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Nabel CS, Ackman JB, Hung YP, Louissaint A, Riely GJ. Single-Cell Sequencing Illuminates Thymic Development: An Updated Framework for Understanding Thymic Epithelial Tumors. Oncologist 2024; 29:473-483. [PMID: 38520743 PMCID: PMC11145005 DOI: 10.1093/oncolo/oyae046] [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: 10/28/2023] [Accepted: 02/23/2024] [Indexed: 03/25/2024] Open
Abstract
Thymic epithelial tumors (TETs) are rare tumors for which treatment options are limited. The ongoing need for improved systemic therapies reflects a limited understanding of tumor biology as well as the normal thymus. The essential role of the thymus in adaptive immunity is largely effected by its epithelial compartment, which directs thymocyte (T-cell) differentiation and immunologic self-tolerance. With aging, the thymus undergoes involution whereby epithelial tissue is replaced by adipose and other connective tissue, decreasing immature T-cell production. Against this natural drive toward involution, a fraction of thymuses will instead undergo oncologic transformation, leading to the formation of TETs, including thymoma and thymic carcinoma. The rarity of these tumors restricts investigation of the mechanisms of tumorigenesis and development of rational treatment options. To this end, the development of technologies which allow deep molecular profiling of individual tumor cells permits a new window through which to view normal thymic development and contrast the malignant changes that result in oncogenic transformation. In this review, we describe the findings of recent illuminating studies on the diversity of cell types within the epithelial compartment through thymic differentiation and aging. We contextualize these findings around important unanswered questions regarding the spectrum of known somatic tumor alterations, cell of origin, and tumor heterogeneity. The perspectives informed by single-cell molecular profiling offer new approaches to clinical and basic investigation of thymic epithelial tumors, with the potential to accelerate development of improved therapeutic strategies to address ongoing unmet needs in these rare tumors.
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Affiliation(s)
- Christopher S Nabel
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeanne B Ackman
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Yin P Hung
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Abner Louissaint
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory J Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Crisafulli L, Brindisi M, Liturri MG, Sobacchi C, Ficara F. PBX1: a TALE of two seasons-key roles during development and in cancer. Front Cell Dev Biol 2024; 12:1372873. [PMID: 38404687 PMCID: PMC10884236 DOI: 10.3389/fcell.2024.1372873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Pre-B cell leukemia factor 1 (PBX1) is a Three Aminoacid Loop Extension (TALE) homeodomain-containing transcription factor playing crucial roles in organ pattering during embryogenesis, through the formation of nuclear complexes with other TALE class and/or homeobox proteins to regulate target genes. Its contribution to the development of several organs has been elucidated mainly through the study of murine knockout models. A crucial role for human development has been recently highlighted through the discovery of different de novo pathogenic PBX1 variants in children affected by developmental defects. In the adult, PBX1 is expressed in selected tissues such as in the brain, in the gastro-intestinal and urinary systems, or in hematopoietic stem and progenitor cells, while in other organs is barely detectable. When involved in the t(1;19) chromosomal translocation it acts as an oncogene, since the resulting fusion protein drives pre-B cell leukemia, due to the induction of target genes not normally targeted by the native protein. Its aberrant expression has been associated to tumor development, progression, or therapy-resistance as in breast cancer, ovarian cancer or myeloproliferative neoplasm (MPN). On the other hand, in colorectal cancer PBX1 functions as a tumor suppressor, highlighting its context-dependent role. We here discuss differences and analogies of PBX1 roles during embryonic development and in cancer, focusing mainly on the most recent discoveries.
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Affiliation(s)
- Laura Crisafulli
- IRCCS Humanitas Research Hospital, Milan, Italy
- Milan Unit, Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council, Milan, Italy
| | - Matteo Brindisi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Milan Unit, Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council, Milan, Italy
| | | | - Cristina Sobacchi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Milan Unit, Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council, Milan, Italy
| | - Francesca Ficara
- IRCCS Humanitas Research Hospital, Milan, Italy
- Milan Unit, Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council, Milan, Italy
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3
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Elm L, Levidou G. The Molecular Landscape of Thymic Epithelial Tumors: A Comprehensive Review. Int J Mol Sci 2024; 25:1554. [PMID: 38338833 PMCID: PMC10855681 DOI: 10.3390/ijms25031554] [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: 12/20/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Thymic epithelial tumors (TETs) are characterized by their extreme rarity and variable clinical presentation, with the inadequacy of the use of histological classification alone to distinguish biologically indolent from aggressive cases. The utilization of Next Generation Sequencing (NGS) to unravel the intricate genetic landscape of TETs could offer us a comprehensive understanding that is crucial for precise diagnoses, prognoses, and potential therapeutic strategies. Despite the low tumor mutational burden of TETS, NGS allows for exploration of specific genetic signatures contributing to TET onset and progression. Thymomas exhibit a limited mutational load, with prevalent GTF2I and HRAS mutations. On the other hand, thymic carcinomas (TCs) exhibit an elevated mutational burden, marked by frequent mutations in TP53 and genes associated with epigenetic regulation. Moreover, signaling pathway analyses highlight dysregulation in crucial cellular functions and pathways. Targeted therapies, and ongoing clinical trials show promising results, addressing challenges rooted in the scarcity of actionable mutations and limited genomic understanding. International collaborations and data-sharing initiatives are crucial for breakthroughs in TETs research.
