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Passarelli A, Ventriglia J, Pisano C, Cecere SC, Napoli MD, Rossetti S, Tambaro R, Tarotto L, Fiore F, Farolfi A, Bartoletti M, Pignata S. The way to precision medicine in gynecologic cancers: The first case report of an exceptional response to alpelisib in a PIK3CA-mutated endometrial cancer. Front Oncol 2023; 12:1088962. [PMID: 36713525 PMCID: PMC9880853 DOI: 10.3389/fonc.2022.1088962] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Endometrial cancer (EC) is the most common gynecologic cancer in Europe and its prevalence is increasing. EC includes a biological and clinical heterogeneous group of tumors, usually classified as type I (endometrioid) or type II (non-endometrioid) based on the histopathological characteristics. In 2013, a new molecular classification was proposed by The Cancer Genome Atlas (TCGA) based on the comprehensive molecular profiling of EC. Several molecular somatic alterations have been described in development and progression of EC. Using these molecular features, EC was reclassified into four subgroups: POLE ultra-mutated, MSI hypermutated, copy-number low, and copy-number high that correlate with the prognosis. To this regard, it is widely reported that EC has more frequent mutations in the phosphatidylinositol 3-kinase (PI3K) pathway signaling than any other tumor. PIK3CA is the main significant mutated gene after PTEN alterations. Overall, over 90% of endometrioid tumors have activating PI3K molecular alterations that suggests its critical role in the EC pathogenesis. Thus, the dysregulation of PI3K pathway represents an attractive target in EC treatment. Herein, we report a radiological and clinically meaningful response to a selective PIK3 inhibitor in a patient with extensively pre-treated advanced endometrioid EC harboring a somatic activating PIK3CA hotspot mutation. These evidences provide the rational for translational strategies of the PI3K inhibition and could support the clinical usefulness of PIK3CA genotyping in advanced EC. To our knowledge, this is the first clinical case of PIK3CA-mutated EC successfully treated with alpelisib.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy,*Correspondence: Anna Passarelli, ,
| | - Jole Ventriglia
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Rosa Tambaro
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Luca Tarotto
- Interventional Radiology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Francesco Fiore
- Interventional Radiology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Emilia-Romagna, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
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Wan S, Sun Y, Fu J, Song H, Xiao Z, Yang Q, Wang S, Yu G, Feng P, Lv W, Luo L, Guan Z, Liu F, Zhou Q, Yin Z, Yang M. mTORC1 signaling pathway integrates estrogen and growth factor to coordinate vaginal epithelial cells proliferation and differentiation. Cell Death Dis 2022; 13:862. [PMID: 36220823 PMCID: PMC9553898 DOI: 10.1038/s41419-022-05293-8] [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: 05/17/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
The mouse vaginal epithelium cyclically exhibits cell proliferation and differentiation in response to estrogen. Estrogen acts as an activator of mTOR signaling but its role in vaginal epithelial homeostasis is unknown. We analyzed reproductive tract-specific Rptor or Rictor conditional knockout mice to reveal the role of mTOR signaling in estrogen-dependent vaginal epithelial cell proliferation and differentiation. Loss of Rptor but not Rictor in the vagina resulted in an aberrant proliferation of epithelial cells and failure of keratinized differentiation. As gene expression analysis indicated, several estrogen-mediated genes, including Pgr and Ereg (EGF-like growth factor) were not induced by estrogen in Rptor cKO mouse vagina. Moreover, supplementation of EREG could activate the proliferation and survival of vaginal epithelial cells through YAP1 in the absence of Rptor. Thus, mTORC1 signaling integrates estrogen and growth factor signaling to mediate vaginal epithelial cell proliferation and differentiation, providing new insights into vaginal atrophy treatment for post-menopausal women.
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Affiliation(s)
- Shuo Wan
- grid.258164.c0000 0004 1790 3548The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510632 China ,grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Yadong Sun
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Jiamin Fu
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Hongrui Song
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Zhiqiang Xiao
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Quanli Yang
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Sanfeng Wang
- grid.459579.30000 0004 0625 057XGuangdong Women and Children Hospital, Guangzhou, Guangdong 510010 China
| | - Gongwang Yu
- grid.12981.330000 0001 2360 039XDepartment of Medical Genetics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080 China
| | - Peiran Feng
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Wenkai Lv
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Liang Luo
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Zerong Guan
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Feng Liu
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Qinghua Zhou
- grid.258164.c0000 0004 1790 3548The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510632 China ,grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Zhinan Yin
- grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
| | - Meixiang Yang
- grid.258164.c0000 0004 1790 3548The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510632 China ,grid.258164.c0000 0004 1790 3548Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000 Guangdong China ,grid.258164.c0000 0004 1790 3548The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, 510632 Guangdong China
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Shu W, Wang Z, Zhao R, Shi R, Zhang J, Zhang W, Wang H. Exploration of the Effect and Potential Mechanism of Echinacoside Against Endometrial Cancer Based on Network Pharmacology and in vitro Experimental Verification. Drug Des Devel Ther 2022; 16:1847-1863. [PMID: 35734366 PMCID: PMC9208491 DOI: 10.2147/dddt.s361955] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wan Shu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Ziwei Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Rong Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Rui Shi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
- Correspondence: Hongbo Wang, Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China, Email
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Stover EH, Xiong N, Myers AP, Tayob N, Engvold V, Polak M, Broaddus RR, Makker V, Drapkin R, Liu JF, Horowitz NS, Meric-Bernstam F, Aghajanian C, Coleman RL, Mills GB, Cantley LC, Matulonis UA, Westin SN, Konstantinopoulos PA. A phase II study of MK-2206, an AKT inhibitor, in uterine serous carcinoma. Gynecol Oncol Rep 2022; 40:100974. [PMID: 35434236 PMCID: PMC9011027 DOI: 10.1016/j.gore.2022.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
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[Effects of lentivirus-mediated RNA interference of HIF-1α and PTEN on oxygen-glucose deprivation injury in primary cultured rat neurons]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1795-1800. [PMID: 35012910 PMCID: PMC8752430 DOI: 10.12122/j.issn.1673-4254.2021.12.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To observe the effects of lentivirus-mediated RNA interference (RNAi) of hypoxia-inducible factor 1α (HIF-1α) and phosphatase and tensin homolog on chromosome ten (PTEN) on oxygen-glucose deprivation (OGD) injury in primary cultured rat neurons. METHODS Primary cultures of neonatal SD rat neurons were infected by lentiviral vectors carrying short hairpin RNA (shRNA) targeting HIF-1α or PTEN followed 4 days later by hypoxic exposure, and the control neurons were infected with the empty virus only with or without subsequent hypoxic exposure. Twenty-four hours after hypoxia, the interference efficiency was assessed with qRT-PCR, and lactate dehydrogenase (LDH) assay and AnnexinV-FITC/ PI assay were performed to detect neuronal damage and apoptosis. The expressions of the related proteins were determined with Western blotting. RESULTS Lentivirus-mediated RNAi effectively silenced the mRNA expression of the target genes. HIF-1α silencing obviously aggravated the hypoxia-induced damage and apoptosis of the neurons, enhanced the expression of PTEN protein and significantly lowered the expressions of p-PTEN, p-AKT, NR2A and VEGFa (P < 0.05). PTEN silencing significantly alleviated hypoxia-induced damage and apoptosis of the neurons and increased the cellular expressions of p-PTEN and p-AKT (P < 0.05) without obviously affecting the expressions of HIF-1α, NR2A or VEGFa (P>0.05). CONCLUSION An up-regulated expression of HIF-1α causes down-regulation of PTEN expression to protect primary cultured rat neurons against OGD injury.
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Wu Q, Zhang W, Liu Y, Huang Y, Wu H, Ma C. Histone deacetylase 1 facilitates aerobic glycolysis and growth of endometrial cancer. Oncol Lett 2021; 22:721. [PMID: 34429761 PMCID: PMC8371952 DOI: 10.3892/ol.2021.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/24/2021] [Indexed: 01/20/2023] Open
Abstract
The deregulation of histone deacetylase 1 (HDAC1) is reportedly involved in the progression of several cancer types. However, its function in endometrial cancer remains unknown. The aim of the present study was to clarify the role of HDAC1 in aerobic glycolysis and the progression of endometrial cancer. Lentiviral vector transfection was used to up- and downregulate HDAC1 expression in HEC-1-A endometrial cancer cells. The effects of HDAC1 on cellular proliferation, apoptosis, migration, invasiveness and tumorigenesis were determined by CCK-8, flow cytometry, wound-healing, transwell chamber and in vivo tumor formation experiments, respectively. HDAC1 level was significantly increased in endometrial cancer tissues and cells, and its high expression was associated with advanced clinicopathological progression. HEC-1-A cell proliferation, invasiveness, migration and tumorigenesis were enhanced, and apoptosis was inhibited when HDAC1 was overexpressed. Moreover, upregulation of HDAC1 significantly promoted the epithelial-mesenchymal transition of HEC-1-A cells, and increased glucose consumption, lactate secretion and ATP levels. Collectively, the present study revealed that HDAC1 promoted the aerobic glycolysis and progression of endometrial cancer, which may provide a potential target for endometrial cancer treatment.
