in-depth discussion of the unique immune characteristics of TLSs in lung cancer, breast cancer, melanoma, and soft tissue sarcomas will be presented. Additionally, the therapeutic implications of TLS, including its role as a marker of therapeutic response and prognosis, and strategies to promote TLS formation and maturation will be explored. Overall, we aim to provide a comprehensive understanding of the role of TLS in the tumor immune microenvironment and suggest potential interventions for cancer treatment.
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Affiliation(s)
- Siyu Wang
- Department of OrthopaedicsThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Hunan Key Laboratory of Tumor Models and Individualized MedicineThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Xiangya School of MedicineCentral South UniversityChangshaHunanChina
| | - Hua Wang
- Department of OrthopaedicsThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Hunan Key Laboratory of Tumor Models and Individualized MedicineThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Chenbei Li
- Department of OrthopaedicsThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Hunan Key Laboratory of Tumor Models and Individualized MedicineThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Binfeng Liu
- Department of OrthopaedicsThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Hunan Key Laboratory of Tumor Models and Individualized MedicineThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Shasha He
- Department of OncologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Chao Tu
- Department of OrthopaedicsThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Hunan Key Laboratory of Tumor Models and Individualized MedicineThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Shenzhen Research Institute of Central South UniversityGuangdongChina
- Changsha Medical UniversityChangshaChina
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An HJ, Yang JW, Kim MH, Song DH. PD-L1 and PD-1 Expression in Early Stage Uterine Endometrioid Carcinoma. In Vivo 2024; 38:246-252. [PMID: 38148043 PMCID: PMC10756439 DOI: 10.21873/invivo.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM Immune checkpoint inhibitors (ICI) and tumor-infiltrating lymphocytes (TILs) for cancer treatment in clinical oncology have revolutionized patient care. However, no gold standard exists for the criteria of analytical validity of TILs of different types of cancer. MATERIALS AND METHODS Clinicopathological data from 60 patients with endometrioid carcinoma (EC) who had undergone surgical treatment at the Gyeongsang National University Hospital between January 2002 and December 2009, were investigated. The programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PDL1) expression levels were characterized by immunohistochemical staining patterns, and the interpretations derived from machine learning morphometric analysis (Genie) and the pathologists' assessments were compared. In solid tumors, pathologists assessed the proportion of positive cells in each core of the tissue microarray. For Genie, the proportion of positive cells in the entire core and the number of positive cells per 1 mm2 were used. RESULTS Both the pathologists and Genie identified the same trend in association with tumor size, with significant differences (p=0.026, p=0.033). Genie expression showed a significant association with PD1 expression, and pathologists identified a significant association with PDL1 expression in immune cells. CONCLUSION The PD1 expression levels identified in immune cells of EC specimens were similar between the pathologists and Genie, suggesting that there is little resistance to the introduction of morphometric analysis. To our knowledge, this is the first study to introduce and validate machine learning as an integrated method for predicting prognosis and treatment based on PD1 expression in EC tumor microenvironments.
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Affiliation(s)
- Hyo Jung An
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- lnstitute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung Wook Yang
- lnstitute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Pathology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Min Hye Kim
- Department of Pathology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea;
- lnstitute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Jumaniyazova E, Lokhonina A, Dzhalilova D, Kosyreva A, Fatkhudinov T. Immune Cells in the Tumor Microenvironment of Soft Tissue Sarcomas. Cancers (Basel) 2023; 15:5760. [PMID: 38136307 PMCID: PMC10741982 DOI: 10.3390/cancers15245760] [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: 11/14/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Soft tissue sarcomas (STSs) are a rare heterogeneous group of malignant neoplasms characterized by their aggressive course and poor response to treatment. This determines the relevance of research aimed at studying the pathogenesis of STSs. By now, it is known that STSs is characterized by complex relationships between the tumor cells and immune cells of the microenvironment. Dynamic interactions between tumor cells and components of the microenvironment enhance adaptation to changing environmental conditions, which provides the high aggressive potential of STSs and resistance to antitumor therapy. Today, active research is being conducted to find effective antitumor drugs and to evaluate the possibility of using therapy with immune cells of STS. The difficulty in assessing the efficacy of new antitumor options is primarily due to the high heterogeneity of this group of malignant neoplasms. Studying the role of immune cells in the microenvironment in the progression STSs and resistance to antitumor therapies will provide the discovery of new biomarkers of the disease and the prediction of response to immunotherapy. In addition, it will help to initially divide patients into subgroups of good and poor response to immunotherapy, thus avoiding wasting precious time in selecting the appropriate antitumor agent.
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Affiliation(s)
- Enar Jumaniyazova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
| | - Anastasiya Lokhonina
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997 Moscow, Russia
| | - Dzhuliia Dzhalilova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Anna Kosyreva
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Timur Fatkhudinov
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia (T.F.)
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
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6
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Zhou MY, Bui NQ, Charville GW, Ganjoo KN, Pan M. Treatment of De-Differentiated Liposarcoma in the Era of Immunotherapy. Int J Mol Sci 2023; 24:ijms24119571. [PMID: 37298520 DOI: 10.3390/ijms24119571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Well-differentiated/de-differentiated liposarcoma (WDLPS/DDLPS) is one of the most common histologic subtypes of soft tissue sarcoma (STS); however, treatment options remain limited. WDLPS and DDLPS both exhibit the characteristic amplification of chromosome region 12q13-15, which contains the genes CDK4 and MDM2. DDLPS exhibits higher amplification ratios of these two and carries additional genomic lesions, including the amplification of chromosome region 1p32 and chromosome region 6q23, which may explain the more aggressive biology of DDLPS. WDLPS does not respond to systemic chemotherapy and is primarily managed with local therapy, including multiple resections and debulking procedures whenever clinically feasible. In contrast, DDLPS can respond to chemotherapy drugs and drug combinations, including doxorubicin (or doxorubicin in combination with ifosfamide), gemcitabine (or gemcitabine in combination with docetaxel), trabectedin, eribulin, and pazopanib. However, the response rate is generally low, and the response duration is usually short. This review highlights the clinical trials with developmental therapeutics that have been completed or are ongoing, including CDK4/6 inhibitors, MDM2 inhibitors, and immune checkpoint inhibitors. This review will also discuss the current landscape in assessing biomarkers for identifying tumors sensitive to immune checkpoint inhibitors.
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Affiliation(s)
- Maggie Y Zhou
- Sarcoma Program, Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Nam Q Bui
- Sarcoma Program, Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Kristen N Ganjoo
- Sarcoma Program, Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Minggui Pan
- Sarcoma Program, Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
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Barb AC, Pasca Fenesan M, Pirtea M, Margan MM, Tomescu L, Melnic E, Cimpean AM. Tertiary Lymphoid Structures (TLSs) and Stromal Blood Vessels Have Significant and Heterogeneous Impact on Recurrence, Lymphovascular and Perineural Invasion amongst Breast Cancer Molecular Subtypes. Cells 2023; 12:cells12081176. [PMID: 37190085 DOI: 10.3390/cells12081176] [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: 03/05/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Tertiary lymphoid structures (TLSs) mediate local antitumor immunity, and interest in them significantly increased since cancer immunotherapy was implemented. We examined TLS- tumor stromal blood vessel interplay for each breast cancer (BC) molecular subtype related to recurrence, lymphovascular invasion (LVI), and perineural invasion (PnI). METHODS TLSs were quantified on hematoxylin and eosin stain specimens followed by CD34/smooth muscle actin (SMA) double immunostaining for stromal blood vessel maturation assessment. Statistical analysis linked microscopy to recurrence, LVI, and PnI. RESULTS TLS negative (TLS-) subgroups in each BC molecular subtype (except to Luminal A) have higher LVI, PnI, and recurrence. A significant rise in LVI and PnI were observed for the HER2+/TLS- subgroup (p < 0.001). The triple negative breast cancer (TNBC)/TLS- subgroup had the highest recurrence and invasion risk which was also significantly related to tumor grade. PnI but not LVI significantly influenced recurrence in the TNBC/TLS+ subgroup (p < 0.001). TLS-stromal blood vessel interrelation was different amongst BC molecular subtypes. CONCLUSION BC invasion and recurrence are strongly influenced by TLS presence and stromal blood vessels, especially for HER2 and TNBC BC molecular subtypes.
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Affiliation(s)
- Alina Cristina Barb
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School in Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- OncoHelp Hospital, 300239 Timisoara, Romania
| | - Mihaela Pasca Fenesan
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School in Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- OncoHelp Hospital, 300239 Timisoara, Romania
| | - Marilena Pirtea
- Doctoral School in Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Madalin Marius Margan
- Department of Functional Sciences, Discipline of Public Health, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Larisa Tomescu
- Doctoral School in Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Eugen Melnic
- Department of Pathology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chișinău, Moldova
| | - Anca Maria Cimpean
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Emergency Hospital for Children Louis Turcanu, 300011 Timisoara, Romania
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Gingrich AA, Nassif EF, Roland CL, Keung EZ. The Landscape of Immunotherapy for Retroperitoneal Sarcoma. Curr Oncol 2023; 30:2144-2158. [PMID: 36826126 PMCID: PMC9955848 DOI: 10.3390/curroncol30020165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Significant multidisciplinary scientific effort has been undertaken to understand the heterogeneous family of neoplasms that comprise soft tissue sarcomas. Within this family of neoplasms, outcomes for retroperitoneal sarcomas (RPS) are currently limited given a lack of effective therapies. In this review, we focus on immunotherapy and its relationship with the common RPS histologic subtypes. Although initial outcomes for RPS patients with immune checkpoint inhibition alone have been somewhat disappointing, subsequent analyses on histologies, the tumor microenvironment, sarcoma immune class, tumor infiltrating lymphocytes and genetic analysis for tumor mutational burden have yielded insight into the interplay between sarcomas and immunotherapy. Such approaches have all provided critical insight into the environment and characterization of these tumors, with targets for potential immunotherapy in future clinical trials. With this insight, molecularly tailored combination treatments for improving response rates and oncologic outcomes for RPS are promising.
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Affiliation(s)
- Alicia A. Gingrich
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elise F. Nassif
- Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christina L. Roland
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Emily Z. Keung
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Resag A, Toffanin G, Benešová I, Müller L, Potkrajcic V, Ozaniak A, Lischke R, Bartunkova J, Rosato A, Jöhrens K, Eckert F, Strizova Z, Schmitz M. The Immune Contexture of Liposarcoma and Its Clinical Implications. Cancers (Basel) 2022; 14:cancers14194578. [PMID: 36230502 PMCID: PMC9559230 DOI: 10.3390/cancers14194578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Liposarcomas (LPS) are the most frequent malignancies in the soft tissue sarcoma family and consist of five distinctive histological subtypes, termed well-differentiated LPS, dedifferentiated LPS (DDLPS), myxoid LPS (MLPS), pleomorphic LPS, and myxoid pleomorphic LPS. They display variations in genetic alterations, clinical behavior, and prognostic course. While accumulating evidence implicates a crucial role of the tumor immune contexture in shaping the response to anticancer treatments, the immunological landscape of LPS is highly variable across different subtypes. Thus, DDLPS is characterized by a higher abundance of infiltrating T cells, yet the opposite was reported for MLPS. Interestingly, a recent study indicated that the frequency of pre-existing T cells in soft tissue sarcomas has a predictive value for immune checkpoint inhibitor (CPI) therapy. Additionally, B cells and tertiary lymphoid structures were identified as potential biomarkers for the clinical outcome of LPS patients and response to CPI therapy. Furthermore, it was demonstrated that macrophages, predominantly of M2 polarization, are frequently associated with poor prognosis. An improved understanding of the complex LPS immune contexture enables the design and refinement of novel immunotherapeutic approaches. Here, we summarize recent studies focusing on the clinicopathological, genetic, and immunological determinants of LPS.
