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Wetterwald L, Riggi N, Kyriazoglou A, Dei Tos G, Dei Tos A, Digklia A. Clear cell sarcoma: state-of-the art and perspectives. Expert Rev Anticancer Ther 2023; 23:235-242. [PMID: 36811446 DOI: 10.1080/14737140.2023.2183846] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Clear cell sarcoma (CCS) is an ultrarare soft tissue sarcoma (STS) with a poor prognosis due to its propensity to metastasize and its low chemosensitivity. The standard treatment of localized CCS consists of wide surgical excision with or without additive radiotherapy. However, unresectable CCS is generally treated with conventional systemic therapies available for treatment of STS despite the weak scientific evidence to support its use. AREAS COVERED In this review, we discuss the clinicopathologic characteristics of CSS, as well as the current treatment landscape and future therapeutic approaches. EXPERT OPINION The current treatment strategy of advanced CCSs, based on STSs regimens, shows a lack of effective options. Combination therapiesin particular, the association of immunotherapy and TKIs, represent a promising approach. Translational studies are needed in order to decipher the regulatory mechanisms involved in the oncogenesis of this ultrarare sarcoma and identify potential molecular targets.
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Affiliation(s)
- Laureline Wetterwald
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - Nicolò Riggi
- Experimental Pathology, Institute of Pathology, Lausanne University Lausanne, Switzerland
| | | | - Giovanni Dei Tos
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - Angelo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova Padua, Italy.,Department of Medicine, University of Padua School of Medicine Padua, Italy
| | - Antonia Digklia
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland.,Sarcoma Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
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2
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Liu Y, Wang K, Zhou Y, Zhuang X, Shao S, Qiao F, Wang X, Zou X, Qiao T. Single-cell analyses reveal the therapeutic effects of ATHENA and its mechanism in a rhabdomyosarcoma patient. Front Oncol 2022; 12:1039145. [PMID: 36523982 PMCID: PMC9745782 DOI: 10.3389/fonc.2022.1039145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/14/2022] [Indexed: 09/10/2024] Open
Abstract
Background Whole-cell tumor vaccines tend to suffer from low immunogenicity. Our previous study showed that irradiated lung cancer cell vaccines in mouse models enhance antitumor efficacy by eliciting an intensive T cells response and improving immunogenicity. Based on these findings, we developed an improved whole-cell tumor vaccine, Autologous Tumor Holo antigEn immuNe Activation (ATHENA). Methods In this study, we report the successful treatment of a 6-year-old male diagnosed with meningeal rhabdomyosarcoma with pulmonary and liver metastases using ATHENA. After 6 cycles of therapy, PET/CT showed the therapeutic efficacy of ATHENA. We profiled the immune response by single-cell RNA sequencing (scRNA-seq). Flow cytometry analysis was implemented to validate the status transitions of CD8+ T cells. Results In CD8+ T cells, the exhausted status was weakened after treatment. The exhausted CD4+ T cells shifted towards the central memory phenotype after the treatment. Breg cells were converted to Plasma or Follicular B cells. Survival analysis for pan-cancer and transcription factor analysis indicated that such T cell and B cell transitions represent the recovery of antitumoral adaptive immune response. We validated that the proportion of CD279+CD8+ T cells were reduced and the expression of CD44 molecule was upregulated by flow cytometry assay. Conclusion Such studies not only show that ATHENA therapy may be a promising alternative treatment for tumor patients but provide a novel idea to analyses the mechanisms of rare cases or personalized cancer treatment.
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Affiliation(s)
- Yujun Liu
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ke Wang
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yanli Zhou
- Nuclear Medicine Department, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xibing Zhuang
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shali Shao
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Fulu Qiao
- Department of Breast Surgery, Tai’an Central Hospital, Tai’an, China
| | - Xiangdong Wang
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xin Zou
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Tiankui Qiao
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
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3
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Anderson KS, Erick TK, Chen M, Daley H, Campbell M, Colson Y, Mihm M, Zakka LR, Hopper M, Barry W, Winer EP, Dranoff G, Overmoyer B. The feasibility of using an autologous GM-CSF-secreting breast cancer vaccine to induce immunity in patients with stage II-III and metastatic breast cancers. Breast Cancer Res Treat 2022; 194:65-78. [PMID: 35482127 PMCID: PMC9046531 DOI: 10.1007/s10549-022-06562-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/02/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The antigenic targets of immunity and the role of vaccination in breast cancer are unknown. We performed a phase I study of an autologous GM-CSF-secreting breast cancer vaccine in patients with metastatic and stage II-III breast cancer. METHODS Tumor cells from patients with metastatic (n = 15) and stage II-III (n = 7) disease were transduced with a replication-defective adenoviral vector encoding GM-CSF, and then irradiated. Twelve and seven patients with metastatic and stage II-III disease, respectively, received weekly vaccination for three weeks, followed by every other week until disease progression or vaccine supply was exhausted (metastatic) or until six total vaccine doses were administered (stage II-III). RESULTS Among those patients with metastatic disease who received vaccinations, eight had progressive disease at two months, three had stable disease for 4-13 months, and one has had no evidence of disease for 13 years. Of the patients with stage II-III disease, five died of metastatic disease between 1.16 and 8.49 years after the start of vaccinations (median 6.24 years) and two are alive as of September 2021. Toxicities included injection site reactions, fatigue, fever, upper respiratory symptoms, joint pain, nausea, and edema. Four of five evaluable patients with metastatic disease developed a skin reaction with immune cell infiltration after the fifth injection of unmodified, irradiated tumor cells. CONCLUSION We conclude that tumor cells can be harvested from patients with metastatic or stage II-III breast cancer to prepare autologous GM-CSF-secreting vaccines that induce coordinated immune responses with limited toxicity. TRIAL REGISTRATION AND DATE OF REGISTRATION: clinicaltrials.gov, NCT00317603 (April 25, 2006) and NCT00880464 (April 13, 2009).