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Affiliation(s)
- Qiongwei Wu
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
| | - Wenying Zhang
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
| | - Yu Liu
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
| | - Yuhua Huang
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
| | - Huiheng Wu
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
| | - Chengbin Ma
- Gynecology Department, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, P.R. China
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Chen C, Gao H, Su X. Autophagy-related signaling pathways are involved in cancer (Review). Exp Ther Med 2021; 22:710. [PMID: 34007319 PMCID: PMC8120650 DOI: 10.3892/etm.2021.10142] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022] Open
Abstract
Autophagy is a self-digestion process in cells that can maintain energy homeostasis under normal circumstances. However, misfolded proteins, damaged mitochondria and other unwanted components in cells can be decomposed and reused via autophagy in some specific cases (including hypoxic stress, low energy states or nutrient deprivation). Therefore, autophagy serves a positive role in cell survival and growth. However, excessive autophagy may lead to apoptosis. Furthermore, abnormal autophagy may lead to carcinogenesis and promote tumorigenesis in normal cells. In tumor cells, autophagy may provide the energy required for excessive proliferation, promote the growth of cancer cells, and evade apoptosis caused by certain treatments, including radiotherapy and chemotherapy, resulting in increased treatment resistance and drug resistance. On the other hand, autophagy leads to an insufficient nutrient supply in cancer cells and the destruction of energy homeostasis, thereby inducing cancer cell apoptosis. Therefore, understanding the mechanism of the double-edged sword of autophagy is crucial for the treatment of cancer. The present review summarizes the signaling pathways and key factors involved in autophagy and cancer to provide possible strategies for treating tumors.
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Affiliation(s)
- Caixia Chen
- Clinical Medicine Research Center, The Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Hui Gao
- Department of Thoracic Surgery, Inner Mongolia Autonomous Region Cancer Hospital, Hohhot, Inner Mongolia 010020, P.R. China
| | - Xiulan Su
- Clinical Medicine Research Center, The Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
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PI3K Pathway Effectors pAKT and FOXO1 as Novel Markers of Endometrioid Intraepithelial Neoplasia. Int J Gynecol Pathol 2020; 38:503-513. [PMID: 30256235 DOI: 10.1097/pgp.0000000000000549] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The diagnosis of endometrioid intraepithelial neoplasia (EIN) is challenging owing to limited sampling, hormonal status, and other confounding histologic variables. Markers such as PTEN or PAX2 can delineate EIN in some cases, but are not wholly reliable. Clearly, new markers of EIN are needed. We explored several potential markers of EIN based rationally on molecular pathways most frequently misregulated in endometrial cancer: the 3-phosphoinositide kinase (PI3K)/AKT, β-catenin, and mismatch repair pathways. We studied PTEN, PAX2, β-catenin, and MLH1, in conjunction with 2 new markers-FOXO1 and phosphorylated AKT (pAKT)-not previously investigated in EIN. Benign (n=14) and EIN (n=35) endometria were analyzed by immunohistochemistry. Staining patterns were interpreted, tabulated, and scored by "clonal distinctiveness" in neoplastic lesions; that is, pattern alterations relative to normal glands. In normal endometria, FOXO1 was cytoplasmic in proliferative phase, but nuclear in secretory phase, showing that PI3K/FOXO1 participates in endometrial cycling and that FOXO1 is a readout of PI3K status. pAKT expression was low across normal endometria. FOXO1 or pAKT expression was altered in the majority of EINs (27/35, 77%), with FOXO1 and pAKT being co-altered only in some (20/35, 57%). β-catenin or MLH1 also exhibited clonal distinctiveness in EINs, showing that these are also useful markers in some cases. This is the first study to demonstrate the potential of pAKT and FOXO1 as biomarkers in the histopathologic evaluation of EIN. However, variability in expression poses challenges in interpretation.
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Pathogenesis and Clinical Management of Uterine Serous Carcinoma. Cancers (Basel) 2020; 12:cancers12030686. [PMID: 32183290 PMCID: PMC7140057 DOI: 10.3390/cancers12030686] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
Uterine serous carcinoma (USC) is an aggressive variant of endometrial cancer that has not been well characterized. It accounts for less than 10% of all endometrial cancers and 80% of endometrial cancer–related deaths. Currently, staging surgery together with chemotherapy or radiotherapy, especially vaginal cuff brachytherapy, is the main treatment strategy for USC. Whole-exome sequencing combined with preclinical and clinical studies are verifying a series of effective and clinically accessible inhibitors targeting frequently altered genes, such as HER2 and PI3K3CA, in varying USC patient populations. Some progress has also been made in the immunotherapy field. The PD-1/PD-L1 pathway has been found to be activated in many USC patients, and clinical trials of PD-1 inhibitors in USC are underway. This review updates the progress of research regarding the molecular pathogenesis and putative clinical management of USC.
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MacKay HJ, Freixinos VR, Fleming GF. Therapeutic Targets and Opportunities in Endometrial Cancer: Update on Endocrine Therapy and Nonimmunotherapy Targeted Options. Am Soc Clin Oncol Educ Book 2020; 40:1-11. [PMID: 32239967 DOI: 10.1200/edbk_280495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Worldwide, the incidence of endometrial cancer is increasing. Although the prognosis remains good for patients diagnosed with early-stage disease, for those diagnosed with recurrent or metastatic disease, options have been limited, and prognosis is short. Optimizing and identifying new well-tolerated treatments for women living with endometrial cancer is a top priority. A new era is dawning where we are starting to see the integration of clinically relevant genomic and pathologic data to inform and refine treatment strategies for women with endometrial cancer. Here, we focus on reviewing nonimmunotherapy-based targeted treatment options and emerging directions for women with endometrial cancer.
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Affiliation(s)
- Helen J MacKay
- Division of Medical Oncology & Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Gini F Fleming
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL
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Rubinstein MM, Hyman DM, Caird I, Won H, Soldan K, Seier K, Iasonos A, Tew WP, O'Cearbhaill RE, Grisham RN, Hensley ML, Troso-Sandoval T, Sabbatini P, Guillen J, Selcuklu SD, Zimel C, Torrisi J, Aghajanian C, Makker V. Phase 2 study of LY3023414 in patients with advanced endometrial cancer harboring activating mutations in the PI3K pathway. Cancer 2019; 126:1274-1282. [PMID: 31880826 DOI: 10.1002/cncr.32677] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND PI3K pathway activation is common in endometrial cancer. We evaluated the safety and efficacy of the dual PI3K/mTOR inhibitor, LY3023414, in patients with advanced endometrial cancer harboring activating mutations in the PI3K pathway. METHODS We conducted a single-arm phase 2 study of monotherapy LY3023414. Eligible patients had advanced endometrial cancer of any grade, prior management with 1-4 cytotoxic lines, and PI3K pathway activation prospectively defined as a loss-of-function PTEN alteration or activating alteration in PIK3CA, AKT1, PIK3R1, PIK3R2, or MTOR. The primary objective was best overall response rate (ORR) per RECIST 1.1. RESULTS Twenty-eight patients were treated; histologies included endometroid (39%), carcinosarcoma (25%), serous (21%), and mixed (14%). Patients were heavily pretreated, with a median of 2 prior cytotoxic lines (range, 1-3). The most common alterations involved PIK3CA (68%), PTEN (43%), and PIK3R1 (32%). In the 25 efficacy-evaluable patients, the ORR was 16% (90% CI, 7%-100%), and the clinical benefit rate was 28% (90% CI, 16%-100%). Four patients had a confirmed partial response, and 2 responses lasted for >9 months. The median progression-free survival and overall survival were 2.5 months (95% CI, 1.2-3.0) and 9.2 months (95% CI, 5.0-15.9), respectively. The most common all-grade treatment-related adverse events were anemia (71%), hyperglycemia (71%), hypoalbuminemia (68%), and hypophosphatemia (61%). No correlation between molecular alterations and response was observed. CONCLUSION In patients with heavily pretreated advanced endometrial cancer prospectively selected for tumors with activating PI3K pathway mutations, LY3023414 demonstrated modest single-agent activity and a manageable safety profile.
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Affiliation(s)
- Maria M Rubinstein
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Imogen Caird
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helen Won
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Krysten Soldan
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William P Tew
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Rachel N Grisham
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Tiffany Troso-Sandoval
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Paul Sabbatini
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Joyce Guillen
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Duygu Selcuklu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Zimel
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jean Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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12
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Wortman BG, Nout RA, Bosse T, Creutzberg CL. Selecting Adjuvant Treatment for Endometrial Carcinoma Using Molecular Risk Factors. Curr Oncol Rep 2019; 21:83. [PMID: 31367798 PMCID: PMC6669195 DOI: 10.1007/s11912-019-0825-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of common molecular risk factors in endometrial cancer (EC) with the possibility to improve adjuvant treatment selection. RECENT FINDINGS Recent studies have discovered and confirmed four different molecular subclasses in EC, with each having a distinct prognosis; POLE-ultramutated, microsatellite unstable, copy-number low, and copy-number high. Subsequent studies have shown that combining both molecular with clinicopathological risk factors can potentially improve adjuvant treatment selection for women with high-intermediate risk EC. For high risk and advanced stage EC, several molecular alterations are being explored for targeted therapy. Molecular alterations are frequently found in endometrial cancer and have currently not been implemented in the treatment guidelines for EC. Assessment of molecular alterations can distinguish patients that require less or more intensified adjuvant treatment. Trials investigating targeted therapies in EC are ongoing and have shown some promising results, however, more evidence is needed and results of randomized trials have to be awaited.