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Affiliation(s)
- Antonia Resag
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Giulia Toffanin
- Department of Surgery Oncology and Gastroenterology, University of Padova, Via Gattamelata 64, 35128 Padova, Italy
| | - Iva Benešová
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Department of Immunology, Second Faculty of Medicine, Charles University, University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Luise Müller
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Vlatko Potkrajcic
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Andrej Ozaniak
- Third Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Robert Lischke
- Third Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Jirina Bartunkova
- Department of Immunology, Second Faculty of Medicine, Charles University, University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Antonio Rosato
- Department of Surgery Oncology and Gastroenterology, University of Padova, Via Gattamelata 64, 35128 Padova, Italy
- Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy
| | - Korinna Jöhrens
- Institute of Pathology, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University, University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
- Correspondence: (Z.S.); (M.S.); Tel.: +420-604712471 (Z.S.); +49-351-458-6501 (M.S.)
| | - Marc Schmitz
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Correspondence: (Z.S.); (M.S.); Tel.: +420-604712471 (Z.S.); +49-351-458-6501 (M.S.)
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Baldi GG, Gronchi A, Tazzari M, Stacchiotti S. Immunotherapy in soft tissue sarcoma: current evidence and future perspectives in a variegated family of different tumour. Expert Rev Anticancer Ther 2022; 22:491-503. [PMID: 35412415 DOI: 10.1080/14737140.2022.2065986] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the last few years steps forward in the knowledge of the biology of soft tissue sarcomas (STS) has led to the development of new therapeutic strategies, including immunotherapy. AREAS COVERED This review outlines the recent findings on immunological features and provides a synopsis of the results of clinical trials with different immunotherapy approaches in STS, discussing criticisms and how the efficacy of immunotherapy could be improved. EXPERT OPINION The heterogeneity of STS has limited generalized approaches of immunotherapy in the disease. Clinical decisions should encompass a comprehensive characterization of the tumour microenvironment (TME), marked by intra-histotype diversity. Profiling of immune cells, checkpoint molecules and antigen target/HLA expression is deemed to re-shape the classical histotype classification for a selection of the most appropriate immune-based treatment. In a synergistic view, tumour-directed treatments, designed on the genetic and epigenetic histotype make-up, should be monitored for their immunomodulant effect and applied to ensure or amplify immunotherapy response. In light of the dynamic nature of the TME, this immunomonitoring should be conducted at baseline and during treatment, for improved therapeutic decisions and rational sequence of treatment combination, pursuing an immunological marker approach by histotype guidance.
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Affiliation(s)
- Giacomo G Baldi
- Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcella Tazzari
- Immunotherapy, Cell Therapy and Biobank Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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11
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Istl AC, Gronchi A. Neoadjuvant Therapy for Primary Resectable Retroperitoneal Sarcomas-Looking Forward. Cancers (Basel) 2022; 14:cancers14071831. [PMID: 35406603 PMCID: PMC8998126 DOI: 10.3390/cancers14071831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary This review summarizes the current evidence around neoadjuvant radiotherapy and systemic therapy for retroperitoneal sarcoma (RPS). While surgery is the cornerstone of treatment for these tumors, data from prospective studies, retrospective studies, early phase trials, and—most recently—our first phase III randomized trial for RPS suggest there are clinical scenarios in which neoadjuvant therapy may provide benefit. This review evaluates the STRASS results in the setting of other recent studies, identifies active trials of interest, and suggests future directions of study in this field. The intersection of STRASS and STRASS2 is considered and a summary of current acceptable approaches to neoadjuvant therapy for RPS is provided. Abstract The cornerstone of therapy for primary retroperitoneal sarcomas (RPS) is complete surgical resection, best achieved by resecting the tumor en bloc with adherent structures even if not overtly infiltrated. Until recently, trials designed to elucidate the role of neoadjuvant radiation or chemotherapy for RPS have been unable to achieve sufficient enrollment. The completion of the STRASS trial, which explored neoadjuvant radiotherapy for primary resectable RPS, is a major milestone in RPS research, but has prompted further questions about histology-driven treatment paradigms for RPS. Though it was ultimately a negative trial with respect to its primary endpoint of abdominal recurrence-free survival, STRASS produced a signal that suggested improved abdominal recurrence-free survival with neoadjuvant radiotherapy (RT) for patients with liposarcoma (LPS). No effect was seen for leiomyosarcoma (LMS) or high-grade dedifferentiated (DD) LPS, consistent with recent literature suggesting LMS and high-grade DD-LPS have a predominant pattern of distant rather than local failure. These results, along with those from other recent studies conducted at the bench and the bedside, emphasize the importance of a histology-specific approach to RPS research. Recent evidence for patterns of distant failure in LMS and high-grade DD-LPS has prompted the initiation of STRASS2, a study of neoadjuvant chemotherapy for these histologies. As this study unfolds, evidence may emerge for novel systemic therapy options in specific sarcoma histotypes given the explosion in targeted and immunotherapeutic applications over the last decade. This article reviews current and recent evidence around neoadjuvant radiation and chemotherapy as well as avenues for future study to optimize these treatment approaches.
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Affiliation(s)
- Alexandra C. Istl
- Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
- Correspondence:
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12
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Pan D, Li TP, Xiong JH, Wang SB, Chen YX, Li JF, Xiao Q. Treatment with sorafenib plus camrelizumab after splenectomy for primary splenic angiosarcoma with liver metastasis: A case report and literature review. World J Clin Cases 2022; 10:2818-2828. [PMID: 35434106 PMCID: PMC8968800 DOI: 10.12998/wjcc.v10.i9.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/04/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary splenic angiosarcoma (PSA) is an extremely rare and aggressive mesenchymal malignancy with high metastatic potential and a poor prognosis. There are no established treatment guidelines for PSA, even for adjuvant therapy. This rare case may provide a reliable therapeutic regime for a better prognosis.
CASE SUMMARY A 49-year-old female who complained of right-upper quadrant abdominal pain was diagnosed as having PSA with splenic rupture and liver metastasis. After splenectomy and liver tumor resection, she received sorafenib and camrelizumab therapy. After 15 mo of follow-up, she is in good condition, without recurrence or any identified metastasis.
CONCLUSION Immunotherapy combined with targeted therapy could be a potential option for the adjuvant therapy of PSA.
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Affiliation(s)
- Dan Pan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Ping Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jian-Hui Xiong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Shu-Bo Wang
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Yao-Xu Chen
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Jian-Feng Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qi Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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13
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Immunologic Gene Signature Analysis Correlates Myeloid Cells and M2 Macrophages with Time to Trabectedin Failure in Sarcoma Patients. Cancers (Basel) 2022; 14:cancers14051290. [PMID: 35267598 PMCID: PMC8909887 DOI: 10.3390/cancers14051290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 01/29/2023] Open
Abstract
Patients with metastatic soft tissue sarcoma (STS) have a poor prognosis and few available systemic treatment options. Trabectedin is currently being investigated as a potential adjunct to immunotherapy as it has been previously shown to kill tumor-associated macrophages. In this retrospective study, we sought to identify biomarkers that would be relevant to trials combining trabectedin with immunotherapy. We performed a single-center retrospective study of sarcoma patients treated with trabectedin with long-term follow-up. Multiplex gene expression analysis using the NanoString platform was assessed, and an exploratory analysis using the lasso-penalized Cox regression and kernel association test for survival (MiRKAT-S) methods investigated tumor-associated immune cells and correlated their gene signatures to patient survival. In total, 147 sarcoma patients treated with trabectedin were analyzed, with a mean follow-up time of 5 years. Patients with fewer prior chemotherapy regimens were more likely to stay on trabectedin longer (pairwise correlation = -0.17, p = 0.04). At 5 years, increased PD-L1 expression corresponded to worse outcomes (HR = 1.87, p = 0.04, q = 0.199). Additionally, six immunologic gene signatures were associated with up to 7-year survival by MiRKAT-S, notably myeloid-derived suppressor cells (p = 0.023, q = 0.058) and M2 macrophages (p = 0.03, q = 0.058). We found that the number of chemotherapy regimens prior to trabectedin negatively correlated with the number of trabectedin cycles received, suggesting that patients may benefit from receiving trabectedin earlier in their therapy course. The correlation of trabectedin outcomes with immune cell infiltrates supports the hypothesis that trabectedin may function as an immune modulator and supports ongoing efforts to study trabectedin in combination with immunotherapy. Furthermore, tumors with an immunosuppressive microenvironment characterized by macrophage infiltration and high PD-L1 expression were less likely to benefit from trabectedin, which could guide clinicians in future treatment decisions.
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14
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Roulleaux Dugage M, Nassif EF, Italiano A, Bahleda R. Improving Immunotherapy Efficacy in Soft-Tissue Sarcomas: A Biomarker Driven and Histotype Tailored Review. Front Immunol 2021; 12:775761. [PMID: 34925348 PMCID: PMC8678134 DOI: 10.3389/fimmu.2021.775761] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Anti-PD-(L)1 therapies yield a disappointing response rate of 15% across soft-tissue sarcomas, even if some subtypes benefit more than others. The proportions of TAMs and TILs in their tumor microenvironment are variable, and this heterogeneity correlates to histotype. Tumors with a richer CD8+ T cell, M1 macrophage, and CD20+ cells infiltrate have a better prognosis than those infiltrated by M0/M2 macrophages and a high immune checkpoint protein expression. PD-L1 and CD8+ infiltrate seem correlated to response to immune checkpoint inhibitors (ICI), but tertiary lymphoid structures have the best predictive value and have been validated prospectively. Trials for combination therapies are ongoing and focus on the association of ICI with chemotherapy, achieving encouraging results especially with pembrolizumab and doxorubicin at an early stage, or ICI with antiangiogenics. A synergy with oncolytic viruses is seen and intratumoral talimogene laherpavec yields an impressive 35% ORR when associated to pembrolizumab. Adoptive cellular therapies are also of great interest in tumors with a high expression of cancer-testis antigens (CTA), such as synovial sarcomas or myxoid round cell liposarcomas with an ORR ranging from 20 to 50%. It seems crucial to adapt the design of clinical trials to histology. Leiomyosarcomas are characterized by complex genomics but are poorly infiltrated by immune cells and do not benefit from ICI. They should be tested with PIK3CA/AKT inhibition, IDO blockade, or treatments aiming at increasing antigenicity (radiotherapy, PARP inhibitors). DDLPS are more infiltrated and have higher PD-L1 expression, but responses to ICI remain variable across clinical studies. Combinations with MDM2 antagonists or CDK4/6 inhibitors may improve responses for DDLPS. UPS harbor the highest copy number alterations (CNA) and mutation rates, with a rich immune infiltrate containing TLS. They have a promising 15-40% ORR to ICI. Trials for ICB should focus on immune-high UPS. Association of ICI with FGFR inhibitors warrants further exploration in the immune-low group of UPS. Finally translocation-related sarcomas are heterogeneous, and although synovial sarcomas a poorly infiltrated and have a poor response rate to ICI, ASPS largely benefit from ICB monotherapy or its association with antiangiogenics agents. Targeting specific neoantigens through vaccine or adoptive cellular therapies is probably the most promising approach in synovial sarcomas.