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Affiliation(s)
- Karen S Anderson
- Center for Personalized Diagnostics, School of Life Sciences, Biodesign Institute, Arizona State University, PO Box 876401, Tempe, AZ, 85287-6401, USA.
- Department of Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA.
| | - Timothy K Erick
- Department of Medical Oncology, Dana-Farber Cancer Institute, MB, Boston, USA
| | - Meixuan Chen
- Center for Personalized Diagnostics, School of Life Sciences, Biodesign Institute, Arizona State University, PO Box 876401, Tempe, AZ, 85287-6401, USA
| | - Heather Daley
- Cancer Vaccine Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Margaret Campbell
- Department of Medical Oncology, Dana-Farber Cancer Institute, MB, Boston, USA
| | - Yolonda Colson
- Department of Thoracic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Mihm
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Labib R Zakka
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marika Hopper
- Center for Personalized Diagnostics, School of Life Sciences, Biodesign Institute, Arizona State University, PO Box 876401, Tempe, AZ, 85287-6401, USA
| | - William Barry
- Department of Medical Oncology, Dana-Farber Cancer Institute, MB, Boston, USA
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, MB, Boston, USA
| | - Glenn Dranoff
- Cancer Vaccine Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Beth Overmoyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, MB, Boston, USA
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4
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GM-CSF secreting leukemia cell vaccination for MDS/AML after allogeneic HSCT: a randomized, double-blinded, phase 2 trial. Blood Adv 2022; 6:2183-2194. [PMID: 34807983 PMCID: PMC9006263 DOI: 10.1182/bloodadvances.2021006255] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
Vaccination using irradiated, adenovirus transduced autologous myeloblasts to secrete granulocyte-macrophage colony-stimulating factor (GVAX) early after allogeneic hematopoietic stem cell transplantation (HSCT) can induce potent immune responses. We conducted a randomized phase 2 trial of GVAX after HSCT for myelodysplastic syndrome with excess blasts or relapsed/refractory acute myeloid leukemia. Myeloblasts were harvested before HSCT to generate the vaccine. Randomization to GVAX vs placebo (1:1) was stratified according to disease, transplant center, and conditioning. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and methotrexate. GVAX or placebo vaccination was started between day 30 and 45 if there was engraftment and no GVHD. Vaccines were administered subcutaneously/intradermally weekly × 3, then every 2 weeks × 3. Tacrolimus taper began after vaccine completion. A total of 123 patients were enrolled, 92 proceeded to HSCT, and 57 (GVAX, n = 30; placebo, n = 27) received at least 1 vaccination. No Common Toxicity Criteria grade 3 or worse vaccine-related adverse events were reported, but injection site reactions were more common after GVAX (10 vs 1; P = .006). With a median follow-up of 39 months (range, 9-89 months), 18-month progression-free survival, overall survival, and relapse incidence were 53% vs 55% (P = .79), 63% vs 59% (P = .86), and 30% vs 37% (P = .51) for GVAX and placebo, respectively. Nonrelapse mortality at 18 months was 17% vs 7.7% (P = .18), grade II to IV acute GVHD at 12 months was 34% vs 12% (P = .13), and chronic GVHD at 3 years was 49% vs 57% for GVAX and placebo (P = .26). Reconstitution of T, B, and natural killer cells was not decreased or enhanced by GVAX. There were no differences in serum major histocompatibility chain-related protein A/B or other immune biomarkers between GVAX and placebo. GVAX does not improve survival after HSCT for myelodysplastic syndrome/acute myeloid leukemia. This trial was registered at www.clinicaltrials.gov as #NCT01773395.