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Affiliation(s)
| | - Georgia Levidou
- Department of Pathology, Nuremberg Clinic, Paracelsus Medical University, 90419 Nuremberg, Germany;
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Maniar R, Loehrer PJ. What Have We Learned from Molecularly Informed Clinical Trials on Thymomas and Thymic Carcinomas-Current Status and Future Directions? Cancers (Basel) 2024; 16:416. [PMID: 38254905 PMCID: PMC10813974 DOI: 10.3390/cancers16020416] [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: 12/08/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Thymic epithelial tumors (TETs), which include thymomas and thymic carcinomas, are a rare, heterogeneous group of malignancies that originate from the thymus gland. As an important organ of immune cell development, thymic tumors, particularly thymomas, are often associated with paraneoplastic autoimmune disorders. The advances in targeted therapies for both solid and hematologic malignancies have resulted in improved patient outcomes, including better and more durable efficacy and improved toxicity. Targeted therapies have also been investigated in the treatment of TETs, though the results have largely been modest. These have included somatostatin-receptor-targeting therapies, KIT- and EGFR-directed tyrosine kinase inhibitors, epigenetic modulators, anti-angiogenesis agents, and agents targeting the cell proliferation and survival pathways and cell cycle regulators. Numerous investigated treatments have failed or underperformed due to a lack of a strong biomarker of efficacy. Ongoing trials are attempting to expand on previous experiences, including the exploration of effective drugs in early-stage disease. Novel combination therapy strategies are also undergoing evaluation, with the goal of augmenting efficacy and understanding the toxicity while expanding the biomarkers of efficacy and safety. With advances in technology to improve target identification and drug delivery, old targets may become new opportunities, and the subsequently developed drugs may find their place in the treatment of thymic tumors.
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Affiliation(s)
| | - Patrick J. Loehrer
- Division of Hematology & Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
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Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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6
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Zhang X, Zhang P, Cong A, Feng Y, Chi H, Xia Z, Tang H. Unraveling molecular networks in thymic epithelial tumors: deciphering the unique signatures. Front Immunol 2023; 14:1264325. [PMID: 37849766 PMCID: PMC10577431 DOI: 10.3389/fimmu.2023.1264325] [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: 07/20/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Thymic epithelial tumors (TETs) are a rare and diverse group of neoplasms characterized by distinct molecular signatures. This review delves into the complex molecular networks of TETs, highlighting key aspects such as chromosomal abnormalities, molecular subtypes, aberrant gene mutations and expressions, structural gene rearrangements, and epigenetic changes. Additionally, the influence of the dynamic tumor microenvironment on TET behavior and therapeutic responses is examined. A thorough understanding of these facets elucidates TET pathogenesis, offering avenues for enhancing diagnostic accuracy, refining prognostic assessments, and tailoring targeted therapeutic strategies. Our review underscores the importance of deciphering TETs' unique molecular signatures to advance personalized treatment paradigms and improve patient outcomes. We also discuss future research directions and anticipated challenges in this intriguing field.
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Affiliation(s)
- Xiao Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengpeng Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ansheng Cong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yanlong Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chi
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, China
| | - Zhijia Xia
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians University Munich, Munich, Germany
| | - Hailin Tang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Nabel CS, Hung YP, Kurilovich A, Lopareva A, Dias-Santagata D, Batashkov N, Tabakov D, Sorokina M, Makarov A, Sagaradze G, Butusova A, Kudryashova O, Bedniagin L, Wright CD, Shin N, Bagaev A, Postovalova E, Louissaint A. Longitudinal Molecular Analysis of Tumor Exome and Transcriptome to Evaluate Clonal Evolution and Identify Novel Therapeutic Targets in Thymoma. JCO Precis Oncol 2023; 7:e2300107. [PMID: 37437230 PMCID: PMC10581621 DOI: 10.1200/po.23.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Christopher S. Nabel
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
| | - Yin P. Hung
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | | | - Dora Dias-Santagata
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | - Cameron D. Wright
- Harvard Medical School, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Abner Louissaint
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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Li J, Qi G, Liu Y. Proteomics analysis of serum from thymoma patients. Sci Rep 2023; 13:5117. [PMID: 36991043 PMCID: PMC10060243 DOI: 10.1038/s41598-023-32339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Thymoma is the most common malignant tumor in thymic epithelial tumors (TETS). This study aimed to identify the changes in serum proteomics in patients with thymoma. Proteins were extracted from twenty patients with thymoma serum and nine healthy controls and prepared for mass spectrometry (MS) analysis. Data independent acquisition (DIA) quantitative proteomics technique was used to examine the serum proteome. Differential proteins of abundance changes in the serum were identified. Bioinformatics was used to examine the differential proteins. Functional tagging and enrichment analysis were conducted using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. The string database was used to assess the interaction of different proteins. In all, 486 proteins were found in all samples. There were differences in 58 serum proteins between patients and healthy blood donors, 35 up-regulated and 23 down-regulated. These proteins are primarily exocrine and serum membrane proteins involved in controlling immunological responses and antigen binding, according to GO functional annotation. KEGG functional annotation showed that these proteins play a significant role in the complement and coagulation cascade and the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signal pathway. Notably, the KEGG pathway (complement and coagulation cascade) is enriched, and three key activators were up-regulated: von willebrand factor (VWF), coagulation factor v (F5) and vitamin k-dependent protein c (PC). Protein-protein interaction (PPI) analysis showed that six proteins ((VWF, F5, thrombin reactive protein 1 (THBS1), mannose-binding lectin-associated serine protease 2 (MASP2), apolipoprotein B (APOB), and apolipoprotein (a) (LPA)) were up-regulated and two proteins (Metalloproteinase inhibitor 1(TIMP1), ferritin light chain (FTL)) were down-regulated. The results of this study showed that several proteins involved in complement and coagulation cascades were up-regulated in the serum of patients.