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Affiliation(s)
- Matthieu Roulleaux Dugage
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Elise F. Nassif
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Italiano
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
- Département d’Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Rastislav Bahleda
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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15
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Schroeder BA, LaFranzo NA, LaFleur BJ, Gittelman RM, Vignali M, Zhang S, Flanagan KC, Rytlewski J, Riolobos L, Schulte BC, Kim TS, Chen E, Smythe KS, Wagner MJ, Mantilla JG, Campbell JS, Pierce RH, Jones RL, Cranmer LD, Pollack SM. CD4+ T cell and M2 macrophage infiltration predict dedifferentiated liposarcoma patient outcomes. J Immunother Cancer 2021; 9:jitc-2021-002812. [PMID: 34465597 PMCID: PMC8413967 DOI: 10.1136/jitc-2021-002812] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 01/13/2023] Open
Abstract
Background Dedifferentiated liposarcoma (DDLPS) is one of the most common soft tissue sarcoma subtypes and is devastating in the advanced/metastatic stage. Despite the observation of clinical responses to PD-1 inhibitors, little is known about the immune microenvironment in relation to patient prognosis. Methods We performed a retrospective study of 61 patients with DDLPS. We completed deep sequencing of the T-cell receptor (TCR) β-chain and RNA sequencing for predictive modeling, evaluating both immune markers and tumor escape genes. Hierarchical clustering and recursive partitioning were employed to elucidate relationships of cellular infiltrates within the tumor microenvironment, while an immune score for single markers was created as a predictive tool. Results Although many DDLPS samples had low TCR clonality, high TCR clonality combined with low T-cell fraction predicted lower 3-year overall survival (p=0.05). Higher levels of CD14+ monocytes (p=0.02) inversely correlated with 3-year recurrence-free survival (RFS), while CD4+ T-cell infiltration (p=0.05) was associated with a higher RFS. Genes associated with longer RFS included PD-1 (p=0.003), ICOS (p=0.006), BTLA (p=0.033), and CTLA4 (p=0.02). In a composite immune score, CD4+ T cells had the strongest positive predictive value, while CD14+ monocytes and M2 macrophages had the strongest negative predictive values. Conclusions Immune cell infiltration predicts clinical outcome in DDLPS, with CD4+ cells associated with better outcomes; CD14+ cells and M2 macrophages are associated with worse outcomes. Future checkpoint inhibitor studies in DDLPS should incorporate immunosequencing and gene expression profiling techniques that can generate immune landscape profiles.
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Affiliation(s)
- Brett A Schroeder
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | | | | | - Shihong Zhang
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | - Laura Riolobos
- UW Medicine Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Brian C Schulte
- Division of Oncology, Northwestern University Department of Medicine, Chicago, Illinois, USA
| | - Teresa S Kim
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Eleanor Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Kimberly S Smythe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael J Wagner
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Oncology, University of Washington, Seattle, Washington, USA
| | - Jose G Mantilla
- Pathology, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Robert H Pierce
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Robin L Jones
- Sarcoma, Royal Marsden Hospital NHS Trust, London, UK
| | - Lee D Cranmer
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Seth M Pollack
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA .,Division of Oncology, Northwestern University, Chicago, Illinois, USA
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16
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van Oost S, Meijer DM, Kuijjer ML, Bovée JVMG, de Miranda NFCC. Linking Immunity with Genomics in Sarcomas: Is Genomic Complexity an Immunogenic Trigger? Biomedicines 2021; 9:1048. [PMID: 34440251 PMCID: PMC8391750 DOI: 10.3390/biomedicines9081048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcomas comprise a collection of highly heterogeneous malignancies that can be grossly grouped in the categories of sarcomas with simple or complex genomes. Since the outcome for most sarcoma patients has barely improved in the last decades, there is an urgent need for improved therapies. Immunotherapy, and especially T cell checkpoint blockade, has recently been a game-changer in cancer therapy as it produced significant and durable treatment responses in several cancer types. Currently, only a small fraction of sarcoma patients benefit from immunotherapy, supposedly due to a general lack of somatically mutated antigens (neoantigens) and spontaneous T cell immunity in most cancers. However, genomic events resulting from chromosomal instability are frequent in sarcomas with complex genomes and could drive immunity in those tumors. Improving our understanding of the mechanisms that shape the immune landscape of sarcomas will be crucial to overcoming the current challenges of sarcoma immunotherapy. This review focuses on what is currently known about the tumor microenvironment in sarcomas and how this relates to their genomic features. Moreover, we discuss novel therapeutic strategies that leverage the tumor microenvironment to increase the clinical efficacy of immunotherapy, and which could provide new avenues for the treatment of sarcomas.
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Affiliation(s)
- Siddh van Oost
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.v.O.); (D.M.M.); (M.L.K.); (N.F.C.C.d.M.)
| | - Debora M. Meijer
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.v.O.); (D.M.M.); (M.L.K.); (N.F.C.C.d.M.)
| | - Marieke L. Kuijjer
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.v.O.); (D.M.M.); (M.L.K.); (N.F.C.C.d.M.)
- Centre for Molecular Medicine Norway (NCMM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Judith V. M. G. Bovée
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.v.O.); (D.M.M.); (M.L.K.); (N.F.C.C.d.M.)
| | - Noel F. C. C. de Miranda
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.v.O.); (D.M.M.); (M.L.K.); (N.F.C.C.d.M.)
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17
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Tumor and Peripheral Immune Status in Soft Tissue Sarcoma: Implications for Immunotherapy. Cancers (Basel) 2021; 13:cancers13153885. [PMID: 34359785 PMCID: PMC8345459 DOI: 10.3390/cancers13153885] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Soft Tissue Sarcomas are a rare and heterogeneous group of tumors, which have a characteristic complexity, leading to a difficult diagnosis and a lack of response to treatment. The aim of this review is to summarize the role of immune cells, soluble plasmatic factors, immune checkpoints; and the expression of immune-related genes predicting survival, response to therapy, and potential immunotherapeutic agents or targets in Soft Tissue Sarcomas. Abstract Soft Tissue Sarcomas (STS) are a heterogeneous and rare group of tumors. Immune cells, soluble factors, and immune checkpoints are key elements of the complex tumor microenvironment. Monitoring these elements could be used to predict the outcome of the disease, the response to therapy, and lead to the development of new immunotherapeutic approaches. Tumor-infiltrating B cells, Natural Killer (NK) cells, tumor-associated neutrophils (TANs), and dendritic cells (DCs) were associated with a better outcome. On the contrary, tumor-associated macrophages (TAMs) were correlated with a poor outcome. The evaluation of peripheral blood immunological status in STS could also be important and is still underexplored. The increased lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR), higher levels of monocytic myeloid-derived suppressor cells (M-MDSCs), and Tim-3 positive CD8 T cells appear to be negative prognostic markers. Meanwhile, NKG2D-positive CD8 T cells were correlated with a better outcome. Some soluble factors, such as cytokines, chemokines, growth factors, and immune checkpoints were associated with the prognosis. Similarly, the expression of immune-related genes in STS was also reviewed. Despite these efforts, only very little is known, and much research is still needed to clarify the role of the immune system in STS.
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18
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Chae H, Kim JE, Kim W, Lee JS, Song SY, Lee MH, Chung HW, Cho KJ, Song JS, Ahn JH. Clinicopathologic Characteristics and Clinical Outcome of Localized Liposarcoma: A Single Center Experience Over 25 Years and Evaluation of PD-L1 Expression. Cancer Res Treat 2021; 54:579-589. [PMID: 34237209 PMCID: PMC9016292 DOI: 10.4143/crt.2021.496] [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] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose For liposarcoma (LPS), clinical course and proper treatment strategies have not been well-established. Recently, immune-checkpoint inhibitors have shown potential efficacy in LPS. We aimed to describe the clinical course of LPS and evaluate the clinical impact of programmed death-ligand 1 (PD-L1). Materials and Methods We reviewed all consecutive patients (n=332) who underwent curative-intent surgery for localized LPS at Asan Medical Center between 1989 and 2017. PD-L1 testing was performed in well-differentiated and dedifferentiated LPS. Results The median age was 56 years with males comprising 60.8%. Abdomen-pelvis (47.6%) and well-differentiated (37.7%) were the most frequent primary site and histologic subtype, respectively. During a median follow-up of 81.2 months, recurrence was observed in 135 (40.7%), and 86.7% (117/135) were loco-regional. Well-differentiated subtype (hazard ratio [HR], 0.38), abdomen-pelvis origin (HR, 2.43), tumor size larger than 5 cm (HR, 1.83), positive resection margin (HR, 2.58), and postoperative radiotherapy (HR, 0.36) were significantly related with recurrence-free survival as well as visceral involvement (HR, 1.84) and multifocality (HR, 3.79) in abdomen-pelvis LPS. PD-L1 was positive in 31.5% (23/73) and 51.3% (39/76) of well-differentiated and dedifferentiated LPS, respectively, but had no impact on survival outcomes. Conclusion Clinical course of LPS was heterogeneous according to histology and anatomic location. Clear resection margin was important to lower recurrence and postoperative radiotherapy might have additional benefit. A decent portion of well-differentiated and dedifferentiated LPS were positive for PD-L1, but its prognostic role was unclear. Further research is needed to determine clinical implications of PD-L1, especially for advanced-stage LPS with unmet needs for effective systemic treatment.