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5
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O'Sullivan Coyne G, Naqash AR, Sankaran H, Chen AP. Advances in the management of alveolar soft part sarcoma. Curr Probl Cancer 2021; 45:100775. [PMID: 34284873 DOI: 10.1016/j.currproblcancer.2021.100775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 12/21/2022]
Abstract
Alveolar Soft Part Sarcoma is one of the less commonly diagnosed soft tissue sarcoma subtypes, an infrequent subtype within the already rare category of human malignancy of sarcoma. In this article we will summarize the histopathological features, natural history and distinct molecular and biological features that have become increasingly appreciated with newer technologies and precision oncology. We will discuss the contemporary management of this disease as well as emerging treatment options.
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Affiliation(s)
- Geraldine O'Sullivan Coyne
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Abdul Rafeh Naqash
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Hari Sankaran
- Biometric Research Program, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alice P Chen
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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6
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Sasso MS, Mitrousis N, Wang Y, Briquez PS, Hauert S, Ishihara J, Hubbell JA, Swartz MA. Lymphangiogenesis-inducing vaccines elicit potent and long-lasting T cell immunity against melanomas. SCIENCE ADVANCES 2021; 7:eabe4362. [PMID: 33762337 PMCID: PMC7990326 DOI: 10.1126/sciadv.abe4362] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/22/2021] [Indexed: 05/06/2023]
Abstract
In melanoma, the induction of lymphatic growth (lymphangiogenesis) has long been correlated with metastasis and poor prognosis, but we recently showed it can synergistically enhance cancer immunotherapy and boost T cell immunity. Here, we develop a translational approach for exploiting this "lymphangiogenic potentiation" of immunotherapy in a cancer vaccine using lethally irradiated tumor cells overexpressing vascular endothelial growth factor C (VEGF-C) and topical adjuvants. Our "VEGFC vax" induced extensive local lymphangiogenesis and promoted stronger T cell activation in both the intradermal vaccine site and draining lymph nodes, resulting in higher frequencies of antigen-specific T cells present systemically than control vaccines. In mouse melanoma models, VEGFC vax elicited potent tumor-specific T cell immunity and provided effective tumor control and long-term immunological memory. Together, these data introduce the potential of lymphangiogenesis induction as a novel immunotherapeutic strategy to consider in cancer vaccine design.
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Affiliation(s)
- Maria Stella Sasso
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA.
| | - Nikolaos Mitrousis
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Yue Wang
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Priscilla S Briquez
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Sylvie Hauert
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Jun Ishihara
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Jeffrey A Hubbell
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Melody A Swartz
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA.
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL, USA
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7
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Li X, Wang G, Cai Z, Sun W. Immunotherapeutic strategies for sarcoma: current perspectives. Am J Transl Res 2020; 12:7693-7701. [PMID: 33437354 PMCID: PMC7791481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
There are more than 100 sarcoma subtypes, each of which is uncommon and challenging to diagnose. Most patients with locally advanced and unresectable sarcomas are still treated with cytotoxic chemotherapy and have low long-term survival. Therefore, novel therapeutic methods are needed to improve the prognosis of patients with sarcomas. Immunotherapy is increasingly recognized as have an essential role in the treatment of malignant tumors. Emerging strategies, such as immune checkpoint inhibitors, vaccines, and adoptive cell therapies have been investigated for the treatment of sarcomas. Advances in these immunotherapies have provided a better understanding of how immuno-oncology can be best applied to the treatment of sarcomas, including their potential as adjuvant therapies in combination strategies. In this review, we discuss the immune microenvironment and how it relates to immunoresponsiveness, focusing on the advances in immunotherapy (immune checkpoint inhibitors, vaccines and adoptive cell therapies), the use of which will hopefully lead to improved outcomes for patients with sarcomas.