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Affiliation(s)
- Jiaduo Li
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guoyan Qi
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Yaling Liu
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China
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Conforti F, Pala L, De Pas T, He Y, Giaccone G. Investigational drugs for the treatment of thymic cancer: a focus on phase 1 and 2 clinical trials. Expert Opin Investig Drugs 2022; 31:895-904. [PMID: 35961945 DOI: 10.1080/13543784.2022.2113373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are rare tumors of thymic epithelial cells. Treatment options for advanced disease patients who failed standard platinum-based chemotherapy are limited. AREAS COVERED Phase I and II trials published in the last five years testing new systemic treatments for advanced TET patients are discussed, as well as ongoing trials. A PubMed database literature review was conducted for articles published between January 2016 and December 2021, and ongoing clinical trials were retrieved from ClinicalTrials.gov database. EXPERT OPINION The most promising classes of new drugs in TET patients are angiogenesis inhibitors and immune checkpoint antibodies (ICIs). Sunitinib and Lenvatinib showed response rates of 26% and 38%, respectively, and ICIs showed durable responses in 20-25% in thymic carcinoma patients (TCs). Both approaches are mainly active in TCs, therefore new treatment options for thymomas is an unmet medical need.Two major new therapeutic strategies are ICIs combinations with other drugs and drugs that target pathways that are dysregulated in TETs.Future challenges include the development of preclinical models to help identify novel targets and test new treatment strategies, and randomized clinical trials to provide reliable evidence based on survival endpoints.
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Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Laura Pala
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Yongfeng He
- Meyer Cancer Center, Weill Cornell Medicine, New York, USA
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Perrino M, De Pas T, Bozzarelli S, Giordano L, De Vincenzo F, Conforti F, Digiacomo N, Cordua N, D'Antonio F, Borea F, Santoro A, Zucali PA. Resound Trial: A phase 2 study of regorafenib in patients with thymoma (type B2-B3) and thymic carcinoma previously treated with chemotherapy. Cancer 2021; 128:719-726. [PMID: 34706060 DOI: 10.1002/cncr.33990] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Angiogenesis has an important role in thymic epithelial tumors (TETs). Regorafenib inhibits vascular endothelial growth factor receptors (VEGFRs), platelet-derived growth factor receptor β (PDGFR-β), and fibroblast growth factor receptors (FGFRs). This study explored the activity of regorafenib as monotherapy in patients with advanced or recurrent B2-B3 thymoma (T) and thymic carcinoma (TC) previously treated with platinum-containing chemotherapy. METHODS A Fleming single-arm, single-stage, phase 2 trial to evaluate the activity of regorafenib (160 mg once a day by mouth for 3 weeks on/1 week off) was planned. The study was designed to reject the null hypothesis of an 8-week progression-free survival (PFS) rate ≤25% with a type I error of 0.10 and a statistical power of 80% at the alternative hypothesis of an 8-week PFS rate of ≥50% (≥8 of 19 evaluable patients progression-free at 2 months). RESULTS From June 2016 to November 2017, 19 patients were enrolled (11T/8TC). We observed partial response (PR) in 1 patient (1T) (5.3%), stable disease (SD) in 14 patients (9T/5TC) (73.7%), and progressive disease in 2 patients (1T/1TC) (10.5%), with a disease control rate of 78.9%. According to Choi-criteria, 13 patients (68.4%) achieved PR, and 2 patients SD (10.5%). The median PFS was 9.6 months whereas median overall survival was 33.8 months. The 8-week PFS rate was 78.9% (15 of 19 patients). Grade 3-4 treatment-related adverse events were observed in 10 patients (52.6%). CONCLUSIONS The primary end point of this study was reached. The high rate of PR (Choi-criteria) suggests antitumor activity of regorafenib in TETs. On the basis of survival outcomes, the efficacy of regorafenib should be further evaluated in larger studies.
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Affiliation(s)
- Matteo Perrino
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy
| | - Tommaso De Pas
- Department of Oncology, IRCCS, European Institute of Oncology, Milan, Italy
| | - Silvia Bozzarelli
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCCS, Humanitas Research Hospital, Milan, Italy
| | - Fabio De Vincenzo
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy
| | - Fabio Conforti
- Department of Oncology, IRCCS, European Institute of Oncology, Milan, Italy
| | - Nunzio Digiacomo
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy
| | - Nadia Cordua
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Federica Borea
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, IRCCS, Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Umemura S, Chen V, Chahine JJ, Kallakury B, Zhao X, Lee H, Avantaggiati ML, He Y, Wang C, Giaccone G. Arginase Pathway Markers of Immune-Microenvironment in Thymic Epithelial Tumors and Small Cell Lung Cancer. Clin Lung Cancer 2021; 23:e140-e147. [PMID: 34393062 DOI: 10.1016/j.cllc.2021.07.006] [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: 02/20/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Key regulators of antitumor immunity such as arginase-1 and the adenosine pathway may have an important role in modulating the effect of immunotherapy. Here, we investigated the expression profile of these immune-related biomarkers in thymic epithelial tumors (TETs) and small cell lung cancer (SCLC), 2 solid tumors where immune checkpoint inhibitors have activity. MATERIALS AND METHODS Immunohistochemical staining was performed using tissue microarrays of 123 TET (110 thymoma and 13 thymic carcinoma) and 125 SCLC cases. The expression profile of the following immune-related biomarkers was assessed: arginase-1, CD39, CD73, A2AR, PD-L2, and CD15. The expression profile was also correlated with clinical data. RESULTS No sample was positive for arginase-1. In the adenosine pathway, the prevalence of positive staining for CD39, CD73, and A2AR was 4.9%, 2.5%, and 69.2%, in TETs and 0%, 1.7%, and 50.8%, in SCLC. The multivariate analysis showed that CD39 expression was significantly associated with worse disease related survival (hazard ratio [HR], 10.36; 95% confidence interval [CI]: 2.01-53.47; P= .005) and a shorter time-to progression (HR, 11.35; 95% CI, 2.11-61.23; P = .005) in TETs. Other biomarkers were not associated with disease related survival or time to progression in TETs. No biomarker was associated with survival in SCLC. CONCLUSION Arginase-1 was not detectable in TETs and SCLC. Expression of markers in the adenosine pathway were present in both TETs and SCLC. CD39 expression in tumor cells may identify subsets of patients with TETs with an unfavorable prognosis.