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Affiliation(s)
- Heejung Chae
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea.,Center for Breast Cancer, National Cancer Center Korea, Goyang, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Min Hee Lee
- Department of Radiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
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Liu Q, Bao Q, Xu Y, Fu Y, Jin Z, Wang J, Zhang W, Shen Y. MCM4 Is a Novel Biomarker Associated With Genomic Instability, BRCAness Phenotype, and Therapeutic Potentials in Soft-Tissue Sarcoma. Front Cell Dev Biol 2021; 9:666376. [PMID: 34178990 PMCID: PMC8222794 DOI: 10.3389/fcell.2021.666376] [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: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023] Open
Abstract
Soft-tissue sarcoma (STS) is represented by a heterogeneous group of rare malignancies with various molecular oncogenesis. Therapies targeting DNA repair pathways in STS have achieved minimal progress, potentially due to the lack of molecular biomarker(s) beyond the histology subtype. In this report, we comprehensively analyzed the expression profiles of 100 liposarcomas (LPSs), the most common STS subtype, in comparison with 21 adipose tissues from multiple GEO datasets to identify the potential prognostic and therapeutic biomarker for LPS. Furthermore, we investigated TCGA database, our archived tumor samples, and patient-derived tumor cell cultures (PTCCs) as a validation. We identified a total of 69 common differentially expressed genes (DEGs) among public datasets, with mini-chromosome maintenance protein 4 (MCM4) identified as a novel biomarker correlated with patients’ clinical staging and survival outcome. MCM4-high expression LPS was characterized by MCM4 copy number increase, genomic instability, and BRCAness phenotype compared with the MCM4-low expression counterpart. In contrast, the mutational and the immune landscape were minimally different between the two groups. Interestingly, the association of MCM4-high expression with genomic instability and BRCAness were not only validated in LPS samples from our institution (n = 66) but also could be expanded to the pan-sarcoma cohort from TCGA database (n = 263). Surprisingly, based on four sarcoma cell lines and eight PTCCs (three LPS and five other sarcoma), we demonstrated that MCM4 overexpression tumors were therapeutically sensitive to PARP inhibitor (PARPi) and platinum chemotherapy, independent of the histology subtypes. Our study, for the first time, suggested that MCM4 might be a novel prognostic biomarker, associated with dysregulated DNA repair pathways and potential therapeutic vulnerability in STS.
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Affiliation(s)
- Qi Liu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiyuan Bao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqi Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yucheng Fu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijian Jin
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Shanghai Institute of Orthopedics and Traumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Orthopedics and Traumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhui Shen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Orthopedics and Traumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Su Y, Tsagkozis P, Papakonstantinou A, Tobin NP, Gultekin O, Malmerfelt A, Ingelshed K, Neo SY, Lundquist J, Chaabane W, Nisancioglu MH, Leiss LW, Östman A, Bergh J, Sedimbi S, Lehti K, Lundqvist A, Stragliotto CL, Haglund F, Ehnman M. CD11c-CD8 Spatial Cross Presentation: A Novel Approach to Link Immune Surveillance and Patient Survival in Soft Tissue Sarcoma. Cancers (Basel) 2021; 13:cancers13051175. [PMID: 33803245 PMCID: PMC7967210 DOI: 10.3390/cancers13051175] [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: 01/23/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/23/2022] Open
Abstract
Checkpoint inhibitors are slowly being introduced in the care of specific sarcoma subtypes such as undifferentiated pleomorphic sarcoma, alveolar soft part sarcoma, and angiosarcoma even though formal indication is lacking. Proper biomarkers to unravel potential immune reactivity in the tumor microenvironment are therefore expected to be highly warranted. In this study, intratumoral spatial cross presentation was investigated as a novel concept where immune cell composition in the tumor microenvironment was suggested to act as a proxy for immune surveillance. Double immunohistochemistry revealed a prognostic role of direct spatial interactions between CD11c+ antigen-presenting cells (APCs) and CD8+ cells in contrast to each marker alone in a soft tissue sarcoma (STS) cohort of 177 patients from the Karolinska University Hospital (MFS p = 0.048, OS p = 0.025). The survival benefit was verified in multivariable analysis (MFS p = 0.012, OS p = 0.004). Transcriptomics performed in the TCGA sarcoma cohort confirmed the prognostic value of combining CD11c with CD8 (259 patients, p = 0.005), irrespective of FOXP3 levels and in a CD274 (PD-LI)-rich tumor microenvironment. Altogether, this study presents a histopathological approach to link immune surveillance and patient survival in STS. Notably, spatial cross presentation as a prognostic marker is distinct from therapy response-predictive biomarkers such as immune checkpoint molecules of the PD-L1/PD1 pathway.
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Affiliation(s)
- Yanhong Su
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Panagiotis Tsagkozis
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Muskuloskeletal Tumor Service, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Andri Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Nicholas P. Tobin
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Okan Gultekin
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden; (O.G.); (K.I.); (S.S.); (K.L.)
| | - Anna Malmerfelt
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Katrine Ingelshed
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden; (O.G.); (K.I.); (S.S.); (K.L.)
| | - Shi Yong Neo
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Johanna Lundquist
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Wiem Chaabane
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Maya H. Nisancioglu
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Lina W. Leiss
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Arne Östman
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
- Centre for Cancer Biomarkers CCBIO, University of Bergen, 5021 Bergen, Norway
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Saikiran Sedimbi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden; (O.G.); (K.I.); (S.S.); (K.L.)
| | - Kaisa Lehti
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden; (O.G.); (K.I.); (S.S.); (K.L.)
- Department of Biomedical Laboratory Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Andreas Lundqvist
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
| | - Christina L. Stragliotto
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Monika Ehnman
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, 171 64 Solna, Sweden; (Y.S.); (A.P.); (N.P.T.); (A.M.); (S.Y.N.); (J.L.); (W.C.); (M.H.N.); (L.W.L.); (A.Ö.); (J.B.); (A.L.); (F.H.)
- Correspondence:
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21
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Mullinax JE, Hall M, Beatty M, Weber AM, Sannasardo Z, Svrdlin T, Hensel J, Bui M, Richards A, Gonzalez RJ, Cox CA, Kelley L, Mulé JJ, Sarnaik AA, Pilon-Thomas S. Expanded Tumor-infiltrating Lymphocytes From Soft Tissue Sarcoma Have Tumor-specific Function. J Immunother 2021; 44:63-70. [PMID: 33443972 PMCID: PMC8111686 DOI: 10.1097/cji.0000000000000355] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Adoptive cell transfer (ACT) with tumor-infiltrating lymphocytes (TILs) can generate durable clinical responses in patients with metastatic melanoma and ongoing trials are evaluating efficacy in other advanced solid tumors. The aim of this study was to develop methods for the expansion of tumor-reactive TIL from resected soft tissue sarcoma to a degree required for the ACT. From 2015 to 2018, 70 patients were consented to an institutional review board-approved protocol, and fresh surgical specimens were taken directly from the operating room to the laboratory. Fragments of the tumor (1 mm3) or fresh tumor digest were placed in culture for a period of 4 weeks. Successfully propagated TIL from these cultures were collected and analyzed by flow cytometry. TIL were cocultured with autologous tumor and function was assessed by measurement of interferon-γ in the supernatant by enzyme-linked immunosorbent assay. Initial TIL cultures were further expanded using a rapid expansion protocol. Nearly all specimens generated an initial TIL culture (91% fragment method, 100% digest method). The phenotype of the TIL indicated a predominant CD3+ population after culture (43% fragment, 52% digest) and TIL were responsive to the autologous tumor (56% fragment, 40% digest). The cultured TIL expanded to a degree required for clinical use following rapid expansion protocol (median: 490-fold fragment, 403-fold digest). The data demonstrate the feasibility of TIL culture from fresh soft tissue sarcoma. The derived TIL have tumor-specific reactivity and can be expanded to clinically relevant numbers. An active ACT clinical trial using the methods described in this report is now approved for patients with metastatic soft tissue sarcoma.
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Affiliation(s)
- John E. Mullinax
- Department of Sarcoma, University of South Florida, Tampa, FL
- Department of Immunology, University of South Florida, Tampa, FL
| | - MacLean Hall
- Department of Immunology, University of South Florida, Tampa, FL
- Department of Cancer Biology PhD Program, University of South Florida, Tampa, FL
| | - Matthew Beatty
- Department of Immunology, University of South Florida, Tampa, FL
| | - Amy M. Weber
- Department of Immunology, University of South Florida, Tampa, FL
| | | | - Tanja Svrdlin
- Department of Immunology, University of South Florida, Tampa, FL
| | - Jonathan Hensel
- Department of Immunology, University of South Florida, Tampa, FL
| | - Marilyn Bui
- Department of Sarcoma, University of South Florida, Tampa, FL
| | - Allison Richards
- Department of Cutaneous Oncology, University of South Florida, Tampa, FL
| | | | - Cheryl A. Cox
- Department of Cell Therapy Facility, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Linda Kelley
- Department of Immunology, University of South Florida, Tampa, FL
- Department of Cell Therapy Facility, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - James J. Mulé
- Department of Immunology, University of South Florida, Tampa, FL
- Department of Cutaneous Oncology, University of South Florida, Tampa, FL
- Department of Cell Therapy Facility, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Amod A. Sarnaik
- Department of Immunology, University of South Florida, Tampa, FL
- Department of Cutaneous Oncology, University of South Florida, Tampa, FL
| | - Shari Pilon-Thomas
- Department of Immunology, University of South Florida, Tampa, FL
- Department of Cutaneous Oncology, University of South Florida, Tampa, FL
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22
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Dieu-Nosjean MC. Tumor-Associated Tertiary Lymphoid Structures: A Cancer Biomarker and a Target for Next-generation Immunotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1329:51-68. [PMID: 34664233 DOI: 10.1007/978-3-030-73119-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The different forms of lymphoid organization that coexist in our bodies appeared at distinct time points during the evolution of the animal kingdom. Some of these forms are constitutive, either in fully dedicated organs, such as lymph nodes, or in tissue interfacing with the external environment, such as mucosal-associated lymphoid tissues. Others, known as tertiary lymphoid structures (TLS), are selectively induced in response to inflammation in any peripheral tissues and organs. In this chapter, we discuss the functional interest of each of these lymphoid organizations under different physiopathological conditions. In the context of cancer, recent findings have identified TLS formation as a hallmark of active T- and B-cell immune responses against tumors. TLS are thus a powerful prognostic factor in nearly all solid cancers, which must be taken into account along with the tumor microenvironment. The presence of TLS also predicts the response to immunotherapy including immune checkpoint blockade. With tumor-associated TLS now a key target for the next generation of immunotherapy, this chapter discusses their potential therapeutic manipulations in oncology.
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Affiliation(s)
- Marie-Caroline Dieu-Nosjean
- Sorbonne Université, UMRS1135, Paris, France. .,INSERM U1135, Paris, France. .,Laboratory "Immune Microenvironment and Immunotherapy", Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), UMRS 1135 Sorbonne Université, INSERM U1135, Faculté de Médecine Sorbonne Université, Paris, France.
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23
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Clinical Impact of Tumor-Infiltrating Lymphocytes and PD-L1-Positive Cells as Prognostic and Predictive Biomarkers in Urological Malignancies and Retroperitoneal Sarcoma. Cancers (Basel) 2020; 12:cancers12113153. [PMID: 33121123 PMCID: PMC7692684 DOI: 10.3390/cancers12113153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Two host-dependent biological characteristics, “avoiding immune destruction” and “tumor-promoting inflammation” have been added to cancer hallmarks in 2011. The interaction and cross-talk among tumor cells and several immune cells in a tumor microenvironment are dynamic and complex processes. The purpose of this review is to discuss the prognostic impact of tumor-infiltrating lymphocytes and predictive biomarkers for immune checkpoint inhibitors in four urological solid tumors, the urothelial carcinoma, renal cell carcinoma, prostate cancer, and retroperitoneal sarcoma, through summarizing the findings of observation studies and clinical trials. Abstract Over the past decade, an “immunotherapy tsunami”, more specifically that involving immune checkpoint inhibitors (ICIs), has overtaken the oncological field. The interaction and cross-talk among tumor cells and several immune cells in the tumor microenvironment are dynamic and complex processes. As immune contexture can vary widely across different types of primary tumors and tumor microenvironments, there is still a significant lack of clinically available definitive biomarkers to predict patient response to ICIs, especially in urogenital malignancies. An increasing body of evidence evaluating urological malignancies has proven that tumor-infiltrating lymphocytes (TILs) are a double-edged sword in cancer. There is an urgent need to shed light on the functional heterogeneity in the tumor-infiltrating immune system and to explore its prognostic impact following surgery and other treatments. Notably, we emphasized the difference in the immunological profile among urothelial carcinomas arising from different primary origins, the bladder, renal pelvis, and ureter. Significant differences in the density of FOXP3-positive TILs, CD204-positive tumor-infiltrating macrophages, PD-L1-positive cells, and colony-stimulating factors were observed. This review discusses two topics: (i) the prognostic impact of TILs and (ii) predictive biomarkers for ICIs, to shed light on lymphocyte migration in four solid tumors, the urothelial carcinoma, renal cell carcinoma, prostate cancer, and retroperitoneal sarcoma.