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Affiliation(s)
- Xueyao Li
- Department of Orthopaedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200080, China
- Puyang People’s Hospital, Xinxiang Medical UniversityXinxiang 453000, Henan, China
| | - Gangyang Wang
- Department of Orthopaedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200080, China
| | - Zhengdong Cai
- Department of Orthopaedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200080, China
| | - Wei Sun
- Department of Orthopaedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200080, China
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8
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Fedorova L, Mudry P, Pilatova K, Selingerova I, Merhautova J, Rehak Z, Valik D, Hlavackova E, Cerna D, Faberova L, Mazanek P, Pavelka Z, Demlova R, Sterba J, Zdrazilova-Dubska L. Assessment of Immune Response Following Dendritic Cell-Based Immunotherapy in Pediatric Patients With Relapsing Sarcoma. Front Oncol 2019; 9:1169. [PMID: 31799177 PMCID: PMC6868036 DOI: 10.3389/fonc.2019.01169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022] Open
Abstract
Monocyte-derived dendritic cell (DC)-based vaccines loaded with tumor self-antigens represent a novel approach in anticancer therapy. We evaluated DC-based anticancer immunotherapy (ITx) in an academic Phase I/II clinical trial for children, adolescent, and young adults with progressive, recurrent, or primarily metastatic high-risk tumors. The primary endpoint was safety of intradermal administration of manufactured DCs. Here, we focused on relapsing high-risk sarcoma subgroup representing a major diagnosis in DC clinical trial. As a part of peripheral blood immunomonitoring, we evaluated quantitative association between basic cell-based immune parameters. Furthermore, we describe the pattern of these parameters and their time-dependent variations during the DC vaccination in the peripheral blood immunograms. The peripheral blood immunograms revealed distinct patterns in particular patients in the study group. As a functional testing, we evaluated immune response of patient T-cells to the tumor antigens presented by DCs in the autoMLR proliferation assay. This analysis was performed with T-cells obtained prior to DC ITx initiation and with T-cells collected after the fifth dose of DCs, demonstrating that the anticancer DC-based vaccine stimulates a preexisting immune response against self-tumor antigens. Finally, we present clinical and immunological findings in a Ewing's sarcoma patient with an interesting clinical course. Prior to DC therapy, we observed prevailing CD8+ T-cell stimulation and low immunosuppressive monocytic myeloid-derived suppressor cells (M-MDSC) and regulatory T-cells (Tregs). This patient was subsequently treated with 19 doses of DCs and experienced substantial regression of metastatic lesions after second disease relapse and was further rechallenged with DCs. In this patient, functional ex vivo testing of autologous T-cell activation by manufactured DC medicinal product during the course of DC ITx revealed that personalized anticancer DC-based vaccine stimulates a preexisting immune response against self-tumor antigens and that the T-cell reactivity persisted for the period without DC treatment and was further boosted by DC rechallenge. Trial Registration Number: EudraCT 2014-003388-39.
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Affiliation(s)
- Lenka Fedorova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia.,Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Peter Mudry
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Katerina Pilatova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia.,Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Iveta Selingerova
- Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Jana Merhautova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdenek Rehak
- Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Nuclear Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Dalibor Valik
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia.,Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Eva Hlavackova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Dasa Cerna
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Lucie Faberova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavel Mazanek
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdenek Pavelka
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Regina Demlova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Jaroslav Sterba
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
| | - Lenka Zdrazilova-Dubska
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czechia.,Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia
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Dyson KA, Stover BD, Grippin A, Mendez-Gomez HR, Lagmay J, Mitchell DA, Sayour EJ. Emerging trends in immunotherapy for pediatric sarcomas. J Hematol Oncol 2019; 12:78. [PMID: 31311607 PMCID: PMC6636007 DOI: 10.1186/s13045-019-0756-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/14/2019] [Indexed: 12/16/2022] Open
Abstract
While promising, immunotherapy has yet to be fully unlocked for the preponderance of cancers where conventional chemoradiation reigns. This remains particularly evident in pediatric sarcomas where standard of care has not appreciably changed in decades. Importantly, pediatric bone sarcomas, like osteosarcoma and Ewing’s sarcoma, possess unique tumor microenvironments driven by distinct molecular features, as do rhabdomyosarcomas and soft tissue sarcomas. A better understanding of each malignancy’s biology, heterogeneity, and tumor microenvironment may lend new insights toward immunotherapeutic targets in novel platform technologies for cancer vaccines and adoptive cellular therapy. These advances may pave the way toward new treatments requisite for pediatric sarcomas and patients in need of new therapies.
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Affiliation(s)
- Kyle A Dyson
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA
| | - Brian D Stover
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA.,Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Florida, PO Box 100298, Gainesville, FL, 32610, USA
| | - Adam Grippin
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA
| | - Hector R Mendez-Gomez
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA
| | - Joanne Lagmay
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Florida, PO Box 100298, Gainesville, FL, 32610, USA
| | - Duane A Mitchell
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA
| | - Elias J Sayour
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida Brain Tumor Immunotherapy Program, Lillian S. Wells Department of Neurosurgery, McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL, 32611, USA. .,Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Florida, PO Box 100298, Gainesville, FL, 32610, USA.