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Affiliation(s)
- Shigeki Umemura
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Vincent Chen
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Joeffrey J Chahine
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Bhaskar Kallakury
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Xiaoliang Zhao
- Department of Oncology, Georgetown University Medical Center, Washington, DC; Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, China
| | - Hyun Lee
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | | | - Yongfeng He
- Sandra and Edward Meyer Cancer Center, Weill-Cornell Medicine, New York, NY
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, China
| | - Giuseppe Giaccone
- Department of Oncology, Georgetown University Medical Center, Washington, DC; Sandra and Edward Meyer Cancer Center, Weill-Cornell Medicine, New York, NY.
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Clinical management of patients with thymic epithelial tumors: the recommendations endorsed by the Italian Association of Medical Oncology (AIOM). ESMO Open 2021; 6:100188. [PMID: 34116501 PMCID: PMC8193108 DOI: 10.1016/j.esmoop.2021.100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
The Italian Association of Medical Oncology recommendations on thymic epithelial tumors, which have been drawn up for the first time in 2020 through an evidence-based approach, report indications on all the main aspects of clinical management of this group of rare diseases, from diagnosis and staging, to new available systemic treatments, such as targeted therapies and immunotherapies. A summary of key recommendations is presented here and complete recommendations are reported as Supplementary Materials, available at https://doi.org/10.1016/j.esmoop.2021.100188. Thymic epithelial tumors (TETs). Multidisciplinary management of patients with TETs. Rare cancers. Updated recommendations.
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Tateo V, Manuzzi L, Parisi C, De Giglio A, Campana D, Pantaleo MA, Lamberti G. An Overview on Molecular Characterization of Thymic Tumors: Old and New Targets for Clinical Advances. Pharmaceuticals (Basel) 2021; 14:316. [PMID: 33915954 PMCID: PMC8066729 DOI: 10.3390/ph14040316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022] Open
Abstract
Thymic tumors are a group of rare mediastinal malignancies that include three different histological subtypes with completely different clinical behavior: the thymic carcinomas, the thymomas, and the rarest thymic neuroendocrine tumors. Nowadays, few therapeutic options are available for relapsed and refractory thymic tumors after a first-line platinum-based chemotherapy. In the last years, the deepening of knowledge on thymus' biological characterization has opened possibilities for new treatment options. Several clinical trials have been conducted, the majority with disappointing results mainly due to inaccurate patient selection, but recently some encouraging results have been presented. In this review, we summarize the molecular alterations observed in thymic tumors, underlying the great biological differences among the different histology, and the promising targeted therapies for the future.
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Affiliation(s)
- Valentina Tateo
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
| | - Lisa Manuzzi
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
| | - Claudia Parisi
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
| | - Andrea De Giglio
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Davide Campana
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Maria Abbondanza Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico di Sant’Orsola University Hospital, Via P. Albertoni 15, 40138 Bologna, Italy; (V.T.); (L.M.); (C.P.); (D.C.); (M.A.P.); (G.L.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
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14
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Marx A, Belharazem D, Lee DH, Popovic ZV, Reißfelder C, Schalke B, Schölch S, Ströbel P, Weis CA, Yamada Y. Molecular pathology of thymomas: implications for diagnosis and therapy. Virchows Arch 2021; 478:101-110. [PMID: 33674910 PMCID: PMC7966134 DOI: 10.1007/s00428-021-03068-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 01/16/2023]
Abstract
Thymomas exhibit a unique genomic landscape, comprising the lowest on average total mutational burden among adult human cancers; a unique point mutation in the GTF2I gene in WHO type A and AB thymomas (and rarely others); almost unique KMT2A-MAML2 translocations in rare WHO type B2 and B3 thymomas; a unique YAP1-MAML2 translocation in almost all metaplastic thymomas; and unique miRNA profiles in relation to GTF2I mutational status and WHO histotypes. While most thymomas can be diagnosed solely on the basis of morphological features, mutational analyses can solve challenging differential diagnostic problems. No molecular biomarkers have been identified that predict the response of unresectable thymomas to chemotherapy or agents with known molecular targets. Despite the common and strong expression of PDL1 in thymomas, immune checkpoint inhibitors are rarely applicable due to the poor predictability of common, life-threatening autoimmune side effects that are related to the unrivaled propensity of thymomas towards autoimmunity.