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24
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de Arruda JAA, Arantes DAC, Schuch LF, Abreu LG, de Andrade BAB, Romañach MJ, Mesquita RA, Watanabe S, de Oliveira JC, Mendonça EF. Inflammatory Variant of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Buccal Mucosa: An Overview and Case Report with a 10-Year Follow-Up. Head Neck Pathol 2020; 15:1031-1040. [PMID: 33091145 PMCID: PMC8384926 DOI: 10.1007/s12105-020-01242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Liposarcomas of the oral cavity are rare. Those originating in the buccal mucosa cause challenging diagnostic and therapeutic issues since less than 40 cases of liposarcomas of the buccal mucosa and cheek have been reported in the worldwide literature. Herein, we present a case of atypical lipomatous tumor/well-differentiated liposarcoma affecting a 45-year-old female patient. Ultrasonography and magnetic resonance imaging confirmed a well-defined mass located in the right buccal mucosa, extending to the submucosal layers of the cheek. Histopathologically, a well-differentiated fatty neoplasm with presence of prominent stromal inflammatory cells was observed. Multifocally scattered bizarre hyperchromatic stromal cells, some of which multinucleated, were also observed. An immunohistochemical panel comprising vimentin, S-100, CD10, CD34, CD20, CD3, CD68, CD138, MDM2, Ki-67, and P53 was employed to better characterize the lesion. A local recurrence event occurred during a 10-year follow-up period. Surgical resection was performed during both episodes. We also provided an overview of demographic and clinicopathological characteristics, immunohistochemical features, imaging findings, and the differential diagnosis of liposarcoma of the oral cavity. Knowledge of the etiopathological and clinical aspects of this rare neoplasm is fundamental in order to rule out other conditions, including lipomatous lesions that affect the buccal mucosa.
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Affiliation(s)
- José Alcides Almeida de Arruda
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Diego Antônio Costa Arantes
- grid.411195.90000 0001 2192 5801Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, GO Brazil
| | - Lauren Frenzel Schuch
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Lucas Guimarães Abreu
- grid.8430.f0000 0001 2181 4888Department of Child’s and Adolescent’s Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil
| | - Bruno Augusto Benevenuto de Andrade
- grid.8536.80000 0001 2294 473XDepartment of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Mário José Romañach
- grid.8536.80000 0001 2294 473XDepartment of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Ricardo Alves Mesquita
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Satiro Watanabe
- Department of Oral Surgery, School of Dentistry, Universidade de Anápolis, Anápolis, GO Brazil
| | | | - Elismauro Francisco Mendonça
- grid.411195.90000 0001 2192 5801Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, GO Brazil
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25
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Snow H, Mitchell C, Hendry S, McKinley M, Byrne D, Ngan S, Chander S, Chu J, Desai J, Bae S, Henderson M, Choong P, Gyorki D. Characterising the immune microenvironment in liposarcoma, its impact on prognosis and the impact of radiotherapy. J Surg Oncol 2020; 123:117-126. [PMID: 33084061 DOI: 10.1002/jso.26261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Limited literature exists examining the immune microenvironment in liposarcoma, particularly with regard to the impact of radiotherapy. A major problem is the lack of scoring system for the tumour-infiltrating lymphocytes (TILs) in sarcoma. This study aims to describe the immune environment pre- and postradiotherapy and identify the optimal immune infiltrate scoring system for sarcoma. METHODS Thirty-nine paired tissue samples (pre- and postradiotherapy) from patients with liposarcoma were scored by two pathologists for TILs using pre-existing systems (for breast cancer and melanoma) and compared for interobserver reliability. Immunohistochemical staining was performed for various immune markers. RESULTS The TIL scoring system for breast cancer yielded perfect agreement (κ = 1.000). 21% of patients had increased TILs after radiotherapy, 87.5% of whom had dedifferentiated liposarcoma. Immune suppressor expression was increased frequently after radiotherapy (CD68 increased in 59.4%, PD-L1 increased in 25%). Immune effector expression (CD8) was unchanged in 84.4%. CONCLUSIONS Breast cancer TIL scoring is reproducible in liposarcoma and has high interobserver reliability. Radiotherapy was observed to have a limited impact on immune effectors but seemed to have more impact in upregulating immune suppressors, suggesting radiotherapy may contribute to disease control through immunomodulatory effects. Dedifferentiated liposarcoma represents a uniquely responsive subtype.
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Affiliation(s)
- Hayden Snow
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Shona Hendry
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - David Byrne
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sam Ngan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter Choong
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Australia
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26
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Miyake M, Oda Y, Nishimura N, Morizawa Y, Ohnishi S, Hatakeyama K, Fujii T, Hori S, Gotoh D, Nakai Y, Anai S, Torimoto K, Tsukamoto S, Fujii H, Kido A, Honoki K, Matsumura Y, Okajima E, Tanaka N, Fujimoto K. Integrative assessment of clinicopathological parameters and the expression of PD-L1, PD-L2 and PD-1 in tumor cells of retroperitoneal sarcoma. Oncol Lett 2020; 20:190. [PMID: 32952659 PMCID: PMC7479533 DOI: 10.3892/ol.2020.12052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Evidence is limited regarding the immunologic profile and immune microenvironment of soft tissue sarcoma subtypes. The aim of the present study was to describe the clinical significance and prognostic implications of PD-L1, PD-L2, and PD-1 in patients with retroperitoneal sarcoma (RSar). In this retrospective, multicenter, collaborative study, medical charts were reviewed and the immunohistochemical staining results of resected tissue specimens from 51 patients with RSar were examined. Immunohistochemical staining was performed with primary antibodies against PD-L1, PD-L2, PD-1, and Ki-67. The correlations between the baseline clinical parameters and expression levels of the four molecules in sarcoma cells were evaluated, and their prognostic values after tumor resection were assessed. Dedifferentiated liposarcoma (41%), leiomyosarcoma (20%), and undifferentiated pleomorphic sarcoma (16%) were the three major types identified. Dedifferentiated liposarcoma and leiomyosarcoma showed higher levels of PD-L1 expression than did other sarcomas. The Spearman correlation analysis revealed that baseline serum lactate dehydrogenase levels were moderately and positively correlated with PD-L1 (P=0.02, r=0.41) and PD-L2 (P=0.006, r=0.47) expression. The median recurrence-free and disease-specific survival was 58 and 16 months, respectively, during the 29-month median follow-up after surgery. On univariate analysis, a higher expression level of PD-1 was associated with a higher risk of recurrence, whereas multivariate analyses revealed that independent predictors of recurrence-free and disease-specific survival indicated a high expression of Ki-67 (P=0.03; hazard ratio, 2.29 vs. low expression) and prognostic stage IIIB (P=0.04; hazard ratio, 5.11 vs. stage I-II), respectively. Findings of the current study provide novel insights about the prognostic value of PD-L1, PD-L2, and PD-1 expression in RSar. Serum lactate dehydrogenase levels constitute a potential predictor of PD-L1 and PD-L2 expression levels in RSar. Further investigations are needed to determine the immunologic landscape of RSar and provide a foundation for therapeutic intervention using immune checkpoint inhibitors.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yuki Oda
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Sayuri Ohnishi
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shinji Tsukamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiromasa Fujii
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Akira Kido
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kanya Honoki
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yoshiaki Matsumura
- Department of Urology, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Eijiro Okajima
- Department of Urology, Nara City Hospital, Nara 630-8305, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan.,Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
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27
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Dufresne A, Lesluyes T, Ménétrier-Caux C, Brahmi M, Darbo E, Toulmonde M, Italiano A, Mir O, Le Cesne A, Le Guellec S, Valentin T, Chevreau C, Bonvalot S, Robin YM, Coindre JM, Caux C, Blay JY, Chibon F. Specific immune landscapes and immune checkpoint expressions in histotypes and molecular subtypes of sarcoma. Oncoimmunology 2020; 9:1792036. [PMID: 32923153 PMCID: PMC7458655 DOI: 10.1080/2162402x.2020.1792036] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Soft tissue sarcomas are a group of rare and aggressive connective tissue neoplasms for which curative therapeutic opportunities are limited in advanced phase. Clinical trials assessing immunotherapy in these tumors have so far reported limited efficacy. The objective of this study is to provide a description of the immunologic landscape of sarcomas to guide the next clinical trials of immunotherapy in these diseases. The gene expression profile of 93 immune checkpoint (ICP) and membrane markers (MM) of immune cells was analyzed in a series of 253 soft tissue sarcoma (synovial sarcoma, myxoid liposarcoma, sarcoma with complex genomic and GIST) using Agilent Whole Human Genome Microarrays. The unsupervised hierarchical clustering of gene expression level was found able to properly group patients according to the histological subgroup of sarcoma, indicating that each sarcoma subgroup is associated with a specific immune signature defined by its gene expression pattern. Using the prognostic impact of CIBERSORT signature on metastatic-free survival in each subgroup, specific target could be proposed for each of the four groups: Treg through ICOS and GITR in GIST, M0 macrophages in all four sarcoma subtypes, OX40 in SS, CD40 in GIST and SS. The immune landscape of sarcoma was found to be as heterogeneous as the histotypes and molecular subtypes, but strongly correlated to the histotype. Histotype adapted immunotherapeutic approaches in each sarcoma subtypes must be considered in view of these results, consistently with the already reported specific response of histotypes of ICPs.