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10
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Duran-Moreno J, Kontogeorgakos V, Koumarianou A. Soft tissue sarcomas of the upper extremities: Maximizing treatment opportunities and outcomes. Oncol Lett 2019; 18:2179-2191. [PMID: 31404317 PMCID: PMC6676724 DOI: 10.3892/ol.2019.10575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumors; they do not even equate to 1% of all malignant tumor cases. One-fifth of all STS occur in the upper extremities, where epithelioid sarcoma, synovial sarcoma, clear cell sarcoma and malignant fibrohistiocytoma are the most frequent subtypes. Surgical resection is the cornerstone of treatment. However, accomplishment of optimal oncological and functional results of STS of the upper extremities may represent a challenge for hand surgeons, due to the complex anatomy. In several cases, preoperative therapies are needed to facilitate tumor resection and improve the oncological outcome. Oligometastatic disease may also be a challenging scenario as curative strategies can be applied. Radiotherapy and chemotherapy are commonly used for this purpose albeit with conflicting evidence. Novel drug combinations have also been approved in the metastatic setting, further improving the quality of life and survival of eligible patients. Thus, prior to any approach, every case should be individually discussed in sarcoma centers with specialized multidisciplinary tumor boards. The aim of the present review was to gather the multidisciplinary experiences of the available therapeutic strategies for STS of the upper extremities.
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Affiliation(s)
- Jose Duran-Moreno
- Hematology Oncology Unit, Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University General Hospital, Athens 12462, Greece
| | - Vasileios Kontogeorgakos
- Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens 12462, Greece
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University General Hospital, Athens 12462, Greece
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11
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Pender A, Jones RL, Pollack S. Optimising Cancer Vaccine Design in Sarcoma. Cancers (Basel) 2018; 11:E1. [PMID: 30577459 PMCID: PMC6356514 DOI: 10.3390/cancers11010001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022] Open
Abstract
Immunotherapeutics are increasingly recognized as a key tool in the armamentarium against malignancy. The success of immune checkpoint-targeting drugs and adoptive cell therapy has refocused attention on the potential anti-cancer effect of eliciting a tumour-specific immunological response. Sarcomas are a rare and diverse group of tumours with a limited prognosis in advanced disease despite systemic therapeutics. Various vaccine strategies including peptide vaccines against cancer testis antigens, dendritic cell vaccines, and viral vectors have been trialled in sarcoma with growing evidence of efficacy. Here, we review the principles of successful vaccine development and how these have been applied thus far to the treatment of sarcoma.
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Affiliation(s)
- Alexandra Pender
- Sarcoma Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
| | - Robin L Jones
- Sarcoma Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
- Division of Clinical Studies, The Institute of Cancer Research, London SW3 6JB, UK.
| | - Seth Pollack
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA.
- Division of Oncology, University of Washington, Seattle, WA 98195, USA.
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Ravindranathan S, Nguyen KG, Kurtz SL, Frazier HN, Smith SG, Koppolu BP, Rajaram N, Zaharoff DA. Tumor-derived granulocyte colony-stimulating factor diminishes efficacy of breast tumor cell vaccines. Breast Cancer Res 2018; 20:126. [PMID: 30348199 PMCID: PMC6198508 DOI: 10.1186/s13058-018-1054-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/25/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although metastasis is ultimately responsible for about 90% of breast cancer mortality, the vast majority of breast-cancer-related deaths are due to progressive recurrences from non-metastatic disease. Current adjuvant therapies are unable to prevent progressive recurrences for a significant fraction of patients with breast cancer. Autologous tumor cell vaccines (ATCVs) are a safe and potentially useful strategy to prevent breast cancer recurrence, in a personalized and patient-specific manner, following standard-of-care tumor resection. Given the high intra-patient and inter-patient heterogeneity in breast cancer, it is important to understand which factors influence the immunogenicity of breast tumor cells in order to maximize ATCV effectiveness. METHODS The relative immunogenicity of two murine breast carcinomas, 4T1 and EMT6, were compared in a prophylactic vaccination-tumor challenge model. Differences in cell surface expression of antigen-presentation-related and costimulatory molecules were compared along with immunosuppressive cytokine production. CRISPR/Cas9 technology was used to modulate tumor-derived cytokine secretion. The impacts of cytokine deletion on splenomegaly, myeloid-derived suppressor cell (MDSC) accumulation and ATCV immunogenicity were assessed. RESULTS Mice vaccinated with an EMT6 vaccine exhibited significantly greater protective immunity than mice vaccinated with a 4T1 vaccine. Hybrid vaccination studies revealed that the 4T1 vaccination induced both local and systemic immune impairments. Although there were significant differences between EMT6 and 4T1 in the expression of costimulatory molecules, major disparities in the secretion of immunosuppressive cytokines likely accounts for differences in immunogenicity between the cell lines. Ablation of one cytokine in particular, granulocyte-colony stimulating factor (G-CSF), reversed MDSC accumulation and splenomegaly in the 4T1 model. Furthermore, G-CSF inhibition enhanced the immunogenicity of a 4T1-based vaccine to the extent that all vaccinated mice developed complete protective immunity. CONCLUSIONS Breast cancer cells that express high levels of G-CSF have the potential to diminish or abrogate the efficacy of breast cancer ATCVs. Fortunately, this study demonstrates that genetic ablation of immunosuppressive cytokines, such as G-CSF, can enhance the immunogenicity of breast cancer cell-based vaccines. Strategies that combine inhibition of immunosuppressive factors with immune stimulatory co-formulations already under development may help ATCVs reach their full potential.