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Affiliation(s)
- Bastiaan G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, K1-P, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, K1-P, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, K1-P, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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13
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Li CW, Chen BS. Investigating HIV-Human Interaction Networks to Unravel Pathogenic Mechanism for Drug Discovery: A Systems Biology Approach. Curr HIV Res 2019; 16:77-95. [PMID: 29468972 DOI: 10.2174/1570162x16666180219155324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/18/2018] [Accepted: 02/14/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Two big issues in the study of pathogens are determining how pathogens infect hosts and how the host defends itself against infection. Therefore, investigating host-pathogen interactions is important for understanding pathogenicity and host defensive mechanisms and treating infections. METHODS In this study, we used omics data, including time-course data from high-throughput sequencing, real-time polymerase chain reaction, and human microRNA (miRNA) and protein-protein interaction to construct an interspecies protein-protein and miRNA interaction (PPMI) network of human CD4+ T cells during HIV-1 infection through system modeling and identification. RESULTS By applying a functional annotation tool to the identified PPMI network at each stage of HIV infection, we found that repressions of three miRNAs, miR-140-5p, miR-320a, and miR-941, are involved in the development of autoimmune disorders, tumor proliferation, and the pathogenesis of T cells at the reverse transcription stage. Repressions of miR-331-3p and miR-320a are involved in HIV-1 replication, replicative spread, anti-apoptosis, cell proliferation, and dysregulation of cell cycle control at the integration/replication stage. Repression of miR-341-5p is involved in carcinogenesis at the late stage of HIV-1 infection. CONCLUSION By investigating the common core proteins and changes in specific proteins in the PPMI network between the stages of HIV-1 infection, we obtained pathogenic insights into the functional core modules and identified potential drug combinations for treating patients with HIV-1 infection, including thalidomide, oxaprozin, and metformin, at the reverse transcription stage; quercetin, nifedipine, and fenbendazole, at the integration/replication stage; and staurosporine, quercetin, prednisolone, and flufenamic acid, at the late stage.
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Affiliation(s)
- Cheng-Wei Li
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Bor-Sen Chen
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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14
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Class I Phosphoinositide 3-Kinase PIK3CA/p110α and PIK3CB/p110β Isoforms in Endometrial Cancer. Int J Mol Sci 2018; 19:ijms19123931. [PMID: 30544563 PMCID: PMC6321576 DOI: 10.3390/ijms19123931] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022] Open
Abstract
The phosphoinositide 3-kinase (PI3K) signalling pathway is highly dysregulated in cancer, leading to elevated PI3K signalling and altered cellular processes that contribute to tumour development. The pathway is normally orchestrated by class I PI3K enzymes and negatively regulated by the phosphatase and tensin homologue, PTEN. Endometrial carcinomas harbour frequent alterations in components of the pathway, including changes in gene copy number and mutations, in particular in the oncogene PIK3CA, the gene encoding the PI3K catalytic subunit p110α, and the tumour suppressor PTEN. PIK3CB, encoding the other ubiquitously expressed class I isoform p110β, is less frequently altered but the few mutations identified to date are oncogenic. This isoform has received more research interest in recent years, particularly since PTEN-deficient tumours were found to be reliant on p110β activity to sustain transformation. In this review, we describe the current understanding of the common and distinct biochemical properties of the p110α and p110β isoforms, summarise their mutations and highlight how they are targeted in clinical trials in endometrial cancer.
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15
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Holst F, Werner HMJ, Mjøs S, Hoivik EA, Kusonmano K, Wik E, Berg A, Birkeland E, Gibson WJ, Halle MK, Trovik J, Cherniack AD, Kalland KH, Mills GB, Singer CF, Krakstad C, Beroukhim R, Salvesen HB. PIK3CA Amplification Associates with Aggressive Phenotype but Not Markers of AKT-MTOR Signaling in Endometrial Carcinoma. Clin Cancer Res 2018; 25:334-345. [PMID: 30442683 DOI: 10.1158/1078-0432.ccr-18-0452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/07/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Amplification of PIK3CA, encoding the PI3K catalytic subunit alpha, is common in uterine corpus endometrial carcinoma (UCEC) and linked to an aggressive phenotype. However, it is unclear whether PIK3CA amplification acts via PI3K activation. We investigated the association between PIK3CA amplification, markers of PI3K activity, and prognosis in a large cohort of UCEC specimens. EXPERIMENTAL DESIGN UCECs from 591 clinically annotated patients including 83 tumors with matching metastasis (n = 188) were analyzed by FISH to determine PIK3CA copy-number status. These data were integrated with mRNA and protein expression and clinicopathologic data. Results were verified in The Cancer Genome Atlas dataset. RESULTS PIK3CA amplifications were associated with disease-specific mortality and with other markers of aggressive disease. PIK3CA amplifications were also associated with other amplifications characteristic of the serous-like somatic copy-number alteration (SCNA)-high subgroup of UCEC. Tumors with PIK3CA amplification also demonstrated an increase in phospho-p70S6K but had decreased levels of activated phospho-AKT1-3 as assessed by Reverse Phase Protein Arrays and an mRNA signature of MTOR inhibition. CONCLUSIONS PIK3CA amplification is a strong prognostic marker and a potential marker for the aggressive SCNA-high subgroup of UCEC. Although PIK3CA amplification associates with some surrogate measures of increased PI3K activity, markers for AKT1-3 and MTOR signaling are decreased, suggesting that this signaling is not a predominant pathway to promote cancer growth of aggressive serous-like UCEC. Moreover, these associations may reflect features of the SCNA-high subgroup of UCEC rather than effects of PIK3CA amplification itself.
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Affiliation(s)
- Frederik Holst
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Department of Cancer Biology and Department of Medical Oncology, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,The Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Henrica M J Werner
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Siv Mjøs
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Erling A Hoivik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Kanthida Kusonmano
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Computational Biology Unit, University of Bergen, Bergen, Norway.,Bioinformatics and Systems Biology Program, School of Bioresources and Technology, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Elisabeth Wik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Center for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anna Berg
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Even Birkeland
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Center for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - William J Gibson
- Department of Cancer Biology and Department of Medical Oncology, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,The Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mari K Halle
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Jone Trovik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | | | - Karl-Henning Kalland
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Gordon B Mills
- Department of Systems Biology, MD Anderson Cancer Center, Houston, Texas
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Camilla Krakstad
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Rameen Beroukhim
- Department of Cancer Biology and Department of Medical Oncology, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,The Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helga B Salvesen
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
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16
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Remmerie M, Janssens V. Targeted Therapies in Type II Endometrial Cancers: Too Little, but Not Too Late. Int J Mol Sci 2018; 19:E2380. [PMID: 30104481 PMCID: PMC6121653 DOI: 10.3390/ijms19082380] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/02/2018] [Accepted: 08/08/2018] [Indexed: 01/14/2023] Open
Abstract
Type II endometrial carcinomas (ECs) are responsible for most endometrial cancer-related deaths due to their aggressive nature, late stage detection and high tolerance for standard therapies. However, there are no targeted therapies for type II ECs, and they are still treated the same way as the clinically indolent and easily treatable type I ECs. Therefore, type II ECs are in need of new treatment options. More recently, molecular analysis of endometrial cancer revealed phosphorylation-dependent oncogenic signalling in the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways to be most frequently altered in type II ECs. Consequently, clinical trials tested pharmacologic kinase inhibitors targeting these pathways, although mostly with rather disappointing results. In this review, we highlight the most common genetic alterations in type II ECs. Additionally, we reason why most clinical trials for ECs using targeted kinase inhibitors had unsatisfying results and what should be changed in future clinical trial setups. Furthermore, we argue that, besides kinases, phosphatases should no longer be ignored in clinical trials, particularly in type II ECs, where the tumour suppressive phosphatase protein phosphatase type 2A (PP2A) is frequently mutated. Lastly, we discuss the therapeutic potential of targeting PP2A for (re)activation, possibly in combination with pharmacologic kinase inhibitors.
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Affiliation(s)
- Michiel Remmerie
- Laboratory of Protein Phosphorylation & Proteomics, Department of Cellular & Molecular Medicine, University of Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Leuven Cancer Institute (LKI), B-3000 Leuven, Belgium.
| | - Veerle Janssens
- Laboratory of Protein Phosphorylation & Proteomics, Department of Cellular & Molecular Medicine, University of Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Leuven Cancer Institute (LKI), B-3000 Leuven, Belgium.