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Affiliation(s)
- A Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - T Lesluyes
- University of Bordeaux, Bordeaux, France.,Inserm U1218, Institut Bergonié, Bordeaux, France.,Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - C Ménétrier-Caux
- Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - E Darbo
- University of Bordeaux, Bordeaux, France.,Inserm U1218, Institut Bergonié, Bordeaux, France.,Bordeaux Bioinformatics Center (BCIB), Bordeaux, France
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - O Mir
- Department of Ambulatory Care, Institut Gustave Roussy, Villejuif, France
| | - A Le Cesne
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - S Le Guellec
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, Toulouse, France
| | - T Valentin
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - C Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Bordeaux, France
| | - Y M Robin
- Department of Pathology, Centre Oscar Lambret, Lille, France
| | - J-M Coindre
- University of Bordeaux, Bordeaux, France.,Department of Pathology, Institut Bergonié, Bordeaux, France
| | - C Caux
- Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - J Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - F Chibon
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
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28
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Abstract
PURPOSE OF REVIEW Development of immune therapy in sarcoma faces the rarity and heterogeneity of the disease. This review analyses the data available from published clinical trials, and the new clinical strategies under assessment, developed in parallel to the exploration of biological mechanisms underlying the efficacy of immune therapy. RECENT FINDINGS Published data of four clinical trials assessing the efficacy of immune therapy in metastatic bone and soft-tissue sarcoma and associated translational programs are available. Response rate and progression-free survival with single-agent immune check point blockade in unselected sarcoma are low. No biomarkers of efficacy have been identified so far. To increase the efficacy of such treatments, combination of immune check point blockade with chemotherapy, radiotherapy or targeted therapy is currently assessed. Signal of specific sensibility of some histological subtypes is explored. Adoptive cell therapy or vaccine seems particularly promising in translocation-associated sarcoma. SUMMARY Characterization of immune environment, mechanism of action of combined regimen and identification of biomarkers will be key steps to build the next clinical trials to improve the efficacy of such strategy.
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29
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Abstract
Soft-tissue sarcoma (sts) is a rare mesenchymal malignancy that accounts for less than 1% of all adult tumours. Despite the successful advancement of localized therapies such as surgery and radiotherapy, these tumours can, for many, recur-often with metastatic disease. In the advanced setting, the role of systemic therapies is modest and is associated with poor survival. With the discovery of immunotherapies in other tumour types such as melanoma and lung cancer, interest has been renewed in exploring immunotherapy in sts. The biology of some stss makes them ripe for immunotherapy intervention; for example, some stss might have chromosomal translocations resulting in pathognomonic fusion products that have been shown to express cancer/testis antigens. Here, we present a targeted review of the published data and ongoing clinical trials for immunotherapies in patients with sarcoma, which comprise immune checkpoint inhibitors, adoptive cell therapies, and cancer vaccines.
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Affiliation(s)
- O Ayodele
- Toronto Sarcoma Program, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, ON
| | - A R Abdul Razak
- Toronto Sarcoma Program, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, ON
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30
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Withers SS, York D, Choi JW, Woolard KD, Laufer-Amorim R, Sparger EE, Burton JH, McSorley SJ, Monjazeb AM, Murphy WJ, Canter RJ, Rebhun RB. Metastatic immune infiltrates correlate with those of the primary tumour in canine osteosarcoma. Vet Comp Oncol 2019; 17:242-252. [PMID: 30684301 PMCID: PMC6658355 DOI: 10.1111/vco.12459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
Our lack of understanding of the immune microenvironment in canine osteosarcoma (cOSA) has limited the identification of potential immunotherapeutic targets. In particular, our ability to utilize readily available tissue from a dog's primary tumour to predict the type and extent of immune response in their pulmonary metastatic lesions is unknown. We, therefore, collected 21 matched pairs of primary tumours and pulmonary metastatic lesions from dogs with OSA and performed immunohistochemistry to quantify T-lymphocyte (CD3), FOXP3+ cell, B-lymphocyte (Pax-5), and CD204+ macrophage infiltration. We found that T-lymphocytes and FOXP3+ infiltrates in primary tumours positively correlated with that of metastatic lesions (ρ = 0.512, P = 0.038 and ρ = 0.698, P = 0.007, respectively), while a strong trend existed for CD204+ infiltrates (ρ = 0.404, P = 0.087). We also observed T- and B-lymphocytes, and CD204+ macrophages to be significantly higher in a dog's pulmonary metastasis compared to their primary tumour (P = 0.018, P = 0.018, P = 0.016, respectively), while FOXP3+ cells were only significantly higher in metastases when all primary tumour and metastasis lesions were compared without pairing (P = 0.036). Together, these findings suggest that the metastatic immune microenvironment may be influenced by that of the primary cOSA, and that primary tumour immune biomarkers could potentially be applied to predict immunotherapeutic responses in gross metastatic disease. We, therefore, provide a rationale for the treatment of cOSA pulmonary metastases with immunotherapeutics that enhance the anti-tumour activity of these immune cells, particularly in dogs with moderate to high immune cell infiltration in their primary tumours.
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Affiliation(s)
- Sita S Withers
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Daniel York
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jin W Choi
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Kevin D Woolard
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Renee Laufer-Amorim
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Ellen E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jenna H Burton
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Stephen J McSorley
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Arta M Monjazeb
- Comprehensive Cancer Center, Department of Radiation Oncology, School of Medicine, University of California-Davis, Sacramento, California
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert J Canter
- Comprehensive Cancer Center, Department of Surgery, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert B Rebhun
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
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31
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Yan L, Wang Z, Cui C, Guan X, Dong B, Zhao M, Wu J, Tian X, Hao C. Comprehensive immune characterization and T-cell receptor repertoire heterogeneity of retroperitoneal liposarcoma. Cancer Sci 2019; 110:3038-3048. [PMID: 31385405 PMCID: PMC6778648 DOI: 10.1111/cas.14161] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/28/2022] Open
Abstract
Retroperitoneal liposarcoma (RLPS) is one of the most common subtypes of retroperitoneal soft tissue sarcomas and lacks effective treatment. This study aimed to provide a thorough profile of immune characteristics of RLPS. This study included 56 RLPS patients. Multisite tumor tissues were collected from 16 patients. Immunohistochemistry was carried out to identify CD4+, CD8+, FoxP3+, CD20+, or programmed cell death‐1 (PD‐1)+ tumor infiltrating lymphocytes (TILs) and Programmed cell death ligand‐1 (PD‐L1) expression in tumor tissues. Ultradeep sequencing of T‐cell receptor (TCR) β‐chain gene was carried out in 42 tumor samples as well as peripheral blood samples collected from 6 patients. In RLPS, TILs were distributed in 3 patterns and T cells were more prevalent than B cells. Generally, the proportion of TILs decreased and PD‐L1 expression increased with tumor progression. Patients with higher PD‐1/PD‐L1 expression tended to have poorer prognosis, whereas patients with tertiary lymphoid structure tended to have a favorable disease‐free survival. Although T‐cell clones in tumors were quite different from those in peripheral blood, TCR sequencing showed low TCR repertoire reads as well as polyclonal status within tumors, which indicated limited T cell response in the tumors. Both TILs distribution and TCR repertoires suggested spatial immune heterogeneity in RLPS. Our research described the immune landscape of RLPS, and suggested RLPS might be a kind of tumor with low T cell infiltration as well as great immune heterogeneity. Therefore, strategies that can facilitate lymphocytic infiltration and immune reactivity need to be developed in the future to improve the efficacy of immunotherapy.
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Affiliation(s)
- Liang Yan
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhen Wang
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Can Cui
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoya Guan
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Dong
- Central Laboratory, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Min Zhao
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianhui Wu
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiuyun Tian
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chunyi Hao
- Department of Hepato-Pancreato-Biliary Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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32
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Luo P, Cai W, Yang L, Chen S, Wu Z, Chen Y, Zhang R, Shi Y, Yan W, Wang C. Prognostic significance of pretreatment lymphocyte/monocyte ratio in retroperitoneal liposarcoma patients after radical resection. Cancer Manag Res 2018; 10:4727-4734. [PMID: 30425569 PMCID: PMC6201845 DOI: 10.2147/cmar.s171602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to evaluate the prognostic value of pretreatment inflammatory biomarkers in retroperitoneal liposarcoma (RPLS) patients after radical resection. Patients and methods One hundred patients with RPLS who underwent radical resection between September 2004 and October 2010 at Fudan University Shanghai Cancer Center were included in this study. Laboratory tests of peripheral blood were sampled before surgery. The optimal cutoff values of systemic inflammatory markers were defined by receiver-operating curve analyses. Curves of disease-free survival (DFS) and overall survival (OS) were obtained by the Kaplan-Meier method. Cox proportional hazards regression modeling was used to perform univariate and multivariate analyses. Results The median follow-up time was 53 months. The median DFS and OS were 27 and 86 months, respectively. On the basis of the optimal cutoff value of 3, 24 patients were classified into low lymphocyte/monocyte ratio (LMR) group and 76 patients into high LMR group. In univariate analysis, low LMR group had significantly shorter DFS (P<0.001) and OS (P<0.001) compared to high LMR group. In multivariate analysis, low LMR was demonstrated as an independent negative prognostic factor for both DFS (HR=2.854, 95% CI=1.392-5.851, P=0.004) and OS (HR=3.897, 95% CI=1.681-9.033, P=0.002). Conclusion Pretreatment LMR is a useful prognostic marker in RPLS patients after radical resection.
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Affiliation(s)
- Peng Luo
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Weiluo Cai
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Lingge Yang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Shiqi Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Zhiqiang Wu
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yong Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Ruming Zhang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yingqiang Shi
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Wangjun Yan
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Chunmeng Wang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
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33
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Dancsok AR, Asleh-Aburaya K, Nielsen TO. Advances in sarcoma diagnostics and treatment. Oncotarget 2018; 8:7068-7093. [PMID: 27732970 PMCID: PMC5351692 DOI: 10.18632/oncotarget.12548] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/29/2016] [Indexed: 01/06/2023] Open
Abstract
The heterogeneity of sarcomas with regard to molecular genesis, histology, clinical characteristics, and response to treatment makes management of these rare yet diverse neoplasms particularly challenging. This review encompasses recent developments in sarcoma diagnostics and treatment, including cytotoxic, targeted, epigenetic, and immune therapy agents. In the past year, groups internationally explored the impact of adding mandatory molecular testing to histological diagnosis, reporting some changes in diagnosis and/or management; however, the impact on outcomes could not be adequately assessed. Transcriptome sequencing techniques have brought forward new diagnostic tools for identifying fusions and/or characterizing unclassified entities. Next-generation sequencing and advanced molecular techniques were also applied to identify potential targets for directed and epigenetic therapy, where preclinical studies reported results for agents active within the receptor tyrosine kinase, mTOR, Notch, Wnt, Hedgehog, Hsp90, and MDM2 signaling networks. At the level of clinical practice, modest developments were seen for some sarcoma subtypes in conventional chemotherapy and in therapies targeting the pathways activated by various receptor tyrosine kinases. In the burgeoning field of immune therapy, sarcoma work is in its infancy; however, elaborate protocols for immune stimulation are being explored, and checkpoint blockade agents advance from preclinical models to clinical studies.