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Affiliation(s)
| | - Khue G Nguyen
- Cell and Molecular Biology Program, University of Arkansas, Fayetteville, AR, USA.,Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Samantha L Kurtz
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Haven N Frazier
- Honors College, University of Arkansas, Fayetteville, AR, USA
| | - Sean G Smith
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.,Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC and North Carolina State University, Raleigh, NC, USA
| | - Bhanu Prasanth Koppolu
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.,Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC and North Carolina State University, Raleigh, NC, USA
| | - Narasimhan Rajaram
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - David A Zaharoff
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA. .,Cell and Molecular Biology Program, University of Arkansas, Fayetteville, AR, USA. .,Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA. .,Honors College, University of Arkansas, Fayetteville, AR, USA. .,Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC and North Carolina State University, Raleigh, NC, USA.
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13
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Molecular Landscape in Alveolar Soft Part Sarcoma: Implications for Molecular Targeted Therapy. Biomed Pharmacother 2018; 103:889-896. [DOI: 10.1016/j.biopha.2018.04.117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022] Open
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14
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Deng G, Hu P, Zhang J, Liu Q, Liang N, Xie J, Qiao L, Luo H, Xu D, Liu F, Yu X, Liu Z, Lv Y, Zhang J. Elevated serum granulocyte-macrophage colony-stimulating factor levels during radiotherapy predict favorable outcomes in lung and esophageal cancer. Oncotarget 2018; 7:85142-85150. [PMID: 27835886 PMCID: PMC5356724 DOI: 10.18632/oncotarget.13202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/26/2016] [Indexed: 01/08/2023] Open
Abstract
The combination of exogenous granulocyte-macrophage colony-stimulating factor (GM-CSF) with radiotherapy (RT) has been demonstrated to strengthen the antitumor immune response. We hypothesized that the variation of GM-CSF during RT was correlated with cancer prognosis. We measured serum levels of GM-CSF and interferon-γ (IFN-γ) before and during RT in 126 unresectable lung and esophageal cancer patients and performed survival analyses. Upregulated GM-CSF levels during RT correlated with longer overall survival (OS) and progression-free survival (PFS). On the other hand, no difference in OS or PFS was seen at different IFN-γ levels. However, the “integrated factor”, computed as the combination of high pre-RT IFN-γ levels and upregulated GM-CSF, correlated with prolonged OS and PFS. Multivariate analyses revealed that GM-CSF levels and the integrated factor were both stronger independent prognostic factors than disease stage. These data demonstrate that GM-CSF levels during RT can be used as a prognostic biomarker for lung and esophageal cancer.
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Affiliation(s)
- Guodong Deng
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Pingping Hu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Jingxin Zhang
- Division of Oncology, Department of Graduate, Weifang Medical College, Weifang 261053, PR China
| | - Qiqi Liu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Ning Liang
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Jian Xie
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Lili Qiao
- Department of Oncology, The Fifth Peoples' Hospital of Jinan, Jinan 250022, PR China
| | - Hui Luo
- Department of Radiation Oncology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Deguo Xu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Fengjun Liu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Xinshuang Yu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Zhen Liu
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Yajuan Lv
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Jiandong Zhang
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
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Dancsok AR, Asleh-Aburaya K, Nielsen TO. Advances in sarcoma diagnostics and treatment. Oncotarget 2018; 8:7068-7093. [PMID: 27732970 PMCID: PMC5351692 DOI: 10.18632/oncotarget.12548] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/29/2016] [Indexed: 01/06/2023] Open
Abstract
The heterogeneity of sarcomas with regard to molecular genesis, histology, clinical characteristics, and response to treatment makes management of these rare yet diverse neoplasms particularly challenging. This review encompasses recent developments in sarcoma diagnostics and treatment, including cytotoxic, targeted, epigenetic, and immune therapy agents. In the past year, groups internationally explored the impact of adding mandatory molecular testing to histological diagnosis, reporting some changes in diagnosis and/or management; however, the impact on outcomes could not be adequately assessed. Transcriptome sequencing techniques have brought forward new diagnostic tools for identifying fusions and/or characterizing unclassified entities. Next-generation sequencing and advanced molecular techniques were also applied to identify potential targets for directed and epigenetic therapy, where preclinical studies reported results for agents active within the receptor tyrosine kinase, mTOR, Notch, Wnt, Hedgehog, Hsp90, and MDM2 signaling networks. At the level of clinical practice, modest developments were seen for some sarcoma subtypes in conventional chemotherapy and in therapies targeting the pathways activated by various receptor tyrosine kinases. In the burgeoning field of immune therapy, sarcoma work is in its infancy; however, elaborate protocols for immune stimulation are being explored, and checkpoint blockade agents advance from preclinical models to clinical studies.