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Affiliation(s)
- Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Djeda Belharazem
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - De-Hyung Lee
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Zoran V Popovic
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sebastian Schölch
- Department of Surgery, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Yosuke Yamada
- Institute of Pathology, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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15
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Conforti F, Pala L, Giaccone G, De Pas T. Thymic epithelial tumors: From biology to treatment. Cancer Treat Rev 2020; 86:102014. [PMID: 32272379 DOI: 10.1016/j.ctrv.2020.102014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/29/2020] [Accepted: 03/19/2020] [Indexed: 11/30/2022]
Abstract
In the last few years, meaningful advances have been made in the knowledge of the biology of Thymic Epithelial Tumors (TETs). Data available suggest that in most cases, the different histological subtypes could be distinct biological entities, characterized by specific molecular aberrations, rather than representing a histological continuum of diseases. Recurrent gene mutations in Thymomas and Thymic Carcinoma have been identified, but we still do not know the exact role played by these mutations in TETs pathogenesis. Relevant new data are now available on the pathogenetic mechanisms underlying the association between TETs and autoimmune diseases that warrant further investigations for the potential therapeutic implications. The progress in knowledge of the molecular pathways involved in TETs pathogenesis, allowed to identify and to test target therapies potentially active in such diseases. Platinum-based chemotherapy remains the standard first line treatment for patients with advanced or metastatic TETs. However, some promising data have been reported on the activity of new target therapies, including anti-angiogenic drugs, Cycline Dependent Kinases and PI3K/mTOR inhibitors, as well as of Immune-checkpoint inhibitors. A number of new drugs and combinations are currently under evaluation. The efficacy of new drugs should be balanced with their toxicity profiles, in such complex patients that seem to be more susceptible to develop drug-related toxicities, in particular with immunotherapies.
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Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Laura Pala
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Tommaso De Pas
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
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16
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Zhao T, Wu J, Liu X, Zhang L, Chen G, Lu H. Diagnosis of thymic epithelial tumor subtypes by a quantitative proteomic approach. Analyst 2018; 143:2491-2500. [PMID: 29645059 DOI: 10.1039/c8an00218e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study shows the first depth proteomic profiling of all TET subtypes and six candidate biomarkers were identified and validated.
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Affiliation(s)
- Ting Zhao
- Institutes of Biomedical Sciences and Department of Chemistry
- Fudan University
- Shanghai 200032
- P.R. China
| | - Jie Wu
- Department of Pathology
- Zhongshan Hospital
- Fudan University
- Shanghai 200032
- P.R. China
| | - Xiaohui Liu
- Institutes of Biomedical Sciences and Department of Chemistry
- Fudan University
- Shanghai 200032
- P.R. China
| | - Lei Zhang
- Institutes of Biomedical Sciences and Department of Chemistry
- Fudan University
- Shanghai 200032
- P.R. China
| | - Gang Chen
- Department of Pathology
- Zhongshan Hospital
- Fudan University
- Shanghai 200032
- P.R. China
| | - Haojie Lu
- Institutes of Biomedical Sciences and Department of Chemistry
- Fudan University
- Shanghai 200032
- P.R. China
- Key Laboratory of Glycoconjugates Research Ministry of Public Health
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17
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Zucali PA, De Pas T, Palmieri G, Favaretto A, Chella A, Tiseo M, Caruso M, Simonelli M, Perrino M, De Vincenzo F, Toffalorio F, Damiano V, Pasello G, Garbella E, Ali M, Conforti F, Ottaviano M, Cioffi A, De Placido S, Giordano L, Bertossi M, Destro A, Di Tommaso L, Santoro A. Phase II Study of Everolimus in Patients With Thymoma and Thymic Carcinoma Previously Treated With Cisplatin-Based Chemotherapy. J Clin Oncol 2017; 36:342-349. [PMID: 29240542 DOI: 10.1200/jco.2017.74.4078] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose No effective salvage treatments are available for patients with advanced/recurrent thymoma (T) or thymic carcinoma (TC) who have progressed after platinum-based chemotherapy. This study evaluated the activity of everolimus in patients with advanced/recurrent T or TC previously treated with cisplatin-containing chemotherapy. Patients and Methods This was a single-arm, single-stage, open-label, multicenter, phase II trial. Patients received oral everolimus 10 mg/d until disease progression, unacceptable toxicity, or patient refusal. A Fleming phase II trial was designed. The null hypothesis of a true disease control rate (DCR) of 40% was tested against a one-sided alternative of a true DCR of 60% (α = β = 0.10): If disease control were achieved in ≥ 21 of the first 41 evaluable patients, everolimus could be recommended for further evaluation. Progression-free survival, overall survival, and safety were also evaluated. Results From 2011 to 2013, 51 patients were enrolled (T, n = 32; TC, n = 19). Complete remission was observed in one patient with TC, partial response in five patients (T, n = 3; TC, n = 2), and stable disease in 38 patients (T, n = 27; TC, n= 11), with a DCR of 88% (T,: 93.8%; TC, 77.8%). With a median follow up of 25.7 months, median progression-free survival was 10.1 months (T,: 16.6 months; TC, 5.6 months), and median overall survival was 25.7 months (T, not reached; TC, 14.7 months). Fourteen patients had a serious drug-related adverse event; of these patients, nine permanently discontinued treatment. Three patients died of pneumonitis while in the study. Immunohistochemical positivity for p4E-BP1 or insulin-like growth factor-1 receptor was statistically significantly related to a shorter survival. Conclusion Everolimus may induce durable disease control in a high percentage of patients with T or TC, albeit with a potential high risk of fatal pneumonitis.