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17
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Torricelli F, Nicoli D, Bellazzi R, Ciarrocchi A, Farnetti E, Mastrofilippo V, Zamponi R, La Sala GB, Casali B, Mandato VD. Computational development of a molecular-based approach to improve risk stratification of endometrial cancer patients. Oncotarget 2018; 9:25517-25528. [PMID: 29876005 PMCID: PMC5986657 DOI: 10.18632/oncotarget.25354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
Histological classification and staging are the gold standard for the prognosis of endometrial cancer (EC). However, in morphologically intermediate and doubtful cases this approach results largely insufficient, defining the need for better classification criteria. In this work we developed an algorithm that based on EC genetic alterations and in combination with the current histological classification, improves EC patients prognostic stratification, in particular in doubtful cases. A panel of 26 cancer related genes was analyzed in 89 EC patients and somatic functional mutations were investigated in association with different histology and outcome. An unsupervised hierarchical clustering analysis revealed that two groups of patients with different tumor grade and different prognosis can be distinguished by mutational profile. In particular, the mutational status of APC, CTNNB1, PIK3CA, PTEN, SMAD4 and TP53 resulted to be principal drivers of prognostic clustering. Consistently, a decisional tree generated by a data mining approach summarizes the consequential molecular criteria for patients prognostic stratification. The model proposed by this work provides the clinician with a tool able to support the prognosis of EC patients and consequently drives the choice of the most appropriated therapeutic strategy and follow up.
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Affiliation(s)
- Federica Torricelli
- Laboratory of Translational Research, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Davide Nicoli
- Laboratory of Molecular Biology, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Enrico Farnetti
- Laboratory of Molecular Biology, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Unit of Surgical Gynecologic Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raffaella Zamponi
- Laboratory of Molecular Biology, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Giovanni Battista La Sala
- Unit of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Bruno Casali
- Laboratory of Molecular Biology, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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18
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MacKay HJ, Levine DA, Bae-Jump VL, Bell DW, McAlpine JN, Santin A, Fleming GF, Mutch DG, Nephew KP, Wentzensen N, Goodfellow PJ, Dorigo O, Nijman HW, Broaddus R, Kohn EC. Moving forward with actionable therapeutic targets and opportunities in endometrial cancer: NCI clinical trials planning meeting report on identifying key genes and molecular pathways for targeted endometrial cancer trials. Oncotarget 2017; 8:84579-84594. [PMID: 29137450 PMCID: PMC5663622 DOI: 10.18632/oncotarget.19961] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022] Open
Abstract
The incidence and mortality rates from endometrial cancer are increasing. There have been no new drugs approved for the treatment of endometrial cancer in decades. The National Cancer Institute, Gynecologic Cancer Steering Committee identified the integration of molecular and/or histologic stratification into endometrial cancer management as a top strategic priority. Based on this, they convened a group of experts to review the molecular data in this disease. Here we report on the actionable opportunities and therapeutic directions identified for incorporation into future clinical trials.
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Affiliation(s)
- Helen J. MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Douglas A. Levine
- Division of Gynecologic Cancer, Department of OB/GYN, NYU Langone Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Victoria L. Bae-Jump
- Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, CA, United States
| | - Daphne W. Bell
- Reproductive Cancer Genetics Section, Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute/NIH, MSC 8000, Bethesda, ML, United States
| | - Jessica N. McAlpine
- University of British Columbia & BC Cancer Agency, Division of Gynecologic Oncology, Vancouver, British Columbia, Canada
| | - Alessandro Santin
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Gini F. Fleming
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - David G. Mutch
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kenneth P. Nephew
- Medical Sciences Program, Indiana University School of Medicine, Bloomington, IN, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, ML, United States
| | - Paul J. Goodfellow
- James Comprehensive Cancer Center and The Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States
| | - Oliver Dorigo
- Division Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford, CA, United States
| | - Hans W. Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Russell Broaddus
- Department of Pathology, Unit 85, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Elise C. Kohn
- Clinical Investigations Branch of The Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, ML, United States
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19
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Abstract
Endometrial carcinomas (ECs) are heterogeneous at the genetic level. Although TP53 mutations are highly recurrent in serous endometrial carcinomas (SECs), these are also present in a subset of endometrioid endometrial carcinomas (EECs). Here, we sought to define the frequency, pattern, distribution, and type of TP53 somatic mutations in ECs by performing a reanalysis of the publicly available data from The Cancer Genome Atlas (TCGA). A total of 228 EECs (n=186) and SECs (n=42) from the TCGA data set, for which an integrated genomic characterization was performed, were interrogated for the presence and type of TP53 mutations, and for mutations in genes frequently mutated in ECs. TP53 mutations were found in 15% of EECs and 88% of SECs, and in 91% of copy-number-high and 35% of polymerase (DNA directed), epsilon, catalytic subunit (POLE) integrative genomic subtypes. In addition to differences in prevalence, variations in the type and pattern of TP53 mutations were observed between histologic types and between integrative genomic subtypes. TP53 hotspot mutations were significantly more frequently found in SECs (46%) than in EECs (15%). TP53-mutant EECs significantly more frequently harbored a co-occurring PTEN mutation than TP53-mutant SECs. Finally, a subset of TP53-mutant ECs (22%) was found to harbor frameshift or nonsense mutations. Given that nonsense and frameshift TP53 mutations result in distinct p53 immunohistochemical results that require careful interpretation, and that EECs and SECs display different patterns, types, and distributions of TP53 mutations, the use of the TP53/p53 status alone for the differential diagnosis of EECs and SECs may not be sufficient.
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20
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DeLair DF, Burke KA, Selenica P, Lim RS, Scott SN, Middha S, Mohanty AS, Cheng DT, Berger MF, Soslow RA, Weigelt B. The genetic landscape of endometrial clear cell carcinomas. J Pathol 2017; 243:230-241. [PMID: 28718916 DOI: 10.1002/path.4947] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/20/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022]
Abstract
Clear cell carcinoma of the endometrium is a rare type of endometrial cancer that is generally associated with an aggressive clinical behaviour. Here, we sought to define the repertoire of somatic genetic alterations in endometrial clear cell carcinomas (ECCs), and whether ECCs could be classified into the molecular subtypes described for endometrial endometrioid and serous carcinomas. We performed a rigorous histopathological review, immunohistochemical analysis and massively parallel sequencing targeting 300 cancer-related genes of 32 pure ECCs. Eleven (34%), seven (22%) and six (19%) ECCs showed abnormal expression patterns for p53, ARID1A, and at least one DNA mismatch repair (MMR) protein, respectively. Targeted sequencing data were obtained from 30 of the 32 ECCs included in this study, and these revealed that two ECCs (7%) were ultramutated and harboured mutations affecting the exonuclease domain of POLE. In POLE wild-type ECCs, TP53 (46%), PIK3CA (36%), PPP2R1A (36%), FBXW7 (25%), ARID1A (21%), PIK3R1 (18%) and SPOP (18%) were the genes most commonly affected by mutations; 18% and 11% harboured CCNE1 and ERBB2 amplifications, respectively, and 11% showed DAXX homozygous deletions. ECCs less frequently harboured mutations affecting CTNNB1 and PTEN but more frequently harboured PPP2R1A and TP53 mutations than non-POLE endometrioid carcinomas from The Cancer Genome Atlas (TCGA). Compared to endometrial serous carcinomas (TCGA), ECCs less frequently harboured TP53 mutations. When a surrogate model for the molecular-based TCGA classification was used, all molecular subtypes previously identified in endometrial endometrioid and serous carcinomas were present in the ECCs studied, including POLE, MMR-deficient, copy-number high (serous-like)/p53 abnormal, and copy-number low (endometrioid)/p53 wild-type, which were significantly associated with disease-free survival in univariate analysis. These findings demonstrate that ECCs constitute a histologically and genetically heterogeneous group of tumours with varying outcomes. Furthermore, our data suggest that the classification of ECCs as being generally 'high-grade' or 'type II' tumours may not be warranted. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Deborah F DeLair
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen A Burke
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Selenica
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond S Lim
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sasinya N Scott
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sumit Middha
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhinita S Mohanty
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donavan T Cheng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Previs RA, Armaiz-Pena GN, Ivan C, Dalton HJ, Rupaimoole R, Hansen JM, Lyons Y, Huang J, Haemmerle M, Wagner MJ, Gharpure KM, Nagaraja AS, Filant J, McGuire MH, Noh K, Dorniak PL, Linesch SL, Mangala LS, Pradeep S, Wu SY, Sood AK. Role of YAP1 as a Marker of Sensitivity to Dual AKT and P70S6K Inhibition in Ovarian and Uterine Malignancies. J Natl Cancer Inst 2017; 109:3064532. [PMID: 28376174 DOI: 10.1093/jnci/djw296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/08/2016] [Indexed: 12/21/2022] Open
Abstract
Background The PI3K/AKT/P70S6K pathway is an attractive therapeutic target in ovarian and uterine malignancies because of its high rate of deregulation and key roles in tumor growth. Here, we examined the biological effects of MSC2363318A, which is a novel inhibitor of AKT1, AKT3, and P70S6K. Methods Orthotopic murine models of ovarian and uterine cancer were utilized to study the effect of MSC2363318A on survival and regression. For each cell line, 10 mice were treated in each of the experimental arms tested. Moreover, in vitro experiments in 21 cell lines (MTT, immunoblot analysis, plasmid transfection, reverse phase protein array [RPPA]) were carried out to characterize underlying mechanisms and potential biomarkers of response. All statistical tests were two-sided. Results MSC2363318A decreased tumor growth and metastases in multiple murine orthotopic models of ovarian (SKOV3ip1, HeyA8, and Igrov1) and uterine (Hec1a) cancer by reducing proliferation and angiogenesis and increasing cell death. Statistically significant prolonged overall survival was achieved with combination MSC2363318A and paclitaxel in the SKUT2 (endometrioid) uterine cancer mouse model ( P < .001). Mice treated with combination MSC2363318A and paclitaxel had the longest overall survival (mean = 104.2 days, 95% confidence interval [CI] = 97.0 to 111.4) compared with those treated with vehicle (mean = 61.9 days, 95% CI = 46.3 to 77.5), MSC2363318A alone (mean = 89.7 days, 95% CI = 83.0 to 96.4), and paclitaxel alone (mean = 73.6 days, 95% CI = 53.4 to 93.8). Regression and stabilization of established tumors in the Ishikawa (endometrioid) uterine cancer model was observed in mice treated with combination MSC2363318A and paclitaxel. Synergy between MSC2363318A and paclitaxel was observed in vitro in cell lines that had an IC50 of 5 µM or greater. RPPA results identified YAP1 as a candidate marker to predict cell lines that were most sensitive to MSC2363318A (R = 0.54, P = .02). After establishment of a murine ovarian cancer model of adaptive anti-angiogenic resistance (SKOV3ip1-luciferase), we demonstrate that resensitization to bevacizumab occurs with the addition of MSC2363318A, resulting in improved overall survival ( P = .01) using the Kaplan-Meier method. Mice treated with bevacizumab induction followed by MSC2363318A had the longest overall survival (mean = 66.0 days, 95% CI = 53.9 to 78.1) compared with mice treated with control (mean = 42.0 days, 95% CI = 31.4 to 52.6) and bevacizumab-sensitive mice (mean = 47.2 days; 95% CI = 37.5 to 56.9). Conclusions MSC2363318A has therapeutic efficacy in multiple preclinical models of ovarian and uterine cancer. These findings support clinical development of a dual AKT/P70S6K inhibitor.