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Affiliation(s)
- Amanda R Dancsok
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karama Asleh-Aburaya
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Torsten O Nielsen
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Sarcoma Disease Site Committee, Canadian Cancer Trials Group
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Marcrom S, De Los Santos JF, Conry RM. Complete response of mediastinal clear cell sarcoma to pembrolizumab with radiotherapy. Clin Sarcoma Res 2017; 7:14. [PMID: 28725344 PMCID: PMC5513342 DOI: 10.1186/s13569-017-0079-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/22/2017] [Indexed: 12/16/2022] Open
Abstract
Background Clear cell sarcoma (CCS) is a rare, aggressive soft tissue sarcoma thought to derive from neural crest and characterized by a 12;22 translocation. The resulting fusion protein directly activates expression of the melanocyte master transcription factor and drives the same down-stream pathways in CCS and melanoma leading to significant clinical parallels between these malignancies. Striking success of immune checkpoint blockade in melanoma has promoted interest in immunotherapy of CCS. Case presentation We report the first complete clinical response of a bulky chest wall recurrence of mediastinal CCS in a young woman to anti-PD1 checkpoint blockade with pembrolizumab combined with standard fractionation radiotherapy to enhance regional control and potentially boost the systemic immune response. The treatment was well tolerated with grade 2 skin toxicity within the range expected with radiation alone. Significant reduction in tumor bulk occurred after only 2 radiation fractions and complete response was achieved at 50 Gray. Conclusion The complete clinical response observed in our patient suggests synergy between concurrent radiotherapy and PD1 blockade in CCS. This case and the striking parallels between CCS and melanoma indicate the need for prospective trials of immune checkpoint blockade combined with radiotherapy in this rare malignancy.
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Affiliation(s)
- Samuel Marcrom
- Department of Radiation Oncology, University of Alabama at Birmingham, 2145 Bonner Way, Birmingham, AL 35243 USA
| | - Jennifer F De Los Santos
- Department of Radiation Oncology, University of Alabama at Birmingham, 2145 Bonner Way, Birmingham, AL 35243 USA
| | - Robert M Conry
- Division of Hematology Oncology, University of Alabama at Birmingham, 2145 Bonner Way, Birmingham, AL 35243 USA
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17
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Zhao C, Gao X, Yang J, Li Z, Cai X, Tan T, Hou T, Yan W, Yang X, Yang C, Liu T, Xiao J. Surgical management and outcome of spinal alveolar soft part sarcoma (ASPA): a case series of five patients and literature review. World J Surg Oncol 2017; 15:39. [PMID: 28166791 PMCID: PMC5294916 DOI: 10.1186/s12957-017-1112-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/01/2017] [Indexed: 01/14/2023] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is a rare entity of soft tissue malignancies with uncommon spinal involvements. Surgical management should be the best choice of cure. Methods Five patients with spinal ASPS were interviewed retrospectively, where data was collected. The relevant literatures were also systematically examined. Thereafter, patient and surgical data were obtained and pooled for prognostic analysis. Results A total of five patients with eight surgeries were reviewed retrospectively, and three patients previously reported were also included. All patients were surgically treated, where five of them underwent additional adjuvant therapies such as chemotherapy, radiotherapy, and targeted therapy in order to manage their local and/or systematic diseases. One patient was lost in follow-up. For the remaining seven patients, the mean follow-up period was 19.7 ± 8.8 months, two succumbed to disease while five were alive at the time of the study. Conclusions Surgical management is shown to be the most important and the most effective treatment strategy for spinal ASPS, whereas adjuvant therapies made little impact. The prognostic factors for spinal ASPS are primary or metastatic lesions, neurological status, disease progression, systematic conditions, and resection approaches.
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Affiliation(s)
- Chenglong Zhao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Xin Gao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Jian Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Zhenxi Li
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Xiaopan Cai
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Tao Tan
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Tianhui Hou
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.,College of Physical Education and Health, East China Normal University, Minhang District, Dongchuan Rd 500#, Shanghai, China
| | - Wangjun Yan
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Xinghai Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Cheng Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Tielong Liu
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Jianru Xiao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
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Treatment of Metastatic, Refractory Alveolar Soft Part Sarcoma: Case Reports and Literature Review of Treatment Options in the Era of Targeted Therapy. J Pediatr Hematol Oncol 2016; 38:e169-72. [PMID: 27164526 DOI: 10.1097/mph.0000000000000571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma is a rare soft tissue sarcoma that is characterized by a pattern of slow growth with metastases to the lung, bone, and brain that is not responsive to conventional cytotoxic chemotherapy. OBSERVATIONS We describe 2 patients, with a combined 19 years of treatment experience including multiple different chemotherapeutic and targeted therapy regimens, surgery, and radiotherapy. We also present a review of the literature regarding treatment options to highlight recent findings. CONCLUSIONS Alveolar soft part sarcoma is an indolent, but persistently progressive disease. Novel therapeutic agents hold promise in its management.