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Affiliation(s)
- Paolo Andrea Zucali
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Tommaso De Pas
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Giovannella Palmieri
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Adolfo Favaretto
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Antonio Chella
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Marcello Tiseo
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Michele Caruso
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Matteo Simonelli
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Matteo Perrino
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Fabio De Vincenzo
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Francesca Toffalorio
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Vincenzo Damiano
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Giulia Pasello
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Erika Garbella
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Marco Ali
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Fabio Conforti
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Margaret Ottaviano
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Angela Cioffi
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Sabino De Placido
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Laura Giordano
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Monica Bertossi
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Annarita Destro
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Luca Di Tommaso
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Armando Santoro
- Paolo Andrea Zucali, Matteo Simonelli, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Monica Bertossi, Annarita Destro, Luca Di Tommaso, and Armando Santoro¸ Humanitas Clinical and Research Hospital; Tommaso De Pas, Francesca Toffalorio, Fabio Conforti, and Angela Cioffi, European Institute of Oncology; Paolo Andrea Zucali, Matteo Simonelli, Luca Di Tommaso, and Armando Santoro, Humanitas University, Milan; Giovannella Palmieri, Vincenzo Damiano, Margaret Ottaviano, and Sabino De Placido, Università Federico II, Naples; Adolfo Favaretto and Giulia Pasello, Istituto Oncologico Veneto, Padua; Antonio Chella and Erika Garbella, University Hospital, Pisa; Marcello Tiseo, Azienda Ospedaliero-Universitaria of Parma, Parma; and Michele Caruso and Marco Ali, Humanitas Centro Catanese di Oncologia, Catania, Italy
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Yang Z, Jiang S, Cheng Y, Li T, Hu W, Ma Z, Chen F, Yang Y. FOXC1 in cancer development and therapy: deciphering its emerging and divergent roles. Ther Adv Med Oncol 2017; 9:797-816. [PMID: 29449899 PMCID: PMC5808840 DOI: 10.1177/1758834017742576] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
Forkhead box C1 (FOXC1) is an essential member of the forkhead box transcription factors and has been highlighted as an important transcriptional regulator of crucial proteins associated with a wide variety of carcinomas. FOXC1 regulates tumor-associated genes and is regulated by multiple pathways that control its mRNA expression and protein activity. Aberrant FOXC1 expression is involved in diverse tumorigenic processes, such as abnormal cell proliferation, cancer stem cell maintenance, cancer migration, and angiogenesis. Herein, we review the correlation between the expression of FOXC1 and tumor behaviors. We also summarize the mechanisms of the regulation of FOXC1 expression and activity in physiological and pathological conditions. In particular, we focus on the pathological processes of cancer targeted by FOXC1 and discuss whether FOXC1 is good or detrimental during tumor progression. Moreover, FOXC1 is highlighted as a clinical biomarker for diagnosis or prognosis in various human cancers. The information reviewed here should assist in experimental designs and emphasize the potential of FOXC1 as a therapeutic target for cancer.
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Affiliation(s)
- Zhi Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education. Faculty of Life Sciences, Northwest University, Xi'an, China Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an, China
| | - Shuai Jiang
- Department of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Yicheng Cheng
- Department of Stomatology, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Tian Li
- Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an, China
| | - Wei Hu
- Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an, China
| | - Zhiqiang Ma
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Fulin Chen
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Yang Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, 229 Taibai North Road, Xi'an 710069, China
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Lee HS, Jang HJ, Shah R, Yoon D, Hamaji M, Wald O, Lee JS, Sugarbaker DJ, Burt BM. Genomic Analysis of Thymic Epithelial Tumors Identifies Novel Subtypes Associated with Distinct Clinical Features. Clin Cancer Res 2017; 23:4855-4864. [PMID: 28400429 DOI: 10.1158/1078-0432.ccr-17-0066] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/09/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Abstract
Purpose: To reconcile the heterogeneity of thymic epithelial tumors (TET) and gain deeper understanding of the molecular determinants of TETs, we set out to establish a clinically relevant molecular classification system for these tumors.Experimental Design: Molecular subgrouping of TETs was performed in 120 patients from The Cancer Genome Atlas using a multidimensional approach incorporating analyses of DNA mutations, mRNA expression, and somatic copy number alterations (SCNA), and validated in two independent cohorts.Results: Four distinct molecular subtypes of TETs were identified. The most commonly identified gene mutation was a missense mutation in General Transcription Factor II-I (GTF2I group), which was present in 38% of patients. The next group was identified by unsupervised mRNA clustering of GTF2I wild-type tumors and represented TETs enriched in expression of genes associated with T-cell signaling (TS group; 33%). The remaining two groups were distinguished by their degree of chromosomal stability (CS group; 8%) or instability (CIN group; 21%) based upon SCNA analyses. Disease-free survival and overall survival were favorable in the GTF2I group and unfavorable in the CIN group. These molecular subgroups were associated with TET histology and clinical features including disease-free survival. Finally, we demonstrate high expression of PD1 mRNA and correlation of PD1 and CD8A in the TS subgroup.Conclusions: Molecular subtyping of TETs is associated with disease-free and overall survival. Classification of TETs by a molecular framework could aid in the refinement of staging and in the discovery and development of rational treatment options for patients with TETs. Clin Cancer Res; 23(16); 4855-64. ©2017 AACR.
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Affiliation(s)
- Hyun-Sung Lee
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hee-Jin Jang
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rohan Shah
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - David Yoon
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Ori Wald
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ju-Seog Lee
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sugarbaker
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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20
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Roden AC. Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby. Arch Pathol Lab Med 2017; 141:232-246. [PMID: 28134578 DOI: 10.5858/arpa.2016-0057-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor. OBJECTIVE -To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described. DATA SOURCES -Search of literature database (PubMed) and current (2015) World Health Organization classification. CONCLUSIONS -Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.