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Affiliation(s)
- Rebecca A Previs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo N Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, Ponce Health Sciences University, Ponce, Puerto Rico.,Division of Cancer Biology, Ponce Research Institute, Ponce, Puerto Rico
| | - Cristina Ivan
- Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather J Dalton
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesha Rupaimoole
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean M Hansen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasmin Lyons
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Huang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monika Haemmerle
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael J Wagner
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kshipra M Gharpure
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Archana S Nagaraja
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justyna Filant
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H McGuire
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyunghee Noh
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Piotr L Dorniak
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah L Linesch
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Y Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Elvin JA, Chura J, Gay LM, Markman M. Comprehensive genomic profiling (CGP) of ovarian clear cell carcinomas (OCCC) identifies clinically relevant genomic alterations (CRGA) and targeted therapy options. Gynecol Oncol Rep 2017; 20:62-66. [PMID: 28349114 PMCID: PMC5357688 DOI: 10.1016/j.gore.2017.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/08/2017] [Accepted: 02/19/2017] [Indexed: 12/22/2022] Open
Abstract
MTOR pathway genes are often mutated in ovarian clear cell carcinomas (OCCC). 11.2% of OCCC have targetable alterations only in the mTOR pathway. MTOR pathway mutations in OCCC can underlie robust, lasting responses to everolimus.
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Affiliation(s)
- Julia A Elvin
- Foundation Medicine, Inc., Cambridge, MA, United States
| | - Justin Chura
- Cancer Treatment Centers of America at Eastern Regional Medical Center, Philadelphia, PA, United States
| | - Laurie M Gay
- Foundation Medicine, Inc., Cambridge, MA, United States
| | - Maurie Markman
- Cancer Treatment Centers of America at Eastern Regional Medical Center, Philadelphia, PA, United States
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23
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A Review of mTOR Pathway Inhibitors in Gynecologic Cancer. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4809751. [PMID: 28286604 PMCID: PMC5327776 DOI: 10.1155/2017/4809751] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/12/2017] [Indexed: 12/31/2022]
Abstract
The treatment of advanced gynecologic cancers remains palliative in most of cases. Although systemic treatment has entered into the era of targeted drugs the antitumor efficacies of current therapies are still limited. In this context there is a great need for more active treatment and rationally designed targeted therapies. The PI3K/AKT/mTOR is a signaling pathway in mammal cells that coordinates important cell activities. It has a critical function in the survival, growth, and proliferation of malignant cells and was object of important research in the last two decades. The mTOR pathway emerges as an attractive therapeutic target in cancer because it serves as a convergence point for many growth stimuli and, through its downstream substrates, controls cellular processes that contribute to the initiation and maintenance of cancer. Aberrant PI3K-dependent signaling occurs frequently in a wide range of tumor types, including endometrial, cervical, and ovarian cancers. The present study reviewed the available evidence regarding the potential impact of some mTOR pathway inhibitors in the treatment of gynecological cancer. Few advances in medical management have occurred in recent years in the treatment of advanced or recurrent gynecological malignancies, and a poor prognosis remains. Rationally designed molecularly targeted therapy is an emerging and important option in this setting; then more investigation in PI3K/AKT/mTOR pathway-targeted therapies is warranted.
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24
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Packer LM, Geng X, Bonazzi VF, Ju RJ, Mahon CE, Cummings MC, Stephenson SA, Pollock PM. PI3K Inhibitors Synergize with FGFR Inhibitors to Enhance Antitumor Responses in FGFR2 mutant Endometrial Cancers. Mol Cancer Ther 2017; 16:637-648. [PMID: 28119489 DOI: 10.1158/1535-7163.mct-16-0415] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/01/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022]
Abstract
Improved therapeutic approaches are needed for the treatment of recurrent and metastatic endometrial cancer. Endometrial cancers display hyperactivation of the MAPK and PI3K pathways, the result of somatic aberrations in genes such as FGFR2, KRAS, PTEN, PIK3CA, and PIK3R1 The FGFR2 and PI3K pathways, have emerged as potential therapeutic targets in endometrial cancer. Activation of the PI3K pathway is seen in more than 90% of FGFR2mutant endometrial cancers. This study aimed to examine the efficacy of the pan-FGFR inhibitor BGJ398 with pan-PI3K inhibitors (GDC-0941, BKM120) and the p110α-selective inhibitor BYL719. We assessed synergy in three FGFR2mutant endometrial cancer cell lines (AN3CA, JHUEM2, and MFE296), and the combination of BGJ398 and GDC-0941 or BYL719 showed strong synergy. A significant increase in cell death and decrease in long-term survival was seen when PI3K inhibitors were combined with BGJ398. Importantly, these effects were seen at low concentrations correlating to only partial inhibition of AKT. The combination of BGJ398 and GDC-0941 showed tumor regressions in vivo, whereas each drug alone only showed moderate tumor growth inhibition. BYL719 alone resulted in increased tumor growth of AN3CA xenografts but in combination with BGJ398 resulted in tumor regression in both AN3CA- and JHUEM2-derived xenografts. These data provide evidence that subtherapeutic doses of PI3K inhibitors enhance the efficacy of anti-FGFR therapies, and a combination therapy may represent a superior therapeutic treatment in patients with FGFR2mutant endometrial cancer. Mol Cancer Ther; 16(4); 637-48. ©2017 AACR.
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Affiliation(s)
- Leisl M Packer
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Xinyan Geng
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Vanessa F Bonazzi
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Robert J Ju
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Clare E Mahon
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Margaret C Cummings
- School of Medicine, University of Queensland Centre for Clinical Research, Queensland, Australia
| | - Sally-Anne Stephenson
- Eph Receptor Biology Group, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia
| | - Pamela M Pollock
- Endometrial Cancer Laboratory, Queensland University of Technology (QUT), Translational Research Institute, Queensland, Australia.
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25
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Gupta D. Clinical Behavior and Treatment of Endometrial Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 943:47-74. [PMID: 27910064 DOI: 10.1007/978-3-319-43139-0_2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Endometrial cancer is the most common gynecologic malignancy diagnosed in women in the developed nations. It affects a disproportionate number of reproductive-aged women. While the overall prognosis is good compared to other cancers affecting women, the pathogenesis and clinical behavior of endometrial cancer are heterogeneous. The risk factors associated with the type I and type II endometrial cancers and their pathogenesis will be discussed, as well as the evaluation and primary treatment of women with endometrial cancer. The chapter will also focus on risk stratification for recurrence after surgery and role of adjuvant treatments. Finally, the treatment of recurrent endometrial cancer will be presented.
