The “Total Cancer Care” Concept: Linking Technology and Health Care

Exploiting convergent phenotypes to derive a pan-cancer cisplatin response gene expression signature

Precision medicine offers remarkable potential for the treatment of cancer, but is largely focused on tumors that harbor actionable mutations. Gene expression signatures can expand the scope of precision medicine by predicting response to traditional (cytotoxic) chemotherapy agents without relying on changes in mutational status. We present a new signature extraction method, inspired by the principle of convergent phenotypes, which states that tumors with disparate genetic backgrounds may evolve similar phenotypes independently. This evolutionary-informed method can be utilized to produce consensus signatures predictive of response to over 200 chemotherapeutic drugs found in the Genomics of Drug Sensitivity in Cancer (GDSC) Database. Here, we demonstrate its use by extracting the Cisplatin Response Signature (CisSig). We show that this signature can predict cisplatin response within carcinoma-based cell lines from the GDSC database, and expression of the signatures aligns with clinical trends seen in independent datasets of tumor samples from The Cancer Genome Atlas (TCGA) and Total Cancer Care (TCC) database. Finally, we demonstrate preliminary validation of CisSig for use in muscle-invasive bladder cancer, predicting overall survival in a small cohort of patients who undergo cisplatin-containing chemotherapy. This methodology can be used to produce robust signatures that, with further clinical validation, may be used for the prediction of traditional chemotherapeutic response, dramatically increasing the reach of personalized medicine in cancer.

A genome-based model for adjusting radiotherapy dose (GARD): a retrospective, cohort-based study

BACKGROUND

Despite its common use in cancer treatment, radiotherapy has not yet entered the era of precision medicine, and there have been no approaches to adjust dose based on biological differences between or within tumours. We aimed to assess whether a patient-specific molecular signature of radiation sensitivity could be used to identify the optimum radiotherapy dose.

METHODS

We used the gene-expression-based radiation-sensitivity index and the linear quadratic model to derive the genomic-adjusted radiation dose (GARD). A high GARD value predicts for high therapeutic effect for radiotherapy; which we postulate would relate to clinical outcome. Using data from the prospective, observational Total Cancer Care (TCC) protocol, we calculated GARD for primary tumours from 20 disease sites treated using standard radiotherapy doses for each disease type. We also used multivariable Cox modelling to assess whether GARD was independently associated with clinical outcome in five clinical cohorts: Erasmus Breast Cancer Cohort (n=263); Karolinska Breast Cancer Cohort (n=77); Moffitt Lung Cancer Cohort (n=60); Moffitt Pancreas Cancer Cohort (n=40); and The Cancer Genome Atlas Glioblastoma Patient Cohort (n=98).

FINDINGS

We calculated GARD for 8271 tissue samples from the TCC cohort. There was a wide range of GARD values (range 1·66-172·4) across the TCC cohort despite assignment of uniform radiotherapy doses within disease types. Median GARD values were lowest for gliomas and sarcomas and highest for cervical cancer and oropharyngeal head and neck cancer. There was a wide range of GARD values within tumour type groups. GARD independently predicted clinical outcome in breast cancer, lung cancer, glioblastoma, and pancreatic cancer. In the Erasmus Breast Cancer Cohort, 5-year distant-metastasis-free survival was longer in patients with high GARD values than in those with low GARD values (hazard ratio 2·11, 95% 1·13-3·94, p=0·018).

INTERPRETATION

A GARD-based clinical model could allow the individualisation of radiotherapy dose to tumour radiosensitivity and could provide a framework to design genomically-guided clinical trials in radiation oncology.

FUNDING

None.

Invasion emerges from cancer cell adaptation to competitive microenvironments: quantitative predictions from multiscale mathematical models

In this review we summarize our recent efforts using mathematical modeling and computation to simulate cancer invasion, with a special emphasis on the tumor microenvironment. We consider cancer progression as a complex multiscale process and approach it with three single-cell-based mathematical models that examine the interactions between tumor microenvironment and cancer cells at several scales. The models exploit distinct mathematical and computational techniques, yet they share core elements and can be compared and/or related to each other. The overall aim of using mathematical models is to uncover the fundamental mechanisms that lend cancer progression its direction towards invasion and metastasis. The models effectively simulate various modes of cancer cell adaptation to the microenvironment in a growing tumor. All three point to a general mechanism underlying cancer invasion: competition for adaptation between distinct cancer cell phenotypes, driven by a tumor microenvironment with scarce resources. These theoretical predictions pose an intriguing experimental challenge: test the hypothesis that invasion is an emergent property of cancer cell populations adapting to selective microenvironment pressure, rather than culmination of cancer progression producing cells with the "invasive phenotype". In broader terms, we propose that fundamental insights into cancer can be achieved by experimentation interacting with theoretical frameworks provided by computational and mathematical modeling.

Effective x-ray attenuation coefficient measurements from two full field digital mammography systems for data calibration applications

Background

Breast density is a significant breast cancer risk factor. Currently, there is no standard method for measuring this important factor. Work presented here represents an essential component of an ongoing project that seeks to determine the appropriate method for calibrating (standardizing) mammography image data to account for the x-ray image acquisition influences. Longer term goals of this project are to make accurate breast density measurements in support of risk studies.

Methods

Logarithmic response calibration curves and effective x-ray attenuation coefficients were measured from two full field digital mammography (FFDM) systems with breast tissue equivalent phantom imaging and compared. Normalization methods were studied to assess the possibility of reducing the amount of calibration data collection. The percent glandular calibration map functional form was investigated. Spatial variations in the calibration data were used to assess the uncertainty in the calibration application by applying error propagation analyses.

Results

Logarithmic response curves are well approximated as linear. Measured effective x-ray attenuation coefficients are characteristic quantities independent of the imaging system and are in agreement with those predicted numerically. Calibration data collection can be reduced by applying a simple normalization technique. The calibration map is well approximated as linear. Intrasystem calibration variation was on the order of four percent, which was approximately half of the intersystem variation.

Conclusion

FFDM systems provide a quantitative output, and the calibration quantities presented here may be used for data acquired on similar FFDM systems.

Methodological issues in online data collection

AIM

This paper is a report of a study to evaluate the use of an online data collection method to survey early survivors of childhood cancer about their physical and psychosocial characteristics and health-related quality of life.

BACKGROUND

A major advantage in conducting web-based nursing research is the ability to involve participants who are challenging to study because of their small numbers or inaccessibility because of geographic location. As paediatric oncology patients and early survivors of childhood cancer are often not easily accessible because of their small numbers at single institutions, web-based research methods have been proposed as a potentially effective approach to collect data in studies involving these clinical populations.

METHOD

Guided by published literature on using the Internet for data collection, an online protocol was developed; this included construction of a website, development of a homepage and interactive HyperText Markup Language pages and the posting of the study link on various websites. Data collection occurred over a 6-month period between December 2005 and May 2006.

FINDINGS

Despite using strategies in conducting online research cited in published literature, the recruitment of subjects was very prolonged and the volume of missing data among many respondents excluded them from the study and created bias within the study's results.

CONCLUSION

Web-based, online data collection methods create opportunities to conduct research globally, especially among difficult to access populations. However, web-based research requires careful consideration of how the study will be advertised and how data will be collected to ensure high quality data and validity of the findings.