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Bürger T, Schaefer IM, Küffer S, Bohnenberger H, Reuter-Jessen K, Chan JKC, Emmert A, Hinterthaner M, Marx A, Ströbel P. Metastatic type A thymoma: morphological and genetic correlation. Histopathology 2016; 70:704-710. [PMID: 27926794 DOI: 10.1111/his.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/02/2016] [Indexed: 01/08/2023]
Abstract
AIMS The vast majority of type A thymomas are diagnosed in tumour stages 1 or 2, and metastatic cases are exceedingly rare. The histological and genetic features of such metastatic type A thymomas have not been described in detail. METHODS AND RESULTS Five metastatic type A thymomas in tumour stage Masaoka IVb that had been reviewed by a panel of expert pathologists were analysed using comparative genomic hybridization (CGH). Cases 1, 2 and 3 showed the prototypical morphology of type A thymomas with mainly solid growth patterns. These cases displayed only very subtle nuclear irregularities and slight nuclear crowding, but no other atypical features. Mitoses were absent. Cases 3 and 4, in contrast, had a distinctly atypical morphology. CGH revealed partially recurrent alterations in four cases (with and without atypical morphology), including gains on chromosome 1q (one case), 17q (two cases), chromosome 19 (three cases) and 22q (one case) and losses on chromosome 17p (two cases) and 22q (one case). CONCLUSION Rare metastatic type A thymomas, both with typical and 'atypical' histological features, show partially recurrent genomic alterations that differ from the much more frequent localized and indolent tumours. The fact that these alterations were recurring points to a link between clinical behaviour and molecular features. Our findings may have implications for the management and treatment of such tumours.
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Affiliation(s)
- Tobias Bürger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
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The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol 2016; 10:1383-95. [PMID: 26295375 DOI: 10.1097/jto.0000000000000654] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This overview of the 4th edition of the World Health Organization (WHO) Classification of thymic tumors has two aims. First, to comprehensively list the established and new tumor entities and variants that are described in the new WHO Classification of thymic epithelial tumors, germ cell tumors, lymphomas, dendritic cell and myeloid neoplasms, and soft-tissue tumors of the thymus and mediastinum; second, to highlight major differences in the new WHO Classification that result from the progress that has been made since the 3rd edition in 2004 at immunohistochemical, genetic and conceptual levels. Refined diagnostic criteria for type A, AB, B1-B3 thymomas and thymic squamous cell carcinoma are given, and it is hoped that these criteria will improve the reproducibility of the classification and its clinical relevance. The clinical perspective of the classification has been strengthened by involving experts from radiology, thoracic surgery, and oncology; by incorporating state-of-the-art positron emission tomography/computed tomography images; and by depicting prototypic cytological specimens. This makes the thymus section of the new WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart a valuable tool for pathologists, cytologists, and clinicians alike. The impact of the new WHO Classification on therapeutic decisions is exemplified in this overview for thymic epithelial tumors and mediastinal lymphomas, and future perspectives and challenges are discussed.
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Abstract
Thymomas are rare tumors but are one of the most common mediastinal neoplasms in adults and exhibit an enormous variability in histological, biological and genetic features. The morphological spectrum within a given entity is enormous and some tumors with histological patterns of more than one entity are more common than pure histological subtypes. Due to a lack of subtype-specific markers classification of thymomas often requires complex diagnostic algorithms. The refined presentation including the definition of obligatory and optional features and of diagnostic immunohistochemical profiles, is the focus of the new World Health Organization (WHO) classification of thymomas, aiming at improving diagnostic reproducibility. This review highlights novel aspects of the WHO classification of thymomas and addresses typical differential diagnostic challenges with a focus on diagnostic pitfalls.
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Affiliation(s)
- A Marx
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - C-A Weis
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Abstract
Thymic carcinomas (TC) are approximately 10 times less prevalent than thymomas but of high clinical relevance because they are more aggressive, less frequently resectable than thymomas and usually refractory to classical and targeted long-term treatment approaches. Furthermore, in children and adolescents TC are more frequent than thymomas and particularly in this age group, germ cell tumors need to be a differential diagnostic consideration. In diagnostic terms pathologists face two challenges: a), the distinction between thymic carcinomas and thymomas with a similar appearance and b), the distinction between TC and histologically similar metastases and tumor extensions from other primary tumors. Overcoming these diagnostic challenges is the focus of the new WHO classification of thymic epithelial tumors. The objectives of this review are to highlight novel aspects of the WHO classification of thymic carcinomas and to address therapeutically relevant diagnostic pitfalls.
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Abstract
The rapid advent of technology in recent years has resulted in a substantial increase in our knowledge of the molecular underpinnings of thymic epithelial tumors. In addition to previously described chromosomal aberrations and alterations in DNA methylation, genome sequencing has helped unravel hitherto unknown mutations in these tumors. Attempts are also being made to develop gene signatures to help in the identification of patients likely to benefit from adjuvant therapy. Some of the recently identified genetic alterations have the potential to serve as targets for biological therapy, thus opening newer avenues for treatment of thymic epithelial tumors and increasing the number of effective options for treatment of recurrent or refractory disease.
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Petrini I, Meltzer PS, Kim IK, Lucchi M, Park KS, Fontanini G, Gao J, Zucali PA, Calabrese F, Favaretto A, Rea F, Rodriguez-Canales J, Walker RL, Pineda M, Zhu YJ, Lau C, Killian KJ, Bilke S, Voeller D, Dakshanamurthy S, Wang Y, Giaccone G. A specific missense mutation in GTF2I occurs at high frequency in thymic epithelial tumors. Nat Genet 2014; 46:844-9. [PMID: 24974848 DOI: 10.1038/ng.3016] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/02/2014] [Indexed: 12/15/2022]
Abstract
We analyzed 28 thymic epithelial tumors (TETs) using next-generation sequencing and identified a missense mutation (chromosome 7 c.74146970T>A) in GTF2I at high frequency in type A thymomas, a relatively indolent subtype. In a series of 274 TETs, we detected the GTF2I mutation in 82% of type A and 74% of type AB thymomas but rarely in the aggressive subtypes, where recurrent mutations of known cancer genes have been identified. Therefore, GTF2I mutation correlated with better survival. GTF2I β and δ isoforms were expressed in TETs, and both mutant isoforms were able to stimulate cell proliferation in vitro. Thymic carcinomas carried a higher number of mutations than thymomas (average of 43.5 and 18.4, respectively). Notably, we identified recurrent mutations of known cancer genes, including TP53, CYLD, CDKN2A, BAP1 and PBRM1, in thymic carcinomas. These findings will complement the diagnostic assessment of these tumors and also facilitate development of a molecular classification and assessment of prognosis and treatment strategies.