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Affiliation(s)
- Divya Gupta
- University of Connecticut, St. Francis Hospital & Medical Center, Comprehensive Women's Health Center, 114 Woodland Hospital, Hartford, CT, 06105, USA.
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26
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Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:14. [PMID: 27999680 PMCID: PMC5154099 DOI: 10.1186/s40661-016-0035-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/22/2016] [Indexed: 01/13/2023]
Abstract
Endometrial carcinoma (EC) is the fourth most common cancer in women in the developed world. Classification of ECs by histomorphologic criteria has limited reproducibility and better tools are needed to distinguish these tumors and enable a subtype-specific approach to research and clinical care. Based on the Cancer Genome Atlas, two research teams have developed pragmatic molecular classifiers that identify four prognostically distinct molecular subgroups. These methods can be applied to diagnostic specimens (e.g., endometrial biopsy) with the potential to completely change the current risk stratification systems and enable earlier informed decision making. The evolution of genomic classification in ECs is shared herein, as well as potential applications and discussion of the essential research still needed in order to optimally integrate molecular classification in to current standard of care.
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Affiliation(s)
- A Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC Canada
| | - J N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, 2775 Laurel St. 6th Floor, Vancouver, BC Canada V5Z 1M9
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27
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Bestvina CM, Fleming GF. Chemotherapy for Endometrial Cancer in Adjuvant and Advanced Disease Settings. Oncologist 2016; 21:1250-1259. [PMID: 27412393 PMCID: PMC5061541 DOI: 10.1634/theoncologist.2016-0062] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022] Open
Abstract
: Level I evidence exists for use of adjuvant chemotherapy in stage IIIC endometrial cancer (positive lymph nodes), although results of randomized trials have varied. Chemotherapy is also often recommended for high-risk subsets of stage I disease, such as serous carcinomas, although prospective trial data to validate this practice are lacking. Carboplatin plus paclitaxel is the current standard regimen, based on extrapolation of data from the metastatic setting. Several clinical trials have compared adjuvant pelvic radiotherapy alone to a combination of radiotherapy and chemotherapy with mixed results. One of the largest of these trials, Postoperative Radiation Therapy in Endometrial Carcinoma 3 (PORTEC-3), has completed accrual and is awaiting data maturation. Metastatic disease is not curable. For tumors of low-grade endometrioid histology with a prolonged time to recurrence, endocrine therapy with a progestin-based regimen is appropriate. Chemotherapy will be used in most other cases, and the standard first-line regimen is carboplatin and paclitaxel. Few chemotherapy agents have been shown to produce meaningful response rates in the second-line setting. Molecularly targeted therapies such as mTOR inhibitors and antiangiogenic agents including bevacizumab have been studied but their role in the armamentarium remains uncertain. IMPLICATIONS FOR PRACTICE Following surgical resection and staging for endometrial cancer, adjuvant chemotherapy with carboplatin and paclitaxel can be administered to patients with a high risk for recurrence. This includes patients with stage IIIC disease with positive lymph nodes, and high-risk subsets of stage I disease such as serous carcinomas. In the metastatic setting, endocrine therapy can be considered, particularly for patients with lower-grade disease and a prolonged time to recurrence. Combined therapy with carboplatin and paclitaxel is the standard of care used for front-line chemotherapy. Antiangiogenic agents are clearly active, but how they should be integrated into treatment is not yet determined. Immunotherapy is a promising direction for patients with mismatch repair-deficient or polymerase ε-mutated tumors.
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28
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Lheureux S, Oza AM. Endometrial cancer—targeted therapies myth or reality? Review of current targeted treatments. Eur J Cancer 2016; 59:99-108. [DOI: 10.1016/j.ejca.2016.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 12/30/2022]
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29
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Del Campo JM, Birrer M, Davis C, Fujiwara K, Gollerkeri A, Gore M, Houk B, Lau S, Poveda A, González-Martín A, Muller C, Muro K, Pierce K, Suzuki M, Vermette J, Oza A. A randomized phase II non-comparative study of PF-04691502 and gedatolisib (PF-05212384) in patients with recurrent endometrial cancer. Gynecol Oncol 2016; 142:62-69. [PMID: 27103175 DOI: 10.1016/j.ygyno.2016.04.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/12/2016] [Accepted: 04/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE PF-04691502 and gedatolisib (PF-05212384) are potent, dual PI3K/mTOR inhibitors. This phase II study (B1271004) was conducted in patients with recurrent endometrial cancer following platinum-containing chemotherapy. The primary endpoint was to assess clinical benefit response (complete or partial response, or stable disease for ≥16weeks) following treatment with PF-04691502 or gedatolisib. METHODS The main study consisted of four independent arms based on a Simon two-stage design. Patients were assigned to putative PI3K-basal (PF-04691502 or gedatolisib) or PI3K-activated (PF-04691502 or gedatolisib) arms based on stathmin-low or stathmin-high tumor expression, respectively. Japanese patients were also enrolled in a separate lead-in cohort. RESULTS In stage 1 (main study), eighteen patients were randomized to PF-04691502 and 40 to gedatolisib. The two PF-04691502 arms were discontinued early due to unacceptable toxicity, including pneumonia and pneumonitis. The most common treatment-related adverse events associated with gedatolisib were nausea (53%), mucosal inflammation (50%), decreased appetite (40%), diarrhea (38%), fatigue (35%), and dysgeusia and vomiting (each 30%). Clinical benefit response rate was 53% (10/19) in the gedatolisib/stathmin-low arm and 26% (5/19) in the gedatolisib/stathmin-high arm. Safety profile and pharmacokinetic characteristics of both drugs in the Japanese lead-in cohort were comparable to the Western population. CONCLUSIONS Gedatolisib administered by weekly intravenous infusion demonstrated acceptable tolerability and moderate activity in patients with recurrent endometrial cancer. PF-04691502 daily oral dosing was not well tolerated. Clinical benefit response criteria for proceeding to stage 2 were only met in the gedatolisib/stathmin-low arm. Stathmin-high expression did not correlate with greater treatment efficacy. ClinicalTrials.gov registration ID: NCT01420081.
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Affiliation(s)
- Josep María Del Campo
- Vall d'Hebron Institute of Oncology (VHIO), Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain.
| | - Michael Birrer
- Massachusetts General Hospital, 55 Fruit St # 410, Boston, MA 02114, USA.
| | - Craig Davis
- Pfizer Oncology, 10646 Science Center Drive, La Jolla, CA 92121, USA.
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.
| | - Ashwin Gollerkeri
- Pfizer Worldwide Research and Development, 35 Cambridge Park Drive, Cambridge, MA 02140, USA.
| | - Martin Gore
- Royal Marsden Hospital, 203 Fullham Road, London SW3 6JJ, UK.
| | - Brett Houk
- Pfizer Oncology, 10646 Science Center Drive, La Jolla, CA 92121, USA
| | - Susie Lau
- McGill University, Jewish General Hospital, 3755 Chemin Cote Ste Catherine, Montreal, QC H3R 1E2, Canada.
| | - Andres Poveda
- Fundación Instituto Valenciano de Oncología, C/ Gregorio Gea, 31, Valencia 46009, Spain.
| | - Antonio González-Martín
- M. D. Anderson Cancer Center, Servicio de Oncologia Medica C/ Arturo Soria, 270, Madrid 28033, Spain.
| | - Carolyn Muller
- University of New Mexico Health Sciences Center, MSC07 4025 1201 Camino de Salud Northeast, Albuquerque, NM 87131, USA.
| | - Kei Muro
- Aichi Cancer Center Hospital, 1-1 Kanododen, Chikusa-ku, Nagoya, Aichi 464-8681, Japan.
| | - Kristen Pierce
- Pfizer Oncology, 558 Eastern Point Rd, Groton, CT 06340, USA.
| | - Mie Suzuki
- Pfizer Japan, 3-22-7, Yoyogi, Shibuya-ku, Tokyo 151-8589, Japan.
| | - Jennifer Vermette
- Pfizer Oncology, 300 Technology Square, Suite 302, Cambridge, MA 02139, USA.
| | - Amit Oza
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto M5G 2M9, Canada.
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Zhu Y, Shen J, Gao L, Feng Y. Estrogen promotes fat mass and obesity-associated protein nuclear localization and enhances endometrial cancer cell proliferation via the mTOR signaling pathway. Oncol Rep 2016; 35:2391-7. [PMID: 26884084 DOI: 10.3892/or.2016.4613] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/11/2016] [Indexed: 11/05/2022] Open
Abstract
Extensive exposure to estrogen is generally acknowledged as a risk factor for endometrial cancer. Given that the accumulation of adipocytes also contributes to the increased production of estrogen, in the present study, we evaluated the expression of the fat mass and obesity-associated (FTO) gene in endometrial tumor tissues and further explored the mechanism of how estrogen facilitates FTO nuclear localization and promotes endometrial cancer cell proliferation. Immunohistochemical (IHC) staining assay was used to detect the FTO expression in endometrial tumor samples. Western blotting was performed to investigate the mechanism of estrogen-induced FTO nuclear localization. siRNA was used to knock down ERα and further explore its role in FTO nuclear localization. MTT assay was carried out to determine cell proliferation. We found that FTO was overexpressed in endometrial carcinoma tissues and served as a poor prognostic marker. Additionally, estrogen induced FTO nuclear accumulation via the mTOR signaling pathway and the nuclear localization was ERα-dependent, which contributed to enhanced proliferative activity. Therefore, the present study provides new insight into the mechanisms of estrogen-induced proliferation, implying the possibility of using FTO as a potential therapeutic target for the treatment of endometrial cancer.