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Abstract
Micrometastatic disease following pulmonary metastasectomy is an ideal setting to test adjuvant immunotherapy, as the efficacy of immunotherapy in experimental models is greatest with the smallest tumor burdens. Although there is not a standard-of-care adjuvant immunotherapy for resected pulmonary metastases, there have been several studies using cytokines and other immunostimulatory molecules in conjunction with metastasectomies in patients with melanoma, renal cell carcinoma, sarcoma, and colorectal cancer, which have provided preliminary data that such adjuvant therapy is feasible and safe and may be useful in the future, following more rigorous testing, as routine therapy to prevent recurrences.
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Affiliation(s)
- Michael A Morse
- Division of Medical Oncology, Duke University Medical Center, MSRB Room 403, Box 3233, Research Drive, Durham, NC 27710, USA.
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20
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Cornillie J, van Cann T, Wozniak A, Hompes D, Schöffski P. Biology and management of clear cell sarcoma: state of the art and future perspectives. Expert Rev Anticancer Ther 2016; 16:839-45. [PMID: 27253849 DOI: 10.1080/14737140.2016.1197122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Clear cell sarcoma (CCS) is an aggressive tumor, typically developing in tendons or aponeuroses. The outcome of this orphan disease is poor, with 5-year and 10-year survival rates of localized CCS around 60-70% and 40-50%. Once the disease has metastasized, it is usually fatal due to its chemotherapy-resistant nature. Systemic treatment options are poorly standardized and the use of chemotherapy is based on weak scientific evidence. AREAS COVERED In this review, we systematically discuss the current scientific evidence for the systemic treatment of CCS, including tyrosine kinase inhibitors, immunotherapy and MET inhibitors. Expert commentary: Recent insights in the biology of CCS have identified new potential therapeutic targets, which should be tested in prospective clinical trials. Whenever possible, patients with metastatic CCS should be included in clinical trials with good biological rationale. Innovative trial methodology and new regulatory mechanisms are required to provide patients with uncommon cancers with active drugs.
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Affiliation(s)
- Jasmien Cornillie
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Thomas van Cann
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Agnieszka Wozniak
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Daphne Hompes
- b Department of Surgical Oncology , KU Leuven and University Hospitals Leuven , Leuven , Belgium
| | - Patrick Schöffski
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
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Tsukahara T, Emori M, Murata K, Mizushima E, Shibayama Y, Kubo T, Kanaseki T, Hirohashi Y, Yamashita T, Sato N, Torigoe T. The future of immunotherapy for sarcoma. Expert Opin Biol Ther 2016; 16:1049-57. [PMID: 27158940 DOI: 10.1080/14712598.2016.1188075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The use of immunotherapeutic challenges for sarcoma has a long history. Despite the existence of objective responses, immunotherapy has been overshadowed by the results of chemotherapy, especially for osteosarcoma. However, the prognosis for non-responders to chemotherapy is still poor and immunotherapy is now focused on again. AREAS COVERED We reviewed the following types of clinical trials of immunotherapy for sarcoma: (i) vaccination with autologous tumor cells, (ii) vaccination with peptides derived from tumor-associated antigens, (iii) adoptive cell transfer using engineered T cells expressing T cell receptor directed at NY-ESO-1 and (iv) immune checkpoint inhibitors targeting CTLA-4 and PD1/PDL1. EXPERT OPINION The immunogenicity of sarcoma might be lower than that of melanoma. Patients with small lesions who have not received any chemotherapy are good candidates for peptide-based immunotherapy. Combining peptide vaccination and immune checkpoint inhibitors is an attractive option, and long-lived memory T cells are attracting attention. Memory T stem cells defined by CD95+ are long-lived and have the capacity for self-renewal and multidifferentiation. We also identified a novel memory T cell population, young memory T cells defined by CD73+CXCR3+. Regulation of such memory T stem cells will be useful for peptide vaccination and adoptive cell transfer.
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Affiliation(s)
- Tomohide Tsukahara
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Makoto Emori
- b Department of Orthopaedic Surgery , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Kenji Murata
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan.,b Department of Orthopaedic Surgery , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Emi Mizushima
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan.,b Department of Orthopaedic Surgery , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Yuji Shibayama
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan.,b Department of Orthopaedic Surgery , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Terufumi Kubo
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Takayuki Kanaseki
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Yoshihiko Hirohashi
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Toshihiko Yamashita
- b Department of Orthopaedic Surgery , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Noriyuki Sato
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Toshihiko Torigoe
- a Department of Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
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