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Affiliation(s)
- Iacopo Petrini
- Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Paul S Meltzer
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - In-Kyu Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Marco Lucchi
- Thoracic Surgery, Pisa University Hospital, Pisa, Italy
| | - Kang-Seo Park
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | | | - James Gao
- Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Paolo A Zucali
- Medical Oncology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | | | - Federico Rea
- Thoracic Surgery, Padua University Hospital, Padua, Italy
| | | | - Robert L Walker
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Marbin Pineda
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Yuelin J Zhu
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Christopher Lau
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Keith J Killian
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Sven Bilke
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Donna Voeller
- Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Yisong Wang
- 1] Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA. [2] Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Giuseppe Giaccone
- 1] Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA. [2] Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
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Nagel S, Ehrentraut S, Meyer C, Kaufmann M, Drexler HG, MacLeod RAF. Oncogenic deregulation of NKL homeobox gene MSX1 in mantle cell lymphoma. Leuk Lymphoma 2014; 55:1893-903. [PMID: 24237447 DOI: 10.3109/10428194.2013.864762] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
NKL homeobox gene MSX1 is physiologically expressed during embryonic hematopoiesis. Here, we detected MSX1 overexpression in three examples of mantle cell lymphoma (MCL) and one of acute myeloid leukemia (AML) by screening 96 leukemia/lymphoma cell lines via microarray profiling. Moreover, in silico analysis identified significant overexpression of MSX1 in 3% each of patients with MCL and AML, confirming aberrant activity in subsets of both types of malignancies. Comparative expression profiling analysis and subsequent functional studies demonstrated overexpression of histone acetyltransferase PHF16 together with transcription factors FOXC1 and HLXB9 as activators of MSX1 transcription. Additionally, we identified regulation of cyclin D1/CCND1 by MSX1 and its repressive cofactor histone H1C. Fluorescence in situ hybridization in MCL cells showed that t(11;14)(q13;q32) results in detachment of CCND1 from its corresponding repressive MSX1 binding site. Taken together, we uncovered regulators and targets of homeobox gene MSX1 in leukemia/lymphoma cells, supporting the view of a recurrent genetic network that is reactivated in malignant transformation.
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Affiliation(s)
- Stefan Nagel
- Department of Human and Animal Cell Lines, Leibniz-Institute DSMZ - German Collection of Microorganisms and Cell Cultures , Braunschweig , Germany
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Lee JH, Park KS, Alberobello AT, Kallakury B, Weng MT, Wang Y, Giaccone G. The Janus kinases inhibitor AZD1480 attenuates growth of small cell lung cancers in vitro and in vivo. Clin Cancer Res 2013; 19:6777-86. [PMID: 24158701 PMCID: PMC3872034 DOI: 10.1158/1078-0432.ccr-13-1110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The prognosis of small cell lung cancer (SCLC) is poor, and there has been very little progress in the medical treatment of SCLC in the past two decades. We investigated the potential of Janus-activated kinases (JAK) inhibitor, AZD1480, for treatment of SCLC in vitro and in vivo. EXPERIMENTAL DESIGN JAK1 and JAK2 were inhibited by AZD1480 or siRNAs, and the effect of inhibition of JAK gene family on SCLC cell viability was evaluated. The effect of AZD1480 on cell-cycle distribution and apoptosis induction was studied. Antitumor effects of AZD1480 in tumor xenografts were assessed. RESULTS AZD1480 significantly inhibited growth of six out of 13 SCLC cells with IC50s ranging from 0.73 to 3.08 μmol/L. Knocking down of JAK2 and JAK1 inhibited proliferation of Jak2-positive/Jak1-negative H82 cells and Jak1-positive/Jak2-negative GLC4 cells, respectively. Treatment of SCLC cells with AZD1480 for 24 hours resulted in an increase of 4N DNA content and histone 3 serine 10 phosphorylation, indicative of G2-M phase arrest. Moreover, SCLCs underwent apoptosis after AZD1480 treatment as exemplified by the downregulation of MCL1, the accumulation of cleaved caspase 3, cleaved PARP, and increase of annexin-V-positive cells. Finally, xenograft experiments showed that AZD1480 attenuated the growth of H82 and GLC4 tumors in mice, and we observed stronger apoptosis as well as decreased CD31-positive endothelial cells in H82 and GLC4 xenografts upon AZD1480 treatment. CONCLUSIONS JAK inhibitor AZD1480 attenuated growth of SCLC cells in vitro and in vivo. Clinical development of anti-JAKs therapies in SCLC warrants further investigation.
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Affiliation(s)
- Jih-Hsiang Lee
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Kang-Seo Park
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, USA
- Lombardi Comprehensive Cancer Center, Georgetown University, USA
| | | | | | - Meng-Tzu Weng
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, USA
- Lombardi Comprehensive Cancer Center, Georgetown University, USA
| | - Yisong Wang
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Giuseppe Giaccone
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, USA
- Lombardi Comprehensive Cancer Center, Georgetown University, USA
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