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Affiliation(s)
- Yaping Zhu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai 200080, P.R. China
| | - Jiaqi Shen
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai 200080, P.R. China
| | - Liyan Gao
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai 200080, P.R. China
| | - Youji Feng
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai 200080, P.R. China
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Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016; 26:2-30. [PMID: 26645990 PMCID: PMC4679344 DOI: 10.1097/igc.0000000000000609] [Citation(s) in RCA: 441] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
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Affiliation(s)
- Nicoletta Colombo
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Carien Creutzberg
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Frederic Amant
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Tjalling Bosse
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Antonio González-Martín
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Jonathan Ledermann
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Christian Marth
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Remi Nout
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Denis Querleu
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Mansoor Raza Mirza
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Cristiana Sessa
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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Emons G, Kurzeder C, Schmalfeldt B, Neuser P, de Gregorio N, Pfisterer J, Park-Simon TW, Mahner S, Schröder W, Lück HJ, Heubner ML, Hanker L, Thiel F, Hilpert F. Temsirolimus in women with platinum-refractory/resistant ovarian cancer or advanced/recurrent endometrial carcinoma. A phase II study of the AGO-study group (AGO-GYN8). Gynecol Oncol 2015; 140:450-6. [PMID: 26731724 DOI: 10.1016/j.ygyno.2015.12.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/17/2015] [Accepted: 12/24/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate activity and toxicity of mTOR inhibitor temsirolimus in patients with platinum-refractory/resistant ovarian cancer (OC) or advanced/recurrent endometrial carcinoma (EC). METHODS Women with epithelial ovarian, fallopian tube or primary peritoneal cancer were eligible, when they had progression during treatment with a platinum based regimen or within 6 months after receiving a platinum based regimen and a previous taxane treatment. Women with advanced/recurrent EC, no longer amenable to curative surgery and/or radiotherapy were eligible when they had no previous or only adjuvant chemotherapy. Preceding endocrine therapy for metastatic/recurrent disease was allowed. Patients received weekly IV infusions of 25mg temsirolimus. Primary endpoint was progression free survival rate after 4 months (OC) or 6 months (EC). A two stage design was applied. RESULTS Forty-four patients (OC: n=22; EC: n=22) were enrolled and received temsirolimus treatment. Median age was 56 years (OC) or 63 years (EC). After eight weeks of treatment, 10 of 21 evaluable patients in the OC cohort and 8 of 20 evaluable patients in the EC cohort had progressive disease. Thus efficacy did not meet the predefined levels during the first stage of recruitment and the trial was stopped. Some patients in both cohorts had long lasting PFS (>7 months). Toxicity of temsirolimus was mild. CONCLUSIONS Temsirolimus treatment was well tolerated in our patients, but did not meet the predefined efficacy criteria. In our study as in other trials on rapalogs in OC or EC, a few patients had long lasting disease stabilisations.
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Affiliation(s)
- Günter Emons
- Klinikum Göttingen, Georg-August-Universität, Universitäts-Frauenklinik, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Christian Kurzeder
- Kliniken Essen Mitte, Evang. Huyssens Stiftung/Knappschaft GmbH, Gynäkologische Onkologie, Henricistraße 92, 45136 Essen, Germany.
| | - Barbara Schmalfeldt
- Klinikum rechts der Isar der Technischen Universität, Frauen- und Poliklinik, Ismaningerstr. 22, 81675 München, Germany.
| | - Petra Neuser
- Koordinierungszentrum für Klinische Studien (KKS), Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany.
| | - Nikolaus de Gregorio
- Universitätsklinikum Ulm, Universitätsfrauenklinik, Prittwitzstr. 43, 89075 Ulm, Germany.
| | - Jacobus Pfisterer
- Städtisches Klinikum Solingen, Klinik für Gynäkologie und Geburtshilfe, Gotenstraße 1, 42653 Solingen, Germany.
| | - Tjoung-Won Park-Simon
- Medizinische Hochschule Hannover, Frauenklinik, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Sven Mahner
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie, Martinistraße 52, 20246, Hamburg, Germany.
| | - Willibald Schröder
- GYNAEKOLOGIKUM Bremen, Praxisklinik für Gynäkologische Onkologie und Operative Gynäkologie, Schwachhauser Heerstr. 367, 28211, Bremen, Germany.
| | - Hans-Joachim Lück
- Gynäkologisch-onkologische Praxis, Pelikanplatz 23, 30177 Hannover, Germany.
| | - Martin Leonhard Heubner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Hufelandstr. 55, 45147 Essen, Germany.
| | - Lars Hanker
- Klinikum der J. W. Goethe-Universität, Zentrum für Frauenheilkunde und Geburtshilfe, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Falk Thiel
- Universität Erlangen-Nürnberg, Klinik für Frauenheilkunde, Universitätsstr. 21-23, 91054 Erlangen, Germany.
| | - Felix Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany,.
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Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C, Altundag O, Amant F, van Leeuwenhoek A, Banerjee S, Bosse T, Casado A, de Agustín L, Cibula D, Colombo N, Creutzberg C, del Campo JM, Emons G, Goffin F, González-Martín A, Greggi S, Haie-Meder C, Katsaros D, Kesic V, Kurzeder C, Lax S, Lécuru F, Ledermann J, Levy T, Lorusso D, Mäenpää J, Marth C, Matias-Guiu X, Morice P, Nijman H, Nout R, Powell M, Querleu D, Mirza M, Reed N, Rodolakis A, Salvesen H, Sehouli J, Sessa C, Taylor A, Westermann A, Zeimet A. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015; 27:16-41. [PMID: 26634381 DOI: 10.1093/annonc/mdv484] [Citation(s) in RCA: 718] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy
| | - C Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Amant
- Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A González-Martín
- Department of Medical Oncology, GEICO Cancer Center, Madrid Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - C Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - R Nout
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France Department of Gynecology and Obstetrics, McGill University Health Centre, Montreal, Canada
| | - M R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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ESMO–ESGO–ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Radiother Oncol 2015; 117:559-81. [DOI: 10.1016/j.radonc.2015.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
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Depreeuw J, Hermans E, Schrauwen S, Annibali D, Coenegrachts L, Thomas D, Luyckx M, Gutierrez-Roelens I, Debruyne D, Konings K, Moerman P, Vergote I, Lambrechts D, Amant F. Characterization of patient-derived tumor xenograft models of endometrial cancer for preclinical evaluation of targeted therapies. Gynecol Oncol 2015; 139:118-26. [DOI: 10.1016/j.ygyno.2015.07.104] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/10/2015] [Accepted: 07/25/2015] [Indexed: 01/17/2023]
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Deregulation of the EGFR/PI3K/PTEN/Akt/mTORC1 pathway in breast cancer: possibilities for therapeutic intervention. Oncotarget 2015; 5:4603-50. [PMID: 25051360 PMCID: PMC4148087 DOI: 10.18632/oncotarget.2209] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3 pathway plays prominent roles in malignant transformation, prevention of apoptosis, drug resistance and metastasis. The expression of this pathway is frequently altered in breast cancer due to mutations at or aberrant expression of: HER2, ERalpha, BRCA1, BRCA2, EGFR1, PIK3CA, PTEN, TP53, RB as well as other oncogenes and tumor suppressor genes. In some breast cancer cases, mutations at certain components of this pathway (e.g., PIK3CA) are associated with a better prognosis than breast cancers lacking these mutations. The expression of this pathway and upstream HER2 has been associated with breast cancer initiating cells (CICs) and in some cases resistance to treatment. The anti-diabetes drug metformin can suppress the growth of breast CICs and herceptin-resistant HER2+ cells. This review will discuss the importance of the EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3 pathway primarily in breast cancer but will also include relevant examples from other cancer types. The targeting of this pathway will be discussed as well as clinical trials with novel small molecule inhibitors. The targeting of the hormone receptor, HER2 and EGFR1 in breast cancer will be reviewed in association with suppression of the EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3 pathway.