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Affiliation(s)
- Amanda R Dancsok
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karama Asleh-Aburaya
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Torsten O Nielsen
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Sarcoma Disease Site Committee, Canadian Cancer Trials Group
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34
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Veenstra R, Kostine M, Cleton-Jansen AM, de Miranda NF, Bovée JV. Immune checkpoint inhibitors in sarcomas: in quest of predictive biomarkers. J Transl Med 2018; 98:41-50. [PMID: 29155424 DOI: 10.1038/labinvest.2017.128] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/21/2017] [Accepted: 09/24/2017] [Indexed: 12/14/2022] Open
Abstract
Sarcomas are a rare group of tumors of mesenchymal origin. Metastatic sarcomas are often difficult to treat and unresponsive to standard radio- and chemotherapy, resulting in a poor survival rate for patients. Novel treatments with immune checkpoint inhibitors have been proven to prolong survival of patients with a variety of cancers, including metastatic melanoma, lung, and renal cell carcinoma. Since immune checkpoint inhibitors could provide a novel treatment option for patients with sarcomas, clinical trials investigating their efficacy in these group of tumors are ongoing. However, the discrimination of patients that are the most likely to respond to these treatments is still an obstacle in the design of clinical trials. In this review, we provide a brief overview of the mechanisms of action of immune checkpoint inhibitors and discuss the proposed biomarkers of therapy response, such as lymphocytic infiltration, intratumoral PD-L1 expression, and mutational load in sarcomas.
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Affiliation(s)
- Robin Veenstra
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Kostine
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Noel Fcc de Miranda
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith Vmg Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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35
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McGovern Y, Zhou CD, Jones RL. Systemic Therapy in Metastatic or Unresectable Well-Differentiated/Dedifferentiated Liposarcoma. Front Oncol 2017; 7:292. [PMID: 29250486 PMCID: PMC5715199 DOI: 10.3389/fonc.2017.00292] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
Liposarcoma is one of the most common subtypes of soft-tissue sarcoma and consists of three main subtypes, of which well-differentiated liposarcoma and dedifferentiated liposarcoma account for 40–45%. The current mainstay of systemic treatment for patients with metastatic or unresectable disease remains doxorubicin with or without ifosfamide in the first-line setting. Recently, eribulin and trabectedin have been approved by the US Food and Drug Administration for recurrent liposarcomas and progress in molecular characterization of these tumors has opened up new and potential novel treatment targets. This review will focus on the evidence base for current treatment strategies and will also discuss potential future options.
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Affiliation(s)
- Yevette McGovern
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | - Charlie D Zhou
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
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36
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Boxberg M, Steiger K, Lenze U, Rechl H, von Eisenhart-Rothe R, Wörtler K, Weichert W, Langer R, Specht K. PD-L1 and PD-1 and characterization of tumor-infiltrating lymphocytes in high grade sarcomas of soft tissue - prognostic implications and rationale for immunotherapy. Oncoimmunology 2017; 7:e1389366. [PMID: 29399389 DOI: 10.1080/2162402x.2017.1389366] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022] Open
Abstract
Therapies targeting programmed death 1-(PD-1) or its ligand (PD-L1), promoting antitumor T-cell activity have been successfully introduced into clinical practice. Clinical response correlates with PD-L1 expression by tumor cells or immune cells within the tumor microenvironment. The PD-L1/PD-1 axis and tumor microenvironment has been rarely studied in high-grade sarcomas of soft tissue (hSTS), a group of rare, genetically heterogenous and clinically aggressive tumors. We examined PD-L1 protein and CD274/PD-L1 gene copy number variations in 128 primary resected, therapy-naive hSTS using immunohistochemistry and fluorescence-in-situ hybridization. Frequency of tumoral PD-L1 expression varied widely in different disease subentities, with highest rates of positivity (40%) seen in undifferentiated pleomorphic sarcomas (UPS) and rare positivity detected in synovial sarcomas (6%). Amplification of the CD274/PD-L1 gene occurred in 14% of UPS and was rare in other subtypes. PD-L1 protein expression was significantly more frequent in CD274/PD-L1 amplified cases (p = 0.015). The subgroup of UPS was further characterized regarding the interaction between PD-L1 and the immunologic tumor microenvironment. High density of CD3+ and CD8+ tumor infiltrating lymphocytes (TILs) was significantly correlated with the presence of PD-L1 expression and seen more frequently in tumors with lower TNM stage (p = 0.024). Both, PD-L1 expression and high density lymphocytic infiltration were independent prognostic factors for a favorable overall (p = 0.001, HR 6.105 (2.041-8.258)), disease-specific (p = 0.003, HR 10.536 (2.186-50.774)) and disease-free survival (p = 0.020, HR 3.317 (1.209-9.106); values for CD8) in this particular subgroup of hSTS, whereas PD-L1 expression in TILs or CD274/PD-L1 gene amplification were not associated with outcome. These findings represent novel insights into the immune landscape of soft tissue sarcomas, in particular UPS and strengthen the rationale for immunotherapy, including targeting the PD-1/PD-L1 axis in these tumors.
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Affiliation(s)
- Melanie Boxberg
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Klaus Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany.,National Center of Tumor Diseases (NCT), Heidelberg, University of Heidelberg, Germany.,Department of Pathology, German Cancer Consortium (DKTK), Partner Site Munich, Technical University of Munich, Munich, Germany
| | - Rupert Langer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, Munich, Germany
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37
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Tseng WW, Seo HJ, Pollock RE, Gronchi A. Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma. J Surg Oncol 2017; 117:7-11. [PMID: 29127700 DOI: 10.1002/jso.24888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/06/2022]
Abstract
Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising.
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Affiliation(s)
- William W Tseng
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hyun Jae Seo
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Raphael E Pollock
- Department of Surgery, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Shao Y, Zhang Y, Hou Y, Tong H, Zhuang R, Ji Z, Wang B, Zhou Y, Lu W. A novel long noncoding RNA PILRLS promote proliferation through TCL1A by activing MDM2 in Retroperitoneal liposarcoma. Oncotarget 2017; 8:13971-13978. [PMID: 28129655 PMCID: PMC5355154 DOI: 10.18632/oncotarget.14814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/27/2016] [Indexed: 01/26/2023] Open
Abstract
It is becoming evident that lncRNAs may be an important class of pervasive genes involved in carcinogenesis and metastasis. However, the biological and molecular mechanisms of lncRNAs in retroperitoneal liposarcoma have never been reported. In our study, we found a novel lncRNA PILRLS (Proliferation Interacting LncRNA in Retroperitoneal Liposarcoma), which as an oncogene significantly overexpressed in retroperitoneal liposarcoma. Functions of PILRLS on tumor progression both in vitro and in vivo have verified in this study which PILRLS knockdown significantly inhibited cell proliferation and colony formation. RNA pull-down assay found PILRLS can specific binding with TCL1A which also regulate the expression level of TCL1A. Our work for the first time demonstrated PILRLS can activating the MDM2 by binding with TCL1A which suppress the P53 pathway to promote the unlimited growth of retroperitoneal Liposarcoma cells. It suggests that PILRLS may be an important targets for retroperitoneal liposarcoma therapy.
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Affiliation(s)
- Yebo Shao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyong Hou
- Department of Medical Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hanxing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Rongyuan Zhuang
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhengbiao Ji
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Binliang Wang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yuhong Zhou
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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In GK, Hu JS, Tseng WW. Treatment of advanced, metastatic soft tissue sarcoma: latest evidence and clinical considerations. Ther Adv Med Oncol 2017; 9:533-550. [PMID: 28794805 PMCID: PMC5524246 DOI: 10.1177/1758834017712963] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/04/2017] [Indexed: 12/24/2022] Open
Abstract
Soft tissue sarcoma (STS) is a biologically heterogeneous malignancy with over 50 subtypes. Historically, there have been few systemic treatment options for this relatively rare disease. Traditional cytotoxic agents, such as anthracyclines, alkylating agents, and taxanes have limited clinical benefit beyond the first-line setting; across all high-grade STS subtypes, median overall survival remains approximately 12-18 months for advanced metastatic disease. The development of targeted therapies has led to recent US Food and Drug Administration approval of four new treatments for high-grade STS in the advanced metastatic setting. Among these, olaratumab is most notable for its improvement in overall survival for patients with anthracycline-naïve disease. Further progress in STS management will rely on novel trial design, subtype-specific therapies and validation of biomarkers to tailor therapy. Immunotherapy has shown promise as a new, but yet undiscovered frontier in the management of STS.
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Affiliation(s)
- Gino K. In
- Division of Oncology, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - James S. Hu
- Division of Oncology, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - William W. Tseng
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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40
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Ruffalo M, Bar-Joseph Z. Genome wide predictions of miRNA regulation by transcription factors. Bioinformatics 2017; 32:i746-i754. [PMID: 27587697 DOI: 10.1093/bioinformatics/btw452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
MOTIVATION Reconstructing regulatory networks from expression and interaction data is a major goal of systems biology. While much work has focused on trying to experimentally and computationally determine the set of transcription-factors (TFs) and microRNAs (miRNAs) that regulate genes in these networks, relatively little work has focused on inferring the regulation of miRNAs by TFs. Such regulation can play an important role in several biological processes including development and disease. The main challenge for predicting such interactions is the very small positive training set currently available. Another challenge is the fact that a large fraction of miRNAs are encoded within genes making it hard to determine the specific way in which they are regulated. RESULTS To enable genome wide predictions of TF-miRNA interactions, we extended semi-supervised machine-learning approaches to integrate a large set of different types of data including sequence, expression, ChIP-seq and epigenetic data. As we show, the methods we develop achieve good performance on both a labeled test set, and when analyzing general co-expression networks. We next analyze mRNA and miRNA cancer expression data, demonstrating the advantage of using the predicted set of interactions for identifying more coherent and relevant modules, genes, and miRNAs. The complete set of predictions is available on the supporting website and can be used by any method that combines miRNAs, genes, and TFs. AVAILABILITY AND IMPLEMENTATION Code and full set of predictions are available from the supporting website: http://cs.cmu.edu/~mruffalo/tf-mirna/ CONTACT zivbj@cs.cmu.edu SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Matthew Ruffalo
- Department of Computational Biology, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA 15213
| | - Ziv Bar-Joseph
- Department of Computational Biology, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA 15213
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41
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Weinstein AM, Chen L, Brzana EA, Patil PR, Taylor JL, Fabian KL, Wallace CT, Jones SD, Watkins SC, Lu B, Stroncek DF, Denning TL, Fu YX, Cohen PA, Storkus WJ. Tbet and IL-36γ cooperate in therapeutic DC-mediated promotion of ectopic lymphoid organogenesis in the tumor microenvironment. Oncoimmunology 2017; 6:e1322238. [PMID: 28680760 DOI: 10.1080/2162402x.2017.1322238] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022] Open
Abstract
We have previously reported that direct injection of dendritic cells (DC) engineered to express the Type-1 transactivator Tbet (i.e., DC.Tbet) into murine tumors results in antitumor efficacy in association with the development of structures resembling tertiary lymphoid organs (TLO) in the tumor microenvironment (TME). These TLO contained robust infiltrates of B cells, DC, NK cells, and T cells in proximity to PNAd+ blood vessels; however, they were considered incomplete, since the recruited B cells failed to organize into classic germinal center-like structures. We now report that antitumor efficacy and TLO-inducing capacity of DC.Tbet-based i.t. therapy is operational in peripheral lymph node-deficient LTA-/- mice, and that it is highly dependent upon a direct Tbet target gene product, IL-36γ/IL-1F9. Intratumoral DC.Tbet fails to provide protection to tumor-bearing IL-36R-/- hosts, or to tumor-bearing wild-type recipient mice co-administered rmIL-1F5/IL-36RN, a natural IL-36R antagonist. Remarkably, the injection of tumors with DC engineered to secrete a bioactive form of mIL-36γ (DC.IL36γ) also initiated therapeutic TLO and slowed tumor progression in vivo. Furthermore, DC.IL36γ cells strongly upregulated their expression of Tbet, suggesting that Tbet and IL-36γ cooperate to reinforce each other's expression in DC, rendering them competent to promote TLO formation in an "immunologically normalized," therapeutic TME.