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Mutation profile and clinical outcome of mixed endometrioid-serous endometrial carcinomas are different from that of pure endometrioid or serous carcinomas. Virchows Arch 2015; 466:415-22. [DOI: 10.1007/s00428-015-1728-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/17/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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Matulonis U, Vergote I, Backes F, Martin LP, McMeekin S, Birrer M, Campana F, Xu Y, Egile C, Ghamande S. Phase II study of the PI3K inhibitor pilaralisib (SAR245408; XL147) in patients with advanced or recurrent endometrial carcinoma. Gynecol Oncol 2014; 136:246-53. [PMID: 25528496 DOI: 10.1016/j.ygyno.2014.12.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/02/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with endometrial carcinoma who progress after first-line chemotherapy have a poor prognosis. Phosphoinositide 3-kinase (PI3K) inhibitors are investigational treatment options in this setting. This study evaluated the efficacy and safety of the PI3K inhibitor pilaralisib (SAR245408; XL147) in advanced or recurrent endometrial carcinoma. METHODS This Phase II, multicenter, single-arm, open-label study enrolled patients with histologically confirmed advanced or recurrent endometrial carcinoma, who had received one or two prior chemotherapy regimens. Patients received pilaralisib 600mg capsules or 400mg tablets once daily. Primary endpoints were objective response rate (ORR), proportion of patients with progression-free survival (PFS) >6months and safety. Molecular profiling in archival tumor tissue and circulating tumor DNA were performed to identify molecular markers associated with response or resistance to pilaralisib. RESULTS 67 patients were enrolled, of which 50 and 17 patients had received one or two prior regimens, respectively. Complete or partial tumor responses occurred in two patients each (ORR 6.0%); three had tumors with normal PTEN expression and PIK3R1 mutations and one had a tumor with PTEN protein deficiency. However, there was no association between molecular alterations and clinical activity. Rate of PFS>6months was 11.9%. The most commonly reported treatment-related adverse events (AEs) were rash (40.3%), diarrhea (37.3%) and fatigue (28.4%). The most commonly reported treatment-related grade ≥3 AEs were rash (9.0%), diarrhea (4.5%) and increased alanine aminotransferase (4.5%). CONCLUSIONS Pilaralisib was associated with a favorable safety profile and minimal antitumor activity in advanced or recurrent endometrial carcinoma.
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Affiliation(s)
| | - Ignace Vergote
- Leuven Cancer Institute, Leuven, European Union, Belgium
| | | | | | - Scott McMeekin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael Birrer
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Yi Xu
- Sanofi, Cambridge, MA, USA
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Lopez S, Schwab CL, Cocco E, Bellone S, Bonazzoli E, English DP, Schwartz PE, Rutherford T, Angioli R, Santin AD. Taselisib, a selective inhibitor of PIK3CA, is highly effective on PIK3CA-mutated and HER2/neu amplified uterine serous carcinoma in vitro and in vivo. Gynecol Oncol 2014; 135:312-7. [PMID: 25172762 PMCID: PMC4270135 DOI: 10.1016/j.ygyno.2014.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the efficacy of taselisib, a selective inhibitor of PIK3CA, against primary uterine serous carcinomas (USC) harboring PIK3CA mutations and HER2/neu gene amplification. METHODS Sensitivity to taselisib was evaluated by flow-cytometry viability assays in vitro against nine primary USC cell lines. Cell cycle distribution and downstream signaling were assessed by measuring the DNA content of cells and by phosphorylation of the S6 protein by flow-cytometry. Preclinical efficacy of taselisib was also evaluated in vivo in a mouse model. RESULTS Four USC cell lines harbored HER2/neu gene amplification by FISH and two of them harbored oncogenic PIK3CA mutations. Taselisib caused a strong differential growth inhibition in both HER2/neu FISH positive and HER2/neu FISH positive/PIK3CA mutated USC cell lines when compared to lines that were FISH negative and PIK3CA wild type (taselisib IC50 mean±SEM=0.042±0.006μM in FISH+ versus 0.38±0.06μM in FISH-tumors, P<0.0001). Taselisib growth-inhibition was associated with a significant and dose-dependent increase in the percentage of cells in the G0/G1 phase of the cell cycle and dose-dependent decline in the phosphorylation of S6. Taselisib was highly active at reducing tumor growth in vivo in USC mouse xenografts harboring PIK3CA mutation and overexpressing HER2/neu (P=0.007). Mice treated with taselisib had significantly longer survival when compared to control mice (P<0.0001). CONCLUSIONS Taselisib represents a novel therapeutic option in patients harboring PIK3CA mutations and/or HER2/neu gene amplification.
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Affiliation(s)
- Salvatore Lopez
- Division of Gynecologic Oncology, University Campus Bio-Medico of Roma, Via Alvaro del Portillo 21, 00144 Roma, Italy
| | - Carlton L Schwab
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Emiliano Cocco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Stefania Bellone
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Diana P English
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Thomas Rutherford
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
| | - Roberto Angioli
- Division of Gynecologic Oncology, University Campus Bio-Medico of Roma, Via Alvaro del Portillo 21, 00144 Roma, Italy
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA.
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Abstract
ObjectivesType II endometrial carcinomas—uterine carcinosarcomas or uterine malignant mesodermal mixed tumors (UMMMTs), clear cell carcinomas (UCCs), and uterine serous carcinomas (USCs)—are aggressive malignancies that present with advanced disease and have high mortality rates.PIK3CAmutations are commonly found in endometrial cancers. The objective of the study was to characterize molecular alterations in thePIK3CAgene in these tumors.MethodsA total of 84 cases (20 UMMMTs, 18 UCCs, and 46 USCs) were selected from the surgical pathology files of Weill Cornell Medical College and Johns Hopkins Hospital. The diagnoses were confirmed by gynecologic pathologists (L.H.E. and A.Y.). DNA was extracted from paraffin-embedded tissue. Polymerase chain reaction was performed for mutational analysis. All the studies were performed in accordance with approved Institutional Review Board protocols.ResultsMutations in thePIK3CAgene were identified in 3 (15%) of 20 UMMMT, 3 (16.7%) of 18 UCC, and 10 (21.7%) of 46 USC cases. We report novel mutations inPIK3CAin uterine carcinosarcoma.ConclusionsA significant percentage of UMMMTs, UCCs, and USCs have mutations inPIK3CA. Further investigation is needed to develop targeted therapies for these aggressive uterine cancers.
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Lheureux S, Wilson M, Mackay HJ. Recent and current Phase II clinical trials in endometrial cancer: review of the state of art. Expert Opin Investig Drugs 2014; 23:773-92. [DOI: 10.1517/13543784.2014.907272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fleming GF, Filiaci VL, Marzullo B, Zaino RJ, Davidson SA, Pearl M, Makker V, Burke JJ, Zweizig SL, Van Le L, Hanjani P, Downey G, Walker JL, Reyes HD, Leslie KK. Temsirolimus with or without megestrol acetate and tamoxifen for endometrial cancer: a gynecologic oncology group study. Gynecol Oncol 2014; 132:585-92. [PMID: 24456823 DOI: 10.1016/j.ygyno.2014.01.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the response, toxicities, and progression free survival of a regimen of temsirolimus with or without hormonal therapy in the treatment of advanced, or recurrent endometrial carcinoma. BACKGROUND Preclinical evidence suggested that blockade of the PI3K/AKT/mTOR pathway might overcome resistance to hormonal therapy. METHODS We performed a randomized phase II trial of intravenous temsirolimus 25mg weekly versus the combination of weekly temsirolimus with a regimen of megestrol acetate 80 mg bid for three weeks alternating with tamoxifen 20mg bid for three weeks in women with recurrent or metastatic endometrial carcinoma. RESULTS There were 71 eligible patients who received at least one dose of therapy with 21 of these treated on the combination arm which was closed early because of an excess of venous thrombosis, with 5 episodes of deep venous thrombosis (DVT) and 2 pulmonary emboli. There were three responses observed in that arm (14%). A total of 50 eligible patients were treated on the single agent arm with 3 episodes of DVT and 11 responses (22%). Response rates were similar in patients with prior chemotherapy (7 of 29; 24%) and those with no prior chemotherapy (4 of 21; 19%). Two of four patients with clear cell carcinoma responded. CONCLUSIONS Adding the combination of megestrol acetate and tamoxifen to temsirolimus therapy did not enhance activity and the combination was associated with an excess of venous thrombosis. Temsirolimus activity was preserved in patients with prior adjuvant chemotherapy.
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Affiliation(s)
- Gini F Fleming
- University of Chicago, Chicago, IL 60637, United States.
| | - Virginia L Filiaci
- Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| | - Brandon Marzullo
- Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| | - Richard J Zaino
- Hershey Medical Center, Medical Center of Pennsylvania State University, Hershey, PA 17033, United States
| | - Susan A Davidson
- University of Colorado Cancer Center - Anschutz Cancer Pavilion, Aurora, CO 80045, United States
| | - Michael Pearl
- Stony Brook University Hospital, Stony Brook, NY 11794, United States
| | - Vicky Makker
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, United States
| | - James J Burke
- Memorial Medical Center, Savannah, GA 31404, United States
| | - Susan L Zweizig
- UMass Memorial Medical Center, Worcester, MA 01605, United States
| | - Linda Van Le
- UNC-Chapel Hill, Chapel Hill, NC 27599, United States
| | - Parviz Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington, PA 19001, United States
| | - Gordon Downey
- Gynecologic Oncology of West Michigan, Grand Rapids, MI 49546, United States
| | - Joan L Walker
- University of Oklahoma, Oklahoma City, OK 73190, United States
| | - Henry D Reyes
- University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Kimberly K Leslie
- University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
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