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Affiliation(s)
- Aliyah M Weinstein
- Department of Immunology, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, PA, USA
| | - Lu Chen
- Department of Immunology, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, PA, USA
| | | | | | | | - Kellsye L Fabian
- Department of Immunology, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, PA, USA
| | - Callen T Wallace
- Department of Cell Biology and Physiology, UPSOM, Pittsburgh, PA, USA
| | | | - Simon C Watkins
- Department of Cell Biology and Physiology, UPSOM, Pittsburgh, PA, USA
| | - Binfeng Lu
- Department of Immunology, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, PA, USA
| | - David F Stroncek
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, PA, USA
| | - Timothy L Denning
- Center for Inflammation, Immunity & Infection at Georgia State University, Atlanta, GA, USA
| | - Yang-Xin Fu
- Departments of Pathology and Immunology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Cohen
- Department of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Walter J Storkus
- Department of Immunology, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, PA, USA.,Department of Dermatology, UPSOM, Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, UPSOM, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Bertucci F, Finetti P, Perrot D, Leroux A, Collin F, Le Cesne A, Coindre JM, Blay JY, Birnbaum D, Mamessier E. PDL1 expression is a poor-prognosis factor in soft-tissue sarcomas. Oncoimmunology 2017; 6:e1278100. [PMID: 28405501 DOI: 10.1080/2162402x.2016.1278100] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 12/26/2022] Open
Abstract
Soft-tissue sarcomas (STS) are a group of rare, heterogeneous, and aggressive tumors, with high metastatic risk and relatively few efficient systemic therapies. In the quest for new treatments, the immune system represents an attractive therapeutic target. Recently, PD1/PDL1 inhibitors showed very promising results in patients with solid tumors. PDL1 expression has been rarely studied in STS, in small series only, by using immunohistochemistry (IHC), and with non-concordant prognostic implications. Here, we have analyzed PDL1 mRNA expression in 758 clinical STS samples retrospectively profiled using DNA microarrays and RNAseq, and searched for correlations with clinicopathological variables including metastasis-free survival (MFS) after surgery. PDL1 expression was heterogeneous across the samples. PDL1-high samples (41%) were more frequently leiomyosarcomas and liposarcomas, and showed more frequently a complex genetic profile and a high-risk CINSARC signature. No correlation existed with other clinicopathological features such as tumor site, depth, and pathological tumor grade and size. In multivariate prognostic analysis, the PDL1-high class was associated with shorter MFS, independently of the pathological type and the CINSARC signature. Analysis of correlations with biological factors suggested the existence in tumors of the PDL1-high class of a strong and efficient cytotoxic T-cell response, however associated with some degree of T-cell exhaustion and negative regulation. In conclusion, we show that PDL1 expression refines the prediction of metastatic relapse in operated localized STS, and that PD1/PDL1 blockade holds potential to improve patient survival by reactivating inhibited T cells to increase the antitumor immune in PDL1-high tumors.
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Affiliation(s)
- François Bertucci
- Department of Molecular Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, UMR1068 Inserm, Marseille, France; Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, Marseille, France; French Sarcoma Group, Lyon, France
| | - Pascal Finetti
- Department of Molecular Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, UMR1068 Inserm , Marseille, France
| | - Delphine Perrot
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France; French Sarcoma Group, Lyon, France
| | - Agnès Leroux
- French Sarcoma Group, Lyon, France; Department of Pathology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France
| | - Françoise Collin
- French Sarcoma Group, Lyon, France; Department of Pathology, Centre Georges Leclerc, Dijon, France
| | - Axel Le Cesne
- French Sarcoma Group, Lyon, France; Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Jean-Michel Coindre
- French Sarcoma Group, Lyon, France; Department of Pathology, Institut Bergonie, Bordeaux, France
| | - Jean-Yves Blay
- French Sarcoma Group, Lyon, France; Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Daniel Birnbaum
- Department of Molecular Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, UMR1068 Inserm , Marseille, France
| | - Emilie Mamessier
- Department of Molecular Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, UMR1068 Inserm , Marseille, France
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Paoluzzi L, Cacavio A, Ghesani M, Karambelkar A, Rapkiewicz A, Weber J, Rosen G. Response to anti-PD1 therapy with nivolumab in metastatic sarcomas. Clin Sarcoma Res 2016; 6:24. [PMID: 28042471 PMCID: PMC5200964 DOI: 10.1186/s13569-016-0064-0] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Manipulation of immune checkpoints such as CTLA4 or PD-1 with targeted antibodies has recently emerged as an effective anticancer strategy in multiple malignancies. Sarcomas are a heterogeneous group of diseases in need of more effective treatments. Different subtypes of soft tissue and bone sarcomas have been shown to express PD-1 ligand. METHODS We retrospectively analyzed a cohort of patients (pts) with relapsed metastatic/unresectable sarcomas, who were treated with nivolumab provided under a patient assistance program from the manufacturer. Pts underwent CT or PET/CT imaging at baseline and after at least four doses of nivolumab; RECIST 1.1 criteria were used for response assessment. RESULTS Twenty-eight pts with soft tissue (STS, N = 24) or bone sarcoma (N = 4), received IV nivolumab 3 mg/kg every 2 weeks from July 2015. Median age was 57 (24-78), male:female ratio was 14:14; the median number of nivolumab cycles was eight. Eighteen pts concomitantly received pazopanib at 400-800 mg daily. The most common side effect was grade 1-2 LFT elevations; grade 3-4 toxicity occurred in five patients (colitis, LFT elevations, pneumonitis). Twenty-four pts received at least four cycles. We observed three partial responses: one dedifferentiated chondrosarcoma, one epithelioid sarcoma and one maxillary osteosarcoma (last two patients on pazopanib); nine patients had stable disease including three leiomyosarcomas; 12 patients had progression of disease including 4 leiomyosarcoma. Clinical benefit (response + stability) was observed in 50% of the evaluable patients. CONCLUSIONS These data provide a rationale for further exploring the efficacy of nivolumab and other checkpoint inhibitors in soft tissue and bone sarcoma.
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Affiliation(s)
- L Paoluzzi
- Department of Medicine, NYU Langone Medical Center, New York, NY USA
| | - A Cacavio
- Department of Medicine, NYU Langone Medical Center, New York, NY USA
| | - M Ghesani
- Department of Radiology, NYU Langone Medical Center, New York, NY USA
| | - A Karambelkar
- Department of Radiology, NYU Langone Medical Center, New York, NY USA
| | - A Rapkiewicz
- Department of Pathology, New York University School of Medicine, Laura and Isaac Perlmutter Cancer Center, 10th floor, Room 1041, 160 East 34th street, New York, NY USA
| | - J Weber
- Department of Medicine, NYU Langone Medical Center, New York, NY USA
| | - G Rosen
- Department of Medicine, NYU Langone Medical Center, New York, NY USA
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Tseng WW, Chopra S, Engleman EG, Pollock RE. Hypothesis: The Intratumoral Immune Response against a Cancer Progenitor Cell Impacts the Development of Well-Differentiated versus Dedifferentiated Disease in Liposarcoma. Front Oncol 2016; 6:134. [PMID: 27376027 PMCID: PMC4901033 DOI: 10.3389/fonc.2016.00134] [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: 04/07/2016] [Accepted: 05/23/2016] [Indexed: 12/26/2022] Open
Abstract
Well-differentiated/dedifferentiated (WD/DD) liposarcoma is a rare malignancy of adipocyte origin (“fat cancer”). Tumors may be entirely WD, WD with a DD component, or rarely DD without a clear WD component. WD tumors are low grade and generally indolent, while tumors with a DD component are high grade and behave much more aggressively, with a modest potential for distant metastasis. The presence of cancer progenitor cells in WD/DD liposarcoma is suggested by clinical evidence and reported research findings. In addition, there are emerging data to support the existence of a naturally occurring, antigen-driven, and adaptive immune response within the tumor microenvironment. We hypothesize that the intratumoral immune response is directed against a cancer progenitor cell and that the outcome of this response impacts the development of WD versus DD disease. Further study will likely provide interesting insights into the disease biology of WD/DD liposarcoma that may be readily translated to other more common cancers.
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Affiliation(s)
- William W Tseng
- Section of Surgical Oncology, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Sarcoma Program, Hoag Family Cancer Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Shefali Chopra
- Department of Pathology, Keck School of Medicine, University of Southern California , Los Angeles, CA , USA
| | - Edgar G Engleman
- Department of Pathology, Stanford University School of Medicine , Palo Alto, CA , USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The James Comprehensive Cancer Center, Ohio State University , Columbus, OH , USA
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Hall M, Mullinax J, Royster E, Reagan A, Gonzalez R, Pimiento J, Pilon-Thomas S, Sarnaik A. Expansion and characterization of tumor-infiltrating lymphocytes from human sarcoma. J Immunother Cancer 2015. [PMCID: PMC4645298 DOI: 10.1186/2051-1426-3-s2-p19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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46
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Khoury M, Sim GC, Harao M, Radvanyi L, Amini B, Benjamin RS, Pisters PWT, Pollock RE, Tseng WW. Multicystic dedifferentiated retroperitoneal liposarcoma: tumour cyst fluid analysis and implications for management. BMJ Case Rep 2015; 2015:bcr-2015-211218. [PMID: 26156843 DOI: 10.1136/bcr-2015-211218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Liposarcomas are soft tissue sarcomas of adipocyte origin. We describe a case of a dedifferentiated retroperitoneal liposarcoma with an unusual presentation on recurrence as a large, multicystic tumour. The patient was a 72-year-old woman who had undergone multiple treatments including two prior resections. For her most recent locoregional disease recurrence, the patient was offered surgical debulking for symptom palliation. At this operation, performed after two cycles of chemotherapy, the tumour cyst fluid was analysed and found to have a predominance of immune cells with no identifiable malignant cells. This case and the results of our tumour cyst fluid analysis raise several interesting considerations for the management of this unique situation in a rare disease.
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Affiliation(s)
- Mitri Khoury
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Geok Choo Sim
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michiko Harao
- Department of Breast Surgical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Laszlo Radvanyi
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL Lion Biotechnologies, Woodland Hills, CA
| | - Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Raphael E Pollock
- Division of Surgical Oncology, The James Cancer Center, Ohio State University, Columbus, OH
| | - William W Tseng
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA Sarcoma Program, Hoag Family Cancer Institute and Hoag Memorial Hospital Presbyterian, Newport Beach, CA
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47
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Olimpiadi Y, Song S, Hu JS, Matcuk GR, Chopra S, Eisenberg BL, Sener SF, Tseng WW. Contemporary Management of Retroperitoneal Soft Tissue Sarcomas. Curr Oncol Rep 2015; 17:39. [DOI: 10.1007/s11912-015-0462-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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